Early detection methods for autism spectrum disorder (ASD) in infancy are rapidly advancing, yet the development of interventions for infants under two years with or at-risk for ASD remains limited. In order to guide research and practice, this paper systematically reviewed studies investigating interventions for infants under 24 months with or at-risk for ASD. Nine studies were identified and evaluated for: (a) participants, (b) intervention approach (c) experimental design, and (d) outcomes. Studies that collected parent measures reported positive findings for parent acceptability, satisfaction, and improvement in parent implementation of treatment. Infant gains in social-communicative and developmental skills were observed following intervention in most of the reviewed studies, while comparisons with treatment-as-usual control groups elucidate the need for further research. These studies highlight the feasibility of very early intervention and provide preliminary evidence that intervention for at-risk infants may be beneficial for infants and parents.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
American Academy of Pediatrics. (2006). Identifying infants nad young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics, 118, 405–420.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Bakeman, R., & Adamson, L. B. (1984). Coordinating attention to people and objects in mother-infant and peer-infant interaction. Child Development, 55(4), 1278–1289.
Barbaro, J., & Dissanayake, C. (2009). Autism spectrum disorders in infancy and toddlerhood: A review of the evidence on early signs, early identification tools, and early diagnosis. Journal of Developmental and Behavioral Pediatrics, 30(5), 447–459.
Barbaro, J., & Dissanayake, C. (2013). Early markers of autism spectrum disorders in infants and toddlers prospectively identified in the Social Attention and Communication Study. Autism, 17(1), 64–86.
Billstedt, E., Carina Gillberg, I., & Gillberg, C. (2007). Autism in adults: Symptom patterns and early childhood predictors. Use of the DISCO in a community sample followed from childhood. Journal of Child Psychology and Psychiatry, 48(11), 1102–1110.
Boyd, B., Odom, S., Humphreys, B., & Sam, A. (2010). Infants and toddlers with autism spectrum disorders: Early identification and early intervention. Journal of Early Intervention, 32(75), 75–98.
Bryson, S. E., Zwaigenbaum, L., McDermott, C., Rombough, V., & Brian, J. (2008). The autism observation scale for infants: Scale development and reliability data. Journal of Autism and Developmental Disorders, 38(4), 731–738.
Carter, A. S., Messinger, D. S., Stone, W. L., Celimli, S., Nahmias, A. S., & Yoder, P. (2011). A randomized controlled trial of Hanen’s ‘More Than Words’ in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry, 52(7), 741–752.
Chawarska, K., Klin, A., Paul, R., & Volkmar, F. (2007). Autism spectrum disorder in the second year: Stability and change in syndrome expression. Journal of Child Psychology and Psychiatry, 48(2), 128–138.
Chawarska, K., Macari, S., & Shic, F. (2013). Decreased spontaneous attention to social scenes in 6-month-old infants later diagnosed with autism spectrum disorders. Biological Psychiatry, 74(3), 195–203.
Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & Schultz, R. T. (2012). The social motivation theory of autism. Trends in Cognitive Sciences, 16(4), 231–239.
Council, National Research, & Committee on Educational Interventions for Children with Autism. (2001). Educating children with autism. Washington, DC: National Academy Press.
Courchesne, E., Carper, R., & Akshoomoff, N. (2003). Evidence of brain overgrowth in the first year of life in autism. The Journal of the American Medical Association, 290(3), 337–344.
Crais, E. R., & Watson, L. R. (2014). Challenges and opportunities in early identification and intervention for children at-risk for autism spectrum disorders. International Journal of Speech-Language Pathology, 16(1), 23–29.
Dawson, G. (2008). Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Development and Psychopathology, 20(3), 775–803.
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et al. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125(1), e17–e23.
Dietz, C., Swinkels, S., van Daalen, E., van Engeland, H., & Buitelaar, J. K. (2006). Screening for autistic spectrum disorder in children aged 14–15 months. II: Population screening with the Early Screening of Autistic Traits Questionnaire (ESAT). Design and general findings. Journal of Autism and Developmental Disorders, 36(6), 713–722.
Drew, A., Baird, G., Baron-Cohen, S., Cox, A., Slonims, V., Wheelwright, S., et al. (2002). A pilot randomised control trial of a parent training intervention for pre-school children with autism. European Child and Adolescent Psychiatry, 11(6), 266–272.
Elsabbagh, M., & Johnson, M. H. (2010). Getting answers from babies about autism. Trends in Cognitive Sciences, 14(2), 81–87.
Elsabbagh, M., Mercure, E., Hudry, K., Chandler, S., Pasco, G., Charman, T., et al. (2012). Infant neural sensitivity to dynamic eye gaze is associated with later emerging autism. Current Biology, 22(4), 338–342.
Estes, A., Vismara, L., Mercado, C., Fitzpatrick, A., Elder, L., Greenson, J., et al. (2013). The impact of parent-delivered intervention on parents of very young children with autism. Journal of Autism and Developmental Disorders, 44(2), 353–365.
Eyler, L. T., Pierce, K., & Courchesne, E. (2012). A failure of left temporal cortex to specialize for language is an early emerging and fundamental property of autism. Brain, 135(3), 949–960.
Flanagan, J. E., Landa, R., Bhat, A., & Bauman, M. (2012). Head lag in infants at risk for autism: A preliminary study. The American Journal of Occupational Therapy, 66(5), 577–585.
Fox, S. E., Levitt, P., & Nelson, C. A. (2010). How the timing and quality of early experiences influence the development of brain architecture. Child Development, 81(1), 28–40.
Goin-Kochel, R. P., Mackintosh, V. H., & Myers, B. J. (2009). Parental reports on the efficacy of treatments and therapies for their children with autism spectrum disorders. Research in Autism Spectrum Disorders, 3(2), 528–537.
Granpeesheh, D., Dixon, D. R., Tarbox, J., Kaplan, A. M., & Wilke, A. E. (2009). The effects of age and treatment intensity on behavioral intervention outcomes for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 3(4), 1014–1022.
Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P., et al. (2010). Parent-mediated communication-focused treatment in children with autism (PACT): A randomised controlled trial. The Lancet, 375(9732), 2152–2160.
Green, V. A., Pituch, K. A., Itchon, J., Choi, A., O’Reilly, M., & Sigafoos, J. (2006). Internet survey of treatments used by parents of children with autism. Research in Developmental Disabilities, 27(1), 70–84.
Green, J., Wan, M. W., Guiraud, J., Holsgrove, S., McNally, J., Slonims, V., et al. (2013). Intervention for infants at risk of developing autism: A case series. Journal of Autism and Developmental Disorders, 43(11), 2502–2514.
Guthrie, W., Swineford, L. B., Nottke, C., & Wetherby, A. M. (2012). Early diagnosis of autism spectrum disorder: Stability and change in clinical diagnosis and symptom presentation. Journal of Child Psychology and Psychiatry, 54(5), 582–590.
Henninger, N. A., & Taylor, J. L. (2013). Outcomes in adults with autism spectrum disorders: A historical perspective. Autism, 17(1), 103–116.
Johnson, M. H. (2001). Functional brain development in humans. Nature Reviews Neuroscience, 2(7), 475–483.
Johnson, M. H., Dziurawiec, S., Ellis, H., & Morton, J. (1991). Newborns’ preferential tracking of face-like stimuli and its subsequent decline. Cognition, 40(1), 1–19.
Johnson, C. P., & Myers, S. M. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215.
Jones, W., & Klin, A. (2013). Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism. Nature, 504, 427–431. doi:10.1038/nature12715.
Kaiser, A. P., & Hester, P. P. (1994). Generalized effects of enhanced milieu teaching. Journal of Speech and Hearing Research, 37(6), 1320–1340.
Kasari, C. (2002). Assessing change in early intervention programs for children with autism. Journal of Autism and Developmental Disorders, 32(5), 447–461.
Kashinath, S., Woods, J., & Goldstein, H. (2006). Enhancing generalized teaching strategy use in daily routines by parents of children with autism. Journal of Speech, Language and Hearing Research, 49(3), 466.
Kleinman, J. M., Robins, D. L., Ventola, P. E., Pandey, J., Boorstein, H. C., Esser, E. L., et al. (2008). The modified checklist for autism in toddlers: A follow-up study investigating the early detection of autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(5), 827–839.
Koegel, R. L., & Koegel, L. K. (2012). The PRT pocket guide: Pivotal response treatment for autism spectrum disorders. Baltimore, MD: Brookes Publishing Company.
Koegel, L. K., Koegel, R. L., Harrower, J. K., & Carter, C. M. (1999). Pivotal response intervention I: Overview of approach. Research and Practice for Persons with Severe Disabilities, 24(3), 174–185.
Koegel, L. K., Singh, A. K., Koegel, R. L., Hollingsworth, J. R., & Bradshaw, J. (2013). Assessing and improving early social engagement in infants. Journal of Positive Behavior Interventions, 16(2), 69–80.
Kuhl, P. K., Conboy, B. T., Padden, D., Nelson, T., & Pruitt, J. (2005). Early speech perception and later language development: Implications for the” Critical Period”. Language Learning and Development, 1(3–4), 237–264.
Landa, R. J., Holman, K. C., & Garrett-Mayer, E. (2007). Social and communication development in toddlers with early and later diagnosis of autism spectrum disorders. Archives of General Psychiatry, 64(7), 853–864.
Lord, C., Luyster, R., Gotham, K., & Guthrie, W. J. (2012). Autism diagnostic observation schedule: Toddler module. Los Angeles, CA: Western Psychological Services.
Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3.
Love, J. R., Carr, J. E., Almason, S. M., & Petursdottir, A. I. (2009). Early and intensive behavioral intervention for autism: A survey of clinical practices. Research in Autism Spectrum Disorders, 3(2), 421–428.
Maestro, S., Muratori, F., Cavallaro, M. C., Pei, F., Stern, D., Golse, B., et al. (2002). Attentional skills during the first 6 months of age in autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 41(10), 1239–1245.
Maglione, M. A., Gans, D., Das, L., Timbie, J., & Kasari, C. (2012). Nonmedical interventions for children with ASD: Recommended guidelines and further research needs. Pediatrics, 130(Supplement 2), S169–S178.
Mundy, P., & Neal, R. (2000). Neural plasticity, joint attention, and a transactional social-orienting model of autism. International Review of Research in Mental Retardation, 23, 139–168.
National Autism Center. (2009). National standards report. Randolph, MA: National Autism Center.
Ozonoff, S., Young, G. S., Carter, A., Messinger, D., Yirmiya, N., Zwaigenbaum, L., et al. (2011). Recurrence risk for autism spectrum disorders: A Baby Siblings Research Consortium study. Pediatrics, 128(3), e488–e495.
Parlade, M. V., Messinger, D. S., Delgado, C. E., Kaiser, M. Y., Van Hecke, A. V., & Mundy, P. C. (2009). Anticipatory smiling: Linking early affective communication and social outcome. Infant Behavior and Development, 32(1), 33–43.
Paul, R. (2007). Language disorders from infancy through adolescence: Assessment and intervention (3rd ed.). St. Louis: Mosby/Elsevier.
Reed, P., Osborne, L. A., & Corness, M. (2007). Brief report: Relative effectiveness of different home-based behavioral approaches to early teaching intervention. Journal of Autism and Developmental Disorders, 37(9), 1815–1821.
Reichow, B. (2012). Overview of meta-analyses on early intensive behavioral intervention for young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(4), 512–520.
Reznick, J. S., Baranek, G. T., Reavis, S., Watson, L. R., & Crais, E. R. (2007). A parent-report instrument for identifying one-year-olds at risk for an eventual diagnosis of autism: The first year inventory. Journal of Autism and Developmental Disorders, 37(9), 1691–1710.
Robins, D. L. (2008). Screening for autism spectrum disorders in primary care settings. Autism, 12(5), 537–556.
Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). The modified checklist for autism in toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31(2), 131–144.
Rocha, M. L., Schreibman, L., & Stahmer, A. C. (2007). Effectiveness of training parents to teach joint attention in children with autism. Journal of Early Intervention, 29(2), 154–172.
Rogers, S. J., & Dawson, G. (2010). Early start Denver model for young children with autism: Promoting language, learning, and engagement. New York, NY: Guilford Press.
Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., et al. (2012). Effects of a brief Early Start Denver Model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 1052–1065.
Schertz, H. H., & Odom, S. L. (2007). Promoting joint attention in toddlers with autism: A parent-mediated developmental model. Journal of Autism and Developmental Disorders, 37(8), 1562–1575.
Schertz, H. H., Reichow, B., Tan, P., Vaiouli, P., & Yildirim, E. (2012). Interventions for toddlers with autism spectrum disorders an evaluation of research evidence. Journal of Early Intervention, 34(3), 166–189.
Schopler, E., Reichler, R. J., & Renner, B. R. (1988). The Childhood Autism Rating Scale (CARS). Los Angeles, CA: Western Psychological.
Schreibman, L., et al. (2014). Common Elements of Research-Based Practices for Toddlers with ASD: Naturalistic Developmental Behavioral Interventions. Autism Speaks Toddler Treatment Network Meeting, International Meeting for Autism Research, May 14, 2014.
Schultz, R. T. (2005). Developmental deficits in social perception in autism: The role of the amygdala and fusiform face area. International Journal of Developmental Neuroscience, 23(2), 125–141.
Schumann, C. M., & Amaral, D. G. (2006). Stereological analysis of amygdala neuron number in autism. The Journal of Neuroscience, 26(29), 7674–7679.
Shattuck, P. T., Durkin, M., Maenner, M., Newschaffer, C., Mandell, D. S., Wiggins, L., et al. (2009). Timing of identification among children with an autism spectrum disorder: Findings from a population-based surveillance study. Journal of the American Academy of Child and Adolescent Psychiatry, 48(5), 474–483.
Sherer, M. R., & Schreibman, L. (2005). Individual behavioral profiles and predictors of treatment effectiveness for children with autism. Journal of Consulting and Clinical Psychology, 73(3), 525.
Shic, F., Macari, S., & Chawarska, K. (2014). Speech disturbs face scanning in 6-month-old infants who develop autism spectrum disorder. Biological Psychiatry, 75(3), 231–237.
Siegel, B. (2001). Pervasive developmental disorder screening test-II. San Antonio, TX: Harcourt Assessment.
Smith, T., Scahill, L., Dawson, G., Guthrie, D., Lord, C., Odom, S., et al. (2007). Designing research studies on psychosocial interventions in autism. Journal of Autism and Developmental Disorders, 37(2), 354–366.
Stahmer, A. C., Collings, N. M., & Palinkas, L. A. (2005). Early intervention practices for children with autism: Descriptions from community providers. Focus on Autism and Other Developmental Disabilities, 20(2), 66–79.
Stahmer, A. C., Schreibman, L., & Cunningham, A. B. (2011). Toward a technology of treatment individualization for young children with autism spectrum disorders. Brain Research, 1380, 229–239.
Steiner, A. M., Gengoux, G. W., Klin, A., & Chawarska, K. (2013). Pivotal response treatment for infants at-risk for autism spectrum disorders: A pilot study. Journal of Autism and Developmental Disorders, 43(1), 91–102.
Stone, W. L., Coonrod, E. E., Turner, L. M., & Pozdol, S. L. (2004). Psychometric properties of the STAT for early autism screening. Journal of Autism and Developmental Disorders, 34(6), 691–701.
Tomasello, M., & Carpenter, M. (2007). Shared intentionality. Developmental Science, 10(1), 121–125.
Vismara, L. A., Colombi, C., & Rogers, S. J. (2009). Can one hour per week of therapy lead to lasting changes in young children with autism? Autism, 13(1), 93–115.
Vismara, L. A., & Rogers, S. J. (2008). The early start denver model a case study of an innovative practice. Journal of Early Intervention, 31(1), 91–108.
Webb, S. J., Jones, E. J., Kelly, J., & Dawson, G. (2014). The motivation for very early intervention for infants at high risk for autism spectrum disorders. International Journal of Speech-Language Pathology, 16(1), 36–42.
Wetherby, A. M., Brosnan-Maddox, S., Peace, V., & Newton, L. (2008). Validation of the infant—Toddler Checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age. Autism, 12(5), 487–511.
Wetherby, A., & Woods, J. (2002). Systematic observation of red flags for autism spectrum disorders in young children, unpublished manual. Tallahassee, FL: Florida State University.
Wetherby, A. M., & Woods, J. J. (2006). Early social interaction project for children with autism spectrum disorders beginning in the second year of life a preliminary study. Topics in Early Childhood Special Education, 26(2), 67–82.
Wolff, J. J., Gu, H., Gerig, G., Elison, J. T., Styner, M., Gouttard, S., et al. (2012). Differences in white matter fiber tract development present from 6 to 24 months in infants with autism. The American journal of psychiatry, 169(6), 589–600.
Young, R. L., Brewer, N., & Pattison, C. (2003). Parental identification of early behavioural abnormalities in children with autistic disorder. Autism, 7(2), 125–143.
Zachor, D. A., Ben-Itzchak, E., Rabinovich, A. L., & Lahat, E. (2007). Change in autism core symptoms with intervention. Research in Autism Spectrum Disorders, 1(4), 304–317.
This study was not directly funded, however conceptualization for this article was aided by a predoctoral fellowship awarded to the first author by the Autism Science Foundation (11-1014). We would like to express our appreciation to all families who continue to dedicate their time to autism research.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Bradshaw, J., Steiner, A.M., Gengoux, G. et al. Feasibility and Effectiveness of Very Early Intervention for Infants At-Risk for Autism Spectrum Disorder: A Systematic Review. J Autism Dev Disord 45, 778–794 (2015). https://doi.org/10.1007/s10803-014-2235-2
- Early intervention
- High-risk infants