Toddlers with autism may benefit from early treatment

Intensive early treatment and education can improve the abilities of toddlers with autism to communicate and raise their IQ, new research suggests. The study is the first of its kind to look properly at treatment for children this young.

What do we know already?
Autism affects the way a child develops, communicates, and learns about the world. It tends to be picked up when a child is around 18 months of age, if the child doesn't meet the usual developmental milestones of smiling, following when people point, and speaking a few words. But some people say they knew there was something different about their baby right from birth.

Some research has suggested that early teaching and treatment, from both parents and therapists, started before a child begins school, can be helpful. But little research has been done into ways of helping very young children.

This new study looked at what happened to a group of 48 children aged 18 months to two and a half years, who'd been diagnosed with autism or pervasive developmental disorder (a condition similar to autism, but where the child doesn't meet all the autism criteria). Half were given intensive treatment using a programme called the Early Start Denver Model (ESDM), while half were referred for the usual care available locally. The children were tested after one and two years of treatment.

What does the new study say?
Children who'd had the intensive treatment programme had improved IQ scores, were able to communicate better, and got on better in everyday life.

The children's IQ scores went up fastest in the first year of treatment, then stabilised. Their scores on questionnaires measuring 'adaptive behaviour' (how they communicate and manage in everyday life) stayed stable for their age-group during the study. This means they were keeping up with the changes in behaviour expected as children get older.

The adaptive behaviour scores of children who'd not had intensive treatment got worse. They had a small improvement in IQ, but much less than the children with intensive treatment.

Seven of the 24 children who'd had intensive treatment improved to the point that they were no longer categorised as having autism by the end of the study (although they still had pervasive developmental disorder). Only one of the children not given intensive treatment was recategorised in this way.

How reliable are the findings?
This was a well-designed study (a randomised controlled trial) which is the best type of study for finding out whether a treatment works. The children were tested by independent assessors, using questionnaires and tests that have been shown before to be reliable.

The only potential problem is that the tests of 'adaptive behaviour' involved questioning the parents about how the children were doing. The parents who had been involved in the intensive treatments might have answered more positively, because they'd put so much effort into the treatment themselves, that they were very alert for any signs of improvement. This might make the treatment seem better than it is.

Where does the study come from?
The study was carried out by doctors and researchers from several universities in the US. It was published in the medical journal Pediatrics. It was funded by a grant from the US government's National Institute of Mental Health.

What does this mean for me?
If your child has been diagnosed with autism, you'll be interested in any treatment that can make a difference to how they grow up and develop. This particular treatment (ESDM) may not be available where you live. But it used techniques from a system called 'applied behavioural analysis' (also called Lovaas therapy, after the doctor who developed it) which is sometimes used in the UK.

These types of treatment ask a great deal of the family. For two years, the children had two hours of treatment, twice a day, five days a week, by a therapist coming to the home. And parents spent on average 16 hours a week using these techniques with their children themselves. That's a lot of time to devote to treatment. It's also unlikely that this intensity of treatment will be available freely on the NHS. And it would be very expensive to pay for it privately.

BMJ Group, Wednesday 2 December 2009 00.00 GMT Article history