New research supports EIBI, as BC cuts therapy program to ‘save money’

As autism early intervention programs in BC prepare to close their doors or significantly scale back services in coming weeks due to provincial funding cuts, leaving many desperate BC families in the lurch, the US media are all abuzz over a major new study published today in the journal Pediatrics. That study documented significant gains in toddlers with Autism Spectrum Disorder in the Seattle area who were diagnosed and given intensive early behavioural intervention under a program known as the Early Start Denver Model (ESDM) starting at a very early age.

Below are two of the news reports (Note: some, such as the CNN report, had major errors!):

• Time Magazine: New evidence that early therapy helps autistic kids
• CBC: Early intervention helps autistic toddlers

Some key points:

• Participants: The study focussed on toddlers - all children started treatment before they were 2.5 years old, some as young as 18 months old. (With recommendations to screen for autism at 18 months now, the authors wanted to demonstrate the efficacy of starting intensive intervention immediately upon diagnosis.)
• Randomized, controlled study: 48 children were randomly assigned to either the Early Start Denver Model or to regular services available in the community, such as preschools, private ABA providers, infant & child development programs ,etc.
• Study period: Gains for both groups were compared after 2 years of intervention.
• Results: After 2 years, the ESDM group had significant improvements in IQ, adaptive behaviour, and autism diagnosis, compared to the other group. The ESDM group developed at the same rate as typical children during the two years, while the control group fell further behind.
• 7 children in the ESDM group (30%) had their diagnosis downgraded from Autism to PDD-NOS after the 2 years, compared to one child in the control group.

Conclusion: The study results "compare favourably" with other controlled studies of intensive early intervention approaches. The gains seen were also larger than those seen in studies that used developmental behavioural approaches over shorter periods or with fewer hours of therapy delivered per week .

Early Start Denver Model

ESDM is a comprehensive early behavioural intervention for infants to preschool-aged children with ASD that integrates ABA with developmental and relationship-based approaches. Intervention is provided in the home by trained therapists and parents, and embedded in fun, interactive play activities.

For the study, ESDM children were provided 2-hour sessions, twice per day, 5 days/week by trained therapists. There was a detailed manual and curriculum, extensive parent training, ongoing supervision and consultation from a full multi-disciplinary team. Due to illness, vacations etc, the ESDM children ended up actually receiving an average of 15 hours/week from trained therapists and 16 hrs/week from parents during the 2 years.

Families in the control group received comprehensive advice on intervention, including resource manuals and reading materials. This group reported receiving an average of 9 hours of individual therapy and 9.3 hours/week of group therapy from regular community resources in the greater Seattle area, such as developmental preschools, local infant and child development programs and/or private ABA providers).

Sustainability

Intensive early intervention programs for autism cost ~ $50 - 70,000 per year but a major recent US study found that effective intervention can reduce the estimated lifetime costs of $3.2 million per child with autism by 65% on average. Source: US National Standards Report, 2009

BC Children's Minister Mary Polak has defended her decision to cut BC's early intervention programs and instead give families $6,000 - $22,000 each to spend on family-directed programs and community services, a move that will produce direct savings of $1.5 million per year, but which is expected to cost far more in the long run. After being forced to retract the rationale that BC's autism early intervention programs are not effective, Polak argued that the move is necessary to ensure the long-term sustainability of BC's autism program.

Here is the link to the only Canadian study that I've been able to find on cost benefits of autism early intervention. It found that expanding intensive early intervention to all children with autism in Ontario would save government an estimated $45 million annually in 2003 dollars, while providing improved quality of life for individuals with autism and their families.  Those savings disappeared if intervention programs were less effective than assumed under best practice models.