The challenges for early intervention and its effects on the prognosis of autism spectrum disorder: a systematic review

Pires, Jackson Frederico; Grattão, Caroline Cajuela; Gomes, Regiane Maria Ribeiro

doi:10.1590/1980-5764-DN-2023-0034

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Dementia & Neuropsychologia

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View & Review • Dement. neuropsychol. 18 • 2024 • https://doi.org/10.1590/1980-5764-DN-2023-0034 copy

The challenges for early intervention and its effects on the prognosis of autism spectrum disorder: a systematic review

Os desafios para a intervenção precoce e seus efeitos no prognóstico do transtorno do espectro autista: uma revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

Autism spectrum disorder (ASD) is expressed with neurobehavioral symptoms of different degrees of intensity. It is estimated that, for every three cases detected, there are two cases that reach adulthood without treatment.

Objective:

To establish what challenges are still present in the implementation of early intervention (EI) and its effects on the prognosis of ASD.

Methods:

A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) methodology was carried out in the PubMed and ScienceDirect databases in January 2023. The search keywords were “autism spectrum disorder”, “early intervention” and “prognosis”.

Results:

Sixteen studies were included, two randomized and 14 non-randomized. Knowledge about the signs of ASD, diagnostic and therapeutic methods, age at the start of treatment, and socioeconomic factors were the main challenges encountered in the implementation of the EI.

Conclusion:

EI is capable of modifying the prognosis of ASD and challenges in its implementation persist, especially in developing regions with low socioeconomic status.

Keywords:
Autism Spectrum Disorder; Autistic Disorder; Early Medical Intervention; Prognosis

Author	Year	Study design	Sample	Objective	Main results	MMAT score (%)
Clark et al.²³23. Clark MLE, Vinen Z, Barbaro J, Dissanayake C. School age outcomes of children diagnosed early and later with autism spectrum disorder. J Autism Dev Disord. 2018;48(1):92-102. https://doi.org/10.1007/s10803-017-3279-x https://doi.org/https://doi.org/10.1007/...	2018	Quantitative non-randomized	Experimental (n=48) Comparison (n=37)	Comparison of prognoses according to the initiation of EI for ASD at different ages	Intervention for ASD was most effective in children diagnosed up to 2 years of age.	80
Maksimovic et al.²⁴24. Maksimović S, Marisavljević M, Stanojević N, Ćirović M, Punišić S, Adamović T, et al. Importance of early intervention in reducing autistic symptoms and speech-language deficits in children with autism spectrum disorder. Children (Basel). 2023;10(1):122. https://doi.org/10.3390/children10010122 https://doi.org/https://doi.org/10.3390/...	2023	Quantitative non-randomized	Experimental (n=29)	Comparison of prognoses according to the initiation of EI for ASD at different ages	Autistic symptoms are reduced more in younger children than in older children. EI had better effects in younger children.	100
Lombardo et al.²⁵25. Lombardo MV, Busuoli EM, Schreibman L, Stahmer AC, Pramparo T, Landi I, et al. Pre-treatment clinical and gene expression patterns predict developmental change in early intervention in autism. Mol Psychiatry. 2021;26(12):7641-51. https://doi.org/10.1038/s41380-021-01239-2 https://doi.org/https://doi.org/10.1038/...	2021	Quantitative non-randomized	Experimental (n=41)	Comparison of prognoses according to the initiation of EI for ASD at different ages	Shows the importance of early treatment starting ideally before 24 months. Also shows for the first time that blood gene expression characteristics can predict how fast toddlers with ASD respond to early treatment.	60
Vinen et al.²⁶26. Vinen Z, Clark M, Paynter J, Dissanayake C. School age outcomes of children with autism spectrum disorder who received community-based early interventions. J Autism Dev Disord. 2018;48(5):1673-83. https://doi.org/10.1007/s10803-017-3414-8 https://doi.org/https://doi.org/10.1007/...	2018	Quantitative non-randomized	Experimental (n=31) Comparison (n=28)	Comparison of prognoses according to the initiation of EI for ASD at different ages	The results of school-aged children with ASD who received EI during their preschool years are promising.	80
Green et al.²⁷27. Green J, Charman T, Pickles A, Wan M W, Elsabbagh M, Slonims V, et al. Parent-mediated intervention versus no intervention for infants at high risk of autism: a parallel, single-blind, randomised trial. Lancet Psychiatry. 2015;2(2):133-40. https://doi.org/10.1016/S2215-0366(14)00091-1 https://doi.org/https://doi.org/10.1016/...	2015	Quantitative randomized controlled trials	Intervention (n=28) Control (n=26)	Establishment of prognostic gains from different intervention programs	The specific results suggest that the intervention increased the baby’s attention to parents. Parent-mediated intervention was applied.	100
Frazier et al.²⁸28. Frazier TW, Klingemier EW, Anderson CJ, Gengoux GW, Youngstrom EA, Hardan AY. A longitudinal study of language trajectories and treatment outcomes of early intensive behavioral intervention for autism. J Autism Dev Disord. 2021;51(12):4534-50. https://doi.org/10.1007/s10803-021-04900-5 https://doi.org/https://doi.org/10.1007/...	2021	Quantitative non-randomized	Experimental (n=131)	Establishment of prognostic gains from different intervention programs	The EIBI method demonstrated significant changes in the prognosis of ASD, mainly with regard to language. More representative surveys are needed.	60
MacDonald et al.²⁹29. MacDonald R, Parry-Cruwys D, Dupere S, Ahearn W. Assessing progress and outcome of early intensive behavioral intervention for toddlers with autism. Res Dev Disabil. 2014;35(12):3632-44. https://doi.org/10.1016/j.ridd.2014.08.036 https://doi.org/https://doi.org/10.1016/...	2014	Quantitative non-randomized	Experimental (n=83) Comparison (n=58)	Establishment of prognostic gains from different intervention programs	Significant gains with EIBI, especially when applied before 24 months	60
Waters et al.³⁰30. Waters CF, Dickens MA, Thurston SW, Lu X, Smith T. Sustainability of early intensive behavioral intervention for children with autism spectrum disorder in a community setting. Behav Modif. 2020;44(1):3-26. https://doi.org/10.1177/0145445518786463 https://doi.org/https://doi.org/10.1177/...	2020	Quantitative non-randomized	Experimental (n=48) Comparison (n=46)	Establishment of prognostic gains from different intervention programs	The study demonstrates that the EIBI method is effective in community settings for children with ASD starting an intervention in different ages throughout early childhood.	100
Howard et al.³¹31. Howard JS, Stanislaw H, Green G, Sparkman CR, Cohen HG. Comparison of behavior analytic and eclectic early interventions for young children with autism after three years. Res Dev Disabil. 2014;35(12):3326-44. https://doi.org/10.1016/j.ridd.2014.08.021 https://doi.org/https://doi.org/10.1016/...	2014	Quantitative non-randomized	Experimental (n=29) Comparison (n=32)	Establishment of prognostic gains from different intervention programs	ABA therapy achieved better results than eclectic therapies.	100
Rahman et al.³²32. Rahman A, Divan G, Hamdani SU, Vajaratkar V, Taylor C, Leadbitter K, et al. Effectiveness of the parent-mediated intervention for children with autism spectrum disorder in south Asia in India and Pakistan (PASS): a randomised controlled trial. Lancet Psychiatry. 2016;3(2):128-36. https://doi.org/10.1016/S2215-0366(15)00388-0 https://doi.org/https://doi.org/10.1016/...	2016	Quantitative randomized controlled trials	Intervention (n=32) Control (n=33)	Establishment of prognostic gains from different intervention programs	Use of a tailored (parent-mediated) intervention was effective in low- and middle-income countries.	100
Perera et al.³³33. Perera H, Jeewandara KC, Seneviratne S, Guruge C. Outcome of home-based early intervention for autism in sri lanka: follow-up of a cohort and comparison with a nonintervention group. Biomed Res Int. 2016;2016:3284087. https://doi.org/10.1155/2016/3284087 https://doi.org/https://doi.org/10.1155/...	2016	Quantitative non-randomized	Experimental (n=62) Comparison (n=42)	Establishment of prognostic gains from different intervention programs	The home EI results found a statistically significant improvement between pre- and post-intervention in all measured parameters.	80
Kitzerow et al.³⁴34. Kitzerow J, Teufel K, Jensen K, Wilker C, Freitag CM. Case-control study of the low intensive autism-specific early behavioral intervention A-FFIP: outcome after one year. Z Kinder Jugendpsychiatr Psychother. 2020;48(2):103-12. https://doi.org/10.1024/1422-4917/a000661 https://doi.org/https://doi.org/10.1024/...	2020	Quantitative non-randomized	Case (n=20) Control (n=20)	Establishment of prognostic gains from different intervention programs	The low-intensity early intervention called A-FFIP was effective and brought important prognostic results.	80
Estes et al.³⁵35. Estes A, Munson J, Rogers SJ, Greenson J, Winter J, Dawson G. Long-term outcomes of early intervention in 6-year-old children with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2015;54(7):580-7. https://doi.org/10.1016/j.jaac.2015.04.005 https://doi.org/https://doi.org/10.1016/...	2015	Quantitative non-randomized	Experimental (n=24) Comparison (n=24)	Assessment of whether early intervention results are maintained over time	There is evidence that gains from early intensive intervention are maintained for at least 2 years afterwards.	100
Wei et al.³⁶36. Wei H, Li Y, Zhang Y, Luo J, Wang S, Dong Q, et al. Awareness and knowledge of autism spectrum disorder in Western China: promoting early identification and intervention. Front Psychiatry. 2022;13:970611. https://doi.org/10.3389/fpsyt.2022.970611 https://doi.org/https://doi.org/10.3389/...	2022	Quantitative non-randomized A Cross-sectional analytic study	Medical Workers (n=269) Educators (n=181) Community (n=188)	Knowledge survey about ASD in people who work or will have early contact with children with ASD	Professionals were able to recognize early signs of ASD but had an inadequate understanding of the disorder.	80
Coelho et al.³⁷37. Coelho AM, Conceição V. Predictors in ASD: the importance of parents’ perception. Front Psychiatry. 2021;12:506148. https://doi.org/10.3389/fpsyt.2021.506148 https://doi.org/https://doi.org/10.3389/...	2021	Quantitative non-randomized	Experimental (n=55)	Investigation of the development trajectory of two groups of children with ASD in search of predictive factors and adjustments for better intervention strategies	Diagnosis and early intervention are determinants of different prognoses. Parent participation is critical to the success of EI.	80
Jonsdottir et al.³⁸38. Jonsdottir SL, Saemundsen E, Gudmundsdottir S, Haraldsdottir GS, Palsdottir AH, Rafnsson V. Implementing an early detection program for autism in primary healthcare: Screening, education of healthcare professionals, referrals for diagnostic evaluation, and early intervention. Res Autism Spectr Disord. 2020;77:101616. https://doi.org/10.1016/j.rasd.2020.101616 https://doi.org/https://doi.org/10.1016/...	2020	Quantitative non-randomized	Experimental (n=1,586)	Study on screening method and its effects on final prognosis	The M-CHAT-R method was able to detect cases of underdiagnosis at 30 months of age.	60

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Correspondence:
Jackson Frederico Pires; Email: jacksonprs@uni9.edu.br.