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Feasibility and Outcomes of the Early Start Denver Model Implemented with Low Intensity in a Community Setting in Austria

Holzinger, Daniel PhD*,†,‡; Laister, Dominik MA*,†; Vivanti, Giacomo PhD§,‖; Barbaresi, William Joseph MD; Fellinger, Johannes MD*,†,**

Journal of Developmental & Behavioral Pediatrics: June 2019 - Volume 40 - Issue 5 - p 354–363
doi: 10.1097/DBP.0000000000000675
Original Article

Objective: To investigate the feasibility and effectiveness of early autism intervention with the Early Start Denver Model (ESDM) implemented with low intensity in a community service in Europe.

Methods: Subjects were boys (n = 13, ages 34–54 months, mean age 43.3 months) consecutively diagnosed with autism spectrum disorder in a regional autism center in Austria. The subjects either received the ESDM intervention for 4.6 hours weekly over 12 months (n = 7) or intervention as usual (n = 6). Feasibility of the ESDM intervention was evaluated by parent and teacher questionnaires, ESDM fidelity measures, and therapists' feedback. Developmental status was assessed through standardized instruments (Mullen Scales of Early Learning [MSEL], Vineland Adaptive Behavior Scales Second Edition, Communicative Development Inventory, Pervasive Developmental Disorder Behavior Inventory [PDDBI], Parenting Sense of Competence Scale) at baseline and after intervention.

Results: The ESDM intervention was delivered with high fidelity (>80%) by a newly trained multiprofessional team. Acceptability by parents was rated as high. The ESDM was considered to be compatible with both family and preschool routines without any major adaptations. The ESDM group showed a trend toward improved receptive language (MSEL receptive language; p = 0.09, effect size [ES] = 0.72) and reduction in parent-reported core autism symptoms (PDDBI Autism Composite Score; p = 0.04; ES = 0.95). No such improvement was noted in the control group.

Conclusion: Low-intensity implementation of the ESDM in a non–English-speaking community service context is feasible. Although outcomes from this small feasibility study should be interpreted with caution, our findings suggest a more favorable response to the ESDM intervention group compared with the control group.

*Hospital of St. John of God, Institute of Neurology of Senses and Language, Linz, Austria;

Research Institute for Developmental Medicine, Johannes Kepler University, Linz, Austria;

Institute of Linguistics, University of Graz, Graz, Austria;

§Early Detection & Intervention Program, AJ Drexel Autism Institute, Drexel University, Philadelphia, PA;

Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia;

Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA;

**Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria.

Address for reprints: Daniel Holzinger, PhD, Hospital of St. John of God, Seilerstaette 2, 4021 Linz, Austria; e-mail:

The study was funded by Hauptverband der österreichischen Sozialversicherungsträger (Grant number 999020098009).

Disclosure: The authors declare no conflict of interest.

Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

The study protocol was approved by the Hospital's Ethics Committee (April 23, 2014).

Informed consent: Parents of all children included in the study gave written consent for their and their child's participation in the study and for use of their anonymized data for analysis.

Received July 20, 2018

Accepted March 01, 2019

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