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Short-Term Outcomes for Pre-Schoolers with ASD Receiving Group-Based and One-on-One Early Start Denver Model (EDSM) Intervention
The Early Start Denver Model (ESDM) is an intensive intervention for young children with Autism Spectrum Disorder (ASD). The individually delivered approach (i.e., one-on-one) has evidence of efficacy – from a published randomised controlled trial (Dawson et al., 2010) – for accelerating children’s cognitive development and building adaptive behaviours. A group-delivery approach has also been developed for implementation within educational settings (G-ESDM; Vivanti et al., 2017), which has some published evidence of effectiveness via evaluation of pre-and post-treatment outcomes in a non-randomised design (Vivanti et al., 2014). Child gains from one or other format have not been directly compared, nor have G-ESDM gains been evaluated in the short-term (i.e., following 5-months).
Objectives:
In the context of an ongoing study comparing child outcomes following various approaches to ESDM delivery, we are comparing the short- and medium-term gains made by children within around 6- and 12-months of participation in either group- or individually-delivered ESDM.
Methods:
We are assessing developmental gains made by children receiving one of two ESDM programs – both provided by the same team – in either an autism-specific group setting, or delivered one-on-one in children’s homes/local childcare. Developmental abilities are assessed using the Mullen Scales of Early Learning (MSEL) and adaptive behaviours using the Vineland Adaptive Behaviour Scales (parent interview; VABS) administered pre-treatment and again after around 6- and 12-months.
Results:
To date, 21 pre-schoolers (M=34 months, SD=5.4; 18 boys, 5 girls) are enrolled in the study (G-ESDM N=14; individual ESDM N=7). All have completed a 5-month mid-point assessment and two have completed 10-month end-point. By the time of INSAR, we will have 10-month end-point data for all. On average, children receiving G-ESDM and individual ESDM appear to have made similar age-equivalence gains within the first 6-months of their program for MSEL Visual Reception (respectively; M=3.9m gains, SD=6.5; M=3.6m, SD=5.3). By contrast, average gains for the individual ESDM group seem more substantial than those for the G-ESDM group for MSEL Fine Motor skills (respectively, M=7.8, SD=11.4; M=2.8, SD=4.9) and Receptive Language (M=13, SD=10.8; M=3.1, SD=10.1) and slightly so for Expressive Language (M=4.6, SD=4.7; M=2.9, SD=6.9). However, MSEL age equivalent gains were highly variable within each group (Figure 1). Children receiving G-ESDM group made substantial age-equivalence gains for VABS Personal skills (Figure 2a) such as feeding and dressing themselves (M=6.6m gains, SD=5.1) as well as VABS Domestic skills (Figure 2b) including cleaning up and safety awareness (M=8.4, SD=12.0). Children in the individual ESDM group made similar gains for VABS Personal skills (M=9, SD= 7.6) and Domestic skills (M=7.3, SD=8.0).
Conclusions:
Children receiving both types of intervention – G-ESDM in specialised playrooms or individual ESDM in the home/community – made gains in verbal and non-verbal development and adaptive behaviour within the initial 6-months of intervention. While preliminary results seem to slightly favour individual ESDM delivery, outcomes were highly variable within each group. Additional, and longer-term developmental and behavioural outcome data (i.e., at 10-month program exit) will be available by INSAR 2019.