Dear Ms. Kirsch,
This letter is being shared in response to your article, “Should We Screen All 2-Year Olds for Autism?” Commendably, you shared important information with your readers about the value of early detection and early intervention. You correctly state that the sooner autism is identified, the sooner children can access early intervention that may reduce the developmental gap and result in significant cost savings in the long term. Research has consistently shown that positive effects can be achieved when therapy based on the science of applied behavior analysis (ABA) is delivered via comprehensive, individualized and intensive intervention programs of 20+ hours per week. Comprehensive, individualized and intensive intervention programs are important for young children with autism spectrum disorder (ASD) for several reasons:
- The second year of life is a dynamic period of brain growth, during which increases in brain volume and atypical connectivity associated with ASD first emerge. However, this is also a time of substantial neural plasticity which may allow for rapid skill acquisition and alteration of the child’s developmental trajectory such that it reaches age-appropriate developmental milestones (Dawson, 2008).
- A proportion of children with ASD reportedly regress in the second year of life. However, intensive intervention during this period may counter the symptoms of regression and ultimately prevent ASD-related impairments before they fully manifest (Dawson, 2008).
- Statistics show that a proportion of children who receive early intensive behavioral intervention will transition into mainstream school by Kindergarten. Many other children will need significantly less support as they get older (Eikeseth, 2009).
- Group design research and randomized controlled clinical trials suggest that behavioral programs that are implemented as early as possible and in an intensive manner can produce significant improvements in cognitive, adaptive, and social–communicative functioning in young children with ASD (Eldevik et al., 2009).
As you mentioned, racial and socio-economic gaps in early detection and early intervention are concerning, and steps need to be taken to ensure that all children have access to high quality early intervention if a developmental delay is evident. Unfortunately, as you also note, children from minority ethnic groups and non-English speaking families in the USA may be disadvantaged because their parents do not know the signs of autism or because they have less access to high quality health care, including access to medical professionals who are able to conduct diagnostic evaluations in languages other than English. Your article raises awareness of these issues and offers some concrete solutions to close racial gaps in early detection and intervention. The more that parents are informed about the importance of early detection and intervention, the more likely they will be to seek assistance from qualified professionals to help their children achieve their full potential. Readers may be interested in some of the resources available on the website of the Association for Science in Autism Treatment (ASAT) such as this 2009 article and 2011 article about what early intervention may involve as well as a summary of the available research related to early intervention.
Sincerely,
Erin Leif, PhD, BCBA-D
Association for Science in Autism Treatment
References
Dawson, G. (2008). Early behavioral intervention, brain plasticity, and the prevention of autism spectrum
disorder. Development and psychopathology, 20(3), 775-803.
Eikeseth, S. (2009). Outcome of comprehensive psycho-educational interventions for young children with
autism. Research in developmental disabilities, 30(1), 158-178.
Eldevik, S., Hastings, R. P., Hughes, J. C., Jahr, E., Eikeseth, S., & Cross, S. (2009). Meta-analysis of early
intensive behavioral intervention for children with autism. Journal of Clinical Child & Adolescent
Psychology, 38(3), 439-450.
