Impact Feature Issue on Supporting Success in School and Beyond for Students with Autism Spectrum Disorders
Early Intervention for Children with ASD
All children with Autism Spectrum Disorders (ASD) benefit from early intervention. And even though ASD is a lifelong disability, some children make remarkable progress as a result of early intervention. Our purpose in this article is to review some recent history about early intervention services for children with ASD and describe what is accepted as evidence-based best practices.
Some Recent History
The landscape of intervention for children with ASD changed drastically in the late 1980s. In 1987, Ivar Lovaas reported the results of a research study that compared intensive home-based intervention of 40 or more hours a week to a less intense intervention of approximately 10 hours a week. He reported that 9 of the 19 participants in the intensive intervention group made such significant gains that they entered first grade without special education services and were indistinguishable from their typically-developing peers. None of the children in the less intense intervention groups made such significant gains.
The intervention and findings reported by Lovaas (1987) were popularized largely by a book by Catherine Maurice published in 1994. In Let Me Hear Your Voice: A Family’s Triumph Over Autism,she describes the experience of her own children and how they “recovered” from Autism as a result of early intensive behavioral intervention (EIBI). This book transformed a research report into information that was available in the popular press. Along with the increasing popularity of e-mail and the Internet, the book sparked a firestorm of interest and information (some quite accurate, some not so evidence-based) for parents, educators, and policy-makers interested in interventions for young children with ASD. Suddenly, parents were requesting 40 hours a week of intervention for their very young children with ASD from their public schools and early intervention providers. These requests raised a number of issues including, “Is this intervention a free, appropriate public intervention?”; “Should school districts be providing this?”; “If so, how will schools and early intervention providers pay for these services?”; and perhaps most important, “Is this intervention effective?” Questions about the effectiveness of this type of intervention are largely based on the failure of other researchers to replicate the Lovaas study. Replication of research findings is an essential component in determining whether an intervention strategy can be considered to be evidence based.
Currently, we do not have very much definitive information about what makes EIBI effective. Although there are many models of preschool programming that have shown promising results (e.g., Boulware, Schwartz, Sandall, & McBride, in press; Handleman, & Harris, 2000; Schwartz, Sandall, McBride, & Boulware, 2004), we do not have any solid evidence comparing one strategy to another or comparing different intensities of services (e.g., 25 hours a week to 40 hours a week).
What Do the Experts Recommend?
In 2001, the Committee on Educational Interventions for Children with Autism of the National Research Council published their report in book form entitled, Educating Children with Autism(NRC, 2001). This committee was formed at the request of the U.S. Department of Education’s Office of Special Education Programs, and was charged “to integrate the scientific, theoretical, and policy literature and create a framework for evaluating the scientific evidence concerning the effects and features of educational interventions for young children with autism” (p. 13). After a thorough and well-documented review of the literature, the committee developed conclusions and made recommendations that are essential reading for anyone interested in early intervention for children with ASD.
According to the NRC report, effective programs for young children with ASD include the following characteristics (NRC, 2001, pp. 220-221):
- A minimum of 25 hours a week, 12 months a year, of systematically-planned educational activity.
- Sufficient individual attention every day so that Individual Family Service Plan (IFSP) and Individualized Education Program (IEP) objectives can be addressed with adequate intensity.
- Ongoing assessment.
- Successful interactions with typically-developing children.
- Instruction in the areas of functional spontaneous communication, social interaction, play skills, cognitive skills taught in a manner to facilitate generalization, proactive and effective approaches to challenging behavior, and functional academic skills.
Parents and providers can use these recommendations as a starting place for planning and evaluating early intervention programs for children with ASD. As in planning every program for children with disabilities, it is essential to consider individual needs and strengths of a child and the priorities of the family in this planning process. A program that uses these recommendations as guidelines would be well on the way to designing interventions that are effective, that meet the needs of children and families, and that are legally defensible according to the Individuals with Disabilities Education Act (IDEA).
An Example of an Early Intervention Program: Project DATA
In 1997, at the University of Washington we opened the doors to Project DATA (Developmentally Appropriate Treatment for Autism) with the help of a Department of Education, Office of Special Education, Model Demonstration Grant. Project DATA was designed to meet a need that we saw in our community to help school districts meet the needs of young children with ASD and their families in a manner that was effective, acceptable to all parties, and sustainable. Our project was developed to combine the best practices from applied behavior analysis and early childhood special education into a program for children that recognized the unique learning characteristics and support needs of children with ASD, and also recognized that children with ASD are children first.
Project DATA consists of five components. The core component is an integrated early childhood program for about 12 hours a week. We want every child with ASD to have opportunities to interact successfully with typically-developing children. To make the interactions successful, they may need to be planned and supported systematically. This component is not just about being with typically-developing children; it is about interacting with and developing relationships with typically-developing children.
The second component of our program is extended, intensive instruction. Three days a week, preschool children in Project DATA have an extended school day. During this time children receive additional, explicit instruction on IEP objectives and on other behaviors that will help them be successful in the classroom, home, and community. Instruction can be provided one-on-one or in small groups. The size of instructional groups and the instructional strategies that are used depend on the child, the objective being taught, and the child’s progress as measured by daily data collection. This component adds approximately 12 hours a week of time at school for every child. In addition, we ask parents to work with their child at home for at least five hours a week.
The third component of Project DATA is technical and social support for families. All families receive a monthly home visit and are required to participate in at least six hours of educational programming every year. The first year that children are in Project DATA, parents are required to participate in a class on teaching basic skills. In subsequent years, parents can participate in Project DATA educational classes on specific topics (e.g., play or teaching communication skills), or participate in other educational opportunities available in the community (e.g., the Autism Society of Washington conference).
The next component is collaboration and coordination across services. Almost every family with whom we work has some type of family-negotiated service for their child with ASD. We define a family-negotiated service as a therapeutic service that the school district does not pay for. These services may include speech therapy, home-based behavioral programming, or horseback riding therapy. Once a year we attempt to have a meeting of all the therapeutic providers for the child and the parents. The purpose of these meetings is to foster communication and collaboration, not to do joint planning or evaluation.
The final component of Project DATA is transition planning and support. We know that transitions are difficult for all children and families, but they may be especially stressful for children with ASD and their families. We work with the school district, the preschool, and the family to insure that adequate planning occurs to facilitate a smooth transition. This may include teaching some skills specific to the new environment (e.g., carrying lunch on a tray), transferring visual supports, and providing an opportunity for the child to visit the new school and meet his or her new teacher a few days before school starts.
Many indicators point to the success and sustainability of Project DATA. First is child outcomes. All the children enrolled in Project DATA make gains and some make gains that are quite substantial. Of the 62 children enrolled in Project DATA as preschoolers, over half (58%) attended kindergarten with typically-developing students. Many completed all of elementary school in inclusive settings and have continued into inclusive middle school placements. Another important outcome is parent perceptions. Repeatedly, parents report to us that “Project DATA changed our lives.” Families report that they are able to include children in family and community activities and are optimistic about their outcomes. The final indicator is support from public schools. The project at UW is currently funded by a local school district, and Project DATA has been replicated by a number of other districts in our state and across the country. Together these indicators point to robust and socially valid outcomes for children and their families.
Project DATA is only one example of what effective early intervention services can look like for children with ASD. The important thing to remember is that there is no one right way to educate children with ASD, and a program is only successful if a child is making progress.
Boulware, G., Schwartz, L. S., Sandall, S. R., & McBride, B. J. (n.d.). Project DATA for toddlers: An inclusive approach to very young children with ASD. Topics in Early Childhood Special Education.
Handelman, J. S., & Harris, S. (2000). Preschool education programs for children with Autism (2nd ed.). Austin, TX: PRO-ED.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3–9.
Maurice, C. (1993). Let me hear your voice: A family’s triumph over Autism. New York: Ballantine Books.
National Research Council (NRC). (2001). Educating children with Autism. Retrieved from www.nap.edu/books/0309072697/html
Schwartz, I. S., Sanndall, S. R., McBride, B. J., & Boulware, G. L. (2004). Project DATA (Developmentally Appropriate Treatment for Autism): An inclusive, school-based approach to educating children with Autism. In Topics in Early Childhood Special Education (Vol. 24, pp. 156–168).