Therapies for Children With Autism Spectrum Disorders

the appropriate children and circumstances. However, with rare exceptions, 259,260,287 few studies
are designed or powered to allow analysis of heterogeneous effects in order to identify true
modifiers of treatment effect. Although we sought studies of treatment modifiers, only one
included study 259,260 actually demonstrated true treatment modifiers based upon appropriate study
design and statistical analysis. One other study 287 was designed to examine the role of provider
on outcomes, but showed no difference, possibly because it was underpowered to do so.
This first study 259 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.
One study 287 explicitly sought to examine the impact of provider choice (parent versus
professional) using similar interventions in an RCT. The study did not show a difference in
outcomes for children receiving UCLA/Lovaas protocol-based intervention in a clinical setting
versus at home from highly trained parents. both clinic and parent groups received over 30 hours
of intervention weekly and no group differences related to IQ, language, adaptive behavior, or
other outcomes were seen. Children in both groups demonstrated substantial gains in a number
of areas. Nonetheless, the results do provide further evidence of response to treatments anchored
in the UCLA/Lovaas method, with some children demonstrating rapid acquisitions of new skills
and change in IQ. Other studies not specifically designed to examine modifiers have also
compared parent to clinic-based interventions 126,132,288 and demonstrated equivalent group
change when delivered in the same intensity.
Other studies in this section are those in which potential correlates were identified that may
act as true moderators, but not in the context of studies designed and powered to identify
modifiers. These potential moderators should be assessed in properly designed and powered
studies for this purpose.
Behavioral Interventions
Frequency, duration, and intensity. Apart from the studies described above, a number of
potential correlates of treatment effect are observed in the existing literature and should be
studied further. The most commonly noted characteristics as potential correlates of effectiveness
in the study of behavioral interventions are treatment intensity and approach (e.g., parent-led
versus clinician-led) as well as baseline measures of child characteristics, including IQ, language
and verbal skills and severity of the autistic disorder.
Vismara and colleagues 178 found equivalent results across training (distance vs. in person)
modalities for providers of ESDM treatment. When examining characteristics of UCLA/Lovaasbased
intervention, Luiselli et al. found that months of treatment was significantly related to
language gain, but numbers of hours per week and total hours of treatment were not. 121 Intensity
of supervision within UCLA/Lovaas-based treatment has also been demonstrated to be positively
correlated with change in cognitive in cognitive abilities, although not other skills domains,
within one treatment study. 126,132
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