Therapies for Children With Autism Spectrum Disorders

Educational Interventions
Child characteristics. In educational interventions, baseline IQ and receptive language
predicted rate of progress in one study. 195 In a comparison of a home-based intervention plus
center-based (intervention) to a center-based only (control) educational intervention, 194,198 no
girls in the intervention group improved in IQ or on the Preschool Behavior Checklist. In the
control group, one girl improved in IQ, and 2 improved on the Preschool Behavior Checklist.
Improvement in IQ in the intervention group was higher with low socioeconomic status, younger
age, and high family stress. Improvement in Preschool Behavior Checklist scores was associated
with younger age in the intervention group. This study also considered the potential effect of
family stress and non-English speaking in the home and found no effect on outcomes.
Family characteristics. One study measured parental stress and its association with outcomes in
four different teaching interventions (reinforcement-based interventions, special nursery, speech
and language therapy, and parent education programs), 196 and found that parenting stress was not
associated with gains seen in interventions that required less total time but reduced the gains
made by those interventions that required more total time. Moreover, evidence suggests that at
lower levels of parenting stress, higher time intensity interventions are more effective than lower
time intensity interventions. For the lower parenting stress group, higher time intensity
interventions significantly improved intellectual functioning and educational functioning but not
adaptive functioning as measured by the VABS.
Medical Interventions
No modifiers of treatment outcome were identified in studies of antipsychotic medications in
ASDs, though one case series of risperidone use 205 reported a correlation between weight gain in
the first month and final weight gain. We were, however, able to identify papers that included
modifier data for stimulants and SRIs. None assessed measures of frequency, duration or
intensity of treatment specifically; nor did they assess training experience of the investigator or
clinician providing care.
Child and family characteristics. Some characteristics of the family and child were found to be
useful in predicting treatment success, including a history of psychiatric diagnoses in the family,
early verbal skills in the child, 224 and, potentially, genotype for predicting lack of treatment
response or adverse reactions. 214,223 Several studies of stimulant use highlighted differences in
effectiveness by diagnosis type 228-230,232,233 finding that children with Asperger syndrome were
typically more responsive to psychostimulant treatment than those with autistic disorder. The
presence of co-morbid intellectual disability was associated with lower treatment response in one
study. 232 Two studies sought to examine differences in treatment response by gender and found
none. 231,232 Details are provided below.
One open-ended study of fluoxetine treatment in 129 children assessed response
qualitatively. Subjects with an average age of 4.5 years were diagnosed with a PDD by DSM-IV
criteria corroborated by Childhood Autism Rating Scale and ADOS and were then treated with
fluoxetine as felt to be clinically indicated, with up to 72 months of treatment. They analyzed
potential predictors of good/excellent response, including family history and subject
characteristics. When comparing to subjects with fair/poor response, they found an increased rate
of family history of affective disorder (major depressive disorder and bipolar disorder) and
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