Quality and efficacy of early intensive autism intervention : a matter of trust, knowledge, and supervision?

In contrast to previous research, mainly focusing on child characteristics and on quantity of treatment as essential moderating and predicting outcome factors of Early Intensive Behavioral Intervention (EIBI), the overall aim of this thesis was to examine the importance of different aspects of quality of EIBI when conducted in a community setting.

In Study 1, EIBI knowledge and allegiance levels among supervisors, supervised preschool staff, non-supervised preschool staff, school staff and parents were examined through an online survey (N=294). We found that EIBI supervisors showed significantly higher knowledge and allegiance than all other groups in the study. EIBI supervised preschool staff had higher levels of knowledge than preschool staff in general but were not more allegiant to the treatment. The results highlight the impact of supervision as a means to increase knowledge among preschool staff and particularly the importance of addressing ethical questions and evidence based practices in order to arbitrate potential misconceptions and negative attitudes. Moreover, the markedly low levels of prerequisite knowledge among preschool staff probably hampers the EIBI quality at the onset of a child’s program and could be rectified by adding components of Applied Behavior Analysis methods and procedures to educational curricula.

In Study 2, we conducted the first validation of the York Measure of Quality of Intensive Behavioural Intervention (YMQI) in a non-Anglo-Saxon country. In our evaluation of 97 video-recorded sequences in a sample of 34 preschool children, the YMQI demonstrated moderate to excellent psychometric properties. We concluded that the YMQI showed feasibility when used in a community setting, but noted that the manual would benefit from some clarifications and modifications.

In Study 3, we investigated whether supervision, enriched with information from the YMQI assessment together with a workshop focusing on quality factors would increase delivered EIBI quality compared to regular supervision. We found that the enriched supervision group improved significantly on overall quality as well as specifically on quality variables concerning organization and planning together with the intensity of teaching, which indicates an increased awareness of the intention of the program as well as the trainer role. We conclude that standard clinical supervision would benefit from including an evaluation of video clips of preschool training sessions and additional relevant quality factors, such as programming and intensity of supervision along with formal education of both supervisors and trainers.

In Study 4, the predictive power of EIBI quality on treatment outcome after a period of 4 to 6 months was examined in a community setting. Multinomial logistic regression showed that overall quality predicted global outcome, and especially basic language and learning skills as well as global functioning. Specific quality factors of predictive value were organization, teaching level, generalization and differential reinforcement. These findings endorse the importance of EIBI quality assurance for treatment success.

List of scientific papers

I. Långh, U., Hammar, M., Klintwall, L., & Bölte, S. (2016). Allegiance and knowledge level of professionals working with early intensive behavioural intervention in autism. Early Intervention in Psychiatry. 2017 Oct;11(5):444-450.
https://doi.org/10.1111/eip.12335

II. Långh, U., Cauvet, E., Hammar, M., & Bölte, S. (2017). Cross-Cultural Validation of the York Measure of Quality of Intensive Behavioural Intervention (YMQI). Behavior Modification. 2017 Jul 1: 145445517719397.
https://doi.org/10.1177/0145445517719397

III. Långh, U., Cauvet, E., Perry, A., Eikeseth, S., & Bölte, S. (2017). A pragmatic randomized controlled trial of standardized supervision on quality of early intensive behavioral intervention in autism. [Submitted]

IV. Långh, U., Perry, A., Eikeseth, S., & Bölte, S. (2017). Quality of Early Intensive Behavioral Intervention as a predictor of children's outcome. [Manuscript]