Therapies for Children With Autism Spectrum Disorders

Table 29. Summary of results of studies of play-/interaction-based interventions
Intervention Study design/ Quality Study results and overall strength of evidence
Parent-focused
therapies
2 RCTs / 1 fair, 161 1
poor 153,154
• Problem behavior declined for the treated group in both studies.
• Adaptive behavior skills increased for the treated group in one
RCT.
• Parent reports indicated that the treated group appeared more
typical following intervention in one study.
• Strength of evidence for effectiveness in affecting challenging
behavior is insufficient.
Imitation 3 RCTs / 3 poor 163-165 • Children in imitation treatment groups showed more interaction
with adults compared with those in contingent response groups in
all three studies.
• Strength of evidence for the effect on social behavior is
insufficient.
Joint attention and
symbolic play
Relationshipfocused
interventions
RCT=randomized controlled trial
2 RCTs / 1 fair 155,156 , 1
poor 157
2 Prospective case
series 158,167
2 Prospective case
series 160,166
2 Retrospective case
series 159,162
• Joint attention and symbolic play were both effective in improving
responsive joint attention or expressive language in the short and
long term in one RCT.
• Greater improvement in outcomes predicated on increased joint
attention in the joint attention groups in one RCT.
• Mother-mediated joint attention intervention yielded increases in
joint engagement in one study.
• Strength of evidence for effectiveness of joint attention
intervention in affecting joint attention outcomes is insufficient.
• Positive behavioral outcomes noted in all series, but no
comparison groups.
• Insufficient evidence to determine effectiveness.
Behavioral Interventions for Commonly Associated Conditions
Summary. We identified 11 studies reported in 12 papers 25,26,168-177 that addressed behavioral
interventions focused on symptoms commonly associated with ASDs. Most studies of behavioral
interventions to address commonly associated conditions are limited to high-functioning children
(based on IQ) with ASDs who are at least school age. These studies evaluated behavioral
treatments for commonly occurring comorbid symptoms in ASDs, including anxiety, anger
management difficulties, and challenging behaviors. All report promising results, with caveats
concerning study quality.
Interventions included cognitive behavioral therapy in individual and group formats, parent
training, and teacher training to address target symptoms. Cognitive behavioral therapy (CBT)based
treatments varied across studies and were generally adapted from existing manuals to be
more amenable for use in children with ASDs. Several studies suggested that CBT-based
interventions were effective in reducing anxiety symptoms. 26,170,171
This category of intervention also included various parent training approaches to decrease
challenging behaviors. Results of two studies combining parent training with risperidone
treatment suggested that adding parent training to medication increased adaptive behavior and
decreased noncompliance and irritability/aggression in children with ASDs. 172,177 Another set of
parent training studies suggested that training parents improved both the frequency and intensity
of a child’s challenging behaviors. 174,175
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