Academic journal article Australian Journal of Early Childhood

Evaluating the Efficacy of Parent-Focused Interventions for Autism: How Do We Know What Will Work?

Academic journal article Australian Journal of Early Childhood

Evaluating the Efficacy of Parent-Focused Interventions for Autism: How Do We Know What Will Work?

Article excerpt

Autism, first identified by Kanner in 1943 (Kanner, 1973), is now concepcualised as a spectrum disorder (Autistic Spectrum Disorder or ASD) in which degrees of impairment are represented. It is characterised by three interacting zones of deficit: qualitative impairments in social interaction; communication; and restricted, repetitive and stereotyped patterns of behaviour, interests and activities (Wing, 1971). Deficits in each area must be present for a diagnosis to be made. According to the Diagnostic and Statistical Manual (DSM-IV-TR), ASD sits within the category of Pervasive Developmental Disorders (PDD) (American Psychiatric Association, 2000).

Despite continued investigations since Kanner's early work, the exact aetiology of autism remains unknown (see for example Frith, 1989; Rutter et al., 1994). It is generally thought that genetic and environmental factors combine to result in the cluster of deficits that make up the condition (Volkmar et al., 2004).

A recent review of epidemiological studies estimates the prevalence of autism to be conservatively 10 per 10,000, with diagnosis of boys outnumbering girls 4:1 (Fombonne, 2003). Children with ASD represent a challenge to their families and to education providers. The functional deficits in autism can include acute sensory sensitivity, an inability to recognise patterns or salient features in the environment, and communication difficulties (Volkmar & Lord, 1998). These deficits may lead to high anxiety; insistence on routine and stereotypic behaviours, as well as tantrums, destructive and aggressive behaviours; and sensory shutdown (Green, 1996). Within the autistic spectrum there is great variability in symptoms between and within individuals over time. This contributes co the difficulties experienced in developing and evaluating interventions for this group of individuals (Kasari, 2002).

A wide range of therapies aimed at reducing symptoms is available, including drug treatments, special diets and intensive behavioural programs. As yet there is no one treatment that is fully effective for all, or even most of, the children within the autistic spectrum (Dempsey & Foreman, 2001; Freeman, 1997; Goldstein, 2002; Green, 1996; Gresham, Beebe-Frankenberger & MacMillan, 1999; Jordan & Jones, 1999; Kasari, 2002; Mirenda & Erickson, 2000), and there is little hard evidence for the effectiveness of any of the programs currently being offered (Gresham et al., 1999; Kasari, 2002; Volkmar et al., 2004). Without adequate evaluation processes there is a danger of resource misuse and of families and children wasting valuable early intervention time on ineffective interventions. Evaluation of treatment programs is therefore essential.

Early intervention involving parent education programs has become increasingly common for both general and special or targeted populations in the past 20 years. In this time there has also been an increasing demand for evaluation and accountability on the part of those who offer interventions. In New Zealand, the Ministry of Education has recently adopted EarlyBird, a parent-training program designed for parents of young children with autism, and engaged the authors of this review to conduct an evaluation of EarlyBird in the context of the national implementation of the program in New Zealand. This paper reviews the rationale for parent-focused autism intervention programs in light of the theoretical literature around early intervention in autism and consideration of the relative merits of both child- and parent-focused early intervention programs. This is followed by a description of the NAS EarlyBird program and the available evidence regarding the effectiveness of this program and its components. From this discussion, a rationale for evaluating EarlyBird and similar programs is derived.

Child-focused early interventions

The evidence to date points to early intervention, using intensive child-focused behavioural programs and directly involving parents in the processes, as among the most effective treatment options (for examples see Green, 1996; Koegel & Koegel, 1995; Lovaas, 1987). …

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