The Efficacy of “Play-Based Communication and Behavior Intervention” Very Early Intervention Model on Toddlers with Autism Spectrum Disorder

Background: Children with autism spectrum disorder(ASD) who participated in the “Play-based Communication and Behavior Intervention(PCBI)” were studied explore the efficacy of the PCBI very early intervention model.

Objectives: To investigate the short-term efficacy and the caregiver factors of the PCBI model on toddlers with autism spectrum disorder.

Methods: Seventy-four ASD toddlers aged from 19 to 30 months were recruit in this study. Toddlers who participate in this study were randomly assigned to PCBI group and ABA group, then intervened weekly by PCBI or ABA in total 12 weeks. The Autism Treatment Evaluation Checklist, Gesell Developmental Schedules and Portage Early Development Checklist were used to evaluate the efficacy of the PCBI. Parenting Stress Index Short Form, General Self-Efficacy Scale, and the self-developed Caregiver Training Course Evaluation Scale and the Homework Completion Level Scale were used to assess the level of parental stress, self-efficacy, curriculum satisfaction and acceptance. The t-test was used to reveal whether there was significant difference between two groups before and after interventions. A pair of sample t-test was used to analyze the ASD symptoms, developmental level and caregiver factors of ASD children before and after intervention. Multivariate regression analysis was used to analyze the caregiver factors and the effects of PCBI.

Results:

• Compared to the ABA group, there was a significant increase in cognitive scores (D_PCBI=9.03，D_ABA=4.27，t=3.997) and a significant decrease in social behavior scores （D_ABA=16.91，D_PCBI=8.87，t=-4.022）of the Portage Early Development Checklist after 12 weeks of intervention in the PCBI group (P<0.001); While the total score and the scores of language, movement, and self-care subscale of Portage Early Development Checklist were also increased after PCBI intervention but not significant (P>0.05).
• Compared to the ABA group, after 12 weeks of PCBI intervention, the scores of social, perception, behavior of ATEC was decreased, but difference was not significant (P>0.05); while the total score of ATEC scale（D_{ABA total}=22.22，D_{PCBI total}=14.89，t=2.209）and the scores of language subscale（D_{ABA language}=6.43，D_{PCBI language}=2.89，t=2.515）was decreased significantly (P<0.05).
• After the end of PCBI, there was a significant decrease in the scores of Parenting Stress Index Short Form (P < 0.05). There was a significant positive correlation between the effect of PCBI and acceptance of the intervention model, and mastery of the skills in the caregiver factors (P < 0.05).

Conclusions: After 12 weeks PCBI very early intervention, the ASD toddlers all improved in clinical symptoms and developmental level. Compared with ABA intervention, the treatment efficacy of parenting-direct PCBI was comparable and used less medical rehabilitation resources. PCBI could reduce the parenting pressure of the caregiver; and the better the mastery of skills and the completion of homework the better the efficacy of intervention.