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J Am Acad Child Adolesc Psychiatry. 2019 Jan 24. pii: S0890-8567(19)30044-9. doi: 10.1016/j.jaac.2019.01.004. [Epub ahead of print]

A Multisite Randomized Controlled Two-Phase Trial of the Early Start Denver Model Compared to Treatment as Usual.

Author information

1
University of California, Davis MIND Institute, Sacramento, CA. Electronic address: sjrogers@ucdavis.edu.
2
University of Washington, Seattle.
3
Weill Cornell Medicine, Cornell University, New York, NY.
4
University of California, Davis MIND Institute, Sacramento, CA.
5
University of Michigan, Ann Arbor.
6
Duke University, Durham, NC.
7
University of California, Los Angeles.

Abstract

OBJECTIVE:

This single-blind, randomized, multi-site, intent-to-treat study was designed to replicate and extend Dawson et al.'s (2010) randomized controlled trial (RCT) testing effects of the Early Start Denver Model (ESDM), an intensive play-and routines-based intervention delivered in natural settings.

METHOD:

An RCT was conducted at three universities. 118 children with autism spectrum disorder (ASD), 14-24 months of age, were enrolled and randomly assigned to ESDM or community interventions for 27 months. 81 children completed the full treatment course and all assessments; data from all 118 children were used in analyses. Children assigned to ESDM intervention received three months of weekly parent coaching followed by 24 months of 15 hour -per -week (on average) 1:1 treatment weekly on average in homes or daycare settings from supervised therapy assistants while parents received coaching four hours monthly from a certified ESDM therapist.

RESULTS:

Primary: There were both time by group and time by group by site interactions for language outcomes. In the significant three-way interaction involving site, two sites showed a significant ESDM advantage and the third site showed no significant group differences. In the planned two-way analysis that pooled the data across all three sites, there was a significant advantage found for the ESDM group.

SECONDARY:

There were no significant differences between ESDM and Community groups in secondary analyses involving DQ, autism severity, or adaptive behavior. The treatment effect of group on language outcomes was not moderated by baseline DQ, autism severity, or language.

CONCLUSION:

Results of the primary analysis provide a partial replication of Dawson et al.'s 2010 language findings.

KEYWORDS:

Autism spectrum disorder; Early Start Denver Model (ESDM); developmental quotient (DQ); early intervention; toddlers

PMID:
30768394
DOI:
10.1016/j.jaac.2019.01.004

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