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Toddler Treatment Network
The Toddler Treatment Network (TTN), which was created in 2006, is a collaboration of researchers sharing the common goal of determining the efficacy of early intervention for children younger than 18 months of age.1 The Toddler Treatment Network was originally comprised of 7 studies, but has since expanded to over a dozen studies conducted around the world.2 Each of the original 7 studies made “a unique contribution to evaluating the efficacy of early intervention strategies as well as developing and evaluating new treatment techniques.”1 The fruits of the TTN’s labor include evidence that an intervention’s effectiveness is dependent on the characteristics of the child3, the First Year Inventory checklist,4 and the employment of the Early Start Denver Model (ESDM) as an intervention that is effective on children as young as 18 months of age.5 Early intervention is a key component of intensive Applied Behavior Analysis (ABA), which is the most widely used behavioral intervention for autism spectrum disorders.6
On December 7, 2006, Autism Speaks approved $6.1 million in funding for the 7 large-scale studies that focus on early treatment and intervention.1 These studies set the foundation for the Toddler Treatment Network. According to the 2008 annual report from the Baby Siblings Research Consortium7, these studies share the following commonalities:
1. The studies are parent-implemented
2. The studies involve naturalistic delivery of interventions addressing the earliest behavioral phenotype and thus are heavily focused on communication
Joint attention, imitation, gestures, and language are some of the behavioral phenotypes that will be examined through the network’s focus on communication.7 These studies tested intervention methods that can be utilized by parents outside of clinical settings. This allows the interventions to be much more cost effective and lessens the gap in time between the “parent’s initial concern and beginning intervention, thus hopefully improving developmental outcome in the long run.”8
Research conducted by the Baby Siblings Research Consortium (BSRC) has allowed for the diagnosis of autism spectrum disorder earlier than ever before.8 According to Dr. Baranek, the leader of the first phase of the Early Development Project, “[t]en years ago, 2 years old was considered young for detecting kids at risk for autism.”9 The studies conducted by the Toddler Treatment Network aim to explore the signs of autism that are visible as early as 1 year of age.10 According to the 2009 annual report from the Baby Siblings Research Consortium11, the long term goals of the Toddler Treatment Network are to:
1. Improve measurement tools regarding outcomes for toddlers and their families
2. Define or identify the best practices for designing and implementing parent-delivered interventions
3. Improve research designs and analytic approaches for early intervention studies
4. Facilitate young researchers to develop productive programs of high quality treatment research
5. Disseminate evidence of efficacy of early intervention with toddlers
Recently the TTN has released a number of publications describing the effectiveness of specific early interventions for toddlers. One of the publications examined the efficacy of Hanen’s “More Than Words”, an intervention designed to improve language function in infants with ASD.12 Although not effective for all children, many in the study “showed more instances of making eye contact, pointing to or reaching for objects of interest and showing or giving the experimenter a toy.”12 The study demonstrated that the effectiveness of any intervention is dependent on the characteristics of the child and that treating symptoms of ASD through parent-mediated interventions can be effective.3
Other accomplishments of the TTN include a study demonstrating the validity of the First Year Inventory (FYI) checklist and the use of the Early State Denver Model as an intervention method effective as early as 18 months of age.13 The FYI checklist is a recently developed intervention tool. The checklist is to be completed by parents when the child reaches 12 months of age to identify if the child is demonstrating any of the early signs of autism.4 Researchers are currently working to refine the First Year Inventory and broaden its use for a wider range of children.9
The Early State Denver Model (ESDM) is a modified version of the Denver Model, which was developed by Sally Rogers, Ph.D, and her colleagues in 1981.13 The Early State Denver Model “is a comprehensive early behavioral intervention for infants to preschool-aged children with ASD that integrates applied behavior analysis (ABA) with developmental and relationship-based approaches.”14 A 2009 study concluded that children who received the Early State Denver Model showed “significant improvements in IQ, adaptive behavior, and autism diagnosis,” compared with children who received community-intervention.14 The youngest children within the study were 18 months old, but “the intervention is designed to be appropriate for children with autism as young as 12 months of age.”15 According to Autism Speaks5, the Early Start Denver Model has the following core features:
- Naturalistic applied behavioral analytic strategies
- Sensitive to normal development sequence
- Deep parental involvement
- Focus on interpersonal exchange and positive affect
- Shared engagement with joint activities
- Language and communication taught inside a positive, affect based relationship
The Early Start Denver Model for Young Children with Autism, authored by Sally Rogers, Ph.D., and Geraldine Dawson, Ph.D., contains a much a more in-depth look into the principles and efficacy of the Early Start Denver Model.
The Toddler Treatment Network has progressed a great deal since its inception in 2006. The first annual symposium for the Toddler Treatment Network was held in conjunction with the 2012 International Meeting for Autism Research in Toronto, Canada. In addition to an annual conference, future plans for the network include expanding memberships to allow researchers who were not part of the original funded projects to join.3 Although early intervention can be effective for preschool-aged children,15 the Toddler Treatment Network aims to continue researching, testing, and implementing interventions that can be successfully utilized for toddlers as young as 12 months of age.