Non-Intensive ABA Is Not Superior to Other Intervention Methods in Young Children with Autism Spectrum Disorder

Background:  

Since age at the start of the treatment is an important predictor of the effect of an intervention in children with autism spectrum disorder (ASD) (McConaghie & Diggle, 2007), it is essential to start the most beneficial treatment as soon as possible. However, the lack of studies that directly compare different intervention methods, makes clear recommendations in favour of a specific method quite difficult. Applied Behaviour Analysis (ABA) is widely recognized as a well-established treatment for ASD. Many controlled studies show gains in language, cognitive and adaptive functioning (see Reichow, 2012; Vismara & Rogers, 2010). It should be noted however that most studies in favour of ABA evaluated very intensive programs, usually of 20 to 40 hours a week. Implementing such programs on a large scale in clinical practice is difficult because of a lack of financial resources and trained staff. Studies with less intensive forms of ABA seem to be less effective (Eldevik, Eikeseth, Jahr, & Smith, 2006). Furthermore most studies have looked primarily at the effects of ABA on cognitive and adaptive abilities. Next to comprehensive interventions like ABA, there is growing attention for specific training programs in social-communicative abilities. These abilities are proposed as important treatment goals because they are considered to be pivotal areas of development. Several researchers have shown that imitation and joint attention abilities of children with ASD can improve with a specific non-intensive training (Ingersoll, 2010; Kasari, Freeman, & Paparella, 2006; Warreyn & Roeyers, 2013).

Objectives:  

The main goal of the present study was to compare the effect of different methods of intervention, used in community settings, on social-communicative abilities in young children with ASD. More specifically an intervention based on ABA was compared with a more specific intervention program targeting imitation and joint attention (I/JA) and with treatment as usual (TAU).

Methods:  

85 young children with ASD between 22 and 75 months were divided in three groups according to intervention method: ABA, I/JA and TAU. Intensity of treatment was similar in the three groups and none of the children had more than 6 hours of 1 to 1 treatment a week. Pre- and post (after 6 months) assessments included autism symptom severity, imitation, joint attention, symbolic play and language.

Results:  

A repeated measures MANOVA revealed that children in the three groups significantly improved for autism severity, imitation, symbolic play, initiating joint attention and receptive and expressive language. There was no interaction with the type of intervention. Follow-up analyses showed large inter-individual differences in the three groups. Both child and general intervention characteristics were associated with outcome.

Conclusions:  

Our results demonstrate that on average there is no difference between the three intervention methods in the amount of progress children make with respect to their social-communicative abilities after a 6-month-period. While a substantial proportion of children made good progress, there was a subgroup that made hardly any progress. This study shows that it is important to focus on “what works for whom” instead of trying to find a one-size-fits-all-treatment for children with ASD.