Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model

Why the study was done

Autism can often be identified before age 2, but few rigorous trials had tested comprehensive programs for children that young. The Early Start Denver Model combines play, relationships and teaching strategies, and involves parents throughout the day.

What the researchers did

Forty-eight toddlers diagnosed with autism, aged 18 to 30 months, were randomly assigned to two years of the Early Start Denver Model or to referral to services usually available in the community. In the program group, trained therapists worked with each child in the home (about 15 hours a week on average), and parents were coached to use the strategies in daily routines. The people who tested the children did not know which group they were in.

What they found

• After two years, thinking and learning scores rose by 17.6 points on average in the program group, compared with 7.0 points in the community group.
• Most of that gain came from language: understanding language rose by 18.9 points versus 10.2, and expressive language by 12.1 versus 4.0.
• Daily-living (adaptive) skills held steady in the program group but fell by 11.2 points in the community group.
• Seven children in the program group (29%) moved to a milder autism diagnosis, compared with one child (5%) in the community group.
• Measures of autism severity and repetitive behaviors did not differ between the groups.

What this means for families

Starting early, at home, with parents involved, can change a young child's path. Play-based, relationship-based therapy is not just pleasant for children; in this trial it led to measurable gains in language and everyday skills. If you have concerns about your toddler, an early evaluation is worth it.

Limits of the study

The trial was small, and the two groups did not receive the same total hours of support. Some children in the community group left the study. Two of the authors receive royalties from the program's manual. Longer follow-up was needed to see whether the gains lasted.