Is Earlier Better? The Relationship between Age When Starting Early Intervention and Outcomes for Children with Autism Spectrum Disorder: A Selective Review.

Although the conventional wisdom is that "earlier is better" when it comes to intervention for children with ASD, it is not clear what evidence exists to support this notion. This review examined a group of studies that addressed outcomes for young children with ASD who started early intervention at a range of ages. The review was selective by including only papers that examined the age of initiation of treatment as well as baseline cognitive, language, or adaptive level and, in addition, employed a method to control for the covariance between early ability level and age of beginning intervention. Fourteen studies were identified and then compared on methods and outcomes. The support for "earlier is better" was mixed, but it was clear that complex relationships among predictor variables need to be explored in order to understand the role of age of starting early intervention for later outcomes.

A Longitudinal Study of Children Diagnosed with Autism Spectrum Disorder Before Age Three: School Services at Three Points Time for Three Levels of Outcome Disability.

This study follows 70 children determined to have Autism Spectrum Disorder (ASD) before age three (Time 1). Parents filled out questionnaires and standardized measures about their child when he/she was school-aged (Time 2), including information about their children's preschool, kindergarten, and grade school educational settings. At Time 2, the researchers placed children in three diagnostic groups of No ASD, ASD-Higher Functioning, and ASD-Lower Functioning. Retrospective results showed that most children were receiving intensive services at the preschool level. In kindergarten, there was some divergence among the three groups, with more intensive services continuing for the ASD groups. At school age, classroom placement and services reflected service patterns that were consistent with these three levels of disability.

Autism Spectrum Disorder Screening Instruments for Very Young Children: A Systematic Review.

Research on ASD in infancy has provided a rationale for developing screening instruments for children from the first year of life to age of 18 months. A comprehensive literature search identified candidate screening tools. Using methodological probe questions adapted from the Quality Assessment of Diagnostic Accuracy Studies (QUADAS), two Level 1 and three Level 2 screening instruments were reviewed in detail. Research evidence conclusions were that instrument development was in beginning phases, is not yet strong, and requires further development. Clinical recommendations were to continue vigilant developmental and autism surveillance from the first year on but to use the screening instruments per se only for high-risk children rather than for population screening, with considerations regarding feasibility for individual settings, informing caregivers about strengths and weaknesses of the tool, and monitoring new research.

School-aged functioning of children diagnosed with autism spectrum disorder before age three: parent-reported diagnostic, adaptive, medication, and school placement outcomes.

Eighty children with early autism spectrum disorder (ASD) diagnoses (under 36 months) were identified using a chart abstraction protocol applied to early intervention charts. Parents filled out questionnaires by mail when the children were school-aged (ages 6-16 years). Similar to previous studies, approximately 20% no longer had ASD diagnoses; the other participants were assigned to Moderate/Severe versus Mild ASD outcome groups. These three groups were compared across several variables, including diagnostic features and functional features including adaptive behavior, social experiences, medication use, and school placement. The findings expand our knowledge about outcomes in longitudinal studies of children with ASD, as well as provide support for using relatively indirect methods (chart review, parent questionnaire) to gather this type of information.

Incorporating life course theory and social determinants of health into the LEND curriculum.

The goal of this paper is to describe strategies for revising LEND curricula to incorporate a stronger focus on life course theory and social determinants of health (LCT/SDOH). The Maternal and Child Health Bureau (MCHB) includes a central focus on LCT/SDOH and states that a goal of Maternal and Child Health (MCH) training is to "Prepare and empower MCH leaders to promote health equity…and reduce disparities in health and health care." Two LEND programs engaged in a comprehensive process to strengthen LCT/SDOH in their curricula that included choosing content and themes and developing instructional strategies congruent with MCH Leadership Competencies and with the learning needs of LEND trainees. We describe: key elements of LCT/SDOH; the relationship of these to children with disabilities and to the MCH Leadership Competencies; LCT/SDOH resources for the LEND curriculum; a collaborative curriculum revision process for faculty; and LCT/SDOH content and themes for the LEND Curriculum and strategies for incorporating them. We present the results of our work in a format that may be used by other LEND programs undertaking curriculum revision to incorporate LCT/SDOH.

Detecting autism spectrum disorder from early intervention charts: methodology and preliminary findings.

Federal laws mandating a "single point of entry" for early intervention (EI) create a potential database for surveillance of early childhood disabilities. This study evaluated EI records for estimating rates of autism spectrum disorder (ASD) using a chart abstraction protocol, with good interrater agreement (k = .86). Sampling 304 EI records yielded a point prevalence of (per 1,000) 8.5 (95% CI: 4.8-10.9) and a cumulative incidence of 7.4 (95% CI: 5.5-12.4). These rates are similar to recent published estimates. Additionally, the male-to-female ratio for autism, and rates of other developmental disorders were found to be consistent with current literature. These results suggest that local systems EI records may provide an excellent resource for ASD surveillance and research.