The Implementation Challenges of EARLY and Intensive Therapy in the Brazilian Context

Background: Early intervention can be deeply beneficial for autism spectrum disorder (ASD). According to literature, good prognosis is related to early, specialized and intensive intervention. However, response to programs is variable. Besides that, it is important to understand the impacts of interventions models across and within cultures. We intend to present a case study discussing Brazilian social and cultural aspects, which has appeared during the implementation of an Intervention program based on the principles of Early Start Denver Model (ESDM). For this process, culture adaptation were needed in many aspects. For exemple: it was impossible for the team to offer therapy sessions at the family residence. The therapy took place at a school clinic, situated within a Pshycology Departament of an important Brazilian university (Universidade Federal de Minas Gerais); another point was that we didn’t have all the needed professionals within the interdisciplinary team, so the children had to do occupacional therapy and speech therapy by side.

Objectives: Evaluate Brazilian social and cultural aspects that interfered in implementation of an early Intervention program.The most important aspect, which we aim to discuss here, is the difficulty to implement the recommended intensity of the therapy proposed, and the consequences of failing to do so.

Methods: The child started the intervention at the age of 28 months old and continued the treatment for 9 months long. We provided access to 9 to 12 hours of therapy weekly plus parental coaching (one hour per week). We evaluated the daily progress data and ESDM checklists curricullum.

By evaluating the data collected, in a daily progress record, it was possible to identify variables that interfered in the better progress of the intervention. In the beginning of the treatment, the child attended 90% of the sessions . During this period, 94% of the objectives were reached (11 of 13 objectives). However, subsequently, with a slight reduction in the attendance rate, the objectives achievement dropped down to 34%. In the last quarter, with the lowest attendance throughout the intervention (only 58% in the sessions), the child acquired less than 1% of the objectives (1 out of 19 objetives).

Results: Therefore, there is a direct relationship between the number of objectives reached and the intensity of the intervention . The low attendance was due to an increase of family vulnerability, as they are socialeconomically underprivilleged. In Brazilian’s public health system, there is an omission on therapeutic support benefits. Besides that, due to the child’s parent divorce, plus an ASD diagnosis of their second child, parental stress got higher. Macrossocial aspects (high vulnerability) that can affect the micro-social context of the family (divorce).We suggest the relevance of intervention intensity, which can only be achieved through public policies that could guarantee the necessary support to families.

Conclusions: More extensive studies on the importance of the support network for families are needed, especially considering the role of the state in this scenario. New studies, with better analyses of macro-microssocial variables and considering parental needs, will be needed to figure out the issue.