Early intervention in preschoolers with Autism Spectrum Disorder (ASD): the Swiss experience in 5 university centers
Chair: Stephan Eliez, Co-Chair: Joaquin Fuentes.
The last decade has taught us that the most effective method for minimizing the impact of autism spectrum disorders symptoms was early intensive behavioral intervention. While many different approaches have been proposed, it seems that the first three years of life may represent a “window of opportunity”, to get the most optimal long-term benefits. The intensity of intervention is also critical, with some programs offering up to 20h of individual therapy per week. In this symposium, we will share the experience of 5 university centers in Switzerland who started to implement early intervention programs for preschoolers with autism a few years ago. Each center choose the approach which tailored to their needs, trained their team and was able to enroll in average 20 preschoolers with ASD to date. These data are in turn presented regularly to the Swiss invalidity insurance in an effort to demonstrate that local programs can dramatically help improving the lives of affected children. After the individual presentations by 4 of these 5 centers, the last talk will present statistical results based on the more than 100 toddlers with ASD who participated in one of these early intervention programs.
See all abstracts below
Original Synapsys Symposium abstract by Evelyn Herbrecht, Olga Lazari, and Klaus Schmeck (University Department of Child and Adolescent Psychiatry, Basel, Switzerland) on Effectiveness of the FIAS approach for early Intensive Intervention for young children with ASD – the Basel experience (ESCAP 2017 Congress in Geneva, Switzerland).
Herbrecht Evelyn, Lazari Olga, Schmeck Klaus.
University Department of Child and Adolescent Psychiatry, Basel, Switzerland.
In autism spectrum disorder (ASD) impairments in fundamental social abilities and a lack of interest in social stimuli become apparent early in life. Early intensive interventions are considered crucial to attenuate risk factors for impaired social development and thus to ameliorate the deficits associated with ASD (Dawson et al., 2010). The current study evaluates the effectiveness of FIAS (‘Frühintervention bei Autistischen Störungen’, Herbrecht et al., 2015), using both short term- and follow-up data.
A total of 41 young children with autism and their families have participated in the FIAS therapy evaluation from March 2011 to September 2016 (median age: 42 months at intervention start). FIAS intervention consists of an initial 18 days period of highly intensive therapy (6 hours per day) in the FIAS centre and two years of less intensive follow-up care at home, where parents as well as other involved institutions are coached to stabilize treatment effects.
The short-term effectiveness of the FIAS intervention was assessed before, during and after the initial intensive intervention, follow-up effects were assessed one and two years after. We used standardized outcome measures (ADOS, DD-C-GAS, VABS-II) as well as the Autism Behaviour Coding System (ABCS), a novel, video-based observational instrument for assessing core autism symptoms during therapist-child-interaction (Dima et al., 2016).
Short-term results show mostly significant improvement in core autistic symptom domains and level of functioning (ABCS, DD-C-GAS). Follow-up-results one and two years after initial intensive intervention not only confirm the short-term effects but show an increase of intervention benefit.
FIAS seems to highly improve core autistic symptoms as well as the level of everyday functioning in young children with ASD and intervention benefit seems not only to be stabilized but to further increase during follow-up care. These results underlie the importance of early intensive intervention in the group of young children with autism.
Original Synapsys Symposium abstract by Ronnie Gundelfinger (KJPDZH, Universität Zürich, Switzerland) on Early intervention in young children with ASD – the Zürich experience (ESCAP 2017 Congress in Geneva, Switzerland).
About 20 years ago parents of young children with severe autism started using behavioural methods with the help of specialists from the US or Norway. There was a big demand to start a local program in Switzerland. We cooperated with the UCLA clinic, founded by the ABA pioneer Ivar Lovaas and started our „Early Intensive Behavioural Intervention“ programme in 2004. Similar to the UCLA program we work with psychology students to reach the necessary intensity of 30 hours per week. The psychologists in charge of the program are Board Certified Behavior Analysts (BCBA). The methods used have changed dramatically over the years from the classic «discrete trial teaching» to a highly interactive, communicative and playful approach. Main areas are verbal and nonverbal communication, social reciprocity and playful interaction, indepence in activities of daily life and preparation of group activities in Kindergarten. Our program was developped as a home treatment, but in 2015 we started combining center based hours with therapy at the families' home.
We have taken outcome data from the beginning, first results will be published in 2017.
Original Synapsys Symposium abstract by Bettina Tillman and Peter Weber (Autismuszentrum der GSR, Riehen, Switzerland) on Presentation of approach and outcome of the early intervention in Basel - GSR (ESCAP 2017 Congress in Geneva, Switzerland).
Bettina Tillman, Peter Weber
Autismuszentrum der GSR, Riehen, Switzerland
Autism spectrum disorder (ASD) comprises impaired social interaction and communication and behavioural restrictions. There is strong evidence that early intervention with intense training can improve outcomes of children with autism spectrum disorder. This is independent from the type of intervention (Spjut Jansson et al., 2016). We show the eclectic approach of the “Autismuszentrum der GSR” and present results collected so far.
Between 2008 and 2017 46 Children diagnosed with autism-spectrum disorder were treated with an eclectic model including early intervention therapy, occupational therapy and speech therapy. All children received trainings in PECS (Picture Exchange Communication System) and TEACCH (Treatment and Education of Autistic and related Communication handicapped CHildren). The intensity was between 20 and 35 hours per week depending on the possibilities of individual families. Parental coaching is an important part of the therapy. Psychoeducational Profile as well as the Sensory Profile were used to assess developmental skills at the beginning and after one year of intensive intervention.
As shown in the combined data of all Swiss centers, early specific intervention leads to improved outcomes in communication, interaction and behaviour. We add data showing improvements in core autistic symptoms after one year of eclectic therapy.
The eclectic approach of the “Autismuszentrum der GSR” is one out of five different settings in Switzerland providing early intensive intervention in early childhood autism. We conclude that the type of intervention is not critical for the outcome. Intensity and specificity to autism seem to be crucial for a successful intervention. As we are facing a wide spectrum of disorders we see a wide spectrum of outcomes independent of the approach. This suggests that individual approaches are promising to treat patients and families based on their primary symptomatology.
Original Synapsys Symposium abstract by Hilary Wood de Wilde (Centre d’Intervention Précoce en Autisme, Office Médico-Pédagogique et Fondation Pôle Autisme, Geneva, Switzerland) on Early intervention following the Early Start Denver Model – the Geneva experience (ESCAP 2017 Congress in Geneva, Switzerland).
Soon after receiving a diagnosis of autism for their child, parents are quickly confronted with the reality that there are no medical treatments available to tackle the myriad of developmental and behavioral challenges they will face. There is, however, one form of treatment that proves effective for all children with autism, and that is early intensive intervention. In recent years, randomized controlled studies of various approaches in early intervention have proved that regardless of theoretical approach, certain elements, such as parent involvement and emphasis on social communication, are key.
The Center for Early Intervention in Autism of Geneva opened its doors in 2010. Today, 27 children are treated across 3 centers, receiving intensive, individualized early intervention using the Early Start Denver Model (ESDM). This talk will give an overview of how the centers function, how the ESDM model is used with children ages 12 months to 4 years, as well as the challenges and future goals of the program.
As our ability to detect autism in very young babies and children improves, we are also facing an increasing number of questions that represent challenges for the years to come: Which therapy is effective for which presentation of autism symptoms? Why do some children respond better to treatment than others? How will we be able to make early intervention affordable for all in the years to come? How will we treat babies diagnosed at 6 months old?
Original Synapsys Symposium abstract by Gian Paolo Ramelli et al. (Pediatric Department of Southern Switzerland, Neuropediatric unit San Giovanni Hospital, Bellinzona, and OTAF Institute Sorengo, Switzerland) on Early diagnosis and intervention of autism spectrum disorders: experience in the southern part of Switzerland (ESCAP 2017 Congress in Geneva, Switzerland).
Before 2009, in Ticino, the southern part of Switzerland, all the children diagnosed with ASD attended special needs schools.
In 2009, thanks to the substantial sensitization of the paediatricians on the use of M-CHAT the age of diagnosis dropped from 4 to 2.5 years old.
This allowed an earlier and specific therapeutic intervention for this particular population.
- Intensive behavioural intervention (approximately 21 hours/week) using ABA principles: a) 1:1 instructions, b) group instructions.
- Inclusion in an ordinary school setting (kindergarten) with a support teacher (from 6 hours/week) trained ABA.
- Collaboration within a multi-disciplinary team: a) speech pathologist, occupational therapist, teachers, support teachers and ABA interventionists.
Results and conclusion
At the moment, thanks to this approach more than 60% of the children are included in regular classroom.
Original Synapsys Symposium abstract by Martina Franchini et al. (Geneva University, Switzerland) on Pooling data from all the Swiss Early Intervention Programs – challenges, opportunities and results (ESCAP 2017 Congress in Geneva, Switzerland).
Martina Franchini, Evelyn Herbrecht, Olga Lazari, Klaus Schmeck, Hilary Wood de Wilde, Ronnie Gundelfinger, Nadja Studer, Ghadder Barghouty, Gian Paolo Ramelli, Peter Weber, Stephan Eliez, Marie Schaer.
In this talk, we integrate all the results from the Swiss centers using early intensive intervention. Five centers from 4 different cantons (Basel, Geneva, Ticino, and Zürich) are making a combined effort to evaluate the efficiency of various behavioral and developmental interventions for young children with ASD, having the common features of being intensive and empirically supported.
Within this protocol, children were longitudinally followed at the baseline, after one year and after two years by mean of clinical, developmental and cognitive standardized assessments. To date, we collected these measures for 111 young children with ASD (185 visits in total) under the age of 5. Conclusive longitudinal results were only ensured for the first 1-year visit.
After one year of treatment, results have shown a reduction in Symptom Severity (p=0.03), and an increase in standard score for communication (p<0.01). Imitation skills also exhibited a significant gain in the standard score (p=0.04). We also observed a trend toward significance increase in spatial IQ (p=0.09; p=0.08). Finally, a counter-intuitive result indicated increased anxiety scores in the mothers of the children included in our protocol.
After one year of treatment, our preliminary results showed some improvements in cognitive performance, communication, and imitation skills in some young children with ASD who benefited from one year of early and intensive intervention. These encouraging results confirm the need for early interventions and their positive impact on the developmental outcome of children with autism. Further efforts should be encouraged to explore this impact on a longer outcome and in a larger sample.