Koegel Lynn Kern, Koegel Robert L, Ashbaugh Kristen, Bradshaw Jessica
University of California , Santa Barbara, CA , USA.
Int J Speech Lang Pathol. 2014 Feb;16(1):50-6. doi: 10.3109/17549507.2013.861511. Epub 2013 Dec 11.
There has been a dramatic rise in the number of children being diagnosed with autism spectrum disorders (ASD), which has led to increased attention paid to assessment and intervention issues. This manuscript agrees with Camarata (2014) that the evidence base for early assessment and intervention should be expanded. However, it disagrees with Warren et al.'s (2011) assumption that there are not empirically validated early interventions. Reliable diagnosis has been documented during infancy and toddlerhood, and evidence suggests that the earlier the onset of intervention, the greater likelihood of an improved developmental trajectory. It is argued that early intervention is more cost and time efficient than a "wait and see" approach. With regard to published studies, the large amount of heterogeneity in the ASD population supports the use of rigorous single case experimental design research. It is an error to limit empirical evidence for treatments to only randomized clinical trials, which have the weakness of masking individual differences. Single case experimental designs examine the effects of intervention beyond typical maturation by allowing for clear estimations of developmental trajectories prior to the onset of intervention, followed by evaluation of the impact of the intervention. This commentary discusses the short- and long-term benefits of early diagnosis and intervention.
被诊断患有自闭症谱系障碍(ASD)的儿童数量急剧上升,这使得人们对评估和干预问题的关注度增加。本手稿认同卡马拉塔(2014年)的观点,即早期评估和干预的证据基础应予以扩大。然而,它不同意沃伦等人(2011年)的假设,即不存在经过实证验证的早期干预措施。可靠的诊断在婴儿期和幼儿期就有记录,而且有证据表明,干预开始得越早,发育轨迹改善的可能性就越大。有人认为,早期干预比“观望”方法更具成本效益和时间效益。关于已发表的研究,ASD人群中大量的异质性支持采用严格的单病例实验设计研究。将治疗的实证证据仅局限于随机临床试验是错误的,因为随机临床试验存在掩盖个体差异的缺点。单病例实验设计通过在干预开始前对发育轨迹进行清晰的估计,然后评估干预的影响,来研究干预对典型成熟过程之外的效果。本评论讨论了早期诊断和干预的短期和长期益处。