September 2009—Through the support of a $1.85 million grant from the National Institute of Mental Health (NIMH), Richard Solomon, MD, is conducting a three-year study of The Play and Language for Autistic Youngsters (P.L.A.Y.) Project Home Consulting model, a parent-training program that addresses the need for intensive early intervention for young children on the autism spectrum.
Today, approximately one in every 150 children is diagnosed with an autistic spectrum disorder. As the fastest growing disability in the U.S., autism continues to gain public attention, yet there is a national shortage of personnel trained in intensive approaches as recommended by the National Academy of Sciences (NAS). The P.L.A.Y. Project addresses this shortage by using a ‘train the trainer’ approach, which promotes rapid dissemination of the program.
Developed by Dr. Solomon, P.L.A.Y. is a practical, family-friendly application of renowned child psychiatrist Dr. Stanley Greenspan’s Developmental, Individual-differences, Relationship-based (DIR) framework, popularly known as Floortime. Through structured monthly home visits focused on modeling, coaching and video feedback, consultants train parents to engage their child with autism in ways that promote emotional connection and communication. By training parents to participate in their child’s intervention, the program also promises to be cost-effective. The P.L.A.Y. Project costs under $4,000 per year, in comparison with other interventions that cost $40,000 to $60,000 per year.
Details of the study: With research-design guidance from Michigan State University, and community-outreach support from Easter Seals, The P.L.A.Y. Project is conducting a randomized, controlled, and blinded clinical trial. Drawing participants from five Easter Seals autism service locations, the study compares the outcomes of 60 children who participate in The P.L.A.Y. Project with the outcomes of 60 children who receive standard, community interventions, making it the largest study of its kind. Before and after the 12-month intervention, each child is assessed with a battery of tests to measure developmental level, speech and language, sensory-motor profile, and social skills.
“Preliminary research and early dissemination into community agencies, schools and hospitals around the world has demonstrated the effectiveness of our model,” said Dr. Solomon, medical director of The P.L.A.Y. Project. “Positive research outcomes would support efforts to encourage private insurers and government agencies to approve increases in funding for play-based autism intensive intervention services and ultimately, help children with autism become more engaged with the world around them.”
The development of a reliable, cost-effective form of intensive intervention for the treatment of children with autistic spectrum disorders (ASD) is a major priority for both the health and education systems in this country. A large majority of states do not provide such interventions because there is a national shortage of trained personnel and also because such interventions, when provided by professionals, are very expensive ($25-60K). The most recent prevalence estimate for ASD from the CDC is 1 in 150 children. We have developed an innovative train-the-trainer solution to potentially address this national need. The P.L.A.Y. Project (Play and Language for Autistic Youngsters) Home Consultation model can quickly and effectively train masters level child development experts to train parents at home for one-tenth the cost ($4K) of having professionals providing intensive services in accordance with recommendations of the National Academy of Sciences. Using Greenspan’s DIR/developmental framework, and a highly-structured educational approach including video feedback, home consultants train parents how to be their child’s best play partner. This makes sense because not only does every parent want a better relationship with his or her child, but they have the strongest commitment to help their children and can provide the hours needed. We have preliminary clinical evidence from a pilot study to show that this model is promising. Furthermore, in the Phase I SBIR controlled study just completed, 2 intervention and 2 control sites each enrolled 20 children with ASD. In close partnership with Easter Seals and Michigan State University, the grant successfully piloted the procedures needed for execution of the Phase II trial. The results of the controlled study, despite small numbers and brief intervention, were encouraging. Parents learned the methods of The PLAY Project and children in the intervention group showed major improvements. Early dissemination of the model into the real world settings of community agencies, schools, and hospitals has also been successfully accomplished. Our hypothesis for the next clinical trial is that the parent-training intervention model can improve functional outcomes for young children with autism. We expect that a successful trial would encourage private insurers and government agencies to approve major increases in funding for autism intensive intervention services, resulting in wide dissemination of this model, substantial growth in our business, and significant social benefit.
Emerging research strongly suggests that child centered, relationship based intervention is very effective in helping young children with autistic spectrum disorders gain language and social skills. Below is a list of the most recent research evidence including Dr. Solomon’s findings based on the PLAY Project’s Home Consulting model (see Abstract or download the full length article [PDF]).
