The 2001 recommendations of the National Research Council (NRC), based largely on research with children over age 3, may need revision if applied to toddlers. Part C of the Individuals with Disabilities Education Improvement Act, the Division for Early Childhood (DEC) of the Council for Exceptional Children, and the National Association for Education of Young Children (NAEYC) provide guidance for toddler intervention. Currently, intensive and structured intervention approaches are widely represented in autism research with older children and the prevalence and appropriateness of these methods for toddlers is worthy of examination. Other considerations for toddler interventions are the focus of intervention efforts, the environments in which intervention occurs, and the role of parents in intervention delivery.
Objectives:
This study explored the extent to which emerging early intervention autism research “pushed down” approaches commonly used with older children, if and how recommended practices for early intervention influenced intervention research approaches, and how specific developmental needs of toddlers with ASD were addressed in researched intervention. This study did not aim to describe the effectiveness of reported interventions.
Methods:
A survey of online databases for intervention research conducted with toddler-aged participants with autism risk or diagnosis yielded 23 reports of intervention. Inclusion was limited to studies with a majority of participants aged 36 months or less, intervention descriptions, and participant risk or diagnosis of ASD. Two authors independently coded for the presence or absence of indicators of recommended practice for toddler-aged children.
Results:
Ten of the studies referenced one or more sets of recommended practices including Part C or DEC (4), NAEYC (6), and/or the NRC report (7). A large majority of studies used structured behavioral intervention approaches (19), applied the intervention in settings that were neither the child’s natural environment nor fully inclusive (15), and used professional, clinical, or paraprofessional personnel as the primary agent of child-focused intervention (15). Of the 22 studies that reported intensity in hours per week, eight provided over 15 hours weekly of professionally delivered intervention. These results suggest that research methods were heavily influenced by earlier research conducted with older children with ASD. Recommended practices for toddlers such as those promoted by DEC or NAEYC were under-represented in these studies. The preverbal pivotal competency of joint attention, a critical foundation for social communication that presents special difficulty for toddlers with autism, was explicitly reported in only half of the intervention studies.
Conclusions:
These results call for discussion on the need for early intervention autism research to model recommended practices for early intervention for the field. Additionally, the field should consider whether autism is a special case; that is, whether intensive, highly structured, and clinically-oriented intervention practices are appropriate for widespread application before less intensive, developmentally appropriate, and family-centered intervention methods have been systematically researched. Finally, comprehensive interventions for toddlers with autism targeted for replication in the field should consider developmental foundations that are critical for development of verbal and social communication (e.g., joint attention).