Early intervention refers to the combination of physical, occupational, speech, and other services a child receives prior to the age of three. More than 400 different treatment approaches are currently being used as an early intervention in autism, but only a tiny fraction have been researched to determine effectiveness. Treatment programs range from very structured, teacher-led programs to developmental, child-led programs. Studies looking at early intervention in autism up to this point in time have largely dealt with one-on-one structured teaching and developmental approaches. Regardless of the treatment, research appears to make one thing clear: the sooner a child receives early intervention in autism, the better off he or she will be during the preschool years, and this is especially true when compared with children who receive no early intervention.
Research shows that as an early intervention in autism, Lovaas and other applied behavior analysis (ABA) programs are most effective when the early intervention specialist and parents work with the child 30-40 hours per seven-day week. The structure of each discrete trial training session is very rigid and focuses on training the child to respond to simple commands in exchange for a reward. Over time, the child's response becomes closer and closer to the desired behavior and rewards are faded out. In order to maintain the child's response to the cue, parents and therapists must repeat training sessions periodically.
Although the research shows the effectiveness of ABA, there are people who question its practicality and real-world effectiveness over time. The weekly time commitment necessary for ABA to be effective can be off-putting and impractical for some caregivers; this can result in poor follow through with therapy and lessen its effectiveness. Another issue is the substantial cost of early intervention programs, which insurance and school districts are often reluctant to pay. Finally, some people criticize ABA as being too much like animal training, and hold that even though a child can perform on cue during sessions, the behavior does not necessarily transfer to real-life situations.
Developmental programs such as Floortime focus on building the core deficits inherent in autism, namely the ability to interact with others in an empathetic, reciprocal way. Under the guidance of a professional, developmental early intervention in autism has parents and others in the child's life, engage the child in a wide variety of situations and settings 20 minutes at a time. The foundational belief behind developmental therapies is that learning how to interact socially is a necessary step to learning other things in life, including academics.
Research has shown that Floortime and other programs like it are most effective long term in children with Asperger's syndrome, a less severe form of autism in which children have average or above-average cognitive abilities. Children with severe autism and cognitive impairments show less improvement using a developmental approach as they do when taught with ABA. Like ABA, developmental programs can be expensive, but are much easier to implement on a budget. Compared to ABA, parent-therapists using developmental approaches have a higher follow-through rate, which enhances the effectiveness of treatment.
Research into the effectiveness of early intervention in autism is still in its infancy. One-on-one discrete trial training achieves more improvement overall with children who have cognitive impairments and severe autism when compared to developmental approaches. Long-term results are promising for less impaired children who are provided with developmentally based therapy. Over the next decade, researchers may learn much more about the effectiveness of many more approaches to treatment that are being used as early intervention in autism today. Until then, people must go by what we do know and give all children with autism some kind of early intervention as promptly as possible.
