Implementing the Get SET Early Model in a Community Setting to Lower the Age of ASD Diagnosis

Mega-analytic support for Early Start Denver Model, age at intervention start, and pre-intervention developmental level as factors differentiating early intervention outcomes in autism

Objective

Autism early intervention meta-analyses have provided initial answers to questions such as 'what types of interventions work' and 'for what outcomes'? However, we also want to know 'for whom' is early intervention most effective for? Mega-analysis can offer up complementary insights to meta-analyses regarding the 'what works' and 'for what', while also offering unique insights into the 'for whom' question.

Methods

Here we conduct a mega-analysis with linear mixed effect modeling on AEIR consortium early intervention datasets totaling n=645 children spanning several countries (e.g., USA, Switzerland, Italy, Israel, and Australia). Early Start Denver Model (ESDM) and other non-ESDM approaches (e.g., EIBI, NDBI, other community/treatment as usual approaches) was evaluated as contrasting intervention types. Models also evaluated intervention intensity, type, participant sex, age at intervention start, and pre-intervention developmental quotient. Subscales of Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behavior Scales (VABS), and Autism Diagnostic Observation Schedule (ADOS) were utilized as outcome measures.

Results

Neither intervention intensity nor participant sex affected outcomes. ESDM showed faster growth in language and non-verbal cognition compared to non-ESDM intervention. Irrespective of intervention type, earlier intervention start was associated with increased MSEL and VABS scores and decreased ADOS severity. Growth trajectories on the MSEL also varied by pre-intervention developmental quotient, with higher quotients predicting faster growth irrespective of intervention type.

Conclusions

Age at intervention start and pre-intervention developmental quotient are important individualized factors that predict early intervention response. ESDM also impacts language, non-verbal cognition, and core autism features.

Examination of Clinical and Assessment Type Differences Between Toddlers with ASD from Multiplex and Simplex Families

Few studies have examined differences in autism spectrum disorder (ASD) phenotype between children from multiplex and simplex families at the time of diagnosis. The present study used an age- and gender-matched, community-based sample (n = 105) from the southwestern United States to examine differences in ASD symptom severity, cognitive development, and adaptive functioning. No significant differences between children from multiplex and simplex families were observed. Exploratory analysis revealed that parents underreported receptive and expressive language and fine motor skills compared to professional observation, especially among children from multiplex families. These findings suggest that diagnosticians may need to consider family structure when choosing and interpreting assessments of receptive language, expressive language, and fine motor skills.

Improving Access to Autism Evaluation: A Coordinated Developmental-Behavioral Pediatrics and Pediatric Neurology Diagnostic Pathway

A shortage of board-certified developmental-behavioral pediatricians generates a bottleneck for children and families who seek autism diagnostic services. Wait time for autism evaluation commonly exceeds a year. To improve access, clinicians developed a coordinated Developmental-Behavioral Pediatrics and Pediatric Neurology autism diagnostic pathway. For a subset of children referred to neurology clinic, pediatric neurologists completed the medical part of an autism evaluation and Knights of Columbus Developmental Center psychologists or speech-language pathologists completed developmental assessments. Forty-four autism diagnostic evaluations completed through this coordinated pathway over the course of six months had shortened wait time [mean=50.89 days; range 3 to 184 days; median= 48.50 day]. Parents reported satisfaction with the autism evaluation and resources navigation process. Sustainability and scalability efforts are discussed.

Consistency between parent report and direct assessment of development in toddlers with autism spectrum disorder and other delays: Does sex assigned at birth matter?

The current study examined differences between parent report and diagnostician direct assessment of receptive language, expressive language, and fine motor abilities in toddlers with autism spectrum disorder (ASD) and other delays. Additionally, this study examined whether parent-diagnostician consistency varied by child diagnosis and sex assigned at birth (SAB). Initial mixed analysis of variances (ANOVAs) were conducted using data from a sample of 646 toddlers to examine whether parent-diagnostician consistency differed by child diagnosis. Matched samples (using child age, SAB, and nonverbal IQ) were then created within each diagnostic group and mixed ANOVAs were conducted to examine if consistency was similar in matched diagnostic subsamples and whether it differed by SAB. Findings from the full sample mostly replicated previous research that has documented consistency between parent report and direct observation regardless of child diagnosis. However, when examined in matched diagnostic subgroups, more nuanced patterns were observed. Parent report of receptive language was lower in ASD and ASD features subgroups and parent report of fine motor skills was lower than direct observation in the ASD, ASD features, and developmental delay groups. When examining the moderating effect of SAB, only expressive language was impacted for children in the ASD group. Results indicate the importance of considering child demographic characteristics and that child SAB may impact parent report and/or diagnostician perception of expressive language.