This article reports on a 4-year follow-up study from the Learning Experiences and Alternative Program for Preschoolers and Their Parents (LEAP) randomized trial of early intervention for young children with autism. Overall, participants from LEAP classes were marginally superior to comparison class children on elementary school outcomes specific to communication, adaptive behavior, social, academic, and cognitive skills. Statistically significant group differences were noted in cognitive development and social skills. However, when placement was treated as an independent variable, very large effects were seen across all outcome measures, including autism symptoms, for children who were enrolled in inclusive settings. Data from adult family members confirmed important changes in perceived quality of life.