Improvement of Autism Symptoms After Comprehensive Intensive Early Interventions in Community Settings.
Community NDBI in Sweden modestly lowered autism severity scores for preschoolers versus usual services.
01Research in Context
What this study did
Researchers in southern Sweden gave preschoolers with autism a community-run program called NDBI. The kids got naturalistic teaching all day in daycare and at home for about a year.
A comparison group stayed in the usual city services. The team scored autism severity with the ADOS-R before and after.
What they found
Kids in the NDBI group showed a small but real drop in ADOS-R total scores. The usual-care group stayed flat.
The change was modest, yet it reached statistical significance.
How this fits with other research
Vinen et al. (2018) followed the same region's kids to school age. They saw cognitive gains no matter which community program was used, but repetitive behaviors rose. The new study zooms in on preschool autism severity and finds a specific NDBI edge.
Spjut Jansson et al. (2016) looks like a contradiction. They saw no difference in adaptive skills between ABA-based and eclectic community services after two years. The key difference: they tracked adaptive living skills, while Haglund et al. tracked autism symptom severity. Measure change, not label, explains the split.
Chiang et al. (2023) extends the story. They ran a lighter dose of the Early Start Denver Model in Taiwan hospitals and still saw short-term gains, but the effect faded when sessions stopped. Together the papers say community NDBI works, yet you may need booster contact to keep the benefit.
Why it matters
If you work in a public preschool or clinic, you can tell funders that everyday NDBI delivered by existing staff already shows measurable symptom reduction. Pair this with the fade-out warning from Taiwan and plan follow-up sessions or parent coaching after the first year. You do not need a university lab to beat treatment as usual, but you do need a maintenance plan.
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02At a glance
03Original abstract
Preschool children with autism in southern Sweden participated in a comprehensive Naturalistic Developmental Behavioral Intervention (NDBI) program. To evaluate the ongoing NDBI program by comparing the pre- and postintervention outcomes in terms of improved autism symptom severity. The improvement of Autism Diagnostic Observation Schedule (ADOS-R) test results between baseline and evaluation among children participating in the NDBI program (n = 67) was compared with the results among children receiving community treatment as usual (n = 27) using analysis of covariance. The study showed that children in the NDBI group improved their ADOS-R total scores between baseline and evaluation (−0.8 scores per year; 95% CI [−1.2, −0.4]), whereas no improvement was detected in the comparison group (+0.1 scores per year; 95% CI [−0.7, +0.9]). The change in the NDBI group versus the change in the comparison group was statistically significant after adjusting for possible confounders as well. Children in the NDBI group also significantly improved their ADOS severity scores, but the scores were not significantly different from those of the comparison group. The results from the current naturalistic study must be interpreted cautiously, but they do support earlier studies reporting on improvement of autism symptoms after early intensive interventions. Results from observational studies are difficult to interpret, but it is nevertheless of uttermost importance to evaluate costly autism intervention programs. The results do indicate that children with autism benefit from participating in early comprehensive intensive programs.
Journal of the American Psychiatric Nurses Association, 2020 · doi:10.1177/1078390320915257