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.