Authors' objectives:

To conduct a systematic review of the research literature on the use of EIBI among young children with autism, pervasive developmental disorder, or Asperger's disorder. A systematic review "aims to identify all relevant primary research, undertake standardized appraisal of study quality, and synthesize the studies of acceptable quality" (Hunink et al. 2001). Three questions are addressed in this Special Report:

Question 1. How effective is EIBI in improving the functioning of children with autism spectrum disorders, and how does it compare to other early intervention approaches?

Question 2. Can patient characteristics be identified that predict better outcomes from EIBI?

Question 3. Does the effect of EIBI vary with the intensity of treatment?

Authors' recommendations: The variability of presentation and progression among children with autism spectrum disorders, as well as potential differences in delivery of behavioral interventions, make this topic challenging to study. Nevertheless, given the importance of caring for children with ASD, additional research is needed to identify those characteristics of treatment—content, technique, intensity, starting and ending age, etc.—that maximize its effectiveness. Because of the challenges in launching a very large randomized trial and the ethical necessity to provide some treatment to the control group, this body of research needs to be built piece by piece, with a series of studies that investigate different components of the larger research question. For this to be effective, however, the overall quality of studies needs to be improved, including a greater emphasis on randomized, controlled trials, where at all possible; substantially larger sample sizes; uniformity of outcomes evaluated and instruments used to measure them; and consistent treatments that do not vary widely within treatment groups (i.e., experimental or control group). The cost of continuing the current course of assuming that EIBI works may not be obvious. EIBI is costly financially for society and requires a large time commitment from children, their families, and their teachers or therapists. However, these programs may not appear to pose any harm for the children themselves. Nevertheless, the opportunity costs could be high, indeed, of providing suboptimal care to these children, simply because we as a society do not know what works best. The children may be treated with an intervention that is not as effective as the alternatives. And if we accept an intervention because it seems to work, without solid evidence, research on the alternatives or on how it can be improved is likely to be stifled.

Project Status: Completed

URL for project: http://www.bcbs.com/blueresources/tec/vols/23/special-report-autism.html

Year Published: 2008

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: BlueCross BlueShield Association

Contact Address: BlueCross BlueShield Association, Technology Evaluation Center, 225 North Michigan Ave, Chicago, Illinois, USA. Tel: 888 832 4321

Contact Name: tec@bcbsa.com

Contact Email: tec@bcbsa.com

Copyright: BlueCross BlueShield Association (BCBS)