The purpose of this study was to pilot test the effects of a culturally adapted early intervention influenced by the Early Start Denver Model (ESDM) on reduction of autism symptoms and severity categorization for young children with autism spectrum disorders in China. Participants were randomly assigned to either the control or intervention groups. The children’s age ranged from 24 to 60 months in this study. Children in the control group (n = 20) received eclectic intervention services for a minimum of 2 hr per day, 10 hr per week, while children in the intervention group (n = 16) received the culturally adapted intervention 1 hr per day, 5 hr per week, plus 5 hr per week of the same services as the control group for a total of 8 weeks. After 8 weeks, children in the intervention group demonstrated a significant decrease in autism symptoms and improved severity categorization, compared with children in the control group. Future studies and implications of the culturally adapted early intervention in China are discussed.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
ChlebowskiC.GreenJ. A.BartonM. L.FeinD. (2010). Using the Childhood Autism Rating Scale to diagnose autism spectrum disorders. Journal of Autism and Developmental Disorders, 40, 787-799. doi:10.1007/s10803-009-0926-x
4.
ClarkE.ZhouZ. (2005). Autism in China: From acupuncture to applied behavior analysis. Psychology in the Schools, 42, 285-295. doi:10.1002/pits.20079
5.
CohenJ. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.
6.
ColombiC.NarzisiA.RutaL.CigalaV.GaglianoA.PioggiaG.. . . MuratoriF. (2016). Implementation of the Early Start Denver Model in an Italian community. Autism. Advance online publication. doi:10.1177/1362361316665792
7.
DawsonG.RogersS.MunsonJ.SmithM.WinterJ.GreensonJ.. . . VarleyJ. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125(1), e17-e23. doi:10.1542/peds.2009-0958
8.
DivanG.HamdaniS. U.VajartkarV.MinhasA.TaylorC.AldredC.. . . PatelV. (2015). Adapting an evidence-based intervention for autism spectrum disorder for scaling up in resource-constrained settings: The development of the PASS intervention in South Asia. Global Health Action, 8, Article 27278. doi:10.3402/gha.v8.27278
9.
EapenV.CrncecR.WalterA. (2013). Clinical outcomes of an early intervention program for preschool children with autism spectrum disorder in a community group setting. BMC Pediatrics, 13, Article 3.
10.
EikesethS.SmithT.JahrE.EldevikS. (2002). Intensive behavioral treatment at school for 4- to 7-year-old children with autism: A 1-year comparison controlled study. Behavior Modification, 26, 49-68.
11.
EstesA.MunsonJ.RogersS. J.GreensonJ.WinterJ.DawsonG. (2015). Long-term outcomes of early intervention in 6-year-old children with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 54, 580-587. doi:10.1016/j.jaac.2015.04.005
12.
EstesA.VismaraL.MercadoC.FitzpatrickA.ElderL.GreensonJ.. . . RogersS. (2014). The impact of parent-delivered intervention on parents of very young children with autism. Journal of Autism and Developmental Disorders, 44, 353-365.
13.
FultonE.EapenV.CrnčecR.WalterA.RogersS. (2014). Reducing maladaptive behaviors in preschool-aged children with autism spectrum disorder using the Early Start Denver Model. Frontiers in Pediatrics, 2, Article 40. doi:10.3389/fped.2014.00040
14.
GranpeeshehD.DixonD. R.TarboxJ.KaplanA. M.WilkeA. E. (2009). The effects of age and treatment intensity on behavioral intervention outcomes for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 3, 1014-1022. doi:10.1016/j.rasd.2009.06.007
15.
GranpeeshehD.TarboxJ.DixonD. R. (2009). Applied behavior analytic interventions for children with autism: A description and review of treatment research. Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists, 21, 162-173.
16.
Heep Hong Society. (2009). Zi bi zheng er tong xin li xue jiao yu ping he- di san ban [Psychoeducational Profile–3rd edition: TEACCH individualized psychoeducational assessment for children with autism spectrum disorders]. Hong Kong, China: The Commercial Press.
17.
HuangA. X.JiaM.WheelerJ. J. (2013). Children with autism in the People’s Republic of China: Diagnosis, legal issues, and educational services. Journal of Autism and Developmental Disorders, 43, 1991-2001. doi:10.1007/s10803-012-1722-6
18.
KhanN. Z.GalloL. A.ArghirA.BudisteanuB.BudisteanuM.DobrescuI.. . . ElsabbaghM. (2012). Autism and the grand challenges in global mental health. Autism Research, 5, 156-159. doi:10.1002/aur.1239
19.
KoegelL. K.KoegelR. L.AshbaughK.BradshawJ. (2014). The importance of early identification and intervention for children with or at risk for autism spectrum disorders. International Journal of Speech-Language Pathology, 16, 50-56. doi:10.3109/17549507.2013.861511
20.
LiJ. H.ZhongJ. M.CaiL. Y.ChenY.ZhouM. Z. (2005). Er tong gu du zheng ping guliang biao de lin chuang ying yong yan jiu [The clinical applications of the Childhood Autism Rating Scale]. Zhong Guo Er Tong Bao Jian Za Zhi, 13, 267-268.
21.
LiuJ.MaH.HeY.-L.XieB.XuY.-F.TangH.-Y.. . . YuX. (2011). Mental health system in China: History, recent service reform and future challenges. World Psychiatry, 10, 210-216.
22.
LovaasO. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.
23.
LuJ. P.YangZ. W.ShuM. Y.SuL. Y. (2004). Er tong gu du zheng liang biao ping ding de xin du xiao du fen xi [Reliability and validity analysis of the Childhood Autism Rating Scale]. Zhong Guo Xian Dai Yi Xue Za Zhi, 14, 119-123.
24.
MatsonM. L.MahanS.MatsonJ. L. (2009). Parent training: A review of methods for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 3, 868-875. doi:10.1016/j.rasd.2009.02.003
25.
MorrisS. B.DeShonR. P. (2002). Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychological Methods, 7, 105-125. doi:10.1037/1082-989X.7.1.105
26.
National Research Council. (2001). Educating children with autism. Washington, DC: National Academies Press. Retrieved from http://www.nap.edu/catalog/10017
27.
OuJ.-J.ShiL.-J.XunG.-L.ChenC.WuR.-R.LuoX.-R.. . . ZhaoJ.-P. (2015). Employment and financial burden of families with preschool children diagnosed with autism spectrum disorders in urban China: Results from a descriptive study. BMC Psychiatry, 15, Article 3. doi:10.1186/s12888-015-0382-4
28.
PennerM.RayarM.BashirN.RobertsS. W.Hancock-HowardR. L.CoyteP. C. (2015). Cost-effectiveness analysis comparing pre-diagnosis Autism Spectrum Disorder (ASD)-targeted intervention with Ontario’s autism intervention program. Journal of Autism and Developmental Disorders, 45, 2833-2847. doi:10.1007/s10803-015-2447-0
29.
RogersS. J.DawsonG. (2010). Early Start Denver Model for young children with autism: Promoting language, learning, and engagement. New York, NY: Guilford Press.
30.
RogersS. J.DawsonG.VismaraL. A. (2012). An early start for your child with autism: Using everyday activities to help kids connect, communicate, and learn. New York, NY: Guilford Press.
31.
RogersS. J.EstesA.LordC.VismaraL.WinterJ.FitzpatrickA.. . . DawsonG. (2012). Effects of a brief Early Start Denver Model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 1052-1065. doi:10.1016/j.jaac.2012.08.003
32.
SallowsG. O.GraupnerT. D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal of Mental Retardation, 110, 417-438. doi:10.1352/0895-8017(2005)110[417:IBTFCW]2.0.CO;2
33.
SchoplerE.LansingM. D.ReichlerR. J.MarcusL. M. (2005). Psychoeducational profile: TEACCH individualized psychoeducational assessment for children with autism spectrum disorders (3rd ed.). Austin, TX: Pro-Ed.
34.
SchoplerE.ReichlerR. J.RennerB. R. (2002). The Childhood Autism Rating Scale (CARS). Los Angeles, CA: Western Psychological Services.
35.
SchreibmanL.DawsonG.StahmerA. C.LandaR.RogersS. J.McGeeG. G.. . . HalladayA. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 2411-2428. doi:10.1007/s10803-015-2407-8
36.
ShekD. T. L.YuL. (2014). Construct validity of the Chinese version of the Psycho-Educational Profile–3rd Edition (CPEP-3). Journal of Autism and Developmental Disorders, 44, 2832-2843. doi:10.1007/s10803-014-2143-5
37.
ShekD. T. L.YuL. (2015). Psychological properties of the Chinese version of the Psychoeducational Profile–Third edition-Caregiver Report. Journal of Intellectual and Developmental Disability, 40, 321-329.
38.
SunX.AllisonC.AuyeungB.MatthewsF. E.Baron-CohenS.BrayneC. (2013). Service provision for autism in mainland China: Preliminary mapping of service pathways. Social Science & Medicine, 98, 87-94. doi:10.1016/j.socscimed.2013.08.016
39.
SunX.AllisonC.MatthewsF. E.SharpS. J.AuyeungB.Baron-CohenS.BrayneC. (2013). Prevalence of autism in mainland China, Hong Kong and Taiwan: A systematic review and meta-analysis. Molecular Autism, 4(7), Article 7. doi:10.1186/2040-2392-4-7
40.
VismaraL. A.ColombiC.RogersS. J. (2009). Can one hour per week of therapy lead to lasting changes in young children with autism?Autism, 13, 93-115. doi:10.1177/1362361307098516
41.
VismaraL. A.McCormickC. E. B.WagnerA. L.MonluxK.NadhanA.YoungG. S. (2016). Telehealth parent training in the Early Start Denver Model: Results from a randomized controlled study. Focus on Autism and Other Developmental Disabilities. Advance online publication. doi:10.1177/1088357616651064
42.
VismaraL. A.RogersS. (2008). The Early Start Denver Model: A case study of an innovative practice. Journal of Early Intervention, 31, 91-108. doi:10.1177/1053815108325578
43.
VismaraL. A.YoungG.RogersS. (2013). Community dissemination of the Early Start Denver Model: Implications for science and practice. Topics in Early Childhood Special Education, 32, 223-233. doi:10.1177/0271121411409250
44.
VismaraL. A.YoungG. S.RogersS. J.VismaraL. A.YoungG. S.RogersS. J. (2012). Telehealth for expanding the reach of early autism training to parents. Autism Research and Treatment, Article 121878. doi:10.1155/2012/121878
45.
VivantiG.DissanayakeC.Victorian ASELCC Team. (2016). Outcome for children receiving the Early Start Denver Model before and after 48 months. Journal of Autism and Developmental Disorders, 46, 2441-2449. doi:10.1007/s10803-016-2777-6
46.
VivantiG.DissanayakeC.ZierhutC.RogersS. (2013). Brief report: Predictors of outcomes in the Early Start Denver Model delivered in a group setting. Journal of Autism and Developmental Disorders, 43, 1717-1724. doi:10.1007/s10803-012-1705-7
47.
VivantiG.PaynterJ.DuncanE.FothergillH.DissanayakeC.RogersS.Victorian ASELCC Team. (2014). Effectiveness and feasibility of the Early Start Denver Model implemented in a group-based community childcare setting. Journal of Autism and Developmental Disorders, 44, 3140-3153. doi:10.1007/s10803-014-2168-9
48.
WaddingtonH.van der MeerL.SigafoosJ. (2016). Effectiveness of the Early Start Denver Model: A systematic review. Review Journal of Autism and Developmental Disorders, 32, 93-106. doi:10.1007/s40489-015-0068-3
49.
WangJ.ZhouX.XiaW.SunC.-H.WuL.-J.WangJ.-L.TomodaA. (2012). Parent-reported health care expenditures associated with autism spectrum disorders in Heilongjiang province, China. BMC Health Services Research, 12, Article 7. doi:10.1186/1472-6963-12-7
50.
WongC.OdomS. L.HumeK. A.CoxA. W.FettigA.KucharczykS.. . . SchultzT. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45, 1951-1966. doi:10.1007/s10803-014-2351-z
51.
WongV. C. N.HuiS. L. H. (2008). Epidemiological study of autism spectrum disorder in China. Journal of Child Neurology, 23, 67-72. doi:10.1177/0883073807308702
