Improvement of Autism Symptoms After Comprehensive Intensive Early Interventions in Community Settings.
Nils Haglund, SvenOlof Dahlgren, Maria Råstam and 2 others
PMID 32321353WHAT IT FOUND
The ADOS severity score did not improve more in children receiving an intensive home and preschool autism programme.
ADOS total scores fell, but the study was not randomised and cannot show which parts of the bundle caused this.
Key findings
01ADOS total scores fell over time in the intervention group (−0.8 points per 12 months) and did not fall in the comparison group (0.1 points per 12 months).
02After adjustment, the difference in ADOS total score change between the intervention and comparison groups was −1.1 points per 12 months.
03The ADOS severity score showed only a weak association before accounting for baseline differences (p = .06) and no adjusted between-group difference.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Children were not randomised. The comparison group was made of parents who declined the programme, and the groups differed at baseline in age at enrolment and developmental delay, so acceptance and family differences may explain the result. The intervention was a bundle of ABA specialist work, parent education, preschool staff training, individualised home and preschool exercises and 15 to 25 hours each week; the study cannot say which component mattered. The comparison group was small (27), which reduced the ability to detect a true difference. The usual support received by comparison children was not fully described, so it is unclear what the programme was compared with. The ADOS total score can fall when social and verbal skills improve, while the ADOS severity score is designed to remain constant; the two outcomes pointed in different directions. There is no single fully validated instrument for measuring developmental outcome in young children with autism, so the symptom measure is imperfect.
Declared interests
The authors declared no potential conflicts of interest. Funding was provided by ALF Foundation, Region Skåne and the Lindhaga Foundation.
The easy way to misread this
Do not read the ADOS total score fall as proof that the programme bundle caused improvement. The comparison group was formed by parents who declined the offer, baseline groups differed, and the ADOS severity score did not show an adjusted difference.