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A meta-analytic
review of the effectiveness of behavioural early intervention programs for children with autistic spectrum disorders.
“The meta-analysis showed that the behavioural EIPs are very effective in improving the
intellectual, language, communication and social abilities of children with ASD, while they had a moderate to high effect
on the adaptive behavioural improvement of the children.”
Results of study found that EI programs were much more effective than the control condition (non- ABA
programs).
Age of intake had a significant
impact on the results of the behavioral program. The younger the child was at intake of the program, the
greater the impact the early intervention behavioral program had on their abilities.
Makrygianni, M. K., & Reed, P. (2010). Research In Autism Spectrum Disorders,
4(4), 577-593. doi:10.1016/j.rasd.2010.01.014
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The effectiveness
of a cross-setting complementary staff- and parent-mediated early intensive behavioral intervention for young children with
ASD.
Studies found that Early
Intensive Behavioral Intervention to be superior to other intervention approaches in producing progress in cognitive abilities,
adaptive skills and autism severity.
Age
at intake was associated with better outcomes in adaptive functioning and early language skills (children that received the
services at a younger age had better outcomes than children that started the same program at an older age).
Fava, L., Strauss, K., Valeri, G., D’Elia,
L., Arima, S., & Vicari, S. (2011). Research In Autism Spectrum Disorders, 5(4), 1479-1492. doi:10.1016/j.rasd.2011.02.009
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The effects
of age and treatment intensity on behavioral intervention outcomes for children with autism spectrum disorders
Results of this study found that children at a younger age receiving early intervention behavioral services mastered
more behavioral objectives. (Younger age was a predictor of increased mastered behavioral objectives)
The youngest group of children in the study showed
the greatest response to the treatment; less of a response to the treatment was recorded as age of intake increased.
This study also found that for children under 7 years
of age, there was no period of “burn-out” from the treatment.
“The results of this study demonstrated that the efficiency of intervention
decreases as the age of the child increases. This finding reinforces the generally accepted notion that early intervention
is crucial for individuals with autism.”
Granpeesheh D., Dixon D.R., Tarbox J., Kaplan A.M., Wilke A.E.. (2009) Research in Autism Spectrum Disorders,
3 (4), pp. 1014-1022.
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The Next Decade of Research on the Effectiveness
of Early Intervention.
Early intervention programs were found to significantly minimize declines in
development for children with developmental disabilities.
Guralnick, M. J. (1991). Exceptional Children,
58(2), 174-183. http://www.freepatentsonline.com/article/Exceptional-Children/11551653.html
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Role of the
Medical Home in Family- Centered Early Intervention Services
“There is growing evidence that
early intervention services have a positive influence on the developmental outcome of children with established disabilities
as well as those who are considered to be “at risk” of disabilities.”
“Well-designed, timely early intervention can improve
the outcome and the quality of life of young children at risk of developing cognitive, social, or emotional impairment”
“The early childhood years
present a singular opportunity to influence lifelong development and prevent or minimize developmental problems in children
with disabilities or those who are at risk of developing disabilities.”
“…these programs may be effective not only in improving some individual
child cognitive outcomes but also in leading to important improvements in family function”
(2007). American Academy of Pediatrics, 120, (5), 1153-1158. http://aappolicy.aappublications.org/cgi/reprint/pediatrics;120/5/1153.pdf
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Identifying
Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and
Screening
Early identification
of developmental disorders is critical to the well-being of children and their families
“Early intervention is available for a wide range of developmental disorders;
their prompt identification can spur specific and appropriate therapeutic interventions.”
(2006). American Academy of Pediatrics, 118, (1), 405-420. http://aappolicy.aappublications.org/cgi/reprint/pediatrics;118/1/405.pdf
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Identifying
Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and
Screening
Early identification
of developmental disorders is critical to the well-being of children and their families
“Early intervention is available for a wide range of developmental disorders;
their prompt identification can spur specific and appropriate therapeutic interventions.”
(2006). American Academy of Pediatrics, 118, (1), 405-420. http://aappolicy.aappublications.org/cgi/reprint/pediatrics;118/1/405.pdf
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Early childhood
intervention: Evolution of a system.
There are 3 major components of EI that make it convenient and effective for children and their families given the
stressors families face today:
- Communities have established resources that help make families aware of services,
and makes those services accessible to them
- Communities
have established social supports for families (parent groups, counseling services, other social supports.
- Communities offer a wide range of information and services
to children.
All of these support systems provided by the community comfort parents and give them the confidence and knowledge
they need to seek out appropriate services and provide optimal circumstances for their children
“When these community-based early intervention programs are in place, the
decline in intellectual development observed for children with developmental delays during the first few years of life is
either prevented entirely or substantially reduced.”
Guralnick, M. J. (2000). Focus On Autism And Other Developmental Disabilities, 15(2), 68-79. doi:10.1177/108835760001500202
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Early intervention
for children with intellectual disabilities: Current knowledge and future prospects.
“We have unequivocal evidence for both the short- and long-term effectiveness
of early intervention, with effect sizes in the modest range (from 0.50 to 0.75 SD).” – This indicates that according
to research, early intervention has a significant impact on children both short and long term.
“…consistent evidence has been found indicating
that comprehensive early intervention programs are able to prevent much of the decline in intellectual development for children
with Down’s syndrome that typically occurs during the first few years of life.”
Guralnick, M. J. (2005). Journal Of Applied Research In Intellectual Disabilities,
18(4), 313-324. doi:10.1111/j.1468-3148.2005.00270.x
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NYS
DEPARTMENT of HEALTH
Autism/Pervasive Developmental Disorders
Assessment
and Intervention
for Young Children (Age 0-3 Years) - Clinical Practice Guideline: Report of the Recommendations
After screening 300 articles and selecting the 49 studies with the highest scientific standards, the
Clinical Practice Guidelines for Autism/Pervasive Developmental Disorders published in 1999 by the NYS Department of Health
states, “It is important to identify children with autism and begin appropriate interventions as soon as possible since
such early interventions may help speed the child’s overall development, reduce inappropriate behaviors, and lead to
better long-term functional outcomes.” (page IV-4)
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NYS DEPARTMENT of HEALTH
Communication
Disorders - Clinical Practice Guideline: Report of the Recommendations
After screening
372 articles, and selecting the 40 studies with the highest scientific standards, the Clinical Practice Guidelines for Communication
Disorders published in 1999 by the NYS Department of Health recommends: “It is important to identify children with communication
disorders and begin appropriate interventions as soon as possible. Early intervention may help speed the
child’s overall language development and lead to better long-term functional outcomes.” (page IV-6)
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THE WORLD BANK
The World Bank has published a book
entitled “Early Child Development: Investing in the Future”. In Chapter I (“The Case
for Early Intervention”) the authors state:
“Thirty years of research has shown
that such programs can improve primary and even secondary school performance, increase children’s prospects for higher
productivity, and reduce the probability that they will become burdens on public health and social service budgets.”
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U.S. SURGEON GENERAL
A
report on autism by the U.S. Surgeon General states: “Intensive, sustained special education programs and behavior
therapy early in life can increase the ability of a child with autism to acquire language and ability to learn…Thirty
years of research has demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing
communication, learning, and appropriate social behavior.”
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JOURNAL of the AMERICAN MEDICAL ASSOCIATION
A 2001 cost-benefit study published in the Journal of the American Medical Association (JAMA, 5/8/01,
vol. 285, no.18) found that an early intervention program costing $6,730 per child generated a return on investment of $47,759
for each child. This means that for every $1 invested, $7.10 was returned to society in the form of decreased expenditures
(e.g., fewer subsequent special education services, less grade retention). (When similar services
for 2nd & 3rd graders were analyzed, results showed a return of only $1.66 for every $1 invested.)
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BEHAVIORAL INTERVENTION
An
article published in the peer-reviewed journal Behavioral Intervention (Jacobson, Mulick, & Green; 1998, vol.13, pages
201-226) found that if 100 children are provided with intensive Early Intervention services, and only 40 of the children demonstrate
just partial improvement, the school district STILL would save $9.5 million over the course of their school years from age
3 to 22.
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THE RAND CORPORATION
Proven Benefits of Early
Intervention (2005)
Well-designed early childhood interventions have been found to generate
a return to society ranging from $1.80 to $17.07 for each dollar spent on the program. Early childhood intervention programs
have been shown to yield benefits in academic achievement, behavior, educational progression and attainment, delinquency and
crime, and labor market success, among other domains. Also, prior to this 2005 report, in 1999 The Rand Corporation reported
that the IQ’s of children who had Early Intervention were 10 points higher than a control group’s.
That report went on to conclude that the societal benefits of early intervention exceed the costs.
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CENTERS for DISEASE CONTROL (CDC)
Citing the National
Research Council. Educating Children with Autism. Washington, DC: National Academy Press, the CDC states, “Research
shows that early intervention treatment services can greatly improve a child’s development. “
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PEDIATRICS (a journal of the American Academy of Pediatrics)
Early
Intervention and Language Development in Children Who Are Deaf and Hard of Hearing
Significantly
better language scores were associated with early enrollment in intervention. High levels of family involvement correlated
with positive language outcomes, and, conversely, limited family involvement was associated with significant child language
delays at 5 years of age, especially when enrollment in intervention was late. The results suggest that success is achieved
when early identification is paired with early interventions that actively involve families.
PEDIATRICS Vol. 106 No. 3 September 1, 2000, pp. e43. Mary Pat Moeller, MS
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PEDIATRICS (a journal of the American Academy of Pediatrics)
Early
intervention for disabled infants and their families: A quantitative analysis.
In support
of home-, routines-based early intervention, it was found that parent involvement resulted in significantly greater effects
than interventions without parent involvement.
Pediatrics, 80, 650-658. Shonkoff,
J., & Hauser-Cram, P. (1987).
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AMERICAN PSYCHOLOGIST (a journal of the American Psychological Association)
The efficacy of psychological, educational, and behavioral treatment: Confirmation from meta-analysis.
The review shows a strong, dramatic pattern of positive overall effects of well-developed psychological,
educational, and behavioral treatment is generally efficacious.
American Psychologist,
Vol. 48(12), Dec 1993, 1181-1209. Lipsey, Mark W.; Wilson, David B.
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BRITISH JOURNAL of DEVELOPMENTAL DISABILITIES: Down Syndrome
Effect
of parental intervention on motor development of Down syndrome infants between birth and two years.
In
support of home-, routines-based early intervention, it was found that motor development increased when parents were highly
involved (and motor development decreased when parent involvement low).
British
Journal of Developmental Disabilities, 44(87), 94-101. Torres, C., & Buceta, J. (1998).
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AMERICAN JOURNAL on MENTAL RETARDATION
Randomized
Trial of Intensive Early Intervention for Children With Pervasive Developmental Disorder
Abstract:
Young children with pervasive developmental disorder were randomly assigned to intensive treatment
or parent training. The intensive treatment group (7 with autism, 8 with pervasive developmental disorder not otherwise specified—NOS)
averaged 24.52 hours per week of individual treatment for one year, gradually reducing hours over the next 1 to 2 years. The
parent training group (7 with autism, 6 with pervasive developmental disorder NOS) received 3 to 9 months of parent training.
The groups appeared similar at intake on all measures; however, at follow-up the intensive treatment group outperformed the
parent-training group on measures of intelligence, visual-spatial skills, language, and academics, though not adaptive functioning
or behavior problems. Children with pervasive developmental disorder NOS may have gained more than those with autism.
American Journal on Mental Retardation: July 2000, Vol. 105, No. 4, pp. 269-285.
Tristram Smith, Annette D. Groen, and Jacqueline W. Wynn (2000)
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ANALYSIS and INTERVENTION in DEVELOPMENTAL DISABILITIES
Age at intervention and treatment outcome for autistic children in a comprehensive intervention
program
This study compared the treatment outcomes of nine autistic children who began
receiving intensive behavioral intervention prior to 60 months of age with outcomes for nine other children who entered the
same intervention program after 60 months of age. Age at program entry was found to be strongly related to positive treatment
outcome (i.e., to children's continued residence with their natural parents and attendance at public school classes). This
investigation underlines the importance of early behavioral intervention for autistic children.
Analysis and Intervention in Developmental Disabilities, Volume 5, Issues 1-2, 1985, Pages 49-58. Edward C. Fenskea, Stanley Zalenskia, Patricia J. Krantza, Lynn E. McClannahan
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CURRENT OPINION in PSYCHIATRY
Early
Intervention
This review considered literature reviews, program descriptions, and empirical
studies in two broad areas of early intervention: for children with developmental disabilities, and for children considered
at-risk for developmental problems. It was concluded that comprehensive early intervention programs can be quite effective
for young children with developmental disabilities, as well as for children who are at risk due to biological or environmental
factors.
Current Opinion in Psychiatry. 2003; 16(5). Bruce L Baker, Kristin
Abbott Feinfield
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TOPICS in EARLY CHILDHOOD SPECIAL EDUCATION: Cerebral Palsy
Parental participation in intervention programs for children with cerebral palsy: A review of
research.
In support of home-, routines-based early intervention, it was found that across
studies there were significantly better child outcomes with parent involvement and strategy use for children with Cerebral
Palsy.
Topics in Early Childhood Special Education, 18, 108-117. Ketelaar, M.,
Vermeer, A., Helders, P., Hart, H. (1998).
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TOPICS in EARLY CHILDHOOD SPECIAL EDUCATION: Low Birth Weight
The relationship of parent-child interaction to the effectiveness of early intervention services
for at-risk children and children with disabilities.
In support of home-, routines-based
early intervention, it was found that maternal responsiveness was a significant predictor of child development. Intervention
effects were unlikely without quality parent interactions. The authors concluded that EI not only worked with parents but
also helped them learn more effective ways of interacting with their children, and broad-based general development was promoted.
Topics in Early Childhood Special Education, 18, 5-17. Mahoney, G., Boyce, G.,
Fewell, R., Spiker, D., Wheedon, C., (1998).
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TOPICS in EARLY CHILDHOOD SPECIAL EDUCATION: Family Systems
Influences of family-systems intervention practices on parent-child interaction and child development.
910 families were studied. In support of home-, routines-based early intervention, it
was found that capacity-building, help-giving, and family systems intervention practices were significantly and directly related
to effective parenting skills and parent well-being. Also, parent well-being was significantly related to positive parent-child
interaction and positive child developmental outcomes.
Topics in Early Childhood
Special Education, 30, 3- 19, Trivette, C., Dunst, C., & Hamby, D. (2010).
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Studies Demonstrating the Clinically Significant Benefits of Parent
Involvement in Early Intervention Service Implementation:
Hart, B., & Risley, T. (1999). The Social World of Children learning to Talk. Baltimore,
MD: Brookes Publishing.
Sample
42
families interacting in everyday situations with 1- to 2- year olds (typically developing)
Design
Longitudinal study; monthly, hour-long observations
Child/Family Outcomes
• More time parents talk to child, more rapid vocabulary growth and IQ at age 3
• Across family SES
• “Extra, optional talk” a
quality indicator
Shonkoff, J., & Hauser-Cram, P. (1987). Early intervention
for disabled infants and their families: A quantitative analysis. Pediatrics, 80, 650-658.
Sample
Children enrolled in EI before 36 months
Design
Meta-analysis of 31 selected EI studies
Intervention
Various
Child/Family Outcomes
Parent involvement showed significantly greater effects than interventions without
• Focus on parent strategy-use more effective than other ways parents participated.
Ketelaar, M., Vermeer, A., Helders,
P., Hart, H. (1998). Parental participation in intervention programs for children with cerebral palsy: A review of research.
Topics in Early Childhood Special Education, 18, 108-117.
Sample
Children with cerebral palsy and other motor disabilities
Design
Reviewed 10 studies that examined the impact of parental role in motor interventions
Intervention
Various studies
Child/Family Outcomes
Across studies: Significantly better child outcomes with parent involvement and strategy use
Mahoney, G., Boyce, G., Fewell, R.,
Spiker, D., Wheedon, C., (1998). The relationship of parent-child interaction to the effectiveness of early intervention services
for at-risk children and children with disabilities. Topics in Early Childhood Special Education, 18, 5-17.
Sample
• IHDP: 298 low- birthweight premature infants
• LSEI: 238 dyads in EI (child mean age = 31 months
• PALS: 21 teen mother-infant/toddler dyads
• FCOS: 47 mother-child dyads
Design
• Re-examined data of four independent intervention research studies:
•
IHDP: 3 IHDP sites, Randomized Control Trial
• LEI: Multisite investigation; 6 sites with interaction data
• PALS: pre-post with control group
•
FCOS: 12-month, field-based investigation
Intervention
•
IHDP: home, center, and parent group
•
LEI: various PALs: 3-month; 24 sessions, 30
minutes each
•
FCOS: 36 community-based programs
Child/Family Outcomes
• Maternal responsiveness significant predictor of child development (e.g., IHDP: Mother-child interaction
6 times more of variance in child development than intervention group assignment)
• Intervention effects unlikely without quality parent interactions
•
Authors conclude that, EI not only worked with
parents but also helped them learn more effective ways of interacting with their children, general development was promoted
Torres, C., & Buceta, J. (1998).
Effect of parental intervention on motor development of Down syndrome infants between birth and two years. British Journal
of Developmental Disabilities, 44(87), 94-101.
Sample
24 infants (0-2 years) with Down syndrome
Design
Portage 3x per week for one hour; parents
instructed how to use the program at home
Intervention
Compared infant motor development when parental involvement was high and when low
Child/Family Outcomes
· Motor development increased when parents highly involved.
·
Motor development decreased
when parent involvement low.
·
HOME variable part of
definition of “involvement”.
Trivette, C., Dunst, C., & Hamby, D. (2010). Influences of
family-systems intervention practices on parent-child interaction and child development. Topics in Early Childhood Special
Education, 30, 3- 19.
Sample
910 families (children ranged from 1 to 89 months; 85% with or at risk for delays
or disabilities)
Design
Meta-analysis SEM
Child/Family Outcomes
· Capacity-building help-giving and family systems intervention practices
were significantly and directly related to parenting parent well-being.
· Parent well-being was significantly related to parent-child interaction and child development
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