Therapies for Children With Autism Spectrum Disorders

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Evidence Table. Therapies for children with ASD (continued) Study Description Intervention Author: Owley et al., 2010 Country: US Practice setting: Academic clinic Intervention setting: Academic medical center Enrollment period: NR Funding: NIH, Autism Speaks Author industry relationship disclosures: NR Design: Prospective case series Intervention: 10-week open label study of escitalopram based on genotype group, with participants seen at clinic at study start (baseline), week 4, and week 10. Forced titration with weekly increasing doses of escitalopram (2.5, 5, 10, 15, 20mg) unless specific criteria for downward titration due to side effects were met. Assessments: ABC-C completed weekly by parents/caregivers Groups: G1: all participants G1a: Low expression of serotonin transporter polymorphism promoter region (5-HTTPLR) genotypic variation (9 S/S) G1b: Intermediate expression (1 LG/LG, 2 S/LG, 2 LA/LG, 24 S/L) G1c: High expression (19 LA/LA) Co-interventions held stable during treatment: NR Frequency of contact during study: Inclusion/ Exclusion Criteria/ Population Inclusion criteria: • Diagnosis of an ASD • Minimum score of 12 on the ABC-CV Exclusion criteria: • Parental sleep diaries during pre-medication baseline week indicating a range in time of awakening greater than 2 hours over 7 days • Concomitant serious medical or psychiatric conditions, including seizures • Study personnel unable to obtain blood sample due to child’s restlessness (n=1) • Dropout (n=1) Age, mean months ± SD (range): G1: 117 ± 31 (54-204) G1a: 124 ± 22 (98–164) G1b: 121 ± 34 (82–204) G1c: 106 ± 28 (54–160) Mental age: NR Gender, n (%): G1: M: 48 (83) F: 10 (17) G1a: M: 8 (89) F: 1 (11) G1b: M: 25 (86) C-18 Baseline Measures Outcomes and school environment issues on followup) ADI-R, mean ± SD (range): G1: Social interaction: 23 ± 5 (11-30) Communication, verbal: 17 ± 4 (7-26) Communication, non-verbal: 13 ± 2 (10-15) Repetitive behavior: 6 ± 3 (1-15) Abnormality of development: 4 ± 1 (1-5) G1a: Social interaction: 24 ± 4 (18-29) Communication, verbal: 18 ± 5 (11- 26) Communication, non-verbal: 13 ± 1 (13-14) Repetitive behavior: 6 ± 2 (2-9) Abnormality of development: 4 ± 1 (2-5) G1b: Social interaction: 24 ± 4 (14-30) Communication, verbal: 17 ± 4 (10- 23) Communication, non-verbal: 12 ± 2 (10-15) Repetitive behavior: 7 ± 3 (2-12) Modifiers No significant effect of Use of alternative therapies, multivitamins, prescription medication or special diets on enzyme effect size in GEE model Problem behavior: Final data on ABC Irritability subscale scores only represented graphically. Harms NR Modifiers Final dose did not differ significantly between genotype groups. Age and weight were not significantly correlated with final dose in the whole group or in the genotype expression subgroups.
Evidence Table. Therapies for children with ASD (continued) Study Inclusion/ Exclusion Description Intervention Criteria/ Population NR F: 4 (14) G1c: Concomitant therapies: Participants ceased psychoactive medication use 1 month prior to study; participants previously on fluoxetine stopped medication 6 weeks prior to study. M: 14 (74) F: 5 (26) Owley et al., 2010 (continued) N at enrollment: G1: 58* G1a: 9 G1b: 29 G1c: 19 N at follow-up: G1: 45 G1a: NR G1b: NR G1c: NR *1 participant with rare genotype excluded from subgroup analyses Race/ethnicity, n (%): G1: African American: 6 (10) Asian: 2 (3) Caucasian: 48 (83) Hispanic: 2 (3) G1a: African-American: 1 (11) Asian: 1 (11) Caucasian: 7 (78) Hispanic: 0 G1b: African-American: 5 (17) Asian: 1 (3) Caucasian: 21 (72) Hispanic: 2 (7) G1c: African-American: 0 Asian: 0 Caucasian: 19 (100) Hispanic: 0 SES: Maternal education: NR Household income: NR Diagnostic approach: In Study: ADI-R, ADOS Diagnostic tool/method: ADI-R, Autism Diagnostic Observation Schedule, cognitive testing, psychiatric evaluation Diagnostic category (best estimate diagnosis), n (%): G1: Autistic disorder: 35 (60) PDD-NOS: 17 (29) Asperger’s: 6 (10) C-19 Baseline Measures Outcomes Abnormality of development: 4 ± 1 (0-5) G1c: Social interaction: 23 ± 5 (11-30) Communication, verbal: 17 ± 4 (7-26) Communication, non-verbal: 13 ± 2 (10-15) Repetitive behavior: 6 ± 3 (1-15) Abnormality of development: 4 ± 1 (1-5) ADOS, mean±SD (range): G1: Social interaction: 9 ± 3 (4-14) Communication: 5 ± 2 (2-10) Communication+ social: 15 ± 4 (7-23) Play: 2 ± 1 (0-4) Stereotyped behavior/interests: 3 ± 2 (0-6) G1a: Social interaction: 9 ± 3 (4-14) Communication: 5 ± 2 (3-8) Communication+ social: 15 ± 5 (7-22) Play: 2 ± 1 (0-4) Stereotyped behavior/interests: 3 ± 2 (0-6) G1b: Social interaction: 10 ± 3 (4-14) Communication: 5 ± 2 (2-10) Communication+ social: 15 ± 5 (7-23) Play: 2 ± 1 (0-4) Stereotyped behavior/interests: 3 ± 2 (0-6) G1c: Social interaction: 9
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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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evaluated the effects of risperidon
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that this somnolence improved over
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Table 17. Outcomes of RCTs of antip
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Serotonin Reuptake Inhibitors SRIs
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One prospective case series of esci
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Most participants were recruited fr
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Dietary and Other Medical Intervent
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Summary of the literature-other int
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withdrew after the first six weeks;
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therefore described separately belo
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addressed, 85 typically involves on
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In the second paper, 89 treatment s
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Table 25. Overview of CAM studies a
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Teacher and Parent Scales, behavior
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Because of the potentially increase
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Educational Interventions Child cha
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showed diminished response to escit
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oom as the other assessments, so it
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contrast group (n=18) on three meas
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and are based on consideration of f
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Few studies directly comparing the
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Strength of evidence. The strength
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While individual studies of CBT and
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Table 32. Summary of results of edu
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Table 33. Summary of results of med
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strength of this reviewed literatur
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Table 36. Intervention, strength of
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Table 37. Interventions/outcomes wi
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gains. 104 Other studies have seen
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percent of behavioral studies repor
Page 155 and 156: limited followup, lack of comparati
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Page 159 and 160: selecting participants for their st
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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
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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
Page 205: 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
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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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Therapies for Children With Autism Spectrum Disorders

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