Social Communication Skills As a Possible Driver of General Developmental of Pre-Schoolers with ASD Who Received Esdm in a Community Setting in Austria

Background: The Early Start Denver Modell (ESDM) seeks to focus on core-symptoms of ASD by social communication intervention to improve social engagement in young children with ASD. The main goal is to increase the social attitude and interest so that the child can use natural social environments for further development. Importance of parent reported outcomes is rising in the literature. The Pervasive Developmental Disorder Behaviour Inventory (PDDBI) is a widely used questionnaire to measure ASD related symptoms in children with ASD. Social communication skills are well described as crucial skills to be taught in early intervention programs.

Objectives: Investigation of the impact of social communication core skills on developmental trajectories and parental related stress. ESDM was delivered in an Austrian community setting with weekly three appointments for 1.5 hrs in the centre, at home and in the kindergarten over a period of one year.

Methods: Subjects were children (n = 43, ages 28 to 54 months, mean age 42.4 months) consecutively diagnosed with ASD in a regional autism centre in Austria. Developmental status was assessed with standardized instruments (Mullen Scales-MSEL, PDDBI, Vineland Adaptive Behaviour Scales-VABS 2 and Parental Stress Inventory-PSI) at baseline and after intervention.

Results: The Intervention-Group showed improved language skills (t-tests) in the MSEL (Expressive Language: T(41)=-2.02, p=.05, ES=.34; and Receptive Language: T(39)=-3.24, p=.002, ES=.59) and highly significant general MSEL-Total-Score improvement (T(37)=-2.92, p=.006, ES=.62). Furthermore, highly significant reduction in parent-reported core autism symptoms (PDDBI-Autism Composite Score: T(42)=5.31, p<.001, ES=-.98) and gains in Social Communication skills (PDDBI-Social Approach (SOCAPP): T(42)=-3.82, p<.001, ES=.65) could be found. The SOCAPP gains significantly correlated with all MSEL-domain-gains (r's from .32 to .45; p's from .005-.046), VABS-Daily Living skills gain (r=.36; p=.017) and PSI-Children-scale gain (r=-.40; p=.016). Regression analyses were used to test if the SOCAPP-skills before intervention significantly predicted children’s developmental gains. Two of the four MSEL-developmental gains (Visual Reception: β=.30, p=.049 and Expressive Language: β=.37, p=.015) were predicted by the SOCAPP-scale. No such prediction was found for PSI-Children-scale- or VABS-Daily Living skills-gains. Dividing the group in two samples with median split into a low-SOCAPP- and high-SOCAPP-gain-group and analysing for trajectory-differences led to one significant interaction effect of MSEL-Receptive Language (F(1,38)=4.85, p=.034).The high-SOCAPP-gain-group showed significant more Receptive Language improvements. No such group-effect was found for any other MSEL-scale-gain.

Conclusions: ESDM reduces reported ASD-symptoms and also showed strong effects on family reported social communication skills. Social Communication skills highly correlated with developmental domains and with parental stress level. Furthermore, Social Communication skills might be predictive for child’s development. The SOCAPP scale of the PDDBI seems to be a highly relevant set of questions which reflect crucial information of children’s development. Developmental gains seem promising, although further research with a control group design is needed. Further studies are needed to assess the predictive value of the SOCAPP scale and to evaluate the possibility of using a set of questions in screening procedures.