Evaluation of an Early Start Denver Model-based intervention for young children with autism in an inclusive preschool setting.

<p>Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by difficulties in social communication and the presence of restricted or repetitive behaviours or interests. There is evidence to suggest that early intervention (EI) can lead to improved outcomes for children with ASD. Inclusive preschool-based delivery of EI appears to satisfy current legal and best-practice recommendations around the delivery of EI for young children with ASD. It may also offer several potential benefits including cost-effectiveness, efficiency and opportunities for children with ASD to learn from their peers. The Early Start Denver Model (ESDM) is a promising naturalistic behavioural developmental intervention for young children with ASD aged between 12 and 60 months. The ESDM can be delivered to children in a group-based format and several studies have demonstrated its effectiveness when delivered for 15 to 25 hours per week in designated ESDM preschools with low child–teacher ratios. However, the preschools involved in these studies may not be representative of the typical preschool setting for many communities. Thus, more research is needed to determine the effectiveness of this intervention when delivered under conditions that more closely reflect the typical real-world preschool setting. In the present thesis, two studies with multiple probe across participants designs, each involving three preschool children with ASD, examined the feasibility and effectiveness of the use of the ESDM in an inclusive preschool setting. Specifically, Study 1 evaluated the effectiveness of a modified version of ESDM therapy delivered by a certified therapist and Study 2 evaluated (a) the effectiveness of a brief ESDM coaching programme, and (b) the effectiveness of a modified version of ESDM therapy delivered by preschool teachers. For both studies, the intervention was delivered in regular community preschools and no major changes were made to the typical preschool environments or routines. Effectiveness was assessed by measuring improvements in child active participation, vocal/verbal communication and imitation, and, for Study 2, teachers’ fidelity of implementation of ESDM techniques. Teachers’ perceptions of the acceptability and effectiveness of the intervention were also assessed via a questionnaire and in-depth interviews. In Study 1, an outside certified therapist delivered 3 hours per week of ESDM to three children with ASD over an 8- to 10-week period. Participants showed improvement in active participation, imitation and either intentional vocalisations or spontaneous functional utterances. These results were generally maintained at follow-up. For Study 2, a brief coaching programme was used to train three preschool teachers to use the ESDM with a child with ASD who attended the inclusive preschools where they worked. Teachers improved in their use of the ESDM strategies and children demonstrated improved levels of active participation but results for child imitation and communication were mixed. Teachers also found the intervention to be acceptable and effective. Together, the results from these studies provide preliminary support for the feasibility and effectiveness of the ESDM when delivered in real-world inclusive preschool settings. More research is needed to determine the most effective approach to delivering EI for ASD in an inclusive preschool setting. It may also be valuable to evaluate the extent to which gains made by children and teachers during intervention generalise to other people and/or settings.</p>

Evaluation of an Early Start Denver Model-based intervention for young children with autism in an inclusive preschool setting.

<p>Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by difficulties in social communication and the presence of restricted or repetitive behaviours or interests. There is evidence to suggest that early intervention (EI) can lead to improved outcomes for children with ASD. Inclusive preschool-based delivery of EI appears to satisfy current legal and best-practice recommendations around the delivery of EI for young children with ASD. It may also offer several potential benefits including cost-effectiveness, efficiency and opportunities for children with ASD to learn from their peers. The Early Start Denver Model (ESDM) is a promising naturalistic behavioural developmental intervention for young children with ASD aged between 12 and 60 months. The ESDM can be delivered to children in a group-based format and several studies have demonstrated its effectiveness when delivered for 15 to 25 hours per week in designated ESDM preschools with low child–teacher ratios. However, the preschools involved in these studies may not be representative of the typical preschool setting for many communities. Thus, more research is needed to determine the effectiveness of this intervention when delivered under conditions that more closely reflect the typical real-world preschool setting. In the present thesis, two studies with multiple probe across participants designs, each involving three preschool children with ASD, examined the feasibility and effectiveness of the use of the ESDM in an inclusive preschool setting. Specifically, Study 1 evaluated the effectiveness of a modified version of ESDM therapy delivered by a certified therapist and Study 2 evaluated (a) the effectiveness of a brief ESDM coaching programme, and (b) the effectiveness of a modified version of ESDM therapy delivered by preschool teachers. For both studies, the intervention was delivered in regular community preschools and no major changes were made to the typical preschool environments or routines. Effectiveness was assessed by measuring improvements in child active participation, vocal/verbal communication and imitation, and, for Study 2, teachers’ fidelity of implementation of ESDM techniques. Teachers’ perceptions of the acceptability and effectiveness of the intervention were also assessed via a questionnaire and in-depth interviews. In Study 1, an outside certified therapist delivered 3 hours per week of ESDM to three children with ASD over an 8- to 10-week period. Participants showed improvement in active participation, imitation and either intentional vocalisations or spontaneous functional utterances. These results were generally maintained at follow-up. For Study 2, a brief coaching programme was used to train three preschool teachers to use the ESDM with a child with ASD who attended the inclusive preschools where they worked. Teachers improved in their use of the ESDM strategies and children demonstrated improved levels of active participation but results for child imitation and communication were mixed. Teachers also found the intervention to be acceptable and effective. Together, the results from these studies provide preliminary support for the feasibility and effectiveness of the ESDM when delivered in real-world inclusive preschool settings. More research is needed to determine the most effective approach to delivering EI for ASD in an inclusive preschool setting. It may also be valuable to evaluate the extent to which gains made by children and teachers during intervention generalise to other people and/or settings.</p>

Evaluation of low-intensity therapy and parent training for young children with autism based on the early start Denver model

<p>Autism spectrum disorder (ASD) is a pervasive developmental disorder that is characterised by deficits in social communication and restricted and repetitive behaviours, interests and activities. Recent developments in identification techniques mean that many children can be reliably diagnosed with ASD before the age of 2. Early identification creates the opportunity for early intervention. In fact, some research suggests that the earlier a child with ASD receives intervention, the greater the progress he or she is likely to make. Naturalistic developmental behavioural interventions are a relatively recent method of early intervention for children with ASD, which combine elements of previous intervention approaches (behavioural, naturalistic behavioural, and developmental/relationship-focused intervention). One such naturalistic developmental behavioural intervention is the early start Denver model (ESDM), which is designed for children with or at risk for ASD between the ages of 12 and 60 months (5 years). Research suggests that ESDM intervention may improve a range of child outcomes when delivered for at least 15 hours per week over at least 10 months. However, many families may not be able to access or afford such intensive intervention. Therefore, the two studies in this thesis evaluated the effectiveness of two ESDM delivery approaches that required relatively few hours of professional input per week. Specifically, low-intensity therapist delivered ESDM intervention, and ESDM parent training. Study 1 used a multiple probe across participants design to evaluate the effectiveness of 3 hours per week of home-based ESDM therapy for 12 weeks for improving imitation, communication, and engagement for four young children with ASD. It also examined whether children showed increases in these outcomes with their mothers following the intervention. The results of this study suggest that, following the intervention, all four children increased their imitation skills and their engagement with the therapist. In addition three of the children had more functional utterances and one child increased his use of intentional vocalisations. These results were maintained four weeks after intervention and generalised to a lesser degree to each child’s mother. This suggests that low-intensity therapist delivered ESDM intervention may improve outcomes for children with ASD. The results of Studies 1 and 2 suggest that both low-intensity therapist delivered ESDM intervention and ESDM parent training may be promising intervention approaches for young children with ASD. This is particularly encouraging as both approaches involved relatively few hours of professional input per week. In theory, this could increase the number of families who are able to access such intervention. More research is needed to identify the most effective low-intensity ESDM intervention method, or combination of methods.</p>

Evaluation of low-intensity therapy and parent training for young children with autism based on the early start Denver model

<p>Autism spectrum disorder (ASD) is a pervasive developmental disorder that is characterised by deficits in social communication and restricted and repetitive behaviours, interests and activities. Recent developments in identification techniques mean that many children can be reliably diagnosed with ASD before the age of 2. Early identification creates the opportunity for early intervention. In fact, some research suggests that the earlier a child with ASD receives intervention, the greater the progress he or she is likely to make. Naturalistic developmental behavioural interventions are a relatively recent method of early intervention for children with ASD, which combine elements of previous intervention approaches (behavioural, naturalistic behavioural, and developmental/relationship-focused intervention). One such naturalistic developmental behavioural intervention is the early start Denver model (ESDM), which is designed for children with or at risk for ASD between the ages of 12 and 60 months (5 years). Research suggests that ESDM intervention may improve a range of child outcomes when delivered for at least 15 hours per week over at least 10 months. However, many families may not be able to access or afford such intensive intervention. Therefore, the two studies in this thesis evaluated the effectiveness of two ESDM delivery approaches that required relatively few hours of professional input per week. Specifically, low-intensity therapist delivered ESDM intervention, and ESDM parent training. Study 1 used a multiple probe across participants design to evaluate the effectiveness of 3 hours per week of home-based ESDM therapy for 12 weeks for improving imitation, communication, and engagement for four young children with ASD. It also examined whether children showed increases in these outcomes with their mothers following the intervention. The results of this study suggest that, following the intervention, all four children increased their imitation skills and their engagement with the therapist. In addition three of the children had more functional utterances and one child increased his use of intentional vocalisations. These results were maintained four weeks after intervention and generalised to a lesser degree to each child’s mother. This suggests that low-intensity therapist delivered ESDM intervention may improve outcomes for children with ASD. The results of Studies 1 and 2 suggest that both low-intensity therapist delivered ESDM intervention and ESDM parent training may be promising intervention approaches for young children with ASD. This is particularly encouraging as both approaches involved relatively few hours of professional input per week. In theory, this could increase the number of families who are able to access such intervention. More research is needed to identify the most effective low-intensity ESDM intervention method, or combination of methods.</p>

An exploration of the synergies, parallels, and divergences between ESDM and music therapy with preschool children with autism, in a music therapy student’s practice.

<p>This qualitative research explores the possibility of an interaction between music therapy and the Early Start Denver Model with preschool children with autism spectrum disorder. Both interventions have been shown to be effective at improving social, emotional and communication skills in young autistic children, and share some use of music and some focus on developmental goals. My findings were generated from Secondary Analysis of Data using my qualitative clinical notes and reflective thoughts from a music therapy setting and an Early Start Denver Model setting. I focused on my use of music in sessions at each setting and found three main themes in the data – building a therapeutic relationship; singing to engage, with primary and secondary focus on the music; and moment of discomfort. A large proportion of my data related to using music to build a positive therapeutic relationship with the child, which is necessary to achieve both the wider goals typical of a music therapy setting and the more specific goals of the Early Start Denver Model setting. My data also showed that the humanistic approach of music therapy and the behavioural approach of the Early Start Denver model created tension in my practice in both settings. My research concluded that there are parallels and synergies which could positively inform each intervention but there may be too many divergences to create one cohesive therapy, due to their differences in approach.</p>

An exploration of the synergies, parallels, and divergences between ESDM and music therapy with preschool children with autism, in a music therapy student’s practice.

<p>This qualitative research explores the possibility of an interaction between music therapy and the Early Start Denver Model with preschool children with autism spectrum disorder. Both interventions have been shown to be effective at improving social, emotional and communication skills in young autistic children, and share some use of music and some focus on developmental goals. My findings were generated from Secondary Analysis of Data using my qualitative clinical notes and reflective thoughts from a music therapy setting and an Early Start Denver Model setting. I focused on my use of music in sessions at each setting and found three main themes in the data – building a therapeutic relationship; singing to engage, with primary and secondary focus on the music; and moment of discomfort. A large proportion of my data related to using music to build a positive therapeutic relationship with the child, which is necessary to achieve both the wider goals typical of a music therapy setting and the more specific goals of the Early Start Denver Model setting. My data also showed that the humanistic approach of music therapy and the behavioural approach of the Early Start Denver model created tension in my practice in both settings. My research concluded that there are parallels and synergies which could positively inform each intervention but there may be too many divergences to create one cohesive therapy, due to their differences in approach.</p>

Feasibility and Outcomes of the Early Start Denver Model Delivered within the Public Health System of the Friuli Venezia Giulia Italian Region

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.

Distinct patterns of treatment response using the Early Start Denver Model with young children with autism spectrum disorder: a cluster analysis

Evidence-based early intervention approaches have been shown to significantly improve many areas of development in young children with autism. Despite having an overall positive impact for most children, there is high inter-individual heterogeneity of response to treatment, and it is currently not possible to predict which child will benefit from which specific intervention. In this study, we analyze developmental trajectories of young children with autism who received two-years of Early Start Denver Model intervention in Geneva, Switzerland (n=47). Using cluster analyses, we distinguish between 3 subgroups based on cognitive level at baseline and rates of change over time. The first subgroup of children had cognitive scores at baseline only slightly below what would be expected for their age and were found to have nearly no cognitive delay by the end of treatment (High at Baseline: HB). The children in the two other subgroups all presented with severe cognitive delay at baseline, with the second group′s cognitive scores improving significantly in the first year of intervention, along with increased communication and daily living skills (High Responders: HR). The third subgroup showed little to no cognitive level change over the course of treatment (Minimal Responders: MR). Furthermore, the rates of change in cognition and adaptative behavior in the HR subgroup were already significantly higher compared to the MR subgroup within the first 6 months of intervention. A rapid and early response to intervention might thus represent a predictor of optimal outcome. Inversely, slower progress by the sixth month of intervention may predict that the child will have a slower response to the treatment overall and may need alternative supports to reach their learning objectives quickly.