Richard Solomon, Jonathan W Necheles, Courtney Ferch and David Bruckman.
Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.
Autistic spectrum disorders (ASD) are increasing dramatically. The National Academy of Sciences recommends individualized, comprehensive, and intensive therapies yet such interventions are not readily available. The Michigan PLAY Project Home Consultation (PPHC) program which trains parents of children with ASD appears to be a cost effective, clinically efficacious and replicable intervention program.
To present the program evaluation results for the first year’s pilot of 74 PPHC program families.
74 sequentially referred young children (ages 18m-6y) diagnosed with ASD, participated in the PPHC program. Home consultants trained parents through structured monthly home visits to use social-pragmatic (play and language-based) methods of intervention. Parents were encouraged to deliver a minimum of 15 hours per week of 1:1 interaction. Video measures by blind raters before and after intervention documented children’s functional developmental gains and parents’ interactional skills. Clinical and standardized measures of autism severity, and parent satisfaction were also obtained before and after the first year of intervention.
68 of 74 children completed the 8-12 month program. Average age was 3.7 years. Most parents had some college education. Pre/post ratings of videotapes by blind raters using the Functional Emotional Assessment Scale (FEAS) showed significant increases (p < 0.0001) in Child Sub-scale scores. Translated clinically, 45.5% of children made good to very good functional developmental progress. Based on home consultants clinical ratings 66 % showed significant (p < 0.001) progress. Low fidelity (fewer hours) of intervention yielded a trend toward poorer outcomes (p=0.09). Pre/post ratings of FEAS Parent Sub-scale score of parent's abilities to interact contingently with the autistic children showed no statistical differences. Satisfaction with home consulting services showed an overall satisfaction rate of 90%. Average cost of intervention was $3500/year.
Nearly half the children participating in the PPHC program made good to excellent progress in the first year of intervention. Parents have the interaction skills necessary to effectively engage their autistic children. More hours of intervention resulted in improved outcomes. The PLAY Project Home Consulting program shows promise as a cost-effective intervention for young children with autism.
