TABLE 3.
Consensus Statements on Early Intervention and Outcomes of ASD
| No. | Statement | Key Messages |
|---|---|---|
| 1. | Current best practice interventions for children aged <3 y with suspected or confirmed ASD should include a combination of developmental and behavioral approaches and begin as early as possible | • Evidence supporting this statement is summarized in Table 1 of the article by Zwaigenbaum et al 18 on early intervention |
| • Behavioral interventions (ie, based on applied behavioral analysis) use evidence-based principles to systematically change behavior | ||
| • Developmental models of intervention use developmental theory to design approaches to target ASD-related deficits | ||
| • In practice, many empirically supported interventions for children aged <3 y blend features of both approaches | ||
| 2. | Current best practice interventions for children aged <3 y with suspected or confirmed ASD should have active involvement of families and/or caregivers | • Active family involvement is consistent with best practices of interventions for children aged <3 y |
| • Parents and caregivers can capitalize on teachable moments as they occur, provide learning opportunities during daily routines, and facilitate the generalization of learned skills across environments | ||
| 3. | Interventions should enhance developmental progress and improve functioning related to both the core and associated features of ASD, including social communication, emotional/behavioral regulation, and adaptive behaviors | • Targeted early interventions have been associated with improvements in early functional domains relevant to ASD, specifically in joint attention and other aspects of social communication, imitation, and functional and symbolic play |
| • Comprehensive interventions for young children with ASD have also led to improvements in adaptive functioning | ||
| 4. | Intervention services should consider sociocultural beliefs of the family and family dynamics and supports, as well as economic capability, in terms of both the delivery and assessment of factors that moderate outcomes | • Respect for the perceptions, priorities, and preferences of family members is an important “family-centered” tenet to keep in mind when working with children with ASD |
| • Service provider training should promote cultural competence, and families should be provided with culturally appropriate program materials | ||
| • Cultural as well as socioeconomic factors may present barriers to accessing services | ||
| 5. | Intervention research should include socially and culturally diverse populations and evaluate familial factors that may affect participation, acceptability, and outcomes of therapeutic approaches as well as willingness to participate | • Recruitment to intervention research should emphasize social and cultural diversity, to maximize generalizability and applicability of the interventions being studied |
| 6. | Future research should prioritize well-defined sampling strategies, rigorous investigative design, fidelity of implementation, and meaningful outcome measurements | • Future directions include: identifying characteristics of children and families who would benefit most from particular interventions and systematically varying components of multifaceted intervention programs to identify critical ingredients |
| • Randomized controlled trials are generally the optimal design, although other designs can be informative, especially at the feasibility stage | ||
| • Intervention studies should include measures that are responsive to change and index relevant areas of functioning | ||
| 7. | Research is needed to sort the specific active components of effective interventions | • These might include (but are not limited to): the type of treatment provided; agent implementing the intervention(s) (parent, therapist, teacher, or combination); consistency of service provision across environments and between providers; and duration of treatment and hours per week |
| 8. | Adopting a common set of research-validated core measures of ASD symptoms that can be used across multiple sites will facilitate comparisons across studies of children with ASD aged <3 y | • Outcome measures do not need to be identical across studies, but agreement on a subset of standardized instruments to use, which may assess changes in cognitive function, core autism symptoms, and adaptive and language behavior, would facilitate future comparisons |
| 9. | Future research should examine biological and behavioral heterogeneity as moderators of individual responses to interventions | • Subtypes of individuals with ASD need to be identified to understand the cause of their disorder, the associated neurobiologic mechanisms at work, and to be able to offer more directed interventions depending on the biological (and/or behavioral) subtype when known |
| 10. | Intervention providers should monitor for medical disorders that may affect a child’s response to an intervention and refer to appropriate health care providers as indicated | • Medical factors such as seizures, sleep disruption, and gastrointestinal symptoms may affect daytime functioning and should thus be considered as possible moderators of treatment response |