Therapies for Children With Autism Spectrum Disorders

Another prospective cohort study described outcomes for 65 children (ages 2.5–4 years at
start of treatment) involved in broad-based eclectic teaching interventions and programs, often
including reinforcement-based interventions, special nursery placements, speech and language
therapy, and parent education programs. The authors compared groups (based on median split) of
children receiving either 196 high/low intensity (less than 15.6 hours per week of intervention)
intervention whose parents either reported high or low levels of stress. Children were assessed at
baseline and then after 9-10 months, including assessments of developmental/cognitive and
adaptive behavior. Children receiving more intervention time (high intensity) had greater
improvements across all three measures compared with those with less intervention time.
Parenting stress did not affect gains with low intensity interventions but reduced the gains made
by those in higher time interventions.
A prospective cohort study 192 compared home-based tutor-led ABA teaching interventions
(n=12) to two other teaching interventions, one of which was a school-based teaching program
borrowing components from TEACCH with 6-8 children in each class (Special Nursery
Placement) (n=20), and one (Portage) of which was a home-based, tutor-led program (n=16).
The ABA intervention group received 1:1 interaction for two to three hours (including Lovaas,
verbal behavior, and Comprehensive Application of Behavior Analysis to Schooling
interventions). In the Special Nursery group, the children had several two to three hour sessions
per week in a structured classroom (outlined by TEACCH methodology) with 6-8 other student
and a teacher. In the portage group, a supervisor visited parents once every one to two weeks to
demonstrate how to apply a system developed by a portage supervisor. Sessions were 40 to 60
minutes per day and scheduled when the parent believed the child would be at his or her most
receptive. Children were taught new skills through the use of questions and tasks, prompts, and
rewards.
The children were evaluated using multiple measures of symptom severity and intellectual
functioning. Scores on measures related to intellectual functioning (the Psycho Educational
Profile) in the ABA intervention group showed an overall gain of approximately 14 points, the
nursery, approximately ten points, and little gain was shown in the portage group (~2 points).
Authors documented cognitive, behavioral and adaptive behavioral skill improvements within
each intervention group, but did not conduct direct comparisons between groups.
In a similar study comparing a one-to-one home based program (Parents of Autistic Children
Training and Support), general special nursery placement, and ASDs-specific nursery placement
and including children between 2 and 4 years old, participants in all groups showed marginal
decreases in autistic severity and improved in educational functioning relative to baseline
scores. 199 Children in the nursery groups also showed improvements in adaptive behavior.
Rickards et al. 194,198 investigated the addition of home-based intervention to a center-based
educational program. The center-based program used training techniques like chaining, variety,
repetition, sequencing, and a reward system to encourage learning through play, and used
communication systems and behavior reinforcement. The home-based program included one of
two specialist preschool teachers who visited each family weekly for one to one and a half hours
for 12 months to discuss protocols developed at the centers, and develop new goals and
strategies.
The home-based program also included parent training and adapting the home environment
for the needs of the child. IQ improved by 1.6 points between baseline and Time 2 for the home
plus center group and decreased by 4.3 for the center only group (p = .09). Preschool Behavior
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