Effects of Early Treatment in Autism After the First Diagnosis: An Observational Italian Study

Background:  In the last two years the results of two wide studies published on prestigious journals as Pediatrics (Dawson et al., 2009) and Lancet (Green et al., 2010) confirm, in different ways, the importance of early interventions for early treatment in autism. We investigated the effect of not manualized AS USUAL intervention in a multicentric study in Italy.

Objectives:  The main aim was to conduct an observational research to evaluate the role of early interventions for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD). Secondary aims were (a) to compare behavioral-oriented intervention vs. developmental-oriented intervention; (b) to compare children attending to school vs. children who do not attend to school; (c) to compare children whose parents are involved in treatment vs. children whose parents are not involved.

Methods:  Seventy children diagnosed with ASD between 18 and 59 months of age (mean age: 34,7 months) were recruited. They were evaluated by blind researchers at baseline and after six months of intervention using ADOS-G; Griffiths Mental Developmental scales; and Vineland Adaptive Behavior scales (VABS). Parents filled out MacArthur inventory; Social Communication Questionnaire; CBCL and Parent Stress Index. All children were referred to community providers for intervention commonly available in the community.

Results:  At endpoint, most children were still classified as having an ADOS-G diagnosis of autism spectrum disorder. However, 20 (35%) of 57 children with AD had changed from core autism to autism spectrum disorder and 4 (5,7%) out of 13 PDDNOS had changed from autism spectrum disorder to non-spectrum. Treatment effects were obtained for cognitive functioning (General Quotient was higher by 15.7 points than baseline on Griffiths); language; adaptive behaviour; child behaviour and parental stress. There were no clinical differences between developmental-oriented and behavioral-oriented intervention except for the larger amount of treatment hours in behavioral interventions. Attending school and parents involvement in child’s treatments were predictive of a best clinical outcome.

Conclusions:  This is the first Italian multisite study that confirm autism as a treatable disorder. We’ll discuss our results considering their similarity and differences compared to findings in Dawson’ (2009) and Green’ (2010) results.