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The Effects of Early Intervention on Social Communication Outcomes for Children with Autism Spectrum Disorder: A Meta-analysis

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Abstract

This meta-analysis examined the effects of early interventions on social communication outcomes for young children with autism spectrum disorder. A systematic review of the literature included 1442 children (mean age 3.55 years) across 29 studies. The overall effect size of intervention on social communication outcomes was significant (g = 0.36). The age of the participants was related to the treatment effect size on social communication outcomes, with maximum benefits occurring at age 3.81 years. Results did not differ significantly depending on the person implementing the intervention. However, significantly larger effect sizes were observed in studies with context-bound outcome measures. The findings of this meta-analysis highlight the need for further research examining specific components of interventions associated with greater and more generalized gains.

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References

  • Aldred, C., Green, J., & Adams, C. (2004). A new social communication intervention for children with autism: Pilot randomised controlled treatment study suggesting effectiveness. Journal of Child Psychology and Psychiatry, 45(8), 1420–1430.

    PubMed  Google Scholar 

  • Amendah, D., Grosse, S. D., Peacock, G., & Mandell, D. S. (2011). The economic costs of autism: A review. In D. Amaral, D. Geschwind & G. Dawson (Eds.), Autism spectrum disorders (pp. 1347–1360). Oxford: Oxford University Press.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

  • Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., … Durkin, M. S. (2018). Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveillance Summaries, 67(6), 1.

    PubMed Central  Google Scholar 

  • Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in high-functioning children with autism. Child Development, 71(2), 447–456.

    PubMed  Google Scholar 

  • Bellini, S., Peters, J. K., Benner, L., & Hopf, A. (2007). A meta-analysis of school-based social skills interventions for children with autism spectrum disorders. Remedial and Special Education, 28(3), 153–162.

    Google Scholar 

  • Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Introduction to meta-analysis. Chichester: Wiley.

    Google Scholar 

  • Boyd, B. A., Hume, K., McBee, M. T., Alessandri, M., Gutierrez, A., Johnson, L., … Odom, S. L. (2014). Comparative efficacy of LEAP, TEACCH and non-model-specific special education programs for preschoolers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(2), 366–380. https://doi.org/10.1007/s10803-013-1877-9.

    Article  PubMed  Google Scholar 

  • Carter, A. S., Messinger, D. S., Stone, W. L., Celimli, S., Nahmias, A. S., & Yoder, P. (2011). A randomized controlled trial of Hanen’s “More than Words” in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry, 52(7), 741–752.

    PubMed  Google Scholar 

  • Casenhiser, D. M., Shanker, S. G., & Stieben, J. (2013). Learning through interaction in children with autism: Preliminary data from a social-communication-based intervention. Autism: The International Journal of Research and Practice, 17(2), 220–241.

    Google Scholar 

  • Chang, Y. C., Shire, S. Y., Shih, W., Gelfand, C., & Kasari, C. (2016). Preschool deployment of evidence-based social communication intervention: JASPER in the classroom. Journal of Autism and Developmental Disorders, 46(6), 2211–2223.

    PubMed  Google Scholar 

  • Charman, T. (2003). Why is joint attention a pivotal skill in autism? Philosophical Transactions of the Royal Society of London B: Biological Sciences, 358(1430), 315–324.

    PubMed  PubMed Central  Google Scholar 

  • Clionsky, L. N. (2012). Child directed interaction training for young children with autism spectrum disorders: The impact on child language, social skills, adaptive skills, and problematic behaviors. Retrieved from ProQuest Central; ProQuest Dissertations & Theses Global.

  • Constantino, J. N. (2002). Social responsiveness scale (SRS). Los Angeles: Western Psychological Services.

    Google Scholar 

  • Delgado, C., Mundy, P., & Block, J. (2001). Pictorial Infant Communication Scales (PICS), Version 1.3. Coral Gables: University of Miami.

    Google Scholar 

  • Drew, A., Baird, G., Baron-Cohen, S., Cox, A., Slonims, V., Wheelwright, S., et al. (2002). A pilot randomized control trial of a parent training intervention for pre-school children with autism: Preliminary findings and methodological challenges. European Child and Adolescent Psychiatry, 11, 266–272.

    PubMed  Google Scholar 

  • Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315(7109), 629–634.

    PubMed  PubMed Central  Google Scholar 

  • Eldevik, S., Hastings, R. P., Hughes, J. C., Jahr, E., Eikeseth, S., & Cross, S. (2009). Meta analysis of early intensive behavioral intervention for children with autism. Journal of Clinical Child & Adolescent Psychology, 38(3), 439–450.

    Google Scholar 

  • Field, T., Lasko, D., Mundy, P., Henteleff, T., Kabat, S., Talpins, S., & Dowling, M. (1997). Brief report: Autistic children’s attentiveness and responsivity improve after touch therapy. Journal of Autism and Developmental Disorders, 27(3), 333–338. https://doi.org/10.1023/A:1025858600220.

    Article  PubMed  Google Scholar 

  • Gillespie-Lynch, K., Sepeta, L., Wang, Y., Marshall, S., Gomez, L., Sigman, M., & Hutman, T. (2012). Early childhood predictors of the social competence of adults with autism. Journal of Autism and Developmental Disorders, 42(2), 161–174.

    PubMed  Google Scholar 

  • Goods, K. S., Ishijima, E., Chang, Y.-C., & Kasari, C. (2013). Preschool based JASPER intervention in minimally verbal children with autism: Pilot RCT. Journal of Autism and Developmental Disorders, 43(5), 1050–1056.

    PubMed  PubMed Central  Google Scholar 

  • Granpeesheh, D., Dixon, D. R., Tarbox, J., Kaplan, A. M., & Wilke, A. E. (2009). The effects of age and treatment intensity on behavioral intervention outcomes for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 3(4), 1014–1022.

    Google Scholar 

  • Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P., … Pickles, A. (2010). Parent-mediated communication-focused treatment in children with autism (PACT): A randomised controlled trial. The Lancet, 375(9732), 2152–2160.

    Google Scholar 

  • Hampton, L. H., & Kaiser, A. P. (2016). Intervention effects on spoken-language outcomes for children with autism: A systematic review and meta-analysis. Journal of Intellectual Disability Research, 60(5), 444–463.

    PubMed  Google Scholar 

  • Hardan, A. Y., Gengoux, G. W., Berquist, K. L., Libove, R. A., Ardel, C. M., Phillips, J., … Minjarez, M. B. (2015). A randomized controlled trial of Pivotal Response Treatment Group for parents of children with autism. Journal of Child Psychology and Psychiatry, 56(8), 884–892.

    PubMed  Google Scholar 

  • Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381.

    PubMed  Google Scholar 

  • Harris, S. L., & Handleman, J. S. (2000). Age and IQ at intake as predictors of placement for young children with autism: A four-to six-year follow-up. Journal of Autism and Developmental Disorders, 30(2), 137–142.

    PubMed  Google Scholar 

  • Higgins, J. P., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., … Sterne, J. A. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. BMJ, 343, d5928.

    PubMed  PubMed Central  Google Scholar 

  • Hwang, B., & Hughes, C. (2000). The effects of social interactive training on early social communicative skills of children with autism. Journal of Autism and Developmental Disorders, 30(4), 331–343.

    PubMed  Google Scholar 

  • Ingersoll, B. (2012). Effect of a focused imitation intervention on social functioning in children with autism. Journal of Autism and Developmental Disorders, 42(8), 1768–1773. https://doi.org/10.1007/s10803-011-1423-6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kamps, D., Thiemann-Bourque, K., Heitzman-Powell, L., Schwartz, I., Rosenberg, N., Mason, R., & Cox, S. (2015). A comprehensive peer network intervention to improve social communication of children with autism spectrum disorders: A randomized trial in kindergarten and first grade. Journal of Autism and Developmental Disorders, 45(6), 1809–1824.

    PubMed  PubMed Central  Google Scholar 

  • Karst, J. S. (2010). Child and caregiver social behavior and joint attention change following P.L.A.Y. project intervention (M.S.). Marquette University, United States—Wisconsin. Retrieved from http://search.proquest.com.proxy.library.vanderbilt.edu/docview/821240017/abstract/C2464529FB3144AFPQ/22?accountid=14816#.

  • Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47(6), 611–620. https://doi.org/10.1111/j.1469-7610.2005.01567.x.

    Article  PubMed  Google Scholar 

  • Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of Consulting and Clinical Psychology, 83(3), 554.

    PubMed  PubMed Central  Google Scholar 

  • Kasari, C., Gulsrud, A. C., Wong, C., Kwon, S., & Locke, J. (2010). Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders, 40(9), 1045–1056. https://doi.org/10.1007/s10803-010-0955-5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Keen, D., Couzens, D., Muspratt, S., & Rodger, S. (2010). The effects of a parent-focused intervention for children with a recent diagnosis of autism spectrum disorder on parenting stress and competence. Research in Autism Spectrum Disorders, 4(2), 229–241. https://doi.org/10.1016/j.rasd.2009.09.009.

    Article  Google Scholar 

  • Koegel, R. L., Koegel, L. K., & Surratt, A. (1992). Language intervention and disruptive behavior in preschool children with autism. Journal of Autism and Developmental Disorders, 22(2), 141–153. https://doi.org/10.1007/BF01058147.

    Article  PubMed  Google Scholar 

  • Lawton, K., & Kasari, C. (2012). Teacher-implemented joint attention intervention: Pilot randomized controlled study for preschoolers with autism. Journal of Consulting and Clinical Psychology, 80(4), 687–693. https://doi.org/10.1037/a0028506.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., Dilavore, P. C., & Risi, S. (2008). Autism diagnostic observation schedule (ADOS). Boston: Hogrefe.

    Google Scholar 

  • Mahoney, G., Kim, J. M., & Lin, C. (2007). Pivotal behavior model of developmental learning. Infants & Young Children, 20(4), 311–325.

    Google Scholar 

  • McCalla, M. K. (2014). Enhancing the social interactions of preschool children with autism: The effectiveness of a peer-mediated intervention. Retrieved from ProQuest Central; ProQuest Dissertations & Theses Global. (1614189419).

  • Mundy, P., Delgado, C., Block, J., Venezia, M., Hogan, A., & Seibert, J. (2003). Early social communication scales (ESCS). Coral Gables, FL: University of Miami.

    Google Scholar 

  • Mundy, P., Sigman, M., & Kasari, C. (1990). A longitudinal study of joint attention and language development in autistic children. Journal of Autism and Developmental Disorders, 20(1), 115–128.

    PubMed  Google Scholar 

  • Mundy, P., Sigman, M., Ungerer, J., & Sherman, T. (1986). Defining the social deficits of autism: The contribution of non-verbal communication measures. Journal of Child Psychology and Psychiatry, 27(5), 657–669.

    PubMed  Google Scholar 

  • Myers, S. M., & Johnson, C. P. (2007). Management of children with autism spectrum disorders. Pediatrics, 120(5), 1162–1182.

    PubMed  Google Scholar 

  • Nefdt, N. (2007). The use of a self-directed learning program to provide introductory training to parents of children with autism (Ph.D). University of California, Santa Barbara, Ann Arbor. Retrieved from ProQuest Dissertations & Theses Full Text. (304881365).

  • Openden, D. A. (2005). Pivotal response treatment for multiple families of children with autism: Probable efficacy and effectiveness of a group parent education workshop (Ph.D.). University of California, Santa Barbara, Ann Arbor. Retrieved from ProQuest Dissertations & Theses Full Text. (305004072).

  • Remington, B., Hastings, R. P., Kovshoff, H., degli Espinosa, F., Jahr, E., Brown, T., … Ward, N. (2007). Early intensive behavioral intervention: Outcomes for children with autism and their parents after two years. American Journal on Mental Retardation, 112(6), 418–438. https://doi.org/10.1352/0895-8017(2007)112%5B418:EIBIOF%5D2.0.CO;2.

    Article  PubMed  Google Scholar 

  • Roberts, M. Y., & Kaiser, A. P. (2011). The effectiveness of parent-implemented language interventions: A meta-analysis. American Journal of Speech-Language Pathology, 20(3), 180–199.

    PubMed  Google Scholar 

  • Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., … Dawson, G. (2012). Effects of a brief Early Start Denver Model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 51(10), 1052–1065. https://doi.org/10.1016/j.jaac.2012.08.003.

    Article  Google Scholar 

  • Salt, J., Shemilt, J., Sellars, V., Boyd, S., Coulson, T., & McCool, S. (2002). The Scottish Centre for Autism preschool treatment programme. Autism, 6(1), 33–46. https://doi.org/10.1177/1362361302006001004.

    Article  PubMed  Google Scholar 

  • Schertz, H. H., Odom, S. L., Baggett, K. M., & Sideris, J. H. (2013). Effects of joint attention mediated learning for toddlers with autism spectrum disorders: An initial randomized controlled study. Early Childhood Research Quarterly, 28(2), 249–258. https://doi.org/10.1016/j.ecresq.2012.06.006.

    Article  Google Scholar 

  • Sigman, M., & Ruskin, E. (1999). Social competence in children with Autism, Down syndrome and other developmental delays: A longitudinal study. Monographs of the Society for Research in Child Development, 64(1), 1–114.

    PubMed  Google Scholar 

  • Smith, T., Groen, A. D., & Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105, 269–285.

    PubMed  Google Scholar 

  • Solomon, R., Van Egeren, L. A., Mahoney, G., Huber, M. S. Q., & Zimmerman, P. (2014). PLAY Project Home Consultation intervention program for young children with autism spectrum disorders: A randomized controlled trial. Journal of Developmental and Behavioral Pediatrics, 35(8), 475.

    PubMed  PubMed Central  Google Scholar 

  • Stone, W. L., Coonrod, E. E., Pozdol, S. L., & Turner, L. M. (2003). The Parent Interview for Autism-Clinical Version (PIA-CV): A measure of behavioral change for young children with autism. Autism, 7(1), 9–30.

    PubMed  Google Scholar 

  • Turner-Brown, L., Hume, K., Boyd, B. A., & Kainz, K. (2016). Preliminary efficacy of Family Implemented TEACCH for toddlers: Effects on parents and their toddlers with autism spectrum disorder. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-016-2812-7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Venker, C. E., McDuffie, A., Weismer, S. E., & Abbeduto, L. (2012). Increasing verbal responsiveness in parents of children with autism: A pilot study. Autism, 16(6), 568–585. https://doi.org/10.1177/1362361311413396.

    Article  PubMed  Google Scholar 

  • Virués-Ortega, J. (2010). Applied behavior analytic intervention for autism in early childhood: Meta-analysis, meta-regression and dose–response meta-analysis of multiple outcomes. Clinical Psychology Review, 30(4), 387–399.

    PubMed  Google Scholar 

  • Wetherby, A. M, & Prizant, B. (2002). Communication and symbolic behavior scales developmental profile. Baltimore: Paul H. Brookes.

    Google Scholar 

  • Wetherby, A. M., & Woods, J. J. (2006). Early Social Interaction Project for children with autism spectrum disorders beginning in the second year of life: A preliminary study. Topics in Early Childhood Special Education, 26(2), 67–82.

    Google Scholar 

  • Whalen, C., & Schreibman, L. (2003). Joint attention training for children with autism using behavior modification procedures. Journal of Child Psychology and Psychiatry, 44(3), 456–468.

    PubMed  Google Scholar 

  • Yoder, P. J., Bottema-Beutel, K., Woynaroski, T., Chandrasekhar, R., & Sandbank, M. (2013). Social communication intervention effects vary by dependent variable type in preschoolers with autism spectrum disorders. Evidence-Based Communication Assessment and Intervention, 7(4), 150–174.

    PubMed  Google Scholar 

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Acknowledgments

This research was supported in part by OSEP Grant #H325D100034A (Doctoral Leadership Training in Early Childhood Special Education, U. S. Department of Education; A. Kaiser, PI). We acknowledge the contributions of Emily Tanner-Smith, Ph.D. to earlier drafts of this paper and Lauren H. Hampton, Ph.D. for her reliability coding support.

Funding

This research was supported in part by OSEP Grant #H325D100034A (Doctoral Leadership Training in Early Childhood Special Education, U. S. Department of Education; A. Kaiser, PI).

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EAF conceptualized and designed this meta-analysis, drafted the manuscript, and approves the final version being submitted. APK contributed to the design of the meta-analysis, has reviewed and contributed to the current manuscript, and approves of the final version being submitted.

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Correspondence to Elizabeth A. Fuller.

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Fuller, E.A., Kaiser, A.P. The Effects of Early Intervention on Social Communication Outcomes for Children with Autism Spectrum Disorder: A Meta-analysis. J Autism Dev Disord 50, 1683–1700 (2020). https://doi.org/10.1007/s10803-019-03927-z

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