Autistic Children Might Not Benefit From More Intensive Interventions

New research suggests that increasing the intensity or duration of interventions like applied behavioral analysis does not significantly improve outcomes for young autistic children.

When a parent first learns their child has autism spectrum disorder (ASD), they are often told that more is better when it comes to treatment or intervention. Based on the available evidence, healthcare providers typically recommend that young autistic children receive Early Intensive Behavioral Intervention (EIBI) for around 20 to 40 hours per week. This includes Naturalistic Developmental Behavioral Intervention (NDBI) therapies like Applied Behavioral Analysis (ABA).

However, in a new meta-analysis, researchers found little evidence to support that this intense level of intervention actually provides benefits for autistic youngsters.

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The study, published on June 24 in JAMA Pediatrics, examined data from 144 research papers, including 9,038 participants with an average age of around four years. The investigators compared the intensity, duration, and cumulative intensity of four intervention types, including NDBI, behavioral, technology-based, and developmental therapies, to participant outcomes.

After accounting for study quality, differences in each intervention, and the participants' age ranges, the scientists found little evidence to support the belief that the benefits of these interventions rise as their intensity increases.

The only statistically significant finding that emerged during the meta-analysis was a link between longer-duration interventions and reductions in the effectiveness of technology-based therapies. However, the researchers urge healthcare professionals to exercise caution when focusing on this specific finding.

Still, the study's authors note that although they did not find evidence that increasing amounts of intervention were associated with increasing benefits, this does not mean autistic children should be left without support.

"Multiple high-quality studies in our sample attested to the effects of some intervention approaches offered at various intensities for young autistic children. In addition, autistic adults have also described feeling harmed by the provision of too little support during childhood," the authors wrote. "Practitioners should be especially careful to calibrate an appropriate amount of support for autistic people with high support needs, especially those who are at risk of injury if left unsupported."

They also say that the optimal amount of intervention needed to produce benefits depends on the child. However, currently, it's unclear what that amount might be.

While the analysis had some limitations, including differences between clinician- and caregiver-delivered intervention hours, the scientists suggest that in light of the findings, healthcare providers should use caution when recommending intensive interventions for autistic children.

Specifically, instead of a one-size-fits-all approach, health professionals should consider working with an autistic child's family to tailor the intensity of interventions to provide benefits without infringing on activities, routines, or educational opportunities critical for the child's development and well-being.

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