The Power of Early Intervention: A Q&A With Dr. Marianne L. Barton
In honor of World Autism Month (April), a Sparkler family & community engagement specialist, Meaghan Penrod, spoke with Dr. Marianne L. Barton, Clinical Professor and Director of Clinical Training at the University of Connecticut Ph.D. Program in Clinical Psychology. Dr. Barton is a licensed psychologist and has worked for more than 30 years providing evaluation and treatment to young children and their families in multiple settings. Dr. Barton is one of the authors of The Modified Checklist for Autism in Toddlers-Revised, (M-CHAT-R/F) and the Working Model of the Child Interview, as well as the Activity Kit for Babies and Toddlers at Risk.
Sparkler: Can you tell us a little bit about yourself and what you do in the field?
Dr. Barton: I am a Clinical Psychologist with specialized interest in Early Childhood. At UConn, I am the director of our training clinic, the Psychological Services Clinic and I oversee Clinical training for our PhD students. I supervise treatment and assessment services, complete assessments with students, consult to local Birth to Three programs, teach graduate courses and engage in research. My research is closely tied to my clinical interests. For example, because of our frustration at not seeing children with suspected Autism until they reached school age, several years ago my colleague Deb Fein and I developed the M-CHAT, a screening tool for young children that is now completed across the country at well-child pediatric visits. We are currently working on a series of videos that would help parents teach and engage with young children with autism.
Sparkler: How would you explain autism to someone who doesn't know much about it?
Dr. Barton: I think of Autism as a neuro-developmental disorder that interferes with a child’s ability to build reciprocal social relationships. Young children with ASD struggle with all of the behaviors that allow them to initiate and sustain social interaction, such as making eye contact, following someone’s attempt to direct their attention, showing things to others or pointing to direct attention. Some children develop communication skills, including language, others struggle to communicate. Children also develop repetitive behaviors, and sensory interests such as spinning toys, watching things fall or spin etc. Repetitive behaviors or restricted interests are required for a diagnosis of ASD. Beyond those two characteristics, there is enormous variability in children diagnosed with ASD. Some have comorbid intellectual disability or ADHD; others do not. Most develop functional communication skills; a small percentage remain minimally verbal.
Sparkler: What are some common misunderstandings people have about autism?
Dr. Barton: I think that people rely more on atypical behaviors, such as hand flapping, to identify children with autism, rather than the difficulties with social interaction. Children with many kinds of difficulty engage in atypical behaviors (for example, ADHD, Intellectual Disability, sensory concerns); unless they also have significant social deficits, they would not be considered autistic. I think people also under-estimate the extent of the progress that individuals with autism can make with intensive early intervention. A small number of children (15-20%) make so much progress that they no longer qualify for the diagnosis. Some of those teen-agers and young adults are indistinguishable from typically developing individuals. In recent years, the diagnostic criteria have been loosened to permit the diagnosis of individuals with less severe impairments. That has allowed for the identification of more children and the provision of services earlier.
Sparkler: How does early intervention support young children with autism?
Dr. Barton: If we can identify children early and provide intervention most children will make significant progress. Services typically focus on improving functional communication skills and developing skills at social interaction. When necessary, intervention may also focus on teaching adaptive skills and reducing atypical behavior. Over many years, we have learned that children with autism can learn many of the skills that typically developing children acquire on their own; children with ASD may require specific teaching to acquire those skills. Early intervention will allow children to address the social difficulties associated with autism and develop more typical friendships and social relationships. It also supports brain development which remains flexible in our youngest children. Finally, intervention provides greater support to families, teaches parents the skills they need to engage their children and reduces some of the stress and isolation that family members experience in raising a child with special needs. We have a great deal of evidence that early intervention results in significant gains in skills, healthier developmental trajectories, improved outcomes for both children and families and markedly reduced costs over the course of a child’s life.
