During the course of my work on the Literature Review Paper, I came across some very important information pertaining to my current students. The paper focused on the reality of early diagnosis and intervention of Autism spectrum disorder. I discovered that ASD can be successfully diagnosed in children as young as 15 months old and that by the preschool years it is possible for effective intervention to be in place. I have more than one student in my current preschool class that has some indications of a disorder resembling ASD. I am not a trained clinician and therefore and unable to diagnose a child in my care, however, I feel confident in referring a family to a qualified physician or clinician for diagnosis. After reading the material regarding the importance of early diagnosis and intervention, it is clear to me that it is better to have a child tested and it be nothing than to wait. In several instances that I read about, children were diagnosed early and symptoms changed as they grew older. There have been indications in several studies that there is a possibility of symptoms morphing from those of ASD to something else as they grow into the preschool years. It is important to have children in the care of these qualified individuals to monitor such things.
Overall, I really enjoyed the research I read through during this project and am grateful for the knowledge I’ve gained in the process of writing this paper.
Early Intervention for Young Children with Autism Spectrum Disorder
The identification of disorders that fall in the category of Autism Spectrum Disorder has been on rise in the United States over the last few decades. Autism Spectrum Disorder (ASD) is defined as a neurodevelopmental disorder characterized by a deficiency in ability to interact and communicate with others as well as the presence of restrictive and repetitive behaviors and interests. These disorders include autistic disorder, Rett syndrome, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome (Ozonoff, Goodlin-Jones & Solomon, 2005). However, as of May 2013, these disorders are now all diagnosed under the umbrella heading of ASD. According to the Centers for Disease Control, it is currently estimated that 1 in every 88 children has ASD. This is a large spike in cases, as in the early 1990’s it was estimated that only 4 to 8 in every 10,000 children had ASD. Another important point to note is that ASD statistically affects boys four to five times more often than girls (2005). The cause of ASD is not known at this point in time, however it is believed that genetics as well as environmental factors might play a role in the widespread disorders (Corsello, C.M., 2005).
Symptoms of ASD, such as lack of developed social and communication skills, typically peak around ages 3-5 years-old (Corsello, Akshoomoff & Stahmer, 2013). Therefore, diagnosis and interventions have centered in that age range. There is evidence suggesting that early diagnosis of children with ASD is possible and the benefits are proving to be significant. Currently, the American Academy of Pediatrics recommends that children are screened for ASD beginning at 18 and 24 months of age. One study conducted by researchers at the Autism Institute at Florida State University tested toddlers for ASD beginning at age 15 months. They concluded that those toddlers who were positively diagnosed with ASD, when reevaluated 1-2 years later, maintained the diagnosis, indicating that they were accurately diagnosed as toddlers. Several of the 82 children who participated in the study were not given an official diagnosis until age 24 months when symptoms became more prominent, demonstrating that while every child should be screened at an early age, not all children show sufficient signs of ASD for proper conclusion so young, and follow up is necessary (Corsello, et.al. 2013).
There are many different forms of intervention for young children with ASD. The average intervention takes place in an early childhood classroom for 15-25 hours per week and target preschool age children (Corsello, 2005). The Walden Toddler Program is one such intervention program that focuses on children with ASD who have not yet reached preschool age. The Walden Toddler Program, an inclusive program for young children with autism, serves children ages 15-36 months. Children’s learning is guided by the developmentally appropriate planned activities and environment that emerge from the children’s interests. Teachers use peer interactions between typically developing children and those with ASD to help children with ASD develop appropriate communication and social skills. This program has a high success rate with 82% of children leaving the program using meaningful language. Also, as a gauge of socialization, the amount of time spent in close proximity to other children is measured and in the Walden Toddler Program, 71% of children exiting the program showed an increase in this behavior (Downs, 2006).
Another successful intervention program for children with ASD is the LEAP model or the Learning Experience and Alternate Program for preschoolers and their parents. The LEAP model leans heavily on peer interactions for intervention. With this model, children with ASD are in an inclusive classroom with a higher ratio of typically developing peers. The typically developing children are trained to facilitate appropriate social and communicative behaviors in the children with ASD. No major studies have been conducted to compare the success rates of the LEAP model with those of proven successful intervention programs. However, in small one-on-one case studies, the LEAP model has shown to be useful in developing social and communicative skills for both children with ASD and their typically developing peers. In a controlled trial conducted in 2011, after two years in a LEAP program, children with ASD were found to have made significantly more progress towards cognitive, language, and social development when compared to children with ASD in a control group (Downs, 2006).
A big obstacle in effective educational services for children with ASD is repetitive and problem behaviors. Concerning these problems in the classroom, many educators implement the Prevent-Teach-Reinforce (PTR) model in their classrooms. The goal of the PTR model is to identify and decrease problem behaviors while increasing desired behaviors. This is achieved by the five step process of teaming, goal setting, PTR assessment (functional assessment), intervention, and evaluation. A team consisting of parents, teachers, and an expert consultant discuss the behavior that is exhibited, determine desired behaviors, and set about creating an intervention plan based on observations of the child. Once a plan is set, intervention begins. The team continues to assess the effectiveness of the intervention until the goals are reached. This model has very high success rates for children with ASD. Because problem behaviors of children with ASD are not only seen in the classroom, but can be a source of stress for families, one study took the PTR model out of the classroom and into the home to test the effectiveness in a home setting. The model was adjusted to include parents in the intervention plan. Parents were coached on exactly how to intervene in children’s problem behaviors and encourage desired behaviors. They were also evaluated on how well they followed professional instructions regarding intervention. The study concluded that when parents are properly trained and intervention techniques were properly implemented, the PTR model was successful at decreasing problem behavior and increasing desired behaviors in the home (Sears, Blair, Iovannone, & Crosland, 2012).
Whether early educators and parents decide to employ the Walden Toddler Program, the LEAP model, the PTR model or any other form of intervention for children with ASD, all research points to early intervention being vital. Data from six major studies that were conducted concerning success rates of early intervention for children with ASD was collected to create an overall analysis of early intervention. All six studies, each one different from the next, reported three results; children showed significant IQ gains, significant language gains, and increased social behavior with decreased autistic behavior. These six studies also reported that when children received interventions earlier, they made larger gains than those who did not receive intervention until the preschool years (Downs,2006).
A number of important challenges still face researches concerned with autism spectrum disorders. Although, all research currently being conducted on the topic of early diagnosis for toddlers with ASD indicates that it is possible for children as young as 15 months to be diagnosed with the disorder, there is much more that needs to be studied. The stability of early diagnoses and the utility of diagnostic tools for toddlers still need to be addressed. Little is known about the connection between the three standardized diagnostic measures used to diagnose ASD in young children. During some studies conducted by Florida State University there were questions of patterns of symptom change in the first few years of life. The possibility of changing symptoms in toddlers is a question that has as of yet remained unaddressed by researchers. There is also a lack of research on what intervention programs are most successful. Each intervention plan has been used in independent studies with varying success rates, but little has been done in the form of controlled, competitive studies to determine the plan with the highest success rate (Guthrie, Swineford, Nottke & Wetherby, 2012).
Given the high rate of ASD among young children in the United States, it is vital for early childhood educators to be informed on the subject. The younger that children can be properly diagnosed with ASD, the sooner intervention can begin. Current research suggests that diagnosis can be obtained as early as 15 months of age and every measure is being made to create effective intervention programs for children of that age. There is no cure for ASD and symptoms are life-long. However, through the work of trained clinicians and educated professionals, receiving intervention as toddlers and preschoolers is widely accessible. Utilizing these interventions has made children with ASD more likely to develop appropriate social and communicative skills as they grow.
Corsello, C. M. (2005). Early intervention in autism. Infants and Young Children, 18(2), 74-85.
Corsello, C. M., Akshoomoff, N., & Stahmer, A. C. (2013). Diagnosis of autism spectrum disorders in 2-year-olds: A study of community practice. The Journal of Child Psychology and Psychiatry, 54(2), (pp. 178-185).
Downs, R. C. (2006). Practices in early intervention for children with autism: A comparison with the national research council recommended practices.
Guthrie, W., Swineford, L. B., Nottke, C., & Wetherby, A. M. (2012). Early diagnosis of autism spectrum disorder: Stability and change in clinical diagnosis and symptom presentation. The Journal of Child Psychology and Psychiatry, 54(5), (pp.582-590). doi: 10.1111/jcpp.12008
Ozonoff, S., Goodlin-Jones, B. L., & Solomon, M. (2005). Evidence-based assessment of autism spectrum disorders in childhood and adolescents. Journal of Clinical Child and Adolescent Psychology, 34(3), (pp. 523-540).
Sears, K. M., Blair, K. C., Iovannone, R., & Crosland, K. (2012). Using the prevent-teach-