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Ferrara R, Damato F, Iovino L, Marti F, Latina R, Colombi C, Ricci P. ESDM intervention in severe preschool autism: an Italian Case report, psychological and social medicine reflections. Ital J Pediatr 2024; 50:60. [PMID: 38575971 PMCID: PMC10993588 DOI: 10.1186/s13052-024-01626-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The goal of our contribution is to discuss a preschool intervention based on the Early Start Denver Model and the use of the main tools for the detection of adaptive behaviour in cases of autism: Vineland, ABAS. CASE PRESENTATION the work is the presentation of a clinical case that has benefited from an intervention with the Early Start Denver Model methodology for the benefit of a child with socio-cultural and economic disadvantages. This early intervention, in a child of 36 months, which followed the diagnosis, was possible thanks to the intervention of many third-sector organizations which allowed this child, with a serious autism profile, to receive an evidence-based intervention for free. At the beginning of the intervention, the child presented a diagnosis of severe autism with absence of gaze, vocalizations and other communicative impairments. The level of motor clumsiness was also quite high, as were stereotypies. CONCLUSIONS Research has shown the usefulness of intervening in this area with an early assessment and/or diagnosis and immediate intervention; however, public health services are not always able to maintain this pace. Our contribution therefore shows on the one hand the evidence of the improvements achieved by the child despite the low intensity of the treatment, and on the other hand, demonstrates the total versatility and adaptability of the Denver Model to the Italian context. In our conclusions, there are also some reflections on the tools used to measure adaptive behavior which seem to have a number of limitations and criticalities.
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Affiliation(s)
- Rosaria Ferrara
- Department of Anatomy Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy.
| | - Felice Damato
- Department of Anatomy Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | | | - Flavio Marti
- Department of Health Professions, A.O. San Camillo Forlanini, Rome, Italy
| | - Roberto Latina
- Nursing Science, Department of Health Promotion Science, Maternal and Infant Care, Internal Medicine, and Medical Specialities (PROMISE), University of Palermo, Palermo, Italy
| | | | - Pasquale Ricci
- Department of Anatomy Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
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Li X, Li J, Zhao S, Liao Y, Zhu L, Mou Y. Magnitude representation of preschool children with autism spectrum condition. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:866-880. [PMID: 37522624 DOI: 10.1177/13623613231185408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
LAY ABSTRACT The mathematical abilities of children with autism spectrum condition have been understudied. Magnitude representation (e.g. presenting the number of a collection of objects) is a fundamental numerical ability presented since early infancy and is correlated with children's later learning of formal mathematics. It remains unclear about whether children with autism spectrum condition differ from their peers without autism spectrum condition in precision of magnitude representations. This study compared preschool children with and without autism spectrum condition in their precision of magnitude representation with an approximate number comparison task, in which children compared two sets of dots without counting and chose the set with more dots. Children with autism spectrum condition exhibited the lower numerical comparison accuracy (i.e. the weaker magnitude representation) than their peers without autism spectrum condition. This difference existed even when multiple general cognitive abilities (working memory, inhibitory control, and nonverbal intelligence) and language abilities were statistically controlled. Moreover, the individual difference of the numerical comparison accuracy was larger in children with autism spectrum condition than without autism spectrum condition. These findings suggest that children with autism spectrum condition are at risk of weaker magnitude representation from an early age, emphasizing the need for specialized mathematics education or interventions to support their learning. In addition, the large variance in the precision of their magnitude representation suggests that individualized mathematics interventions are needed for children with autism spectrum condition.
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Affiliation(s)
- Xueyan Li
- Department of Psychology, Sun Yat-sen University, Guangzhou, China
| | - Jiaxi Li
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Sijia Zhao
- Department of Psychology, Sun Yat-sen University, Guangzhou, China
| | - Yini Liao
- Department of Psychology, Sun Yat-sen University, Guangzhou, China
| | - Liqi Zhu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yi Mou
- Department of Psychology, Sun Yat-sen University, Guangzhou, China
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Montiel-Nava C, Montenegro MC, Ramirez AC, Valdez D, Rosoli A, Garcia R, Garrido G, Cukier S, Rattazzi A, Paula CS. Age of autism diagnosis in Latin American and Caribbean countries. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:58-72. [PMID: 36602228 DOI: 10.1177/13623613221147345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
LAY ABSTRACT An earlier diagnosis of autism spectrum disorder might lead to earlier intervention. However, people living in Latin American and Caribbean countries do not have much knowledge about autism spectrum disorder symptoms. It has been suggested that the older a child is when diagnosed, the fewer opportunities he or she will have to receive services. We asked 2520 caregivers of autistic children in six different Latin America and Caribbean Countries, the child's age when they noticed some developmental delays and their child's age when they received their first autism spectrum disorder diagnosis. Results indicate that, on average, caregivers were concerned about their child's development by 22 months of age; however, the diagnosis was received when the child was 46 months of age. In addition, older children with better language abilities and public health coverage (opposed to private health coverage) were diagnosed later. On the contrary, children with other medical problems and more severe behaviors received an earlier diagnosis. In our study, children were diagnosed around the time they entered formal schooling, delaying the access to early intervention programs. In summary, the characteristics of the autistic person and the type of health coverage influence the age of diagnosis in children living in Latin America and Caribbean Countries.
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Affiliation(s)
| | | | | | - Daniel Valdez
- FLACSO, Argentina
- Universidad de Buenos Aires, Argentina
| | - Analia Rosoli
- Organización Estados Iberoamericanos para la Educación, la Ciencia y la Cultura (OEI), Dominican Republic
| | | | | | - Sebastian Cukier
- Programa Argentino para Niños, Adolescentes y Adultos con Condiciones del Espectro Autista (PANAACEA), Argentina
| | - Alexia Rattazzi
- Programa Argentino para Niños, Adolescentes y Adultos con Condiciones del Espectro Autista (PANAACEA), Argentina
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Alhozyel E, Elbedour L, Balaum R, Meiri G, Michaelovski A, Dinstein I, Davidovitch N, Kerub O, Menashe I. Association Between Early Developmental Milestones and Autism Spectrum Disorder. Res Child Adolesc Psychopathol 2023; 51:1511-1520. [PMID: 37231233 DOI: 10.1007/s10802-023-01085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
Early diagnosis and treatment of autism spectrum disorder (ASD) has been shown to lead to better prognosis. Here, we examined the association of commonly measured early developmental milestones (DMs) with later diagnosis of ASD. We conducted a case-control study of 280 children with ASD (cases) and 560 typically developed children (controls) matched to cases by date of birth, sex, and ethnicity in a control/case ratio of 2:1. Both cases and controls were ascertained from all children whose development was monitored at mother-child health clinics (MCHCs) in southern Israel. DM failure rates during the first 18 months of life in three developmental categories (motor, social, and verbal) were compared between cases and controls. Conditional logistic regression models were used to assess the independent association of specific DMs with the risk of ASD, while adjusting for demographic and birth characteristics.Significant case-control differences in DM failure rates were observed as early as 3 months of age (p < 0.001), and these differences increased with age. Specifically, cases were 2.4 times more likely to fail ≥ 1 DM at 3 months (aOR = 2.39; 95%CI = 1.41-4.06), and 15.3 times more likely to fail ≥ 3 DMs at 18 months (aOR = 15.32; 95%CI = 7.75-30.28). The most notable DM-ASD association was observed for social DM failure at 9-12 months (aOR = 4.59; 95%CI = 2.59-8.13). Importantly, the sex or ethnicity of the participants did not affect these DM-ASD associations. Our findings highlight the potential role of DMs as early signs of ASD that could facilitate earlier referral and diagnosis of ASD.
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Affiliation(s)
- Einav Alhozyel
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leena Elbedour
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rewaa Balaum
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Meiri
- Preschool Psychiatric Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Analya Michaelovski
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Child Development Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Ilan Dinstein
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Psychology and Brain and Cognition Departments, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Orly Kerub
- The Mother and Child Department, Ministry of Health, Beer-Sheva, Israel
| | - Idan Menashe
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Devescovi R, Bresciani G, Colonna V, Carrozzi M, Dissegna A, Celea MA, Cescon D, Frisari S, Guerrieri M, Placer F, Stocchi M, Terpini C, Colombi C. Short-Term Outcomes of an ESDM Intervention in Italian Children with Autism Spectrum Disorder following the COVID-19 Lockdown. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040691. [PMID: 37189940 DOI: 10.3390/children10040691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
The COVID-19 pandemic caused a temporary lockdown period in Italy, during which the delivery of in-person treatment for children with autism spectrum disorder (ASD) in public health services was discontinued. This occurrence represented a crucial challenge for both families and professionals. We assessed the short-term outcomes of a sample of 18 children who received an early intervention with the Early Start Denver Model (ESDM), delivered at low intensity over one year in the pre-pandemic period, after six months of interruption of in-presence treatment due to lockdown restrictions. Children who received the ESDM treatment maintained their gains in sociocommunicative skills and did not exhibit any developmental regression. Additionally, there was evidence of a decrease in the restrictive and repetitive behavior (RRB) domain. The parents, who were already familiar with the principles of the ESDM, only received telehealth support from therapists that aimed to sustain the gains already achieved. We believe that it is always helpful to support parents in their daily lives by implementing interactional and play skills with their children to integrate and consolidate the results obtained in the individual interventions conducted by experienced therapists.
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Affiliation(s)
- Raffaella Devescovi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Giulia Bresciani
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Vissia Colonna
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Marco Carrozzi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Andrea Dissegna
- Department of Life Sciences, University of Trieste, 34127 Trieste, Italy
- CIMeC Centre for Mind/Brain Sciences, University of Trento, 38068 Rovereto, Italy
| | - Maria Antonella Celea
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
| | - Devid Cescon
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
| | - Sara Frisari
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
| | - Marcella Guerrieri
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
| | - Francesca Placer
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
| | - Monica Stocchi
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
| | - Chiara Terpini
- Unit of Neurodevelopmental Disorders and Developmental Psychopathology, Azienda Sanitaria Universitaria Giuliano Isontina, 34132 Trieste, Italy
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Loubersac J, Michelon C, Ferrando L, Picot MC, Baghdadli A. Predictors of an earlier diagnosis of Autism Spectrum Disorder in children and adolescents: a systematic review (1987-2017). Eur Child Adolesc Psychiatry 2023; 32:375-393. [PMID: 33909143 DOI: 10.1007/s00787-021-01792-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/19/2021] [Indexed: 01/11/2023]
Abstract
Autism Spectrum Disorder (ASD) is an early onset neurodevelopmental disorder in which the first signs generally emerge at approximately 12 months of age but its diagnosis is feasible only from the age of 18 months. According to the literature, the average age of diagnosis ranges from 2.7 to 7.2 years, which raises the question of factors associated with early diagnosis as a condition for early intervention. In this systematic review, we aim to identify clinical, social, and environmental factors associated with the age at which the diagnosis of ASD is confirmed in children. A literature search was performed in the Pubmed, Web of Sciences, PsycInfo, and Cochrane databases. Among the 530 publications identified, 50 were selected according to the inclusion criteria. This review focuses on studies conducted in 21 countries using data collected over a period from 1987 to 2017. These studies were published before December 31st, 2019. The results suggest that the diagnosis of ASD occurs earlier if there is a delay in social communication or the presence of intellectual disability. There is a low level of evidence concerning associations between the age at diagnosis and sex, race, parental education, or socioeconomic status and accessibility to health care. Further studies using large and well-characterized data sets are needed to simultaneously explore clinical and socio-environmental factors involved in early diagnosis.
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Affiliation(s)
- Julie Loubersac
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
| | - Cécile Michelon
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France
| | - Laetitia Ferrando
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France
| | - Marie-Christine Picot
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
- Department of Medical Information, University Hospital, Montpellier, France
| | - Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France.
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.
- Faculté de Médecine, Université de Montpellier, Montpellier, France.
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Ferrara R, Iovino L, Di Renzo M, Ricci P. Babies under 1 year with atypical development: Perspectives for preventive individuation and treatment. Front Psychol 2022; 13:1016886. [PMID: 36467138 PMCID: PMC9713249 DOI: 10.3389/fpsyg.2022.1016886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2023] Open
Abstract
A baby's first year of life is a time of immense development and cerebral plasticity. Following today's research and clinical observation, the period of the first year of life provides a new challenge inasmuch it is presently clear that it is possible to identify developmental anomalies in this window of time. Effecting early screening procedures could prove very useful, especially where we find genetic vulnerabilities in brothers and sisters of autistic subjects. Interventions of this kind, already practiced by some Public Health systems, can mean taking early action and primary protective measures with significant impacts not only on the subjects (babies and family members) concerned, but also on the public purse. It is, therefore, essential to provide for specific professionalized procedures for psychologists, pediatricians and neuropsychologists to be introduced through personnel highly specialized in interventions during the first year of life.
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Affiliation(s)
- Rosaria Ferrara
- Department of Anatomy Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Leonardo Iovino
- Department of Economic and Legal Studies, “Parthenope” University of Naples, Naples, Italy
| | | | - Pasquale Ricci
- Department of Anatomy Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
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Asta L, Persico AM. Differential Predictors of Response to Early Start Denver Model vs. Early Intensive Behavioral Intervention in Young Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:1499. [PMID: 36358426 PMCID: PMC9688546 DOI: 10.3390/brainsci12111499] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 08/12/2023] Open
Abstract
The effectiveness of early intensive interventions for Autism Spectrum Disorder (ASD) is now well-established, but there continues to be great interindividual variability in treatment response. The purpose of this systematic review is to identify putative predictors of response to two different approaches in behavioral treatment: Early Intensive Behavioral Interventions (EIBI) and the Early Start Denver Model (ESDM). Both are based upon the foundations of Applied Behavioral Analysis (ABA), but the former is more structured and therapist-driven, while the latter is more naturalistic and child-driven. Four databases (EmBase, PubMed, Scopus and WebOfScience) were systematically screened, and an additional search was conducted in the reference lists of relevant articles. Studies were selected if participants were children with ASD aged 12-48 months at intake, receiving either EIBI or ESDM treatment. For each putative predictor, p-values from different studies were combined using Fisher's method. Thirteen studies reporting on EIBI and eleven on ESDM met the inclusion criteria. A higher IQ at intake represents the strongest predictor of positive response to EIBI, while a set of social cognitive skills, including intention to communicate, receptive and expressive language, and attention to faces, most consistently predict response to ESDM. Although more research will be necessary to reach definitive conclusions, these findings begin to shed some light on patient characteristics that are predictive of preferential response to EIBI and ESDM, and may provide clinically useful information to begin personalizing treatment.
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Affiliation(s)
| | - Antonio M. Persico
- Child & Adolescent Neuropsychiatry Program, Modena University Hospital, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
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Agarwal R, Wuyke G, Sharma U, Burke SL, Howard M, Li T, Sanchez M, Bastida E. Stress and Anxiety Among Parents of Transition-Aged Children with Autism Spectrum Disorder: a Systematic Review of Interventions and Scales. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022:1-23. [PMID: 36065251 PMCID: PMC9434067 DOI: 10.1007/s40489-022-00340-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
The period between adolescence to young adulthood can be stressful for parents of transition-aged children (14 to 22 years old) with autism spectrum disorder. A systematic review was undertaken to examine if existing interventions address the unique parental stressors of this phase and if the scales used to measure parental stress and anxiety are suitable for this group. Of the 9813 studies screened, only 13 studies met the inclusion criteria. Findings indicated that interventions focused on mindfulness, social functioning, or multiple components, of which only two addressed the transition period and only three specifically targeted parents of this age group. Moreover, of the six scales which assessed stress or anxiety, none were designed for these parents. Findings highlight the urgent need for more suitable scales and targeted interventions.
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Affiliation(s)
- Rumi Agarwal
- FIU Embrace, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Gabriella Wuyke
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Utsav Sharma
- College of Liberal Arts and Sciences, University of Florida, Gainesville, FL 32611 USA
| | - Shanna L. Burke
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Melissa Howard
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Mariana Sanchez
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Elena Bastida
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
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Efficacy and moderating factors of the Early Start Denver Model in Chinese toddlers with autism spectrum disorder: a longitudinal study. World J Pediatr 2022:10.1007/s12519-022-00555-z. [PMID: 35697958 DOI: 10.1007/s12519-022-00555-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/13/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Several studies have shown the effectiveness of the Early Start Denver Model (ESDM), but few studies have explored the long-term efficacy of ESDM. This study aimed to explore the efficacy and moderating factors of ESDM in Chinese toddlers with autism spectrum disorder (ASD) in a longitudinal way. METHODS A total of 60 toddlers with ASD were recruited and randomly divided into two groups: ESDM group all received 24 weeks intervention; Control group were waiting for intervention. Baseline assessment (T0) was conducted before intervention, including Gesell Developmental Scale (GDS) and Psycho-educational Profile-3rd Edition (PEP-3). All toddlers with ASD were examined in the first assessment (T1) at 6 months and in the second assessment (T2) at 12 months. RESULTS In T1 assessment, the increments in speech and personal communication development quotient in GDS were significantly larger in the ESDM group than in the control group (P = 0.010, 0.047). In T2 assessment, the ESDM group had higher elevation in cognitive verbal/preverbal (CVP), social reciprocity and characteristic verbal behaviors assessed by PEP-3 (P = 0.021, 0.046, 0.014). In addition, the severity of stereotyped behavior was negatively associated with improvement in CVP. Family income was positively associated with improvement in speech and CVP (all P < 0.05). CONCLUSIONS ESDM can effectively improve speech and communication in toddlers with ASD after 24-week intervention. More importantly, ESDM can promote cognition and social interaction and can reduce stereotyped verbal behavior in toddlers with ASD in longitudinal observation. The severity of stereotyped behavior and family ecological factors may be considered as affecting the efficacy of ESDM.
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Gustafsson BM, Steinwall S, Korhonen L. Multi-professional and multi-agency model PLUSS to facilitate early detection and support of pre-school children with neurodevelopmental difficulties - a model description. BMC Health Serv Res 2022; 22:419. [PMID: 35354442 PMCID: PMC8966250 DOI: 10.1186/s12913-022-07815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Neurodevelopmental difficulties, such as problems in social inter-relatedness, communication, motor coordination, and attention, are frequent in preschoolers and constitute a risk for later negative consequences. This article describes the development of a multi-professional and multi-agency model, PLUSS, to facilitate care and interventions for preschoolers with neurodevelopmental difficulties. Methods The PLUSS model was developed for children aged 1.5–5 years with a need for a further assessment of neurodevelopmental symptoms. The model is evaluated using a quasi-experimental study design along with qualitative interviews that study preschool teacher, and parent experiences of PLUSS. Outcomes of interest are a) implementation, b) effectiveness related to processes and multi-agency collaboration, c) capacity building among professionals, d) child-related outcomes with a longitudinal follow-up as well as d) parental wellbeing and satisfaction. Results The model was launched in 2019 and so far, approximately 130 children have been assessed. Results from a pilot study with 62 children (27–72 months; boys: girls 2.65:1) show that the total mean SDQ score in parental rating was 15 ± 6 and in preschool teacher ratings 14 ± 7, exceeding the Swedish cut-off of 12. 54 parents have participated in parental training and rate high levels of satisfaction (mean score 4.5, max 5.0). In addition, 74 pre-school professionals have been trained in early signs of neurodevelopmental difficulties to facilitate early detection. Feedback from participants indicates high satisfaction with educational activities (mean score 4.2, max 5.0 = very satisfied). Conclusions The pilot study shows that the screening procedure can detect children with clinically significant problems. In addition, participant satisfaction is high in parent- and preschool teacher training. The longitudinal study approach enables both child follow-up and evaluation of interventions provided by the working model. Trial registration Clinical Trials 2021, PLUSS identifier, NCT04815889. First registration 25/03/2021.
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Affiliation(s)
- Berit M Gustafsson
- Department of Psychiatry and Rehabilitation, Psychiatric Clinic, Högland Hospital, Region Jönköping County, Jönköping, Sweden. .,Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Samina Steinwall
- Department of Child and Adolescent Psychiatry, Division of Psychiatry and Rehabilitation, Region Jönköping County, Jönköping, Sweden
| | - Laura Korhonen
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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12
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Godel M, Robain F, Kojovic N, Franchini M, Wood de Wilde H, Schaer M. Distinct Patterns of Cognitive Outcome in Young Children With Autism Spectrum Disorder Receiving the Early Start Denver Model. Front Psychiatry 2022; 13:835580. [PMID: 35815035 PMCID: PMC9256919 DOI: 10.3389/fpsyt.2022.835580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
Evidence-based, early intervention significantly improves developmental outcome in young children with autism. Nonetheless, there is high interindividual heterogeneity in developmental trajectories during the therapy. It is established that starting intervention as early as possible results in better developmental outcomes. But except for younger age at start, there is no clear consensus about behavioral characteristics that could provide a reliable individual prediction of a child's developmental outcome after receiving an early intervention. In this study, we analyze developmental trajectories of preschoolers with autism who received 2 years of intervention using the Early Start Denver Model (ESDM) approach in Geneva, Switzerland in an individual setting (n = 55, aged 28.7 ± 5.1 months with a range of 15-42). Our aim was to identify early predictors of response to intervention. We applied a cluster analysis to distinguish between 3 groups based on their cognitive level at intake, and rates of cognitive change over the course of intervention. The first group of children only had a mild cognitive delay at intake and nearly no cognitive delay by the end of intervention (Higher Cognitive at baseline: HC). The children in the two other groups all presented with severe cognitive delay at baseline. However, they had two very different patterns of response to intervention. The majority significantly improved developmental scores over the course of intervention (Optimal Responders: OptR) whereas a minority of children showed only modest improvement (Minimal Responders: MinR). Further analyses showed that children who ended up having an optimal 2-year intervention outcome (OptR) were characterized by higher adaptive functioning at baseline combined with rapid developmental improvement during the first 6 months of intervention. Inversely, less significant progress by the sixth month of intervention was associated with a less optimal response to treatment (MinR).
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Affiliation(s)
- Michel Godel
- Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - François Robain
- Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Nada Kojovic
- Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Martina Franchini
- Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Hilary Wood de Wilde
- Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Marie Schaer
- Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
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13
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Devescovi R, Colonna V, Dissegna A, Bresciani G, Carrozzi M, Colombi C. Feasibility and Outcomes of the Early Start Denver Model Delivered within the Public Health System of the Friuli Venezia Giulia Italian Region. Brain Sci 2021; 11:brainsci11091191. [PMID: 34573216 PMCID: PMC8464931 DOI: 10.3390/brainsci11091191] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022] Open
Abstract
The Early Start Denver Model (ESDM) is an evidence-based early intervention model for young children with autism spectrum disorder (ASD). It is crucial to investigate the feasibility of the ESDM in community settings in contexts that are culturally different from American universities in which the model was originally developed. The aim was to further evaluate the effectiveness of the ESDM delivered within the Italian community setting at low intensity. We compared a group aged 19 to 43 months receiving the ESDM for 2 h per week over the course of 1 year with a concurrent, comparable, non-randomized control group receiving treatment as usual (TAU). Children were evaluated at baseline (T0) and after 6 months (T1) and 12 months (T2) of intervention. Feasibility was evaluated by parent and therapist questionnaires, retention rate, and therapist treatment fidelity. Both groups made similar gains in cognition and language abilities. The ESDM group made larger improvement in domains measured by the ESDM Curriculum Checklist, including communication, social skills, and maladaptive behaviors. Feasibility seemed well supported by retentions, therapists and parent satisfaction, and treatment fidelity. Our study further supports the feasibility of the ESDM implemented within the Italian public health system and suggests a better response in the ESDM-treated group than in the control group.
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Affiliation(s)
- Raffaella Devescovi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
- Correspondence:
| | - Vissia Colonna
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
| | - Andrea Dissegna
- Department of Life Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Giulia Bresciani
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
| | - Marco Carrozzi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
| | - Costanza Colombi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (V.C.); (G.B.); (M.C.); (C.C.)
- IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
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14
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The effectiveness of early parental coaching in the autism spectrum disorder. J Pediatr (Rio J) 2021; 97:453-458. [PMID: 33069667 PMCID: PMC9432305 DOI: 10.1016/j.jped.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Analysis of the effectiveness of early Parental Coaching in the Autism Spectrum Disorder. METHOD Randomized, controlled and blinded clinical trial to analyze parent-child interaction videos. RESULTS The sample consisted of 18 children being followed up at the Autism Outpatient Clinic of a Neuropediatric Center in southern Brazil diagnosed with Autism Spectrum Disorder, between 29 and 42 months of age, randomly allocated to two groups: the Study Group (SG; n=9), which received Parental Coaching performed by a professional certified by the Early Start Denver Model; and the Control Group (CG; n=9), which was in a routine follow-up, without treatment and training of parents by a trained professional. The parents of the SG were willing to attend weekly meetings and to apply the instructional techniques at home with their children. It took 12 weeks and an average of 2h per meeting. CONCLUSIONS The learning rate for comprehensive development skills in the Early Start Denver Model checklist, such as receptive communication, expressive communication, social capacity, imitation, cognition, games, fine motor skills, gross motor skills, behavior, and personal independence was significantly higher in the SG, as well as the strategies and the quality of interaction between parents and children. Thus, Parental Coaching presents as a possibility of early intervention in children with Autism Spectrum Disorder.
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15
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Hus Y, Segal O. Challenges Surrounding the Diagnosis of Autism in Children. Neuropsychiatr Dis Treat 2021; 17:3509-3529. [PMID: 34898983 PMCID: PMC8654688 DOI: 10.2147/ndt.s282569] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/10/2021] [Indexed: 12/18/2022] Open
Abstract
This comprehensive thematic review aims to highlight and familiarize readers with the challenges and pitfalls encountered in differential diagnosis of autism spectrum disorders (ASD) in children to facilitate the process of accurate identification by stakeholders. Accordingly, articles that best answer our questions and highlight our concerns were chosen from well-established publishers with prime peer reviewed journals. Included are studies showing alternate views of the issues so as to point readers to other possibilities. ASD, a complex dynamic biological-neurodevelopmental disorder, is underscored by its heterogeneous symptomology, severity, and phenotypes - all characterized by social communication deficits and presence of restricted interests and repetitive behaviours (RRBs), the core symptoms in ASD. Language and intellectual capacities do not form ASD core symptoms although vary considerably. Accurate identification is challenging as ASD is often enmeshed with other neurodevelopmental disorders, and medical comorbidities, a situation now recognized as the rule rather than the exception in child psychiatry and developmental medicine. ASD is a disorder with varying performance and severity of symptoms over time, including unexpected loss of early skills, and lost diagnosis in some children following treatment. The review reiterates the urgency in accurate diagnosis in face of the rapid rise in ASD prevalence globally, and risk-increase in delayed or denied treatment with undesirable life-long consequences for most of the affected children. In addition, a call for change is advised to circumvent the ethical dilemma posed by the present "deficit model" in ASD diagnosis. Here, ASD prevalence is presented first, followed by emphasis on importance of accurate early diagnosis, and challenges in its accomplishment due to flaws in diagnostic instruments and other contributing factors. Next follow the required criteria for accurate identification, and its difficulties attributed to comorbid conditions, gender differences, and socio-economic and cultural influences. The conclusion includes future directions and a take away message.
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Affiliation(s)
- Yvette Hus
- Cyprus University of Technology, Department of Rehabilitation Sciences, Theralab Research Collaborator, Limassol, Cyprus
| | - Osnat Segal
- Tel Aviv University, Sackler Faculty of Medicine, Department of Communication Disorders, Tel-Aviv, Israel
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16
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Tateno Y, Kumagai K, Monden R, Nanba K, Yano A, Shiraishi E, Teo AR, Tateno M. The Efficacy of Early Start Denver Model Intervention in Young Children with Autism Spectrum Disorder Within Japan: A Preliminary Study. Soa Chongsonyon Chongsin Uihak 2021; 32:35-40. [PMID: 33424240 PMCID: PMC7788666 DOI: 10.5765/jkacap.200040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/25/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives Among the many intervention programs for children with autism spectrum disorder (ASD), the Early Start Denver Model (ESDM) is one of the few approaches that has succeeded in demonstrating clinical efficacy in randomized control trials. Here, we investigate the clinical efficacy of ESDM intervention in young children with ASD in a community setting within Japan. Methods All subjects were children with ASD who received ESDM intervention during the study period. Each ESDM session lasted 75 min and occurred once per week for at least 12 weeks. The outcome measures consisted of the Kyoto Scale of Psychological Development (K-test), Aberrant Behavior Checklist-Japanese version (ABC-J), and the Clinical Global Impression-Severity scale (CGI-S). Results Twenty-seven subjects (29.4±6.4 months old) received ESDM intervention that lasted for 8.0±2.6 months on average. The score on Language and Social developmental quotient on the K-test increased significantly after the intervention. The total scores on the ABC-J and CGI-S significantly decreased after completion of the ESDM intervention. Conclusion Our results suggest that ESDM intervention could reduce the severity of distinct clinical features of ASD, such as impairments in social interaction and communication assessed by the K-test, and maladaptive behavior rated by the ABC-J and CGI-S. We believe that the ESDM adapted to each institution might become one of the standard options for children with ASD in Japan.
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Affiliation(s)
- Yukie Tateno
- Tokiwa Child Development Center (Division Child Psychiatry of Tokiwa Hospital), Sapporo, Japan.,Tokiwa Developmental Support Center (Division Child Welfare of Tokiwa Hospital), Sapporo, Japan.,Department of Psychiatry, Tokiwa Hospital, Sapporo, Japan
| | - Kahoru Kumagai
- Tokiwa Developmental Support Center (Division Child Welfare of Tokiwa Hospital), Sapporo, Japan
| | - Ryunosuke Monden
- Tokiwa Child Development Center (Division Child Psychiatry of Tokiwa Hospital), Sapporo, Japan
| | - Kotaro Nanba
- Tokiwa Child Development Center (Division Child Psychiatry of Tokiwa Hospital), Sapporo, Japan.,Department of Psychiatry, Tokiwa Hospital, Sapporo, Japan
| | - Ayumi Yano
- Tokiwa Child Development Center (Division Child Psychiatry of Tokiwa Hospital), Sapporo, Japan
| | - Eri Shiraishi
- Tokiwa Child Development Center (Division Child Psychiatry of Tokiwa Hospital), Sapporo, Japan
| | - Alan R Teo
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, Portland, OR, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.,School of Public Health, Oregon Health & Science University, and Portland State University, Portland, OR, USA
| | - Masaru Tateno
- Tokiwa Child Development Center (Division Child Psychiatry of Tokiwa Hospital), Sapporo, Japan.,Department of Psychiatry, Tokiwa Hospital, Sapporo, Japan
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17
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Changes in Developmental Trajectories of Preschool Children with Autism Spectrum Disorder during Parental Based Intensive Intervention. Brain Sci 2020; 10:brainsci10050289. [PMID: 32408610 PMCID: PMC7287674 DOI: 10.3390/brainsci10050289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Research highlights the positive effects of early intensive intervention with parent and school involvement for preschool children with Autism Spectrum Disorder (ASD) on general developmental outcomes and social skills in randomized controlled trials. However, given the inter-individual variability in the response to treatment, it is necessary to investigate intervention effects in terms of mediators and moderators in order to explain variability and to highlight mechanisms of change. Methods: 25 children in the experimental group were exposed to early intensive intervention and 14 children in the control group were subjected to “as usual” intervention. The initial assessment was obtained at the time of diagnosis (T1) and the follow-up assessment was conducted after 15 months of intervention (T2) in both groups. Results: Participants in the experimental group achieved more prominent gains in both cognitive and socio-interactive skills. The role of specific factors able to predict general quotient and language quotient after intervention were investigated, pointing out the contribution of personal–social and performance abilities. Conclusions: The findings support the importance of parental involvement in targeting ASD core symptoms. Further, results informed our understanding of early predictors in order to identify specific elements to be targeted in the individualized intervention design.
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18
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Devescovi R, Monasta L, Bin M, Bresciani G, Mancini A, Carrozzi M, Colombi C. A Two-Stage Screening Approach with I-TC and Q-CHAT to Identify Toddlers at Risk for Autism Spectrum Disorder within the Italian Public Health System. Brain Sci 2020; 10:brainsci10030184. [PMID: 32210022 PMCID: PMC7139459 DOI: 10.3390/brainsci10030184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 01/17/2023] Open
Abstract
Standardized screening programs ensure that children are monitored for early signs of autism spectrum disorder (ASD) in order to promote earlier diagnosis and intervention. The aim of this study is to identify early signs of atypical development consistent with ASD or other developmental disorders in a population of 224 low-risk toddlers through a two-stage screening approach applied at 12 and 18 months of age. We adopted two screening tools combined: 1. the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP) Infant-Toddler Checklist (I-TC) and 2. The Quantitative Checklist for Autism in Toddlers (Q-CHAT). We assessed their sensitivity and specificity related to the diagnostic outcome at 36 months. The results showed that autistic signs can be detected as early as the first year even through a few questions extrapolated from both screeners and that our model could be used as a screening procedure in the Italian public health system.
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Affiliation(s)
- Raffaella Devescovi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (M.B.); (G.B.); (M.C.)
- Correspondence:
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Maura Bin
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (M.B.); (G.B.); (M.C.)
| | - Giulia Bresciani
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (M.B.); (G.B.); (M.C.)
| | - Alice Mancini
- IRCCS Stella Maris Foundation, Calambrone, 56128 Pisa, Italy;
| | - Marco Carrozzi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (M.B.); (G.B.); (M.C.)
| | - Costanza Colombi
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA;
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19
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Tupou J, Waddington H, van der Meer L, Sigafoos J. Effects of a low-intensity Early Start Denver Model-based intervention delivered in an inclusive preschool setting. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:107-121. [PMID: 35309698 PMCID: PMC8928834 DOI: 10.1080/20473869.2019.1707434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 06/14/2023]
Abstract
The Early Start Denver Model (ESDM) is a promising early intervention for promoting improved social, cognitive, and communication outcomes for young children with autism spectrum disorder (ASD). However, most studies evaluating group-based delivery of this program have used 15-25 h per week of intervention in specialized ESDM preschools with low child-teacher ratios. Thus, the positive results from such studies might not be obtained when this intervention model is evaluated in more typical inclusive preschool settings. In this study, a low-intensity version of the ESDM was delivered to three young children with ASD in their regular inclusive preschool by a certified therapist who did not typically work at any of the preschools. The intervention procedures were implemented for 3 h per week over an 8- to 10-week period. Data were gathered on children's levels of participation, imitation, and communication from weekly 10-min video recordings. The effects of the intervention were evaluated using a multiple probe across participants design with 3 weekly follow-up probes, 3 weeks after the intervention ended. All participants showed improvement in active participation, imitation and either intentional vocalizations or spontaneous functional utterances. These results were generally maintained at follow-up. This low-intensity version of the ESDM would seem effective for use in real-world preschool environments.
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Affiliation(s)
- Jessica Tupou
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Hannah Waddington
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | | | - Jeff Sigafoos
- School of Education, Victoria University of Wellington, Wellington, New Zealand
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20
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Contaldo A, Colombi C, Pierotti C, Masoni P, Muratori F. Outcomes and moderators of Early Start Denver Model intervention in young children with autism spectrum disorder delivered in a mixed individual and group setting. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:718-729. [PMID: 31747799 DOI: 10.1177/1362361319888344] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Several studies have shown the efficacy and effectiveness of the Early Start Denver Model, both in university and in community-based settings. However, a limited number of studies have investigated predictors of outcomes. In this study, we examined outcomes in 32 children diagnosed with autism spectrum disorder after 1 year of community-based Early Start Denver Model intervention, with the aim to identify predictors of treatment objectives acquisition, as measured by the Early Start Denver Model Curriculum Checklist. At a group level, the participants demonstrated improvement in their communication as well as adaptive functioning skills, while they showed a decrease in symptom severity. The large heterogeneity in outcomes identified was related to the pre-treatment non-verbal abilities, symptom severity, action and gesture repertoire, and lexical comprehension. We discussed our results in terms of implications for developing "personalized" interventions for children with autism spectrum disorder.
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Affiliation(s)
| | | | | | | | - Filippo Muratori
- IRCCS Stella Maris Foundation, Pisa, Italy.,University of Pisa, Italy
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21
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De Luca R, Leonardi S, Portaro S, Le Cause M, De Domenico C, Colucci PV, Pranio F, Bramanti P, Calabrò RS. Innovative use of virtual reality in autism spectrum disorder: A case-study. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:90-100. [PMID: 31092007 DOI: 10.1080/21622965.2019.1610964] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Autism Spectrum Disorders (ASDs) are developmental disorders affecting communication and behavior. ASD incidence in the world population is about 1%, with a 4:1 ratio between males and females. In clinical practice, ASDs have been usually treated with cognitive-behavioral approaches, involving a face-to-face interaction with the therapist. Over the last years, virtual reality (VR) has played an important role in neurorehabilitation, even for ASD cognitive treatment. A 16-year-old boy with severe ASD and his caregiver were enrolled in the study. Two different cognitive trainings were administered; first, the boy was submitted to one-month cognitive behavioral therapy (CBT); then, after one month of rest, a combined approach using VR (by means of the BTS-Nirvana System) and CBT was applied. Only the combined approach provided an improvement in attention processes and spatial cognition skills, with a significant reduction of ideomotor stereotypes. According to this experience, the use of VR in addition to CBT could be a useful and promising tool to improve cognitive function in individuals severely affected by ASD.
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Affiliation(s)
- Rosaria De Luca
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino Pulejo," Messina, Italy
| | - Simona Leonardi
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino Pulejo," Messina, Italy
| | - Simona Portaro
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino Pulejo," Messina, Italy
| | - Maria Le Cause
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino Pulejo," Messina, Italy
| | - Carmela De Domenico
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino Pulejo," Messina, Italy
| | - Pia Valentina Colucci
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino Pulejo," Messina, Italy
| | - Federica Pranio
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino Pulejo," Messina, Italy
| | - Placido Bramanti
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino Pulejo," Messina, Italy
| | - Rocco Salvatore Calabrò
- Robotic and Behavioral Neurehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino Pulejo," Messina, Italy
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22
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Stahmer AC, Dababnah S, Rieth SR. Considerations in implementing evidence-based early autism spectrum disorder interventions in community settings. PEDIATRIC MEDICINE (HONG KONG, CHINA) 2019; 2:18. [PMID: 31565699 PMCID: PMC6764452 DOI: 10.21037/pm.2019.05.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Evidence-based practices (EBPs) in early intervention for autism spectrum disorder (ASD) have the potential to improve children's developmental trajectories and address family needs. However, the successful use of EBPs in community early intervention settings requires careful attention to the context in which services are delivered. Implementation science, and specifically the Exploration, Preparation, Implementation, and Sustainment (EPIS) Model, provides a framework to examine context across multiple levels and identify barriers and facilitators to community EBP use. This article identifies several considerations most relevant for early intervention in ASD at the outer and inner context levels, as well as bridging and innovation factors. Outer context considerations include the policies and funding streams surrounding service delivery, the role of advocacy in shaping the service landscape, the availability of appropriate specialists to provide services, and family cultural characteristics. Inner context factors include the individual characteristics of both the children receiving the service as well as the provider delivering the service, in addition to the leadership and organizational climate surrounding the use of a particular EBP. We also discuss considerations of the specific innovation (in this case, EBP early interventions) to be deployed, as well as bridging factors.
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23
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Feng X, Hao X, Xin R, Gao X, Liu M, Li F, Wang Y, Shi R, Zhao S, Zhou F. Detecting Methylomic Biomarkers of Pediatric Autism in the Peripheral Blood Leukocytes. Interdiscip Sci 2019; 11:237-246. [DOI: 10.1007/s12539-019-00328-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/25/2019] [Accepted: 03/28/2019] [Indexed: 12/12/2022]
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24
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Kitzerow J, Teufel K, Jensen K, Wilker C, Freitag CM. Case-control study of the low intensive autism-specific early behavioral intervention A-FFIP: Outcome after one year. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 48:103-112. [PMID: 30971173 DOI: 10.1024/1422-4917/a000661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Abstracts: Objective: In current international research, early intervention in children with autism-spectrum disorder (ASD) focuses on naturalistic developmental behavioral interventions (NDBI). The manualized Frankfurt Early Intervention Program for preschool-aged children with ASD (A-FFIP) implements NDBI principles within a low-intensity approach of 2 h intervention/week. The present case-control study established effect sizes of change in autistic symptoms, comorbid behavioral problems as well as IQ after one year. Methodology: An intervention group (N = 20; age: 3.4-7.9 years) and a treatment-as-usual control group (N = 20; age: 3.2-7.3 years) of children with ASD were matched for developmental and chronological age. The outcome measures used were the ADOS severity score, the Child Behavior Checklist, and cognitive development. Results: After one year, the A-FFIP group showed a trend towards greater improvement in autistic symptoms (η2 = .087 [95 %-CI: .000-.159]) and significantly greater improvements in cognitive development (η2 = .206 [CI: .012-.252]) and global psychopathology (η2 = .144 [CI: .001-.205]) compared to the control group. Conclusion: The efficacy of A-FFIP should be established in a larger, sufficiently powered, randomized controlled study.
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Affiliation(s)
- Janina Kitzerow
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Research and Intervention Center of Excellence Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Karoline Teufel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Research and Intervention Center of Excellence Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - Christian Wilker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Research and Intervention Center of Excellence Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Research and Intervention Center of Excellence Frankfurt, Goethe University Frankfurt am Main, Germany
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Weisberg HR, Jones EA. Individualizing Intervention to Teach Joint Attention, Requesting, and Social Referencing to Children with Autism. Behav Anal Pract 2019; 12:105-123. [PMID: 30918774 PMCID: PMC6411543 DOI: 10.1007/s40617-018-0265-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Social communication skills such as joint attention (JA), requesting, and social referencing (SR) are deficits in children with autism spectrum disorder (ASD). Shifting gaze is a common response across these skills. In many studies, children respond variably to intervention, resulting in modifications to planned intervention procedures. In this study, we attempted to replicate the procedures of Krstovska-Guerrero and Jones (Journal of Developmental and Physical Disabilities 28; 289-316, 2016) and Muzammal and Jones (Journal of Developmental and Physical Disabilities 29; 203-221, 2017) to teach JA, requesting, and SR. In general, intervention procedures consisting of prompting and reinforcement were effective in teaching requesting, SR, and JA skills to children with ASD. However, not all children acquired each skill, and all children required individualized procedures to acquire some skills. We report the process of deciding how to modify intervention and discuss considerations for practitioners when planning intervention that may improve children's performance.
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Affiliation(s)
- Holly R. Weisberg
- Queens College, City University of New York, 65-30 Kissena Blvd, Science Building, Room E318, Queens, NY 11367 USA
- The Graduate Center, City University of New York, New York, NY USA
| | - Emily A. Jones
- Queens College, City University of New York, 65-30 Kissena Blvd, Science Building, Room E318, Queens, NY 11367 USA
- The Graduate Center, City University of New York, New York, NY USA
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Waddington H, van der Meer L, Sigafoos J, Ogilvie E. Evaluation of a low-intensity version of the early start Denver model with four preschool-aged boys with autism spectrum disorder. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2019; 66:257-269. [PMID: 34141388 PMCID: PMC7942523 DOI: 10.1080/20473869.2019.1569360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Data indicate that some developmentally and behaviorally based early intervention programs can lead to a range of improvements in children with autism spectrum disorder. However, many such programs call for a fairly intensive amount of intervention. The objective of this preliminary study was to evaluate the effectiveness of a low-intensity therapist delivered intervention for young children with autism spectrum disorder. METHODS The study evaluated the outcomes of 3 hours per week of therapist-delivered early start Denver model intervention (ESDM) over a 12-week period for four preschool-aged boys with autism spectrum disorder. The effects of intervention on communication, imitation, and engagement were evaluated using a non-concurrent multiple probe across participants design. RESULTS Following the intervention, all four children showed increases in imitation, engagement, and either functional utterances or intentional vocalizations. These results were maintained after 4 weeks and mostly generalized to each child's mother. CONCLUSION These preliminary results suggest that low-intensity therapist delivered ESDM intervention may be of some benefit to children with autism spectrum disorder.
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Affiliation(s)
- Hannah Waddington
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Larah van der Meer
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Jeff Sigafoos
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Emily Ogilvie
- School of Education, Victoria University of Wellington, Wellington, New Zealand
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Zhou B, Xu Q, Li H, Zhang Y, Wang Y, Rogers SJ, Xu X. Effects of Parent-Implemented Early Start Denver Model Intervention on Chinese Toddlers with Autism Spectrum Disorder: A Non-Randomized Controlled Trial. Autism Res 2018; 11:654-666. [PMID: 29412514 DOI: 10.1002/aur.1917] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/15/2017] [Accepted: 12/08/2017] [Indexed: 01/12/2023]
Abstract
To evaluate the effects of a 26-week, high-intensity, parent-implemented Early Start Denver Model (P-ESDM) intervention on developmental outcomes, severity of autism spectrum disorder (ASD), and parental stress of ASD toddlers in China. Subjects in P-ESDM group (n = 23) were recruited from 1.5- to 2.5-year-old toddlers who were screened positive in Xuhui and Minhang Districts and were diagnosed with ASD. A community (comparison) group of age-matched toddlers with ASD (n = 20) was recruited from other areas. Subjects of the P-ESDM group attended 1.5-hr parent coaching per week for 26 weeks, and those in the community group received interventions available from communities. Assessments were conducted at baseline (T1) and 26 weeks later (T2). After adjusting for baseline differences between the two groups, P-ESDM group demonstrated greater improvement than the community group in general development, especially in Language domain. Neither group demonstrated significant change in ASD severity, but the P-ESDM group showed greater improvement in social affect, parent-reported social communication and symbolic play than community group did. Finally, parents in P-ESDM group experienced decreased parenting stress while those in community group showed an opposite trend, though the differences did not reach significant association with the P-ESDM intervention. Chinese toddlers with ASD receiving 26 weeks of P-ESDM via regular coaching sessions showed significant greater improvement than those receiving community interventions in multiple aspects of development including social communications. These findings add support to the importance of providing early screening, diagnosis, and immediate referral for evidence-based interventions to improve outcome of young children with ASD. Autism Res 2018, 11: 654-666. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY The development of early screening and diagnosis of autism spectrum disorder (ASD) in China has highlighted the importance of early intervention for young children with ASD. Our current study demonstrated that parent-implemented Early Start Denver Model (P-ESDM) via coaching from professionals improved developmental outcomes, especially in the language domain, and social communicational behaviors of Chinese toddlers with ASD. P-ESDM may help parents in China provide effective early intervention to their children with ASD via improving their skills when they are still at a waiting list for services or lack access to intervention, and has the potential to alleviate their parenting stress.
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Affiliation(s)
- Bingrui Zhou
- Department of Child Health Care, Children's Hospital of Fudan University, 399 Wan Yuan Road, Minhang District, Shanghai, 201102, China
| | - Qiong Xu
- Department of Child Health Care, Children's Hospital of Fudan University, 399 Wan Yuan Road, Minhang District, Shanghai, 201102, China
| | - Huiping Li
- Department of Child Health Care, Children's Hospital of Fudan University, 399 Wan Yuan Road, Minhang District, Shanghai, 201102, China
| | - Ying Zhang
- Department of Child Health Care, Children's Hospital of Fudan University, 399 Wan Yuan Road, Minhang District, Shanghai, 201102, China
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Minhang District, Shanghai, 201102, China
| | - Sally J Rogers
- Department of Psychiatry, MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817
| | - Xiu Xu
- Department of Child Health Care, Children's Hospital of Fudan University, 399 Wan Yuan Road, Minhang District, Shanghai, 201102, China
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