Introduction

Early Intensive Behavioural Intervention (EIBI) for autism has been a widely adopted approach in Québec since the 2000s. This intervention, based on Applied Behaviour Analysis (ABA), aims to support the development of preschool-age autistic children. While some parents and professionals advocate for its benefits, others raise concerns about its effectiveness and impact. The report by the Institut national d’excellence en santé et en services sociaux (INESSS) looked at the efficacy, parental expectations, organisational challenges, and cost-effectiveness of EIBI, providing a comprehensive overview of its role in Québec’s healthcare landscape.

Early Intensive Behavioural Intervention (EIBI) for Autism

EIBI services, provided 13 to 35 hours a week for 1 to 3 years, have shown short-term improvements in adaptive functioning, communication, and cognitive skills in autistic children. The meta-analyses indicate that EIBI can enhance expressive and receptive language and reduce the severity of autism symptoms. However, its effectiveness compared to other interventions in terms of long-term outcomes remains uncertain. The data also does not conclusively identify which child profiles benefit most from EIBI, highlighting the need for further research.

Parental Expectations and Experiences

Parents have diverse expectations from EIBI, hoping it will meet their child’s unique needs. Some parents report significant improvements in adaptive and cognitive functioning and a reduction in problem behaviours. However, others express concerns about the demanding nature of the intervention and its potential negative impact on the child’s behaviour and mood. The need for interventions that respect neurodiversity without attempting to “normalise” autistic behaviours is also emphasised by several stakeholders.

Organisational Challenges in Implementing EIBI

The delivery of EIBI services varies across Québec, with essential components including need analysis, goal setting, and daily data collection. However, issues such as service access, equity, staff turnover, and training challenges hinder optimal implementation. Collaboration between health and social services, childcare, and schools is also a significant challenge, affecting the overall efficacy of EIBI.

Cost-Effectiveness of EIBI

A cost-utility analysis adapted from the UK model to the Québec context suggests that EIBI may not be cost-effective compared to other interventions. The potential savings from reduced school and healthcare resource consumption appear to be less than the costs associated with EIBI. The analysis, based on certain assumptions, indicates that the positive effects of EIBI vary depending on the intervention’s long-term effectiveness. Therefore, the cost-effectiveness results should be interpreted with caution.

Recommendations for Autism Services

Services for autistic children should use diverse, evidence-based approaches to meet their needs and families’ expectations. These interventions should include EIBI. EIBI should take place in the child’s natural environment and involve trained professionals under clinical supervision. Although the optimal intensity of EIBI is still undetermined, it appears effective when provided for more than 13 hours a week for at least 12 weeks.

Interventions should be tailored to each child by regularly analysing their needs and measuring their responses. Adjust intervention strategies, intensity, and duration based on these assessments. Involve parents in decision-making about their child’s services, including identifying needs, setting goals, and choosing reinforcers. Equip parents early to support their child’s development and train professionals in autism, neurodiversity, and shared decision-making.

Conclusion

The evaluation of EIBI for preschool-age autistic children in Québec highlights its potential short-term benefits, but also reveals significant challenges and uncertainties. The recommendations aim to address these issues by promoting a diverse, evidence-based approach to autism interventions, ensuring optimal conditions for EIBI, and emphasising parental involvement and early support. Continued research and tailored interventions are essential to meet the diverse needs of autistic children and their families effectively.