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autism spectrum disorder, early intervention, comprehensive early intervention for toddlers with autism, malaysia
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Han YL, Wan Sulaiman WS and Ahmad Badayai AR. Efficacy of CEITA early intervention program for young children with autism spectrum disorders: A randomized controlled trial design [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:395 (https://doi.org/10.12688/f1000research.145666.1)
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Research Article
Efficacy of CEITA early intervention program for young children with autism spectrum disorders: A randomized controlled trial design
[version 1; peer review: 1 approved with reservations]
PUBLISHED 26 Apr 2024
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Abstract
Corresponding author:
Yung Lin Han
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No competing interests were disclosed.
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The author(s) declared that no grants were involved in supporting this work.
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© 2024 Han YL et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Han YL, Wan Sulaiman WS and Ahmad Badayai AR. Efficacy of CEITA early intervention program for young children with autism spectrum disorders: A randomized controlled trial design [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:395 (https://doi.org/10.12688/f1000research.145666.1)
First published: 26 Apr 2024, 13:395 (https://doi.org/10.12688/f1000research.145666.1)
Latest published: 26 Apr 2024, 13:395 (https://doi.org/10.12688/f1000research.145666.1)
Early intervention for young children
Early interventions for young children with ASD are often recommended to build a comprehensive treatment model (Early Intervention Program for Infants and Toddlers with Disabilities, 2004; Reichow, 2012; Sandall et al., 2005) that aims to promote overall developmental growth through interventions across various domains (Hyman et al., 2020; McConachie & Diggle, 2007; Solomon et al., 2007). Nevertheless, a thorough review of the existing literature indicates a scarcity of interventional studies, specifically targeting toddlers and preschool-aged children diagnosed with ASD (Vismara & Rogers, 2008). Furthermore, only a few of these studies have implemented a comprehensive treatment model that holistically addresses many aspects of the disorder. Behavioral models, such as applied behavioral analysis (ABA) (Lovaas, 1987), and naturalistic developmental models, such as the Early Start Denver Model (ESDM) (Dawson et al., 2010), are, thus far, the most extensively researched approaches for treating ASD (Baril & Humphreys, 2017; MacDonald et al., 2014; Tiura et al., 2017; Velazquez & Nye, 2011; Vivanti & Dissanayake, 2016). However, both methods have been criticized for their limitations (Xu et al., 2018). On the one hand, the structured nature of ABA has faced criticism for its perceived limitations in promoting spontaneity and potential overreliance on prompts (Bradshaw et al., 2015; Schreibman et al., 2015). On the other hand, the widespread adoption of ESDM has been hindered by substantial qualification and training requirements, resulting in increased community costs (Boyd et al., 2010; Dawson et al., 2010).
Further, most early intervention studies have noticeably focused on samples comprising individuals who identify as white and monolingual English speakers (DuBay et al., 2018). Additionally, interventionists with the necessary qualifications are predominantly certified in Western countries. The lack of acknowledgment of cultural diversity when providing early intervention services may hinder the implementation and efficacy of treatment, as research (Buzhardt et al., 2016; Parra Cardona et al., 2012) has shown that the same interventions may not have similar efficacy across different populations. Moreover, interventions incongruent with a family’s culture, values, and expectations often lead to conflicts (Hwa-Froelich & Vigil, 2004), strained therapeutic relationships (Garcia et al., 2012), and higher rates of service discontinuation (Long et al., 2015).
Problem statement
This phenomenon reflects the current situation in Malaysia. The exorbitant costs associated with obtaining the necessary training to become a proficient practitioner in administering early interventions can result in high treatment fees. According to published articles (Kamaralzaman et al., 2018; Md Jani et al., 2022), the estimated annual financial costs associated with intensive comprehensive treatment (10–40 hours per week) could range between RM36,000 and RM42,472. Consequently, a notable obstacle to the availability of therapy emerges, leading to a tendency toward more affordable options that may lack a foundation for empirical evidence (Ong, 2019; Yaacob et al., 2021). For instance, most alternative intervention strategies available in Malaysia, such as dietary supplements, hot-spring therapy, and religious practices, have not been tested empirically (Ong, 2019). Moreover, parents of children with ASD have reported facing difficulties in facilitating therapy at home, which often leads to strained adult-child relationships (Wetherby et al., 2014). Furthermore, vast differences in treatment approaches and outcomes pose difficulties in reaching a consensus as to which treatment strategies are the most effective (Strain et al., 2011; Warren et al., 2011).
In summary, based on several literature reviews, the current limitations of early intervention programs are as follows: (1) limited published studies (Vismara & Rogers, 2008); (2) not acknowledging cultural diversity (DuBay et al., 2018); (3) being overly time-consuming (Kasari et al., 2015); (4) poor transfer of acquired skills to daily life (Prizant et al., 2000); (5) extensive requirements for qualification or training (Boyd et al., 2010; Dawson et al., 2010).
Moreover, with the emerging literature suggesting no relationship between the intensity or style of treatment and treatment outcomes (Rogers et al., 2021), as well as a significant effect of cultural values in early interventions (DuBay et al., 2018; Fong & Lee, 2017), there is an urgent need to develop interventions for young children with ASD specific to the targeted populations. As such, early interventions for young children should be comprehensive and low-intensity and implemented in community settings (Brian et al., 2015).
Study aims: The “CEITA” program
A new comprehensive early intervention program, the Comprehensive Early Intervention for Toddlers with Autism (CEITA) program, was designed in this study to address the above issues. A group of Malaysian researchers developed the CEITA program for young children aged 4 years and below and who have ASD. It was built to complement the recommended guidelines (Early Intervention Program for Infants and Toddlers with Disabilities, 2004; Malaysian Health Technology Assessment Section [MaHTAS], 2014) for developing early intervention programs for young children in Malaysia.
Figure 1 presents an overview of the CEITA theoretical model framework. According to previous research, manifestations of ASD symptoms correlate substantially with their impact on children’s developmental outcomes (Guralnick, 2020; Schertz et al., 2011). Drawing on the positive outcomes of several treatment strategies (Contaldo et al., 2020; Dawson et al., 2010; Kaale et al., 2012; Tiura et al., 2017), the CEITA intervention program was designed to utilize behavioristic strategies and naturalistic contingencies to teach developmentally appropriate pivotal skills. Additionally, thoughts were given to match treatment goals to appropriate values and perspectives culturally and maximize treatment outcomes, including overall developmental growth across various domains and reduction of ASD symptoms. The five key components or principles of the CEITA intervention program are as follows: (a) systematic developmental practices, (b) children’s active learning roles, (c) adult-child relationships, (d) natural settings and reinforcers, and (e) family involvement. Cultural considerations have been incorporated into the practical therapeutic practices of the CEITA program. For example, figurines of “Upin & Ipin,” famous Malaysian cartoon characters, were used in session to enhance social interaction. Another example would be incorporating elements of cultural celebration such as “Hari Raya,” Chinese New Year, and others to increase social communication, verbal expression, cognitive acquisition, and others.
Figure 1. The CEITA theoretical framework.
This study used a randomized controlled trial design and proposed that children with ASD who received the CEITA program would show significant improvement across developmental domains and a reduction in ASD symptoms.
Methods
Design
This study was approved by the Faculty of Social Sciences and Humanities, University of Kebangsaan, Malaysia (UKM) (JEP-2021-871).
This research is registered under both the National University of Malaysia (reg number: JEP-2021-871, date: 14th February 2022, as well as under the Medical Research & Ethics Committee from the Ministry of Health Malaysia (reg number: NMRR ID-22-00626-8LB, dated 29th April 2022 Research Directory List | National Medical Research Register (nmrr.gov.my) before commencement of the first trial.
A randomized pre-post experimental design, with outcomes measured at baseline and after treatment, was used. A 6-week follow-up was also conducted to reduce bias, increase statistical power, and enhance the reliability of the results. Parents or caregivers completed the revised Malay version of the Modified Checklist for Autism in Toddlers (M-CHAT-R/F) to measure autism-related symptoms, whereas developmental growth was measured using the Developmental Profile-4 (DP-4) assessment completed by a therapist or clinician. All measured data were quantitatively collected, and statistical analysis was performed prospectively using SPSS version 27.
Participants
As this study was an extension of the authors’ previous study on validating the Malaysian M-CHAT-R/F, participants were recruited using a purposive sampling method. Malaysian children aged 18–48 months and diagnosed with ASD had participated in the previous study, and they were invited to participate in this study. Additional inclusion criteria were as follows: (a) having an identified caregiver, (b) absence of comorbidity with other neurological illnesses or physical handicap, and (c) capacity to commit to attending the CEITA program weekly for three months. The exclusion criteria were presence of comorbidity of neurological illnesses or physical disabilities, such as cerebral palsy, intellectual disabilities, Down syndrome, and other similar conditions. Further, parents who anticipated enrolling their children with ASD into other interventions throughout the research period were excluded from the study.
Based on Kazdin’s (1994) review of clinical research and practice on the recommendation for sample size, the alpha was set at 0.05, with a power of 0.80, and an estimated effect size of 0.40. G *Power (Faul et al., 2007) calculator was used to generate the required sample size and run a mixed Analysis of Variance (ANOVA) with two groups over three measurement time points. The minimum sample size needed was 12 participants. However, as research has documented a dropout rate of approximately 20% across most medical journals (Bell et al., 2013), this study recruited 16 participants in total and randomly assigned them to either the intervention or control group. Microsoft Excel’s randomization principles were executed for random assignment, with the RAND function used to assign random numbers to each participant. Subsequently, the function SMALL was used to divide the participants into two groups: the intervention group, comprising those with random values less than 0.5, and the control group, comprising the others. Thus, 16 participants were divided into two groups of eight individuals each.
Each participants’ demographic characteristics are listed in Table 1, and the overall descriptive statistics of the intervention and control groups are shown in Table 2. Sixteen participants with an average age of 34.25 months (standard deviation = 7.12) were recruited for the study. The chi-square test was employed to evaluate the statistical significance between groups, considering that both children’s age and sex were categorical variables. No statistically significant differences were observed in terms of age (χ2 = 12.00, p = 0.29) or sex (χ2= 0.25, p = 0.59) among the various groups of participants.
Table 1. Demographic characteristics for each participants.
Procedures
Prior to the data collection, the researcher obtained ethical approvals from the UKM institutional ethical board. Participants were recruited from the researcher’s previous validation study of M-CHAT-R/F Malay, which was approved by the UKM ethical board (JEP-2021-871) and Medical Research & Ethics Committee Malaysia (NMRR ID-22-00626-8LB). Sixteen participants from the previous study, who were diagnosed with ASD and aged 18–48 months, were identified. Figure 2 shows the overall procedure used in this study.
Figure 2. Overall research procedures.
The parents or caregivers provided informed consent through their signature on the printed informed consent form, thereby granting their permission for their children’s participation in the study. Considering the age range, level of maturity and psychological condition of the prospective child who is diagnosed with ASD, the decision to withhold the child’s assent was made due to concerns over their comprehension of the potential risks and benefits associated with the research. All participants were informed of their right to withdraw or terminate their participation at any stage of the study. Next, parents or caregivers were asked to complete the M-CHAT-R/F, and the clinician or therapist completed the DP-4 assessment. The data obtained from these two measurements served as baseline values. Sixteen participants were randomly assigned to either the intervention (n=8) or control (n = 8) group. The therapists or clinicians appointed for each child were blinded to the measured data, and they declared no conflict of interest with any of the participants. The CEITA program intervention was administered to the participants assigned to the intervention group in two sessions per week, with each session lasting 60 minutes. This intervention was provided for approximately three months, equivalent to 24 sessions in total. The individuals assigned to the control group were not subjected to any form of intervention or therapy throughout the study period. All case data were recorded by the respective CEITA therapists and stored in hard or soft copies in the researchers’ cloud-based storage systems. Upon completion of the intervention or three months after baseline, parents, caregivers, and therapists were invited to complete the M-CHAT-R/F Malay and DP-4 again. The three measures were also obtained six weeks post-intervention. As no participant dropped out, all data were included in the analysis.
Measures
Presence of autism symptoms or characteristic
The M-CHAT-R/F (Robins et al., 2009) is an ASD screening tool with 20 yes/no checklist items. This parent-administered questionnaire can be completed within 10 minutes. Translation, cultural adaptation, and validation of this screening tool in Malay for the Malaysian population were conducted prior to this study’s commencement (Han et al., 2023a). The Malaysian M-CHAT-R/F is documented to have high sensitivity (97%) and specificity (94%), with a satisfactory positive predictive value of 53.3% when used among young children aged 18–48 months.
Developmental growth
DP-4 (Alpern, 2020) is a 190-item checklist that measures five developmental domains (i.e., cognitive functioning, communication, social-emotional behavior, adaptive behavior, and physical development) for individuals from birth to 21 years and 11 months. For this study, a clinician-rated checklist was used and completed by the individual therapist or clinician in charge of each participant’s intervention. The scores were calculated by a different clinician who was blinded and had no conflict of interest with the child or the clinician who completed the checklist. Each subscale contained approximately 35 yes/no checklist items. The scores on each subscale were summed and converted into growth scores for comparison and monitoring of developmental progress over the intervention and follow-up periods.
Feasibility analysis
Prior to the study’s commencement, a feasibility analysis was conducted. A case study was conducted using semi-structured interviews with therapists, parents, and an expert panel in the field. Consequently, the case study revealed significant improvements in overall developmental growth and reduction of ASD symptoms. The expert panel advised on the adoption of a randomized controlled trial methodology when studying the CEITA intervention program’s efficacy to increase the results’ reliability and validity. Sample size calculation and randomization strategies were determined based on previous clinical research recommendations. The therapists surveyed suggested that having therapy sessions twice a week, with each session lasting about 60 minutes, would be feasible, and the commitment for 24 sessions, approximately three months, is reasonable. The decision regarding the frequency and duration of sessions was also inclusive of the parents’ willingness to commit and their financial capability. Outcomes were measured using the parent-administered Malaysian M-CHAT-R/F, as the tool had been validated, and the therapists and expert panel suggested that the DP-4 could measure developmental growth.
Statistical analysis
All participants were assessed at baseline, and descriptive statistics for each variable were calculated and listed. Considering the categorical nature of the demographic variables (age and sex), a chi-square test was performed to determine any significant differences between them. Subsequently, independent T-tests were performed to analyze the baseline differences between the intervention and control groups in the M-CHAT-R Malay and DP-4 scores. As this study aimed to examine the effectiveness of the CEITA program through changes in the measured data, analysis of covariance (ANCOVA) or Multivariate analysis of covariance (MANCOVA) statistical tests were performed, where relevant baseline scores were controlled as continuous covariates. As such, more reliable conclusions can be drawn, as the effect of the categorical independent variable (baseline scores) on the dependent variables (post-intervention and follow-up scores) was isolated. The post-hoc test results were then used for directional inferences.
Results
Baseline comparisons
Multiple independent T-tests were performed, and the mean differences between the intervention and control groups were computed. Table 3 displays the Mean and Standard Deviation of each group’s M-CHAT-R/F and DP-4 measured variables. No significant differences were observed in any of the measured variables, p > 0.05.
Table 3. Baseline comparison between groups.
Intervention effect at post-test and follow-up
MANCOVA analysis was performed on the M-CHAT-R and DP-4 scores to examine the intervention effect. In these models, the relevant baseline scores were computed and controlled for as continuous covariates. Table 4 displays the descriptive statistics comparing the intervention and control groups at post-test and follow-up for all variables, whereas Table 5 displays the intervention effect based on partial eta squared and significance values for all variables.
Table 4. Descriptive statistics for each measures in each group at pre-test, post-test and follow-up.
Table 5. Intervention Effect between groups at post-test and follow-up according to the multivariate analysis of covariance (MANCOVA).
| Effect (group) | Model | Post-test | Follow-up | ||
|---|---|---|---|---|---|
| Wilks’ Λ | F | η2 | F | η2 | |
| M-CHAT-R/F | 0.32 | 7.37 | 0.36* | 14.51 | 0.53* |
| DP-4 | |||||
| Physical | 0.59 | 3.22 | 0.20* | 7.99 | 0.38* |
| Adaptive Behavior | 0.23 | 23.29 | 0.64** | 43.49 | 0.77** |
| Social Emotional | 0.27 | 13.65 | 0.51* | 29.89 | 0.70** |
| Cognitive | 0.22 | 16.54 | 0.56** | 45.60 | 0.78** |
| Communication | 0.29 | 25.66 | 0.66** | 17.88 | 0.58** |
After controlling for the baseline scores, the MANCOVA revealed a statistically significant difference between groups based on the M-CHAT-R/F scores at both time points: F(2, 12) = 12.60, p =.001, Wilks’ Λ =.323, partial η2 =.70. Post-hoc analysis of between-subjects effects utilizing MANCOVA (refer to Table 5) revealed a significant group difference at post-test, F(1,13) = 7.37, p =.018, partial η2 =.36, and at follow up, F(1,13)=14.51, p =.002, partial η2 =.53. As shown in Table 4 and Figure 3, participants in the intervention group had significantly lower M-CHAT-R/F scores at post-test (M=6.13, SD=3.00) and follow-up (M=4.88, SD=3.27) compared to participants in the control group at post-test (M=8.88, SD=2.23) and follow-up (M=9.00, SD=2.98).
Figure 3. Line graph depicting score of M-CHAT-R/F between intervention and control group at different data time-poin.
Conversely, MANCOVA results for all DP-4 domains also showed a statistically significant difference between groups on the domain growth scores at both time points after controlling for baseline scores, with Wilks’ Λ ranging from 0.22 to.0.59 and partial η2 ranging from 0.41 to 0.79. Post-hoc analysis of between-subjects effects, using MANCOVA (refer to Table 5), revealed significant group differences in all developmental domains, with partial η2 effects spanning from 0.20 to 0.66. Table 4 and Figure 4 show significantly higher post-test and follow-up growth scores across all developmental domains for participants in the intervention group.
Figure 4. Line graphs depicting score of DP-4 domains between intervention and control group at different data time-points.
Discussion
The primary objective of this current randomized controlled study is to assess the effectiveness of the CEITA program as an early intervention program for children in Malaysia who have been diagnosed with ASD and are aged four years and below. The efficacy of the CEITA program was assessed by examining its impact on developmental domains and the existence of ASD symptoms in the participants. This program is designed to provide a comprehensive intervention, and it has been designed with a rigorous empirical foundation, aiming to optimize the intervention’s impact by employing low-intensity and culturally relevant delivery modalities. This approach was tailored to meet the requirements of a cost-effective yet highly successful intervention for a specific target demographic.
In this study, 16 Malaysian children aged 18–48 months had been diagnosed with ASD were recruited and randomly assigned to either the intervention or control groups. Children in the intervention group who participated in the CEITA program showed a statistically significant decrease in autism-related symptoms. The M-CHAT-R/F scores substantially declined immediately after the completion of the CEITA program. Furthermore, these scores decreased further even after six weeks post-intervention. Conversely, children in the control group did not demonstrate any noteworthy variations during the designated timeline. With the non-significant baseline scores between the intervention and control groups, the huge decrease in scores and significant difference between the groups further suggested the high efficacy of the CEITA program. Indeed, the average initial M-CHAT-R/F scores for both groups fell within the high-risk category. However, following the intervention, the children in the intervention group achieved significantly lower scores (M=6.13) and were classified as falling within the medium-risk range. Contrarily, children in the control group exhibited a consistent pattern of M-CHAT-R scores that fell within the high-risk category. The M-CHAT-R scores for children in the intervention group continued to decrease at even after six weeks post-intervention, further supporting the efficacy and validity of the CEITA program and its possible long-term benefits.
The findings of this study also showed a significant increase in almost all developmental domains among children in the intervention group immediately after the CEITA program completion. The growth scores exhibited a sustained and significant increase across all domains during the post-intervention and at the six-week follow-up, indicating that the effects of the intervention were substantial and enduring. In fact, the strong correlation observed in the post-intervention stage provides clear evidence of the interconnectedness and inter-relatedness of all developmental areas. Further, except for the physical domains, all other domains, such as adaptive behaviors, social-emotional, cognition, and communications, showed a large intervention effect (p<0.001) at post-intervention and follow-up. The consistent increase in growth scores across the measured timeline within the intervention group further validates the intervention effect of the CEITA program in this study. Compared to other intervention studies with control groups (Estes et al., 2015; Vivanti & Dissanayake, 2016) that did not show significant group difference immediately after the intervention, this research evidently presented a substantial intervention effect post-intervention. The immediate group differences observed in this study could be explained by several factors.
Compared to intervention programs and studies conducted in Western countries, the current research highlights the inclusion of cultural values and traditions. Some of the cultural considerations were as follows: (a) the choice of language used in sessions was congruent with the family; (b) the choice of activities or reinforcements given were culturally appropriate; (c) cultural celebrations or events included were relevant to the local community; (d) the materials used were closely related to the local community. The integration of cultural values and traditions in the CEITA program may be one of the prominent factors in its succession. The importance of cultural differences and the need for adaptation to early intervention have also been documented in recent research (Xu et al., 2018), which found a significant intervention effect immediately after treatment. In their study, the authors also claimed that the cultural adaptation steps were necessary to ensure successful implementation of the intervention. Therefore, the findings of this study further support the importance of acknowledging cultural diversity among populations. In line with the widespread use of screening tools globally (Han et al., 2023b; Soto et al., 2015), future studies should explore the potential of modifying efficacious interventions to cater to diverse populations with varying cultural backgrounds.
Apart from the cultural factors, the use of appropriate measures could also have contributed to the success of this study. As noted in previous studies (Fulton et al., 2014; Vivanti & Dissanayake, 2016), different instruments and methodologies have been used to measure intervention efficacy. Although a consensus is reached that the efficacy of an ASD intervention is reflected in the decreased autism symptoms, the data obtained from different instruments may not accurately reflect the severity of symptoms, given the highly complex nature of the disorders. Additionally, young children diagnosed with ASD often exhibit impairments beyond communication and behavioral deficits (Brian et al., 2015). Hence, This study assessed the effectiveness of the intervention by documenting the alterations in symptoms associated with autism and examining the changes in growth scores across various developmental domains. Specifically, the high correlation between developmental domains and autism symptoms further supports the inter-relatedness of the domains. This finding provides additional support for the fundamental theoretical underpinnings of the CEITA program, which is designed to prioritize comprehensive developmental growth rather than solely address the symptoms associated with ASD. Nonetheless, predictive analysis could not be performed in this study because the sample size of the intervention group was small. Future research could gather more data to analyze which developmental domains could be significant predictors of a reduction in ASD symptoms.
Overall, the findings of this study provide preliminary evidence that the CEITA program may be an effective early intervention for young children with ASD. The development-based approach in this model analytically assesses a child’s functioning level across many developmental domains, enabling therapists and parents to establish goals that are more attainable and aligned with the child’s current ability level. Therefore, the implementation and utilization of the CEITA program in this study align with the concept of early intervention for young children (Dunst, 2000), which refers to the provision of assistance and services to young children and their families regardless of whether the child has a diagnosed disability or is at risk of developing a disability. In fact, the current findings provide initial support for further studies on evidence-based early intervention to enhance overall developmental growth as a primary method for mitigating symptoms related to ASD. Consequently, the stigmatization linked to ASD could be alleviated, and the effectiveness of treatments could be conveyed in a more optimistic and encouraging manner to parents. From a practical standpoint, the adoption of the CEITA program is anticipated to be more cost-effective and less time-consuming because of its delivery in low-intensity and brief sessions.
However, this study has several limitations. First, despite the significant intervention effects observed across measures, significant predictors among the developmental domains of autism symptoms could not be pinpointed, as the number of participants was too small for regression analysis. Second, although the CEITA program noted the importance of parental involvement, the analysis or findings on how parental involvement moderated the findings were not discussed. Third, as this study was designed to be quantitative, the qualitative nature that offers insights into other possible key explanations for the efficacy of the CEITA program might have been missed. Therefore, the current research findings are preliminary and should be interpreted cautiously.
Conclusion
In summary, this study makes a significant contribution to the field of early intervention services for young children with ASD, particularly considering the limited number of existing comparable papers. Furthermore, the CEITA program examined in this study was designed to recognize the significance of cultural diversity. This study’s findings suggest that the inclusion of cultural values in early interventions may have a beneficial moderating effect on their efficacy. Furthermore, the CEITA program’s design and methodology were emphasized as being of significant relevance. The developmental trajectory of a child with ASD is highlighted as comparable to that of a neurotypical child, in which the growth of all developmental domains is interwoven during the early years (Hyman et al., 2020). These results emphasize the importance of complete and holistic early interventions.
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Han YL, Wan Sulaiman WS and Ahmad Badayai AR. Efficacy of CEITA early intervention program for young children with autism spectrum disorders: A randomized controlled trial design [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:395 (https://doi.org/10.12688/f1000research.145666.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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How to cite this report:
Gkiolnta E. Reviewer Report For: Efficacy of CEITA early intervention program for young children with autism spectrum disorders: A randomized controlled trial design [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:395 (https://doi.org/10.5256/f1000research.159643.r284849)
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Reviewer Report 01 Jul 2024
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Overall, this is a very interesting and well-written manuscript. The data provided are very sufficient in order to provide comprehensive results and conclusions and the statistical analysis is quite thorough. The only issue is that no sufficient description is given
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Gkiolnta E. Reviewer Report For: Efficacy of CEITA early intervention program for young children with autism spectrum disorders: A randomized controlled trial design [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:395 (https://doi.org/10.5256/f1000research.159643.r284849)
The direct URL for this report is:
https://f1000research.com/articles/13-395/v1#referee-response-284849
https://f1000research.com/articles/13-395/v1#referee-response-284849
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