Therapies for Children With Autism Spectrum Disorders

and are based on consideration of four domains: risk of bias, consistency in direction of the
effect, directness in measuring intended outcomes, and precision of effect. For determining the
strength of evidence for effectiveness outcomes, we only assessed the body of literature deriving
from studies that included comparison groups. We required at least 3 fair studies to be available
to assign a low strength of evidence rather than considering it to be insufficient. We required at
least one good study for moderate strength of evidence and two good studies for high strength of
evidence. In addition, to be considered “moderate” or higher, intervention-outcome pairs needed
a positive response on two out of the three domains other than risk of bias. For determining the
strength of evidence related to harms, we also considered data from case series.
Once we established the maximum strength of evidence possible based upon these criteria,
we assessed the number of studies and range of study designs for a given intervention-outcome
pair, and downgraded the strength of evidence rating when the cumulative evidence was not
sufficient to justify the higher rating. As could be expected in a field that is testing a broad array
of interventions, most intervention-outcome pairs had insufficient strength of evidence to
establish confidence in the stability of observed effects.
Tables 27 through 35 provide summaries of results, including strength of evidence, for each
category of intervention (behavioral, educational, medical, allied health, and CAM). Table 36
documents the strength of evidence for each domain of the major intervention-outcome
combinations for which the strength of evidence was not insufficient. Table 37 presents those
interventions-outcomes pairs for which the strength of evidence is insufficient.
Outcomes and Strength of Evidence of Therapies
Effectiveness of Behavioral Interventions
Categories of behavioral intervention studies included early intensive behavioral and
developmental intervention studies, social skills approaches, play- and interaction-based
approaches, interventions focused on commonly associated conditions, and studies of additional
behavioral interventions. Tables 27 through 31 summarize effectiveness findings for studies of
behavioral approaches.
Early intensive behavioral and developmental interventions. We adopted a similar approach
to the operationalization of this category as Rogers and Vismara 12 in their review of
“comprehensive” evidence-based treatments for early ASDs. Interventions in this category have
their basis in or draw from principles of applied behavior analysis (ABA), with differences in
methods and setting. ABA is an umbrella term describing principles and techniques used in the
assessment, treatment and prevention of challenging behaviors and the promotion of new desired
behaviors. The goal of ABA is to teach new skills, promote generalization of these skills, and
reduce challenging behaviors with systematic reinforcement. The principles and techniques of
ABA existed for decades prior to specific application and study within ASDs.
We first discuss two intensive manualized interventions: the UCLA/Lovaas model and the
ESDM. These two interventions have several key differences in their theoretical frameworks and
implementation, but are similar in the frequent use of high intensity (many hours per week, oneon-one)
instruction utilizing ABA techniques. They are described together here because of these
similarities. The UCLA/Lovaas method relies heavily on one-on-one therapy sessions during
which a trained therapist uses discrete trial teaching with a child to practice target skills, while
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