Running Head: EFFECTS OF AGE OF AUTISM DIAGNOSIS

Effects of Age of Autism Diagnosis: How Age of Intervention Affects Outcomes

Heather Yates
HDFS 5110
The University of Georgia

EFFECTS OF AGE OF AUTISM DIAGNOSIS

INTRODUCTION
Autism is a disorder that is relatively new, and as such, research has continually built
upon itself to better understand the disorder, predict outcomes of autistic children, and
maximizes positive outcomes (Hertz-Picciotto & Delwiche 2009). Autism is defined as a
complex developmental disability that typically appears during the first three years of life.
Autism is the result of a neurological disorder that affects the normal functioning of the brain,
impacting development in the areas of social interaction and communication skills (Autism
Society, n.p.). With the recent discovery of autism only 70 years ago, one of the first known
studies of children with autism was performed by Leo Kanner, who observed the behaviors of a
small group of children, that he termed early infantile autism, the word autism being derived
from the Greek root autos, meaning self (Wing, 1997, n.p.).
Since the incidence of autism has existed for centuries, but the concept of autistic
disorder is relatively new, the treatment of the condition has changed drastically over time
(Wing, 1997). For example, in the 16th century, Martin Luther accused a boy, showing severe
symptoms of autism, of having no soul, because he was possessed by the devil. In the 20th
century, autism has received more attention, particularly around theories of development and the
existence of autism. Many of these early theories, including one that proposed that autism results
from detached and cold parents, are considered false today (Wing, 1997).
Autism was also thought to be one of the earliest forms of schizophrenia, and the two
were paired together in a journal about early research of autism called The Journal of Autism and
Childhood Schizophrenia (DeMeyer, 1974; Wing, 1997). Extensive research performed in the
1990s shaped modern beliefs about autism and debunked previous theories, making it clear that
autism is a neurodevelopmental disorder, involving basic cognitive deficits, with genetic factors

EFFECTS OF AGE OF AUTISM DIAGNOSIS

predominantly strong in etiology (Rutter, 1996, p. 257). These studies further disproved the
earlier schools of thought around parental attachment and schizophrenia as causes of autism.
Currently, the prevalence of autism is on the rise, without showing signs of plateauing
(Hertz-Picciotto & Delwiche 2009). In California alone, the incidence of autism of rose
consistently from 6.2 for 1990 births to 42.5 for 2001 births for child age 5 per 1,000 births
(Hertz-Picciotto & Delwiche 2009). Based on statistics from the Centers for Disease Control
and Prevention, the prevalence of autism nationwide has doubled from 1 of 125 births in 2004 to
an estimated 1 in 68 births in 2014 (Autism Society). Since there is no cure and no concrete
knowledge about the cause of autism, continuing research is imperative in finding evidencebased practices to treat the symptoms of autism.
Since autism was not recognized until the mid-20th century, the research has quickly built
on itself and continued to make improvements in treating symptoms associated with autism.
Treatment options include medication and a multitude of therapy and intervention options
(Autism Speaks). One of the most popular methods of treatment, is a behavioral approach, which
has been successful in increasing language, social, play, and academic skills, as well as in
reducing some of the severe behavioral problems often associated with the disorder
(Schreibman, 2000, p. 373). Typically, the behavioral approach is conducted in a school,
professional institution, or home, multiple days per week. Behavioral therapy has been shown to
be effective in improving behavior and social skills of children with autism, as demonstrated by
multiple studies in this literature review, such as Fenske (1975), Granpeesheh and colleagues
(2009), and Bauminger (2002).
This literature review will explore the use of early behavioral intervention treatment, and
how it affects the outcomes of children on the autistic spectrum. The review will take into

EFFECTS OF AGE OF AUTISM DIAGNOSIS

account the methods of the interventions, the intensity of the intervention, the age of the
participants at the time of the study, and the outcomes of the children after the study.
BEHAVIORAL INTERVENTIONS
Behavioral interventions are used to modify unwanted behaviors in autistic children and
are aimed at reducing the general level of impairment in autism (Ben-Itchak & Zachor, 2007,
p. 288). The theoretical infrastructure of behavioral intervention is founded in psychological
principles of learning human behavior (Schreibman, 2000, p. 373), which allows the
development of applications to alter behaviors. Behavioral interventions, also know as behavior
modification or applied behavior analysis (Ben-Itchak & Zachor, 2007), of autism aims to
eliminate or minimize the symptoms of autism, such as impaired communication skills, and
teach appropriate behaviors to children with autism to maximize positive outcomes in their
education and other environments (Schreibman, 2000). Examples of development that reduce
autism symptoms include: significant IQ gains, significant language gains, and improved social
behavior (Rogers, 1996). Although different behavioral interventions incorporate a range of
strategies like different curricula, settings, and methods of measuring progress, they all have
similar goals of reducing the debilitating symptoms of autism (Rogers, 1996).
Researching interventions to combat symptoms of autism are relatively new. In the
1970s, researchers were trying to understand if measuring the intelligence of a child with autism
was possible and reliable (DeMeyer et al., 1974). Researchers needed to find a reliable method of
measuring autism intelligence before finding methods to increase intelligence and functioning in
children with autism. In 1974, DeMeyer published a study showing that the IQ of children with
autism was reliably measurable using the Cattell- Binet test and Vineland Social Maturity scale.
This study also proved that an autistic childs IQ was predictable for school placement and

EFFECTS OF AGE OF AUTISM DIAGNOSIS

severity of symptoms (DeMeyer, 1974). Since DeMeyers (1974) IQ and outcome study,
researchers have moved forward in researching intervention and outcomes of autistic children.
Research, extending DeMeyers (1974) work examine how early intervention compares to late
intervention and IQ level correlate, how early intervention and school placement correlate, how
intervention intensity and outcomes correlate with reducing symptoms of autism and improving
social, language, and communication skills in children with autism.
AGE AT INTERVENTION
Following DeMeyers (1974) study, Fenske and collegues (1985) published a study that
hypothesized that autistic children who began behavioral intervention at an earlier age would
have a more positive outcome (p. 51) in school and functioning that children who began
intervention at a later age. The research conceptualizes positive outcome as living at home and
being enrolled in school full-time (Fenske et al., 1975) For this study, 18 children were placed in
an educational and treatment program at the Princeton Child Development Institute for five days
a week for 11 months (Fenske et al., 1985). Group 1 consisted of 9 children who entered the
program before the age of 60 months, and Group 2 entered the program after the age of 60
months (Fenske et al., 1985). The results show that 6 of 9 (67%) children who began the program
before age 60 months achieved positive outcome (Fenske et al., 1985). In Group 2, 1 out of 9 of
the children achieved the positive outcome of being placed in a public school, in a regular
classroom or in a special education classroom (Fenske et al., 1985). Therefore, Fenske and
colleagues (1985) study, although small scale, supports that early intervention is beneficial to
children with autism.

EFFECTS OF AGE OF AUTISM DIAGNOSIS

TREATMENT HOURS
A more recent study investigated behavioral treatment of autistic children between the
ages of 2 and 7 years of age, and measured how intensity of treatment (hours being treated) and
the age correlated with the number of behavioral objectives that the child mastered (Granpeesheh
et al., 2009). While Fenske and colleagues (1985) study focused on attaining the outcome of
being enrolled full time in public school classroom, Granpeesheh and colleagues (2009) study
focused on minimizing autism symptoms through the children attaining behavioral goals. The
results of the study showed a linear relationship between the childs age and treatment hours,
meaning an increase in treatment hours and a decrease in child age predicted an increase in the
number of mastered behavioral objectives (Granpeesheh et al., 2009, p. 1019). The age group
consisting of children age 7-12 years showed little difference in improvements based on the
number of hours the were treated (Granpeesheh et al., 2009). Therefore, similar to Fenskes
(1985) study, Granpeesheh and colleagues (2009) study demonstrated that treating autism using
behavioral intervention at an early age is more beneficial than treating it at later ages. This study
also demonstrated that early intervention plus intense, extensive treatment are optimal for
children with autism (Granpeesheh et al., 2009).
LATE INTERVENTION
The previous studies show that early intervention is more beneficial to child outcomes
than later intervention. This does not mean that late intervention is ineffective. A study was
performed in 2002 to test the effectiveness of a cognitive behavior intervention on autistic
children, ages 8 to 17, who are considered high functioning (Bauminger). The behavioral
intervention aimed to pinpoint social skills, such as emotional understanding and problem
solving skills. Baumingers (2002) research concluded that the cognitive behavioral intervention

EFFECTS OF AGE OF AUTISM DIAGNOSIS

correlated with an improvement in social skills, emotional understanding, and problem solving
skills. The study states that overall the group showed improvements and does not mention
discrepancies between the younger participants and the older participants in the study. Therefore,
this study supports that behavioral intervention in late childhood and adolescence, despite
findings by Fenske and collegaues (1985) and Granpeesheh and colleagues (2009) who argue
that early intervention is the most effective route (Bauminger, 2002).
PLACEMENT PREDICTABILITY
As previously mentioned, DeMeyers (1974) study tested the reliability of testing the
intelligence of children with autism, and used IQ to measure predictability of schooling
placement. Harris and Handleman (2000) aimed to continue DeMeyers (1974) research by
studying the effect of early intervention and IQ on the predictability of placement in school.
After the children participated in a preschool behavioral intervention program, the researchers
followed up four to six years later to evaluate the correlation between age at intervention and IQ
and a childs placement in school (Harris & Handleman, 2000). The study showed that all of the
children, but one, who entered the program before the age of 45 months were placed in regular,
public school classrooms (Harris & Handleman, 2000). Fourteen out of fifteen children who
entered the program after 50 months of age were placed in special education classrooms (Harris
& Handleman, 2000). Eleven out of fourteen children that had an IQ of 80 or higher were
included in regular classrooms (Harris & Handleman, 2000). All 13 children with an IQ of 76
and lower were placed in a special education classroom (Harris & Handleman, 2000). Although
the IQ of most children in the study increased after discharge from the study, the children who
entered the program at a younger age demonstrated a larger increase in IQ (Harris & Handleman,
2000). This study and DeMeyers (1974) study illustrate that a childs IQ is a large factor in a

EFFECTS OF AGE OF AUTISM DIAGNOSIS

childs school placement and outcomes. Harris and Handlemans (2000) study builds on
DeMeyers (1974) research to support using IQ, as a prediction for school placement, and
supports early intervention to aid in IQ development and attaining positive outcomes.
IQ AND TREATMENT INTENSITY
As mentioned by Granpeesheh and colleagues (2009) in The Effects of Age and
Treatment Intensity on Behavioral Intervention Outcomes for Children with Autism Spectrum
Disorders, there are few studies about intensity of behavioral treatment on treatment outcomes.
According to Granpeesheh and colleagues, treatment intensity is measured by the numbers of
hours of treatment per week (2009). Granpeesheh (2009) mentions that the only other study of
treatment intensity was performed by Lovaas in 1987. A group of four year olds with autism
were treated with a behavioral intervention program with the goal of helping some of the young
autistic children in the study in attaining a similar level of learning as their peers by first grade
(Lovaas, 1987). The experimental group of children received intense treatment that took place
for 40 hours per week and the control group received a minimal treatment of 10 hours or less per
week (Lovaas, 1987). The results illustrated that 47% of the children receiving the intense 40
hour treatment achieved normal intellectual and educational functioning, with normal-range IQ
scores and successful first grade performance in public schools (Lovaas, 1987) On the other
hand, in the control group, only 2% of the children (n=40) achieved normal educational and
intellectual functioning (Lovaas, 1987). Although less than half of the children (47%) from the
experimental group attained a similar learning level to their peers, the outcome for the
experimental group was stronger than the control group (2%) (Lovaas, 1987). This shows that
among autistic children of the same age, intense treatment with a high number of hours per week
correlates can be more effective than less hours of treatment (Lovaas, 1987). As mentioned

EFFECTS OF AGE OF AUTISM DIAGNOSIS

above in the comparison of late intervention and early intervention, Granpeesheh and colleagues
(2009) investigates how treatment hours differ between a group of younger children, and a group
of older children participating in the intervention. Granpeeshehs (2009) study demonstrates how
research on autism and behavioral intervention has built upon itself and expanded within the last
fifty years. Lovaas (1987) research laid the infrastructure for research examining intervention
intensity, and Granpeesheh and colleagues (2009) extended the research, by adding the variable
of age to the effects of treatment intensity.
DISCUSSION, IMPLICATIONS, AND CONCLUSION
The studies reviewed in this paper indicate the progress being made in the field of autism
research. The earliest study reviewed in this paper question the testability of an autistic childs IQ
in DeMeyer and collegues (1974) study to researching the implications of treatment intensity on
the mastery of behavioral goals and decreasing symptoms of autism in Granpeesheh and
collegues (2009) study. When questioning the implications of these studies, it is important to
review the reliability and generalizability of the studies. Most of the researchers, such as Fenske
(1985), Granspeesheh (2009), Harris and Handleman (2000), and Lovaas (1987) support
beginning behavioral intervention of autism at an early age. When considering the
generalizability of the studies, it is important to consider the sample size. Fenskes (1985) study
included 18 participants. This sample is not representative of the number of children along the
autistic spectrum. But, Granpeeshehs study included 245 children with autism, which can
increase the generalizability of the findings to the population of children with autism (2009).
Baumingers study defies studies that support the detrimental effects of behavioral intervention
after early childhood, but only includes 15 participants (2002). Being a small-scale study and one
of few studies of adolescent intervention, the findings are unreliable and not generalizable

EFFECTS OF AGE OF AUTISM DIAGNOSIS

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enough to compete against the support of behavioral intervention in early childhood. Also,
although some studies support starting behavioral intervention at an early age, the results are not
overwhelmingly positive. In Fenskes study, 66% of the children who received treatment before
age 5 achieved the positive outcome of being enrolled full time in a public school (1985). This
can bring into question whether such an early intervention truly makes the difference. Therefore,
more studies and larger scale studies should be performed about early intervention to investigate
the effectiveness and reliability of early intervention.
Each study that I reviewed consisted of quantitative research that focused on statistical
outcomes of intervention and number of children who achieved the researchers concept of
positive outcomes. Although the studies are small scale, like Fenskes (1985) and Baumingers
(2002), the information is collected through quantitative methods. I think it is necessary to
compose more qualitative studies about autism intervention, such as interviewing the autistic
children who received treatment. It is important to understand how the child feels about their
progress, outcomes, and opinions of the treatment, or even interviewing a family about how the
treatment has affected interactions with their child. A mixed methods approach would be useful
for researchers interested in investigating the effectiveness of a behavioral intervention treatment
program and are also interested in the childs opinions and feelings about the treatment and their
personal outcomes. The research of autism has covered much ground in the short time that
autism has been researched, but research must be continued and expanded. Researchers should
continue to broaden the field of studies pertaining to autism, including expanding to larger scale
studies and using qualitative and mixed methods approaches to gain optimal data about the
participants.

EFFECTS OF AGE OF AUTISM DIAGNOSIS

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From being coined a devil possession and childhood schizophrenia to being defined as
it is today: a neurodevelopmental disorder, researchers have gained extensive knowledge about
the implications, symptoms, and outcomes of autism spectrum disorder (Wing, 1997). Autism,
treatment, and effects are becoming increasingly researched with the rising prevalence of autism.
Studies, such as the research reviewed in this paper, tend to emphasize the importance of
behavioral intervention at an early age. Factors to be noted, along with the importance of early
age, include a childs IQ and intensity of treatment. These factors play into the effects of
behavioral treatment, which increase language, social, play, and academic skills (Schreibman,
2000, p. 373) and reducing the common symptoms associated with autism. Behavioral methods
and interventions are one of the most popular treatments of autism spectrum disorders, so it is
important to continue research about how to tailor intervention methods to be most beneficial to
children with autism.

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