Early Intervention Issues in Autism Spectrum Disorders

Abstract

The pediatrician’s role in chronic management of Autism Spectrum Disorders (ASDs) is now recognized [1]. However, pediatricians and other primary care physicians typically receive little training in long-term behavioral interventions appropriate for these patients, an important medical home issue given that parents seek treatment advice from their child’s doctor. The target audience of this paper includes both physicians caring for children with ASDs and parents who wish to share this ASD behavioral treatment perspective with their child’s doctor. There are more than 25 states that have legally mandated that children with autism receive Early Intensive Behavioral Intervention (EIBI) as per the National Conference of State Legislatures [2]. The necessity of such legislation stems from difficulties families have had historically in obtaining evidence-based EIBI for their children with ASD, an important public health issue [1]. There is growing concern among physicians and families about how to improve the “medical home” for children with autism. Several helpful resources have been developed, yet are limited in addressing complex EIBI issues for physicians, who under new state laws noted above now have the responsibility for authorizing behavioral care such as EIBI. However, most physicians have limited training on behavioral services, especially EIBI. Families typically seek their pediatrician’s recommendations on what interventions to pursue and how to find them. Additionally, funders such as insurers may require referral and progress-monitoring from physicians. Of early intervention services, EIBI is one approach that has generated great interest and is the focus of this review manuscript. In an effort to improve access to evidence-based treatment for autism and inform physicians and parents of children with ASD on treatment options, this article provides an overview of: a) essential components of EIBI, b) EIBI empirical literature and critical analyses; c) common misconceptions about behavioral interventions; and d) critical issues that affect patients’ access to EIBI. Bringing EIBI into the medical home is then summarized to highlight the importance of continuing medical education for physicians on treatment of children with ASDs in order to recognize the public health benefits of evidence-based approaches such as EIBI.