The earlier the better: An RCT of treatment timing effects for toddlers on the autism spectrum.
Whitney Guthrie, Amy M Wetherby, Juliann Woods and 4 others
PMID 36922406WHAT IT FOUND
Toddlers who started intensive, individualized parent coaching at 18 months made larger gains in language, social communication and daily living skills than those who started the same coaching at 27 months.
The effect was not seen for less intensive group education.
Key findings
01Toddlers who received intensive, individualized parent coaching first at 18 months made significantly larger gains during the 9-month treatment period than toddlers who received the same coaching first at 27 months.
02Earlier coaching produced larger receptive language gains: 9.68 T-score points on the MSEL and 2.00 v-scale points on the VABS-II, compared with 2.51 and 0.59 points after later coaching.
03Earlier coaching also produced larger gains in expressive language (1.30 v-scale points versus -.13), social communication (22.75 versus 10.31 raw score points) and daily living (3.87 versus a decrease of 1.24 standard score points).
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
There was no no-treatment control group, so maturation could not be separated from treatment timing for outcomes that improved earlier in both treatment conditions. Children who received Individual-ESI at 27 months had just completed Group-ESI, so carryover effects could not be ruled out for outcomes that improved more during the later condition. The study tested only two start ages, about 18 months and about 27 months, so it cannot show whether starting younger than 18 months or older than 27 months would differ. The sample was mostly White, with 74% and 72% White in the two groups, and mothers averaged 15.64 and 15.51 years of education, so results may not generalize to more racially, ethnically or socioeconomically diverse families. Parents could not be blinded to treatment condition, which may affect parent-reported outcomes such as VABS-II scores. The treatment was a parent-coaching package with SCERTS targets, coaching and everyday routines, so the effect of any single component cannot be separated.
Declared interests
Research was supported by the National Institute of Mental Health under Awards R01MH077730 and R01MH078165. Amy Wetherby is an author of the CSBS and SCERTS Model and receives royalties, but not from this study. Catherine Lord is an author of the ADOS-2, and Catherine Lord and Whitney Guthrie are authors of the ADOS Toddler Module; they receive royalties from use of those tools, but not from this study. Amy Wetherby and Juliann Woods own Autism Navigator, LLC, which distributes web-based courses and tools, and 100% of profits are donated to a nonprofit organization. The remaining authors disclosed no financial relationships relevant to the article.
The easy way to misread this
Do not read this as proof that all autism treatment started at 18 months beats treatment started at 27 months. The timing effect was seen for the intensive, individualized parent coaching package, not the less intensive group education condition, and some outcomes could not be separated from maturation or carryover.