A story being reported on by
CNN, and
Time, as well as other media outlets in reference to the newly published (November 30)
Pediatrics article,
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et. al. (2009). Randomized, controlled trial of an intervention for toddlers with
autism: The Early Start Denver Model.
Pediatrics,
Published online November 30, 2009
(doi:10.1542/ peds.2009- 0958)
Link to the abstract; purchase required for full access.
"Objective To conduct a randomized, controlled trial to evaluate the efficacy of the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention, for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD).
Methods: Forty-eight children diagnosed with ASD between 18 and 30 months of age were randomly assigned to 1 of 2 groups: (1) ESDM intervention, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years; or (2) referral to community providers for intervention commonly available in the community.
Results: Compared with children who received community-intervention, children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis. Two years after entering intervention, the ESDM group on average improved 17.6 standard score points (1 SD: 15 points) compared with 7.0 points in the comparison group relative to baseline scores. The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children. In contrast, over the 2-year span, the comparison group showed greater delays in adaptive behavior. Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group.
Conclusions: This is the first randomized, controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism."
Two of the authors of the study are from University of Washington Autism Center, Center on Human Development and Disability, and the Department of Speech and Hearing Science, Portland State University, Portland, Oregon.
The main significances are the very young ages of the enrolled children and the experimental design of RCT; it should be noted that some need for longitudinal followup to see if gains are maintained is discussed in the last paragraph of the full study, and that while 7 of the 24 student treatment group improved to PDD-NOS classification, 2 of the students in the treatment group moved from PDD to an Autistic Disorder diagnosis as well during the course of the study. The overall effect described for the treatment
group was of significant benefit compared to the "community based" comparison group and spoke to a
potential general benefit of early application of ESDM at the intensity and competency of service delivery as described in the
Pediatrics article.
Two quotes from the newsreporting,
CNN: "...[Sally] Rogers acknowledges that this study is only the first step. "Every piece of science needs to be replicated before it becomes fact, so we are currently doing a replication study," she said...."
Time: "...Whether the Early Start Denver Model will prove to be more effective than other therapies remains to be seen. Leading autism researcher Tristram Smith, an ABA expert at the University of Rochester, who lauds the new study for its methodological rigor, notes that the gains made by children in the intervention group were similar to those reported in studies of ABA models. "I do think there is a need for head-to-head studies," says Smith. Also needed is high-quality research on how to match individual children with the therapy that suits them best."
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