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High-Quality Early Intervention for Autism More Than Pays for Itself

Last year, University of Pennsylvania health-policy researcher David Mandell, Sc.D., reported that autism’s costs the nation around $137 billion per year. Now Dr. Mandell has calculated the cost-savings produced by a high-quality and intensive early behavioral intervention program. 

The analysis focused on the Early Start Denver Model (ESDM). ESDM uses techniques from Applied Behavioral Analysis (ABA) for early intervention with toddlers. It emphasizes relationship-building and interactive play. Previous studies have found that ESDM significantly boosts IQ and social-communication skills and improves underlying brain responses to social cues.

“While early intensive behavioral intervention costs more to deliver in the early years, it more than pays for itself in terms of reduced needs for therapy and educational support by the time a child reaches high school,” Dr. Mandell said.

Dr. Mandell reported his preliminary results today at a meeting of Autism Speaks Toddler Treatment Network, being held in conjunction with the International Meeting for Autism Research (IMFAR), in San Sebastian, Spain.

His cost-benefit analysis was supported by a research grant from Autism Speaks.

Dr. Mandell and his research team tracked the autism-related services used by 39 children who had participated in a two-year ESDM study led by Jeff Munson, Ph.D., and Annette Estes, Ph.D., at the University of Washington. At the time, the children were 18 to 30 months old. Twenty-one received two years of ESDM. For comparison, 18 children received a comparable amount of services through the early intervention programs in their community (Seattle). After the trial ended, parents were referred to their community’s early intervention and special education programs for further services. The researchers tracked their use of these services over the following four years.

Higher up-front costs
During the two years of the ESDM study, autism-related services totaled $9,619 per child per month for those receiving ESDM therapy. Of this, the cost of ESDM was $5,560 per month. (As the children were part of a research study, the families did not bear this cost.) By comparison, the cost of services received by the children in the outside community averaged $2,458 each per month.

The trend toward cost benefits emerged in the four years after the study concluded. During this period, the children in the ESDM group received an average of 158 hours of autism-related services per child per month. By contrast, the children in the comparison group received an average of 257 hours of services each per month. Such services included special education supports as well as speech, physical and occupational therapies. Overall, the children who had received ESDM also spent significantly more time in regular education classrooms, as opposed to special education, than did the other children.

The economic payoff
The cost breakdown for the four follow-up years averaged $3,569 per child per month for the ESDM group. By contrast, it averaged $5,033 per month for those in the comparison group. Projecting out from this trend, Dr. Mandell estimated that ESDM would more than pay for itself before the children reached high school – on average, after about 8 years.

“We used a very narrow definition of cost for this study,” he added. “We included only autism-specific services such as physical, occupational and speech therapies as well as ABA. I believe the cost efficiencies would become even more pronounced with an evaluation of health costs and overall family economics such as the ability of both parents to continue to work and earn income while their child received services.”

The Early Start Denver model was developed by psychologists Sally Rogers, Ph.D., and Geri Dawson, Ph.D., in the 1990s. Dr. Dawson is now chief science officer of Autism Speaks.

“It’s very promising to see that children who received two years of early intensive intervention required fewer hours of therapy and special education services through the remainder of their preschool years,” Dr. Dawson said. “Not only do the young children who receive early intensive intervention benefit in the short term, we see that through their remaining preschool years these children require fewer special education supports.”

For more coverage of this year’s IMFAR presentations, click here.