Therapies for Children With Autism Spectrum Disorders

Because of the potentially increased efficiency and desirability of having parents provide
intervention to their children in their own homes, several studies have reported on varying
approaches to preparing parents to provide behavioral therapies. Sofronoff et al. 174,175 conducted
a parent training intervention with parents of children ages six to twelve years with Asperger
syndrome diagnoses. Parents either (a) participated in a one-day workshop, (b) attended six
weekly 1-hour individual sessions conducted by master’s or doctoral students in psychology, or
(c) were placed in a waitlist control group. Components of the intervention were the same in both
treatment groups and involved psychoeducation, comic strip conversations and social stories
introduction, and management techniques for externalizing behaviors, rigid behaviors, and
anxiety. Parents from both intervention groups reported significantly better social skills in their
children than did parents in the waitlist control group at both 1-month post-treatment and 3month
followup; at 3-month followup, parents from the individual session group reported
marginally better social skills for their children than did parents from the workshop group,
suggesting little modification of effect by intensity (one day vs. weekly training).
Finally, in a case series assessing an intervention intended to improve either joint attention or
symbolic play skills, a teacher-led approach was compared with one in which the child took the
lead and found positive effects associated with the teacher leadership. 158
Child characteristics. Several characteristics of the child have been assessed to determine
whether there were identifiable variables associated with positive outcomes in intensive
behavioral interventions.
Cognitive abilities/IQ. The most commonly reported characteristic investigated relates to
pretreatment cognitive abilities/IQ. Several investigations have noted that pretreatment IQ and
language predicts IQ at followup within the context of UCLA/Lovaas-based
methodologies. 101,104,115,124,287 However, other studies have suggested having a lower IQ at
initiation of treatment is related to increased change in IQ over time 127 or and change in response
to intervention 102,126,132 within this same methodology. In contrast to UCLA/Lovaas-based
methodologies, parent training interventions for teaching early social communication skills
demonstrate that children with lower language levels and/or lower IQ at baseline may actually
benefit more from this intervention. 108,109 Some data from Pivotal Response Training studies
suggest that less impaired children do better in response to offered parent training. 117
Language/communication skills. Baseline language/communication skills may also correlate
with treatment success, with studies generally suggesting a benefit for communication skills,
including changes in ASDs classification associated with baseline language skills in an ABAbased
approach.102, 124 In one RCT155, 156 comparing the use of targeted joint attention
intervention to development of symbolic play skills, children with initially higher levels of
expressive language showed greater growth in expressive language from pre-intervention to 12
months post-intervention. Among children with lower expressive language initially, those in the
joint attention group showed significantly greater improvements in expressive language. In
addition, joint attention initiations, responding to joint attention, the duration of child-initiated
joint attention, average highest level of play, total number of symbolic play types, and initial
receptive language age all predicted greater gains at 6 and 12 months post intervention.
Similarly, social skills studies have found verbal skills, either verbal comprehension (using
the Verbal Comprehension Index) or expressive communication skills to be associated with
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