Developmental, Adaptive and Parental Characteristics of High- and Low-Responders to a Preschool-Based Esdm Intervention

Background:

In the effort to move towards evidence-based treatment individualization for children with ASD, current research attempts to characterize developmental, functional and familial profiles of children with different levels of response to treatment. The Early Start Denver Model is a relationship- and play-based behavioral intervention shown to be effective in home and group settings (Dawson et al. 2010, Vivanti et al. 2014). Previous research exploring outcome predictors in children receiving the ESDM in a group setting has pinpointed chronological age, autism severity, functional use of objects, and imitation abilities as predictive variables of intervention gains.

Objectives:

To identify the profiles of high- and low-responders to treatment in a group of preschool children receiving the ESDM in community specialized-preschool settings in Israel.

Methods:

Thirty-three children (7 girls), aged 34-57 months from four ASD-preschools participated in the current intervention. The ADOS-2 was administered to validate ASD diagnosis. Children received 40 hours per-week of educational and therapeutic preschool-based intervention. The implementation of the ESDM included the use of the model’s curriculum and treatment practices, and therapists’ adherence to the ESDM fidelity rating system. Educational staff incorporated ESDM principles and objectives into the daily preschool routine. Additionally, parents attended weekly parent-child therapy sessions.

To evaluate intervention gains, children were assessed with the Mullen Scales of Early Learning (MSEL) and parent and teacher reports on the Vineland Adaptive Behavior Scales-II (VABS-II), collected pre- and post an 8-month intervention period. Additionally, parents filled out the Parenting Scales of Competence (PSOC) at both timepoints. Total MSEL age-equivalent score differences were compared to overall treatment-length (in months). High treatment-response was defined as a gain equal to or higher from treatment-length, while smaller gains defined a low-response.

Results:

High treatment-responders showed higher age-equivalent scores pre-intervention on the MSEL visual reception, fine-motor, and receptive and expressive language scales. Furthermore, they had higher communication and daily-skills scores pre-intervention, as reported by teachers and parents, higher parent-reported socialization skills, and higher teacher-reported motor skills. The high-responding group also showed lower levels of autism symptom severity, pre-intervention. The groups were not significantly different on age at entry to the program. While not statistically significant, all girls in the sample pertain to the high-responders group. Parents of high responders have reported higher levels of parental satisfaction pre-intervention.

Conclusions:

Higher levels of developmental and adaptive skills, together with lower ASD symptom severity are related to a more significant response to the preschool-based ESDM. Children may need to have a certain baseline of developmental and adaptive skills to benefit from this program. Children with low developmental and adaptive scores may need to receive individual, intensive treatment before they could benefit from preschool-based ESDM.

The current analysis also indicated that high parental satisfaction might be a facilitating factor in response to the ESDM. In the current program, parents participated in weekly joint ESDM-sessions with their children. High parental satisfaction might be associated with higher motivation to take part in the therapy process and to apply learnt principles in other contexts.