Clinically Effective?
Cost Effective?Here’s what the experts say:
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
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.
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
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
Autism/Pervasive Developmental Disorders Assessment and Intervention for Young Children (Age 0-3 Years) - Clinical Practice Guideline: Report of the Recommendations
NYS DEPARTMENT of HEALTH
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)
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.”
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.)
Centers for Disease Control (CDC): Educating Children with Autism
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. “
PEDIATRICS: Early Intervention for Disabled Infants and their Families: A Quantitative Analysis
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).
The Efficacy of Psychological, Educational, and Behavioral Treatment: Confirmation from Meta-Analysis.
AMERICAN PSYCHOLOGIST (a journal of the American Psychological Association)
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.
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)
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
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).
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
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.
https://publications.aap.org/pediatrics/article/118/1/405/69580/Identifying-Infants-and-Young-Children-With
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.
https://depts.washington.edu/chdd/guralnick/pdfs/Guralnick_The_Next_Decade-EC-1991.pdf
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.
https://publications.aap.org/pediatrics/article/120/5/1153/71109/Role-of-the-Medical-Home-in-Family-Centered-Early?autologincheck=redirected
Communication Disorders - Clinical Practice Guideline: Report of the Recommendations
NYS DEPARTMENT of HEALTH
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)
The World Bank has published a book entitled “Early Child Development: Investing in the Future”
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.”
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.
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.
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.
PEDIATRICS: Early Intervention and Language Development in Children Who Are Deaf and Hard of Hearing
PEDIATRICS (A Journal of the American Academy of Pediatrics)
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
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).
Age at Intervention and Treatment Outcome for Autistic Children in a Comprehensive Intervention Program
ANALYSIS and INTERVENTION in DEVELOPMENTAL DISABILITIES
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
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).
Studies Demonstrating the Clinically Significant Benefits of Parent
Involvement in Early Intervention Service Implementation
The Social World of Children Learning to Talk
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
Early Intervention for Disabled Infants and their Families: A Quantitative Analysis
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.
Parental Participation in Intervention Programs for Children with Cerebral Palsy: A Review of Research
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
The relationship of parent-child interaction to the effectiveness of early intervention services for at-risk children and children with disabilities
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
Effect of parental intervention on motor development of Down syndrome infants between birth and two years
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”.
Influences of family-systems intervention practices on parent-child interaction and child development
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,