More intensity may not equal better results in early behavioral intervention

A meta-analysis by researchers in the United States suggests that increasing the intensity of early behavioral intervention for children with autism spectrum disorders (ASD) does not necessarily improve outcomes.

Micheal Sandbank and colleagues analyzed data from 144 studies involving more than 9,000 children ranging in age from infancy to eight years of age. The researchers measured the intensity of treatment in three ways: the amount of intervention offered within a certain time frame (for instance, hours per day); the total number of intervention days; and “cumulative intensity” (the total amount of intervention provided during the total duration). Their results, they say, showed that “none of the models evidenced a significant association between intervention amount and intervention effects.” They conclude, “There is not robust evidence that the benefits of early childhood interventions to young autistic children increase when those interventions are intensified; practitioners recommending interventions should consider what amounts would be developmentally appropriate.”

The researchers also note that intensive interventions can have downsides, such as depriving children of opportunities for rest and socialization with family members. Sandbank comments, “In order to determine what amount of intervention is most effective, while also being minimally interruptive, we need more high-quality primary studies. Few high-quality studies systematically compare the same intervention offered at different amounts.” She adds, “There’s probably a minimum amount of intervention needed to provide any benefit at all, and an optimal amount that is dependent on the child. Unfortunately, right now, we don’t have clear evidence as to what that amount should be.”

Citations

“Determining associations between intervention amount and outcomes for young autistic children: A meta-analysis,” Micheal Sandbank, James E. Pustejovsky, Kristen Bottema-Beutel, Nicolette Caldwell, Jacob I. Feldman, Shannon Crowley LaPoint, and Tiffany Woynaroski, JAMA Pediatrics, June 24, 2024 (online). Address: Micheal Sandbank, Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, [email protected].

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“New study suggests higher amounts of intervention may not be more helpful for children on the autism spectrum,” news release, University of North Carolina School of Medicine, June 25, 2024