Therapies for Children With Autism Spectrum Disorders

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Allied Health Additional Studies Summary. We found eight studies 272-279 addressing disparate additional allied health interventions. No studies reported harms of intervention. Strength of evidence. Insufficient evidence is available to assess these interventions, including animal-assisted occupational therapy, prism lenses, and systematic feeding training. In sum, there have been few studies in the past decade examining the effectiveness of allied health interventions with sufficient sample size to consider closely (Table 34), although these approaches are often pursued by parents of children with autism. It will be important for future research to prioritize studying these treatments using rigorous methodologies to clarify whether (or for what outcomes) these treatments may be effective. Effectiveness of CAM Interventions Complementary and Alternative Medicine (CAM) Summary. Much of the CAM research (seven studies 280-286 ) meeting our inclusion criteria is preliminary (Table 35). Brief trials of massage therapy 284,286 suggest a potential role for massage in promoting sleep and behavioral improvement in children with ASDs. Pilot studies of acupuncture provided insufficient evidence based on small sample sizes and treatment duration. 280,281 Studies included here did not report harms of intervention. Table 35. Summary of results of CAM studies Intervention Study design/ Quality Study results and overall strength of evidence Massage 4 RCTs / 1fair, 283 3 poor 284-286 1 Prospective case series 282 • Some improvements in sensory, adaptive behaviors, social skills, and language measures. • Short-term, small studies (mean 25 participants/study), largely employing parent reported outcome measures. • Insufficient evidence to determine effectiveness. Acupuncture 2 RCTs / 1 fair, 280 1 poor 281 • Small effects on language measured with unvalidated tools. • Adverse effects not addressed. • Insufficient evidence to determine effectiveness. RCT=randomized controlled trial Strength of evidence. We found very few studies of complementary and alternative medicine, so evidence in this area also is insufficient to evaluate effects on outcomes assessed including sleep, language, social skills, sensory difficulties, and adaptive behavior (Table 35). Assessment of Domains for Strength of Evidence Table 36 illustrates assessments for each domain (risk of bias, consistency, directness, and precision) pertaining to strength of evidence for each of the major intervention-outcome combinations in this review that received a strength of evidence rating of low or high. As noted in the Evidence-based Practice Centers’ Methods Guide for Effectiveness and Comparative Effectiveness Reviews, 99 risk of bias reflects issues in study design and conduct that could result in biased estimates of effect. Consistency reflects similarity of effect sizes seen across studies. Consistency cannot be assessed when only one study is available. Directness is a reflection of the relationship between the intervention and the ultimate health outcome of interest. Precision is an assessment of certainty around the effect observed. 112
Table 36. Intervention, strength of evidence domains, and strength of evidence for key outcomes Intervention Domains pertaining to Strength of Evidence (SOE): SOE Risk of Bias Consistency Directness Precision Adaptive behavior Behavioral, UCLA/Lovaas Adverse events/harms Medium Consistent Direct Imprecise Low Medical, Antipsychotics (Aripiprazole) Low Consistent Direct Precise High Medical, Antipsychotics Low Consistent Direct Precise High (Risperidone) ASDs symptom severity Behavioral, UCLA/Lovaas Medium Inconsistent Direct Precise Low Medical, Secretin Challenging behavior Low Consistent Direct Precise High (lack of effectiveness) Medical, Antipsychotics (Aripiprazole) Low Consistent Direct Precise High Medical, Antipsychotics Low Consistent Direct Precise Moderate (Risperidone) IQ/cognitive Behavioral, UCLA/Lovaas Medium Consistent Direct Precise Low Medical, Secretin Language/communication Low Consistent Direct Precise High (lack of effectiveness) Behavioral, UCLA/Lovaas Medium Consistent Direct Precise Low Medical, Secretin Repetitive behavior Low Consistent Direct Precise High (lack of effectiveness) Medical, Antipsychotics (Aripiprazole) Low Consistent Direct Precise High Medical, Antipsychotics Low Consistent Direct Precise Moderate (Risperidone) Social skills/social behaviors Medical, Secretin Low Consistent Direct Precise High (lack of effectiveness) ASDs=Autism Spectrum Disorders; SOE=strength of evidence; SRIs-selective serotonin reuptake inhibitors; UCLA=University of California, Los Angeles Most intervention-outcome combinations have insufficient strength of evidence at this time, often because studies were either too diverse in interventions and outcomes studied to summarize, or because the field is early in its development (Table 37). 113
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Comparative Effectiveness Review Nu
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This report is based on research co
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Acknowledgments We are indebted to
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Therapies for Children With Autism
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Dietary and Other Medical Intervent
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Figures Figure A. Analytic framewor
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Table A. Description of interventio
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Analytic Framework Figure A. Analyt
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Strength of evidence. The degree of
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epetitive behavior showed improveme
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subgroups of children, although the
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We encourage investigators to provi
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9. Remington B, Hastings RP, Kovsho
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46. Green J, Charman T, McConachie
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82. Reaven JA, Blakeley-Smith A, Ni
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120. Masi G, Cosenza A, Mucci M, et
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157. Evangeliou A, Vlachonikolis I,
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Introduction Need for Evidence for
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Interventions intended primarily to
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Table 1. Description of behavioral
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Serotonin reuptake inhibitors. Sero
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Table 3. Description of medical and
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Table 4. Description of allied heal
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Key Questions and Analytic Framewor
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Chapter 4 discusses the results in
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Methods This chapter documents proc
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• Did not present aggregated resu
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Additional behavioral interventions
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1. Did the study employ a group des
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Scoring: Studies minimally had to h
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These ratings of applicability do n
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Figure 2. Disposition of articles a
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• ABA-based approaches including
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education, children in the intensiv
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abilities. This finding is further
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Table 10. Outcomes of early intensi
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forecast behavior; perspective taki
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interaction with peers; outcome mea
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hyperactivity, inattention, challen
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Table 12. Outcomes of RCTs assessin
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Schedule for Affective Disorders an
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SCAS-P=Spence Child Anxiety Scale-P
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Summary of the literature. Jarusiew
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Table 14. Overview of educational s
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on the Ankara Developmental Screeni
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Checklist scores decreased by 8.4 f
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Table 15. Outcomes of studies asses
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Page 145: strength of this reviewed literatur
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Page 153 and 154: percent of behavioral studies repor
Page 155 and 156: limited followup, lack of comparati
Page 157 and 158: individual intervention is warrante
Page 159 and 160: selecting participants for their st
Page 161 and 162: studies lacked an arm that consider
Page 163 and 164: 23. Kanner L. Autistic Disturbances
Page 165 and 166: 62. Dosman CF, Drmic IE, Brian JA,
Page 167 and 168: 104. Ben-Itzchak E and Zachor DA. T
Page 169 and 170: 142. Tyminski RF and Moore PJ. The
Page 171 and 172: 177. Aman MG, McDougle CJ, Scahill
Page 173 and 174: 214. Correia CT, Almeida JP, Santos
Page 175 and 176: 252. Akhondzadeh S, Tajdar H, Moham
Page 177 and 178: 290. Dawson G, Rogers S, Munson J,
Page 179 and 180: Acronyms/Abbreviations ABA Applied
Page 181 and 182: Appendix A. Exact Search Strings an
Page 183 and 184: Table A2. PsycINFO search strategie
Page 185 and 186: Therapies for Children with Autism
Page 187 and 188: Therapies for Children with ASD Sys
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Page 191 and 192: Evidence Table. Therapies for child
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Evidence Table. Therapies for child
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Country: US Practice setting: Clini
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Dunn-Geier et al., 2000 (continued)
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Evidence Table: Therapies for Child
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Appendix D. List of Excluded Studie
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31. Aarsland D, Cummings JL and Lar
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59. Ahearn WH, Clark KM, Gardenier
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89. Allison DB, Basile VC and MacDo
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118. Ando H, Yoshimura I and Wakaba
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146. Atkinson RP, Jenson WR, Rovner
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177. Bakare MO, Agomoh AO, Ebigbo P
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204. Baron-Cohen S, Scott FJ, Allis
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233. Bebko JM, Perry A and Bryson S
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262. Bergmann F, Stepp H, Metzger R
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291. Birkan B, McClannahan LE and K
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319. Boddy F, Rowan EN, Lett D, et
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348. Bouma R and Schweitzer R. The
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376. Broadstock M, Doughty C and Eg
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404. Brudnak MA. Application of gen
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432. Buitelaar JK. Why have drug tr
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460. Butler DE, Nordin IC, L’Ital
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489. Campbell M, Locascio JJ, Choro
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517. Caronna EB, Augustyn M and Zuc
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546. Case-Smith J and Miller H. Occ
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574. Charlop MH, Burgio LD, Iwata B
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602. Cheng CW, Cho SH, Taylor M, et
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631. Cicero FR and Pfadt A. Investi
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662. Collier D and Reid G. A compar
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691. Coskun M, Karakoc S, Kircelli
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718. Cullen LA, Barlow JH and Cushw
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748. Davidovitch M, Holtzman G and
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777. DeLeon IG, Fisher WW and Marhe
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805. Devlin SD, Harber MM. Collabor
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834. Doherty K, Fitzgerald M and Ma
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863. Dudley LL, Johnson C and Barne
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893. Dybvik AC. Autism and the Incl
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924. Elder JH. In-home communicatio
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953. Erickson CA, Posey DJ, Stigler
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979. Faja S, Aylward E, Bernier R,
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1008. Ferri R, Elia M, Agarwal N, e
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1037. Fisher W, Kerbeshian J and Bu
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1066. Fragala-Pinkham M, Haley SM a
Page 683 and 684:
1095. Furneaux B. Keeping the balan
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1124. Garcaa-Villamisar D, Wehman P
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1152. Ghezzi PM. Discrete Trials Te
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1180. Goin-Kochel RP, Myers BJ and
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1210. Gordon R, Handleman JS and Ha
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1239. Grimaldi BL. The central role
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1268. Guptill JT, Booker AB, Gibbs
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1296. Hamdan-Allen G. Brief report:
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1324. Hare DJ, Jones JPR and Paine
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1356. Harrison S and Berry L. Valui
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1386. Heilbrun AB, Jr., Blum N and
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1414. Hetzroni OE and Shalem U. Fro
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1443. Holburn CS. Counter the mistr
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1473. Horner RH, Carr EG, Strain PS
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1504. Hughes C, Soares-Boucaud I, H
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1533. Ijichi S and Ijichi N. Beyond
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1562. James SJ, Cutler P, Melnyk S,
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1591. Johnson CR, Butter EM, Handen
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1619. Joyce PR. The medical model-w
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1647. Karmali I, Greer RD, Nuzzolo-
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1673. Kelly AB, Garnett MS, Attwood
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1702. Kielinen M, Linna SL and Moil
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1731. Klin A, Lin DJ, Gorrindo P, e
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1761. Koegel RL and Frea WD. Treatm
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1790. Kolmen BK, Feldman HM, Handen
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1819. Kratochvil CJ, Findling RL, M
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1846. Lam MK and Rao N. Developing
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1874. Lattimore LP, Parsons MB and
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1903. Lee PC. Verification of a sim
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1932. Lerman DC, Vorndran C, Addiso
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1960. Licciardello CC, Harchik AE a
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1989. Liptak GS, Orlando M, Yinglin
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2015. Lorimer PA, Simpson RL, Myles
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2043. Luiselli JK, Kane A, Treml T,
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2071. MacFarlane JR and Kanaya T. W
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2099. Malone RP, Maislin G, Choudhu
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2127. Marin FZ. CAM versus nucleopl
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2157. Martineau J, Roux S, Adrien J
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2185. Matson JL and Lo Vullo SV. A
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2213. McCabe H. The Importance of P
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2240. McDougle CJ, Holmes JP, Carls
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2267. McHale SM, Olley JG, Marcus L
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2296. Merlo LJ, Lehmkuhl HD, Geffke
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2325. Minderaa RB, Anderson GM, Vol
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2354. Montgomery JM, Duncan CR and
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2385. Morrison RS, Sainato DM, Benc
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2413. Munesue T, Ono Y, Mutoh K, et
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2445. Napolitano DA, Tessing JL, Mc
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2474. Niederhofer H and Pittschiele
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2501. Nwora AJ and Gee BM. A case s
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2530. Olive ML, Lang RB and Davis T
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2559. Owens JA, Rosen CL and Mindel
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2589. Pansegrouw I and Alant E. Com
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2618. Paul C, Williams KE, Riegel K
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2646. Perry R, Nobler MS and Campbe
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2675. Piazza CC, Hagopian LP, Hughe
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2704. Poon L, Partika N and Bolman
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2734. Prizant BM. Speech-language p
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2764. Rapp JT, Vollmer TR, St. Pete
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2792. Reed P, Broomfield L, McHugh
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2819. Remington G, Sloman L, Konsta
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2849. Ringdahl JE, Kitsukawa K, And
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2877. Rogers SJ. Interventions that
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2908. Rossignol DA. Novel and emerg
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2939. Rutter M, Kreppner J, Croft C
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2967. Sandt D. Social Stories for S
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2994. Scanlon K. Art therapy with a
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3023. Schneider CK, Melmed RD, Bars
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3054. Schwartz IS, Sandall SR, Garf
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3085. Shafer MS, Egel AL and Neef N
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3115. Shipley-Benamou R, Lutzker JR
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3143. Siller M and Sigman M. The be
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3173. Smith C, Felce D, Jones E, et
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3202. Snyder A, Bossomaier T and Mi
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3230. Spero MH. The emancipation of
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3259. Stephens CE. Spontaneous imit
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3289. Strambi M, Longini M, Hayek J
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3318. Suzumura K. How an autistic b
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3346. Tager-Flusberg H and Calkins
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3376. Taylor I, O’Reilly M and La
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3407. Thunberg G, Ahlsen E and Sand
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3435. Trembath D, Balandin S, Toghe
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3464. Turner-Brown LM, Perry TD, Di
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3492. Van Der Putt R, Dineen C, Jan
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3522. Vitiello B. Recent NIMH clini
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3553. Walenski M, Mostofsky SH, Gid
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3581. Weber RC and Thorpe J. Teachi
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3610. Wheeler JJ, Baggett BA, Fox J
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3637. Williams B. Mental handicap n
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3669. Wimpory D, Chadwick P and Nas
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3698. Worth S and Reynolds S. The A
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3728. Young JM, Krantz PJ, McClanna
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3759. Zuddas A, Di Martino A, Mugli
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Appendix F. Approach to Categorizin
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APPENDIX G. Discussion of Recent Sy
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one a casein free regime. Diets wer
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outcome data as Type 6, defined as
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Yes—no disclosures to make G7 Bai
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Table G1. Characteristics of recent
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Random assignment Appropriate compa
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Study Group design Random assignmen
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APPENDIX I. Applicability Summary T
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Social skills (continued) Domain De
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