چه کسانی و چگونه کودکان را برای مداخله اوتیسم زودرس انتخاب می کنند

Early Intensive Behavioral Interventions (EIBI) has become a well recognized treatment for autism spectrum disorders (ASD). Nonetheless, many questions remain about how to best administer these interventions and tailor treatments to given children. For researchers to make the best decisions regarding treatment, client populations must be precisely defined and described. Thus, the correct methods for client selection need to be described and used. The purpose of this paper is to take stock of methods of client selection for EIBI research. This paper reviews 34 studies which focus on this treatment model. Methods and procedures used in these studies are discussed. At present, they fall short of optimal standards.

Autism spectrum disorders (ASD) are debilitating, life-long conditions. ASD is increasing in the number of cases being identified putting further urgency on its treatment (Isaksen et al., 2012, Li et al., 2011, Lin et al., 2009 and Matson et al., 20088; Matson & Kozlowski, 2011). Marked deficits include core features such as communication and social behaviors (Fodstad et al., 2009, Matson et al., 1999, Matson and Wilkins, 2009, Smith and Matson, 2010a, Smith and Matson, 2010b and Smith and Matson, 2010c). Excesses such as stereotypies and rituals also characterize the disorder (DiGennaro-Reed et al., 2012, Lanovas et al., 2013 and Wilke et al., 2012). Comorbid adaptive skill deficits, behavior problems and psychopathology are also common (Matson et al., 2009a, Matson et al., 2009b, Matson and Kuhn, 2001, Matson and Rivet, 2008, Smith and Matson, 2010a, Smith and Matson, 2010b and Smith and Matson, 2010c). A host of interventions have been tried, but medications and particularly applied behavior analysis have the best empirical support (Matson and LoVullo, 2008, Matson and Neal, 2009, Matson and Wilkins, 2008 and Singh et al., 2005). The general thinking is that the earlier the intervention the better (Matson et al., 2009c and Matson et al., 2012). The acceptance of this concept points to the use of psychological interventions versus medication for very young children (Matson & LoVullo, 2009). Early Intensive Behavioral Interventions (EIBI) have become more popular with time. This approach dates to interventions first described in the 1960s. Lovaas (1987) published a study that combined a variety of behavioral interventions, over 40 hours a week over a year's time. Multiple behaviors were treated simultaneously in a one to one format. This general methodology with some modifications still constitutes the core of EIBI methods. Newer trends recognize that not only are the comorbid conditions common and debilitating, but chronic as well. Thus, it is also recognized that EIBI must take into account, and intervene not only on core symptoms and independent living skills, but on comorbid disorders as well. Treatment for EIBI programs tends to occur for children 2–5 years of age (Matson, Wilkins et al., 2009). Obviously, this is a very large commitment not only for the child but for the family and the clinicians. A large expenditure in time, money, and resources are required. As a result, how these children are screened and selected for interventions is very important. Additionally, who is likely to respond to these interventions should factor into this decision. The purpose of this paper was to analyze the current state of the client selection process for EIBI research studies.