Evidence-based developmental interventions for autism

Evidence-based developmental interventions for autism | Josh Feder, MD

In this Q+A, Joshua Feder, MD, executive medical director, Positive Development, Solana Beach, California, explains how developmental care alternative models to autism care can help all members involved in the autism care approach.

Feder explains how California, as of March 2023, has seen increased autism prevalence in children, and how the state has supported developmental care models.

Contemporary Pediatrics:

Can you explain evidence-based options and developmental care services and how they are being implemented in California? What is the message for the rest of the country when it comes to these services?

Joshua Feder, MD:

California joins a growing number of organizations supporting developmental care models as a cost-effective way to expand access to care—joining the American Medical Association (AMA) and the American Academy of Pediatrics (AAP) supporting evidence-based developmental interventions.

Developmental care is an evidence-based alternative model of autism care. Positive Development deploys a developmental care model–Developmental Relationship-Based Interventions (DRBI), which draws upon evidence-based disciplines including Developmental Individual Differences Relationship (DIR), PLAY Project, and Project Impact–to help children with autism achieve growth and independence as well as meaningful gains in cognitive, social, and emotional development.

A significant amount of research is also amassing behind DRBI and other evidence-based developmental care models, which are getting recognized as highly effective care models as more and more data is published demonstrating their efficacy in aiding autistic children.

These approaches help parents and other caregivers such as family members, teachers, other helping adults, and even peers to connect with the [person with autism] in interactions that are meaningful and help them build their abilities to relate, communicate, and problem-solve.

Every child and teen, including [youths with autism] with a range of functional challenges, can connect. Developmental care harnesses that ability and works with it to strengthen the child or teen’s relationships, communication, and build their abilities to manage and thrive in the world. Positive Development specializes in a model of care developed from the DIR model of Drs Stanley Greenspan and Serena Wieder. We are using a scalable version of the model that has Parent Support at the center and extends the village, helping the child by using paraprofessional play partners. Part of a comprehensive and in constant communication care team, our Developmental Paraprofessionals (DPPs) meet each child where they are — what looks like play is developmental progress at work. Our outcomes are great, families are happy, and the costs for care are far less than other interventions for autism.

Contemporary Pediatrics:

What trends regarding autism diagnosis are being observed in your location, and are there any new screening measures that you know of?

Feder:

As of March 2023, 1 in 22 children in California [has autism]. That is more than the 1 in 36 national number. These figures have risen over the past 30 years as the science of accurate diagnosis improves and finds more cases.

How do we identify and diagnose autism? Since early intervention tends to maximize functional outcomes, pediatricians should have a low threshold for recommending assessment and intervention for any child with communication delays in infancy and early childhood. The CDC has a great page on screening and diagnostic testing: https://www.cdc.gov/ncbddd/autism/hcp-screening.html

Additionally, autism screening using parent reporting tools is quite accurate, and many screening tools take only 2 minutes of clinician time.

Contemporary Pediatrics:

How important of a role can the general pediatrician play when it comes to autism, especially given the long referral times that are in the headlines frequently?

Feder:

Pediatricians are central to the process of screening children and teens for autism and supporting families as they navigate the systems of care to confirm a diagnosis and seek good support and interventions.

Staying up to date on the different types of autism interventions helps ensure families have the opportunity to evaluate care options and choose what feels best for them.

We see wait times of up to a year for diagnostic assessment and another year for intervention to begin. During this time pediatricians can refer families for assistance through resources such as the Profectum Parent Toolbox, which is a free online training course to help parents and other caregivers understand their child’s challenges in sensory, communication, and other areas of development, and begin to help them connect and communicate in a way that supports their social and cognitive development.

Contemporary Pediatrics:

Can you explain Senate Bill 805 and why its passing has played a role in California? Do you know of other states looking to adopt anything similar?

Feder:

California Senate Bill 805 (SB805) is part of a decades-long effort to give families more options in autism care.

Most families have been offered traditional behavioral intervention approaches, and only families with more resources have had access to developmental care interventions.

SB805 helps make developmental care and other evidence-based approaches available to the wider population by opening insurance coverage for these types of interventions.

A few other states such as New Jersey and Illinois have also put legislation in place that gives families wider access to developmental care, and we’re proactively working with policymakers, healthcare providers, and advocacy groups to ensure evidence-based options remain at the forefront for autistic children and their families.

Contemporary Pediatrics:

Is there anything else you would like to add?

Feder:

We call autism a spectrum for a reason—it’s incredibly diverse—so it makes sense to provide families with a better array of evidence-based care options, like developmental interventions. I am so glad to see more access to developmental care in California. I’ve been trained in a wide range of autism approaches, and I see the power of developmental care interventions when children and teens who were pretty stuck and isolated are now seeking to play with family and friends and becoming more comfortable in school settings.

Joshua Feder, MD discloses he is:

- Editor in Chief, the Carlat Child Psychiatry Report

- Author, Child Medication Fact Book for Psychiatric Practice, Second Edition, 2023

- Inclusion, Disabilities and Autism Is - Anti-bullying inclusion program

- Medical Director, SymPlay Division, Quicksilver Software, Inc.

- Research - Dept of Education Funding - San Diego State University