The Washington State Department of Early Learning recently released new guidelines that are designed to provide direction for birth to three centers to better support children with Autism Spectrum Disorder (ASD) in Washington State. Importantly, the guidelines also include children who are suspected of having ASD not just those with a formal diagnosis. This is critical because many children have not been eligible for autism-specific services until they have a formal diagnosis and the wait list at specialty diagnostic clinics is often months long. These guidelines are a result of a collaborative effort by the Early Support for Infants and Toddlers at the Department of Early Learning and the Haring Center for Applied Research and Training in Education at the University of Washington.

In general, the guidelines promote early and intensive behavioral intervention for young children with ASD, and highlight the need for more intensive or child-focused treatment. This suggestion differs from the more common practice of providing “family-focused” or “parent training” models where professionals go into a child’s home and provide parent education and training by working with the child and parent together. Increased levels of support should include a justification for why best outcomes cannot be achieved in the natural environment alone (e.g. the home) and a plan for transferring services into the natural environment. In addition, the guidelines promote use of methods that have research-based evidence to support their effectiveness, data collection to inform decisions of how, what and when to teach, consistent use of strategies across therapists, a focus on parent training, and training provided to others involved in the child’s care (e.g. day care center personnel, other caregivers). Finally, the guidelines state the number of hours of therapy that a child should receive will vary depending on the child’s needs. However, it is stated that children with ASD require intensive support and that some children may receive up to 12 hours of support per week  in order to “match the amount, type, and location of services with the needs and progress of children” with ASD.  The intensity and amount of services suggested is a substantial increase over the amount of services that are routinely delivered at this time (often between one and three hours per week depending on the center).

The guidelines also provide “Essential Components of Effective Practices”.  These components are summarized below:

  1.  Integrated Toddler Group Experiences:  It is suggested that children with ASD should participate in group activities with peers that include activities that are designed for typically developing children.  Toddler groups should meet at least twice per week and be led by qualified staff (with supervision by a “highly trained” individual).  Adequate support should be provided for the child’s successful participation and a list of possible settings was provided (including preschool, childcare, and community playgroups).
  2. Extended, Intensive Intervention using evidence-based instruction:  It is recommended that sessions take place 2-3 times per week and last 60-90 minutes in duration.  Support should be provided by trained staff and include positive reinforcement, structured and individualized learning tasks in 1:1 or small groups, and activities that occur within natural routines.  Intervention must include parents and other caregivers and can take place in multiple settings (e.g. home, day care, centers).
  3. Specialized Support for Families:  The guidelines state that raising a child with ASD requires special types of support and that parents of children with ASD often experience higher levels of stress.  Therefore, centers should provide parent education (e.g. regarding possible causes of ASD, available services and community support) and parent support (e.g. parent to parent connections, support groups, sibling groups and facilitating connections between the family and the community).
  4. Coordination and Collaboration across Services:  It is recommended that various providers communicate and collaborate to insure consistency and opportunities to generalize skills.  This suggestion includes communication and collaboration across providers within a birth to three center, as well as with private therapists in the community.
  5. Quality of Life Inspired Outcomes:  Goals should include both those that target core deficits of ASD (e.g. social impairments, communication deficits) as well as goals that promote skills that will improve the quality of life for the individual and family (e.g. coping with sensory processing difficulties or behavior issues).  The focus should be on promoting independence, functional communication, and full participation in family and community life.

These new guidelines represent an important step toward increasing the amount and quality of early support for children with autism spectrum disorders and their families. What is unclear is how individual birth to three centers will translate these guidelines into practice, if there will be a meaningful increase in levels of support for children with ASD as a result of these guidelines, and what steps will be taken to help birth to three centers reach these objectives (in terms of training and financial support). For more information regarding these guidelines, contact the Washington State Department of Early Learning at 360-725-3500 or follow this link to the guidelines.

It is important for families to recognize that interventions do need to be individualized for each child so one shouldn’t expect that every child will have the same intervention program whether in birth to three early intervention or subsequently in school. Parents do have the right to be involved in developing a treatment plan, whether as part of the Individualized Family Service Plan (IFSP) that guides services in the birth to three age range, as well as the Individualized Education Plan (IEP) that guides public school -based services. Disagreements may arise between service providers and families though the best approach is always to develop a good team-based working relationship with a service agency as the agencies and families are indeed operating in the best interests of every child.