Two Year Prospective Follow-up on Community-based EIBI
Magiati, I., Charman, T., & Howlin, P. (2007). A two-year prospective follow-up study of community based early intensive behavioral intervention and specialist nursery provision for children with autism spectrum disorders. Journal of Child Psychology and Psychiatry, 48, 803-812.
Reviewed by Kathleen Moran, MA
Why research this topic?
Many researchers have reported positive outcomes using Early Intensive Behavioral Interventions (EIBI). However, this study is one of the few that have compared home-based EIBI programs with autism-specific school-based programs. The authors tested for differences in IQ, language, play, adaptive behavior, and autism severity between the two approaches after a period of two years. In addition, the authors evaluated child, family or treatment characteristics related to outcome.
Forty-four children with autism participated in the current study. All children were between the ages of 22 and 54 months. All were in an EIBI program or an autism-specific school based nursery for a minimum of 15 hours per week. Twenty-eight children were in the EIBI group and 16 children were in the autism-specific school based nursery group. EIBI programs generally employed one-on-one teaching in a discrete trial format in the home. The nursery program took place in 10 different schools (7 autism-specific settings and 3 autism-specific units within schools) Teaching practices were diverse for the nursery program participants. Procedures included structured, individualized teaching, visual cues, and close working with the parents.
Prior to treatment, all children were assessed for IQ, language, adaptive behavior, play, and autism severity. A follow up assessment took place 23 to 27 months after the initial assessment.
What did the researchers find?
The EIBI and school-based nursery groups did not differ at the initial assessment; however, at follow up, improvements averaging 19 months were observed in language, cognitive, and adaptive measures across both groups with no significant group differences between EIBI and school-based nursery programs. The only significant difference was that the EIBI group showed more improvement than the school-based nursery group in daily living skills. Age at intake, intensity of treatment, and family factors were not significantly correlated with outcome results.
What are the strengths and limitations of the study?
One strength of the study was that the two groups were matched at the initial assessment closely in all aspects, allowing for a good comparison of the effectiveness of the treatments. Another strength was the comparison of EIBI with an alternate intervention of equal intensity. However, one limitation was the small subject size in the study. The authors noted the difficulty in recruiting a sufficient number of children who meet inclusion criteria. In addition, the participants in the study were not randomly assigned, which could be considered a methodological concern. Another limitation is that parents ran EIBI teaching sessions, which made it difficult to compare the effects to programs run by professionals specifically trained in the intervention.
What do the results mean?
Given that EIBI and nursery-based program were about equally effective in this study the findings indicate that there may not be a single best treatment for children with autism. As previously noted, however, there were limitations with this study that make the findings difficult to interpret. The authors suggest that it is important to increase parental choice of treatments and minimize inequalities in access to treatment for parents who live in different areas and who have different levels of family resources. They further suggest a need for more research on specific factors such as the providers' level of experience on outcomes achieved by children in early intervention programs.