Therapies for Children With Autism Spectrum Disorders

oom as the other assessments, so it is not clear whether the targeted social skills would
generalize to more naturalistic settings with peers.
In medical studies, although the treatment is prescribed in a clinical setting, it is generally
administered at home, and one would expect effects of medications to be observed in terms of
behavior in the home and other settings. However, medical studies may be good sources of
information on the duration of perceived effects. Unfortunately, other than case series data for
risperidone 177,203,204,206,213 demonstrating continued effects and side effects beyond six months.
few data are available on longer term outcomes of medical treatment.
Two of the case series studies of SRIs are based upon durations of treatment longer than 6
months, but the general and sometimes qualitative ratings of change in these studies are difficult
to compare with the results of the RCTs to understand if medication responses reported in RCTs
are likely to be durable. 221,224
KQ6. Drivers of Treatment Effects
No studies were identified to answer this key question.
KQ7. Treatment Approaches for Children Under Age Two at Risk for
Diagnosis of ASDs
This section presents the results of our literature search and findings regarding the use of
treatment approaches in younger children who are at high risk of developing autism based upon
behavioral, medical, or genetic risk factors. Studies located typically included participants whose
mean age exceeded 24 months; however, the studies address interventions which can be used
with children under age 2. The average age for diagnosis of ASDs in the US is not until at least
age 3, but a reliable diagnosis may be possible as early as age 2. 291-293 Research suggesting that
early intervention can improve outcomes has compelled investigators to consider intervening in
very young children. 115
We identified four papers 178,290,294,295 with unique study populations addressing treatment
approaches for very young children. Three studies were conducted in the US 178,290,294 and one in
the UK. 295 Two of the studies were prospective case series, 178,294 one was a nonrandomized
controlled trial, 295 and one was a randomized controlled trial. 290 Table 26 summarizes outcomes
for studies considered to be fair or good quality and employing comparison groups.
The RCT 290 and nonrandomized trial 295 were completed in a clinic setting with instruction to
continue with parents at home. All children in the RCT met DSM-IV criteria as well as criteria
on ADOS and Toddler Diagnostic Interview for diagnosis confirmation; the mean age of
participants in the treatment and control groups was 23 months. The nonrandomized trial 295
employed parent training techniques to teach social communication skills and included children
with a mean age of 38 months in the intervention group and 34 months in the control group.
One of the case series describes an evaluation of techniques to train personnel to provide
ESDM-based therapy and included children with a mean age of 33 months. 178 The second case
series 294 was completed in the home and classroom and focused on social-communication and
language outcomes; children assessed in the study were between 18 and 36 months. Among
studies in this section, 1 was considered good quality, 1 fair quality, and 2 were considered poor.
The Dawson et al. 290 randomized controlled trial evaluated the effectiveness of the ESDM for
young children with ASDs. ESDM, a comprehensive, manualized intervention that blends ABA
with developmental and relational approaches, was designed to be used with children as young
as 12 months, delivered in the home, and to utilize parents as well as trained therapists.
95