Why early diagnosis of autism should lead to early intervention
Research suggests children can be reliably diagnosed with autism before the age of two. It also shows that many of the behavioural symptoms of autism are present before the age of one.
These behaviours include decreased interest in social interaction, delayed development of speech and intentional communication, a lack of age-appropriate sound development, and unusual visual fixations.
Preliminary results of a study in the Wellington region indicate most children are diagnosed when they are around three years old. However, there is arguably little point of providing early diagnosis if it does not lead to evidence-based early intervention.
The Early Start Denver Model (ESDM) is a promising therapy for very young children (between one and five years) with, or at risk for, autism. ESDM uses play and games to build positive relationships in which the children are encouraged to boost language, social and cognitive skills.
Where ESDM differs most from traditional intervention is that behavioural teaching techniques are embedded within this play. This includes providing clear cues for a behaviour, and rewarding that behaviour. Parents, therapists and teachers can use ESDM techniques within the children's play and daily routines to help them reach developmentally appropriate milestones.
For example, a child who does not yet talk, may be learning to reach for preferred items. A child who has a lot of language may be learning to answer questions like "what is your name?".
Initial research conducted in the United States, where the model was developed, suggests that ESDM is particularly effective when implemented for more than 15 hours a week by trained therapists in the home environment.
Improved cognition in early childhood
The model was adopted in Australia where the government funds autism specific early childhood centres. Research conducted in these centres indicates that children receiving ESDM intervention from trained therapists show greater improvements in understanding and cognitive skills than children who were not receiving treatment.
In New Zealand there is no government funding for such therapy. As a result, the cost of providing this intensive level of early intervention is beyond the budget of most families. There is also a lack of trained professionals with the technical expertise to implement such therapies.
For these reasons, we are working with the Autism Intervention Trust and Autism New Zealand to develop a New Zealand-specific low-intensity approach to delivering ESDM. The team is using the research of what is effective overseas and is applying it within a New Zealand context.
New Zealand takes an inclusive approach to education. The main goal of the research programme therefore is for children with autism and their families to receive support earlier so that they can get a better start in their development and go on to mainstream schools.
One project involves training kindergarten teachers in ESDM. Inclusion of ESDM strategies in kindergartens is the biggest unknown because there is little teacher training in New Zealand around how to best support children with autism in mainstream settings.
A second project involves providing parent coaching and then adding on a small amount of one-on-one therapy. This will provide some preliminary evidence as to whether adding a minimal amount of one-on-one therapy is any more beneficial that just coaching parents.
Each project involves examining specific measures of communication, imitation (a key early learning skill children with autism typically struggle with) and social engagement with others.
Other countries with little government funding and support for children with autism and their families have taken a similar approach to providing ESDM therapy at a lower intensity. The research suggests that just a few hours of therapy can lead to positive outcomes.