Therapies for Children With Autism Spectrum Disorders

therefore described separately below, and Table 23 provides an overview of study information.
Among the four unique studies, one was good quality and three were poor.
Summary of the literature. Four analyses from one randomized trial 258-261 comparing RPMT to
PECS in the United States met our criteria and were included. The 36 preschoolers included in
the study had a confirmed diagnosis of Autistic Disorder or PDD-NOS, were between 18 and 60
months of age, and were nonverbal or had low verbal status (fewer than 20 different words used
cumulatively during three communication samples). Most (86 percent) of the participants were
male, and most (69 percent) were white. Although the mean chronologic age of the children was
33.6 months (range from 21 to 54 months), the mean mental age in the nonverbal children was
18.6 months and in the verbal children was 11.9 months, based on Mullen Scales of Early
Learning. Diagnosis of autism was confirmed with the ADOS for all children. Nineteen children
were randomized to receive PECS and 17 to receive RPMT.
During the six-month treatment phase, children attended three 20-minute therapy sessions per
week, with parents offered up to 15 hours of training. Outcomes were measured at the end of
treatment and 6 months after treatment completion in the context of a 15-minute free play
session in which the interaction style, toys, examiner and location were all different from those
in which the intervention was conducted. Treatment fidelity was assessed monthly, interrater
reliability was assessed on at least 20 percent of data points, and coded data were double entered
to ensure accuracy.
At Time 2, the PECS group had significantly higher frequency of non-imitative spoken
communication at Time 2 than the RPMT group, and higher numbers of different non-imitative
words. No overall significant between group differences were observed at Time 3, indicating that
the treatment effects did not maintain at six months after the end of treatment. This study
included an analysis of initial characteristics of the children, demonstrating that children who
were low in initial object exploration benefitted more from RPMT, which explicitly teaches play
with objects; while children who were relatively high in initial object exploration demonstrated
more benefit from PECS.
These results were maintained at 6 months. An additional analysis based on this study 260
showed greater increases in generalized turn-taking and initiating joint attention in the RPMT
group than in PECS. The increased benefit for RPMT in join attention was only seen, however,
in children who began the study with at least some initiation of joint attention. Specifically,
children most likely to benefit from RPMT in increasing joint attention had demonstrated at least
seven acts of joint attention in the pre-intervention assessment. RPMT was also superior in this
analysis in increasing object exchange turns.
The second RCT 263 in this literature was a pragmatic trial focused on the effect of providing
expert training in PECS to teachers in specialist schools, under the assumption that although
more than half of autism-specific schools in the UK claim to use PECS system, few teachers
have been adequately trained to provide it. This study aimed to explore the potential effects of
intensive training of teachers on child outcomes in spontaneous communication and speech; thus
randomization occurred at the classroom level in three groups – immediate treatment group,
delayed treatment group, and no treatment group. Teachers in the delayed treatment group
received intensive training 2 terms after the immediate treatment group.
The 83 children included in the study were between the ages of 4 and 11 and had little or no
functional language; most (75) met ADOS-Generic criteria for Autistic Disorder, and nine met
criteria for another ASD. Treatment and assessment of language and nonverbal developmental
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