Early outcomes of applied behavior analysis therapy in pediatric autism spectrum disorder: a 3-month observational cohort study

Abstract

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by difÏculties in social interaction, restricted interests, and repetitive behaviors. Evaluating short-term treatment progress and outcomes in children with ASD is important for determining subsequent treatment goals. Aim: This study aimed to evaluate the outcomes during the first 3 months of applied behavior analysis (ABA)-based intervention using changes in Autism Treatment Evaluation Checklist (ATEC) scores. Materials and Methods: A prospective observational study was conducted among 21 children with ASD. Caregivers completed the 77-item ATEC before initiation of treatment and again after 3 months. Scores were calculated for four ATEC domains: Speech/Language/Communication, Sociability, Sensory/Cognitive Awareness, and Health/Physical/Behavior. Results: The mean age of participants was 5.51±1.45 years, and 16 children (76.19%) were male. Mean baseline Clinical Global Impressions–Severity (CGI-S) score was 4.71±0.72, and participants received a mean of 10.00±1.38 hours of ABA-based intervention per week. Mean total ATEC score decreased from 72.71±7.60 at baseline to 67.14±7.81 after 3 months, corresponding to a mean change of -5.57±2.18 points (-7.66%; t=11.706, p<0.001, d=2.55). Speech/Language/ Communication decreased by 7.05%, Sociability by 6.96%, and Sensory/Cognitive Awareness by 6.56%. The largest relative change was observed in the Health/Physical/Behavior domain (-1.90±1.14; -9.80%; p<0.001). Wilcoxon signedrank tests were significant across all ATEC domains (p<0.001). Sixteen children (76.19%) met the study-defined criterion of more than a 5-point reduction. Baseline CGI-S was correlated with pre-post ATEC change using Pearson correlation (r=0.466, p=0.033), whereas the corresponding Spearman analysis was not statistically significant (ρ=0.349, p=0.121); therefore, this association could not be considered a robust predictor. Weekly ABA treatment hours were not significantly associated with ATEC change (r=-0.183, p=0.427), and age was also not associated with change (r=-0.043, p=0.855). Conclusion: Changes across all ATEC domains were observed during the period in which children received ABA-based intervention, suggesting that some treatment-related changes may be detectable over a relatively short period in everyday settings. However, because only two assessment points were available, the rate and sequence of change could not be determined. Future studies should include larger samples, a comparison group, repeated assessments over 6–12 months, and independent developmental and clinical outcome measures.