Therapies for Children With Autism Spectrum Disorders

showed diminished response to escitalopram, 223 with a particularly striking difference in a
subgroup of the low-expression genotype based upon previous association with platelet serotonin
uptake measures. 289 The low-expression genotype group also had verbal and nonverbal IQ scores
that were 25 to 26 points lower than the other subjects; although this was not described as a
statistically significant difference. Genotype groups also differed with respect to percentage of
Caucasian subjects, with the high-expression genotype group only containing Caucasian
subjects; although the pattern of results was reported to be the same in a Caucasian-only analysis.
In other medical studies, children treated with DMSA 250,255 had greater improvement in core
and associated ASDs symptoms if they were older than age 5. Children with lower initial ADOS
scores (below the 50th percentile) also had greater improvements than were seen among children
with initially higher scores. It is unclear whether either of these modifiers is significant in the
context of a trial with no overall difference in response between DMSA and placebo. In one
study of a ketogenic diet, 245 the two patients with the greatest improvement were those whose
baseline condition was classified as mild using CARS scores, and those with severe autistic
behavior showed substantially less improvement. In a study assessing omega 3 fatty acid use, a
negative correlation between docosahexaenoic acid level and CARS before treatment was
observed in nonresponders. Finally, attempts to identify subgroups of children for whom oral
immunoglobulin was successful in treating GI symptoms and associated autism symptoms found
no effect of age, regression onset of symptoms, or predominant bowel type. 64 The treatment was
uniformly ineffective.
CAM Interventions
One CAM study 285 noted correlations between changes in scores on sensory measures after
qigong massage therapy and positive behavioral changes.
KQ3. Early Results in the Treatment Phase That Predict Outcomes
Early Identifiable Changes Predicting Response/Outcome
Information about early response to treatment, or lack thereof, can be essential to guiding
treatment selection, implementation, and modification. The reviewed literature offers almost no
information about what specific changes predict long-terms outcome and response. Some
evidence indicates that early response to both UCLA/Lovaas-based approaches and ESDM
intervention in terms of changes in IQ over the first year of treatment predicts, or accounts for,
longer-term change in IQ. 287,290 However, findings also suggest that while gains in the cognitive
domain might be accounted for primarily within the first year of treatment, changes in adaptive
behavior in response to these same interventions may occur over a longer time frame 110,133,287,290
if they occur at all. 105
KQ4. End of Treatment Effects That Predict Outcomes
One study meeting our criteria addressed whether outcomes measured at the end of treatment
could predict longer term functional outcomes. An RCT comparing joint attention and symbolic
play interventions 155,156 included 58 children with autism between 3 and 4 years of age.
Investigators assessed language development, joint attention and play skills, and mother-child
interactions at pre- and post-intervention and 6 and 12 months after the end of the 5 to 6 week
intervention. Children in the symbolic play and joint attention groups showed significantly
greater growth expressive language over time than did participants in the control group (p