Cochrane review finds weak evidence for early intensive behavioural intervention for autism spectrum disorders

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Early intensive behavioural intervention (EIBI) involves 20-40 hours of individualised instruction each week for children with autism. The therapy usually begins at age 4 or younger and continues for 2-3 years.  The technique was pioneered by Dr. Ivar Lovaas and colleagues in the 1970s.

A new systematic review from the Cochrane Developmental, Psychosocial and Learning Problems Group looks at the evidence for the effectiveness of EIBI in increasing the functional behaviours and skills of young children with autism spectrum disorders (ASD).

The evidence in this field is not as strong as we would like, which is why the reviewers decided to include a range of different study types in their review:

  • Randomised control trials (RCTs)
  • Quasi-randomised control trials
  • Clinical control trials (CCTs) in which EIBI was compared to a no-treatment or treatment-as-usual control condition

The systematic search conducted by the reviewers found 1 RCT and 4 CCTs with a total of just 201 participants. All studies had a treatment-as-usual comparison group.

The results of the CCTs were synthesised using a random-effects model of meta-analysis of the standardised mean differences.

Here’s what they found:

  • The mean effect size for adaptive behaviour was g = 0.69 (95% CI 0.38 to 1.01; P < 0.0001)
  • The mean effect size for IQ was g = 0.76 (95% CI 0.40 to 1.11; P < 0.0001). Three measures of communication and language skills all showed results in favour of EIBI:
    • Expressive language g = 0.50 (95% CI 0.05 to 0.95; P = 0.03)
    • Receptive language g = 0.57 (95% CI 0.20 to 0.94; P = .03)
    • Daily communication skills g = 0.74 (95% CI 0.30 to 1.18; P = 0.0009)
  • The mean effect size for socialisation was g = 0.42 (95% CI 0.11 to 0.73; P = 0.0008)
  • The mean effect size for daily living skills was g = 0.55 (95% CI 0.24 to 0.87; P = 0.0005)

The reviewers concluded:

There is some evidence that EIBI is an effective behavioural treatment for some children with ASD. However, the current state of the evidence is limited because of the reliance on data from non-randomised studies (CCTs) due to the lack of RCTs. Additional studies using RCT research designs are needed to make stronger conclusions about the effects of EIBI for children with ASD.

Link

Reichow B, Barton EE, Boyd BA, Hume K. Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD009260. DOI: 10.1002/14651858.CD009260.pub2.

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Andre Tomlin

Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol with his wife, dog and three little elflings.

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