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The SMART Approach to Early Intervention for Autism

Overview and Implications

Previous research has indicated preschool and elementary school aged children with autism spectrum disorder (ASD) benefit greatly from earlier intervention methods (Rogers et al., 2012). Thus, the development of effective early intervention methods is a major topic of discussion and research within the autism research community.

Since the clinical presentation of ASD is highly heterogeneous, Kasari et al. review Sequential Multiple Assignment Randomized Trials (SMARTs) as a guide for researchers to tailor intervention methods to each individual child on the spectrum. Although play routines aimed at joint engagement between a caregiver and child are a common intervention approach used for children across the spectrum, researchers must further personalize interventions to suit each child’s specific needs. The intervention methods used are often based on the child’s age (to determine whether the child is physically and mentally ready to learn a skill) and initial social and language ability. Kasari et al. recommends taking on an adaptive treatment approach, in which participants are subject to different sequences of treatments at specified time points depending on the child’s development and response to initial treatment.

Despite primarily being a literature review on SMARTs, this article also poses significant questions and explanations on how researchers can improve the personalization of treatment methods for children with autism. The article’s detailed description of experimental designs and research methods may provide an inclusive guide for how ASD researchers should implement systematic personalization of intervention methods.


Kasari et al. do an excellent job of giving a detailed literature review and future guide for researchers looking at clinical treatment-based experiments for autism. This article looks at the various aspects of a research design, including treatment doses, methods of intervention delivery, systematically defining a child’s response to an intervention method, and tailoring variables.

Although this article provides a comprehensive literature review, it was vague about what exactly SMARTs are. Essentially, SMARTs are a type of research design where participants with autism are randomized into various intervention methods, which are corrected over time to suit each child on the spectrum and their symptoms. Furthermore, the article did not explain the development of SMARTs, which may lead to the incorrect conclusion that Kasari et al. designed it, though previous literature on SMARTs goes back to 2005 (Murphy, 2005).

Future Directions

Since this article only serves as a review and guide, future directions for ASD research may include actually implementing the concepts and protocols described. Furthermore, SMARTs are primarily focused on improvement in social communication for children with autism. However, early intervention methods, such as discrete trial training (DTT), placed higher emphasis on cognitive domains, such as IQ (Smith et al., 2000). Thus, I am interested in learning whether there are research designs that could incorporate both gains in social communication and language skills with gains in cognitive function and what type of protocols would be implemented in order to support this.

Article Reviewed

Kasari, C., Sturm, A., Shih, W. (2018). SMARTer approach to personalizing intervention for children with autism spectrum disorder. J Speech Lang Hear Res, vol. 61(11), pp. 2629-2640.


Murphy, S.A. (2005). An experimental design for the development of adaptive treatment strategies. Stat Med, vol. 24(10), pp. 1455-1481.

Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., Guo, M., Dawson, G. (2012). Effects of a brief Early Start Denver Model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, vol. 51(10), pp. 1052–1065.

Smith, T., Groen, A.D., Wynn, J.W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. Am J Ment Retard, vol. 105(4), pp. 269-285.

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