Therapies for Children With Autism Spectrum Disorders

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Evidence Table. Therapies for children with ASD (continued) Study Inclusion/ Exclusion Baseline Description Intervention Criteria/ Population Measures Outcomes NR glutathione lotion • No liver or kidney G2: 93.8 ± 29.5 ± SD: Author industry received DSMA, those disease REXSCA/C G1: 79.5 ± 49.9 relationship disclosures: who received placebo • Well hydrated lotion received placebo Phase II: composite (social G2: 71.6 ± 38.8 approach + express + G1/BL: P < None Design: RCT in Phase II • Excretion of high LMRL), mean ± SD: 0.001 • All participants received amounts of toxic metals G1: 127 ± 52.7 G2/BL: P < vitamin/mineral in Phase I (n=25) 0.001 supplements for ≥ 2 • Normal liver function G2: 135 ± 65.5 REXSCA/C months prior to and (serum transaminases Autism composite composite: through the study ALT and AST), normal (sensory + ritual + G1: 139 ± 54.5 period renal function, and social problems – G2: 150 ± 53.6 Duration: complete blood cell social approach G1/BL: P < 0.01 NR count was not below the behaviors – G2/BL: P < 0.05 Frequency: normal reference range expressive Autism NR • No changes in language), mean ± composite: Assessments: medication, SD: G1: -73.3 ± 67.9 Phase I: ATEC and Heavy supplements, diet, or G1: -53.1 ± 66.4 G2: -88.8 ± 58.3 Metal Exposure Question- behavioral interventions (n=25) G1/BL: P < 0.01 naire completed by during the study G2: -63.5 ± 65.1 G2/BL: P < 0.01 parents at baseline • At least a two-month SAS score, phase 1 SAS score, com- Phase II: ADOS history of taking a multi- onset, mean ± SD: pletion of phase administered by clinician vitamin/mineral G1: 5.2 ± 2.2) 2, mean ± SD: following the completion supplement with a least G2: 5.5 ± 2.7) G1: 4.2 ± 2 of Phase I (at onset and the RDA of zinc, and Social skills: G2: 4.5 ± 2.6 completion of Phase II); continuing to take that ATEC Sociability, G1/BL: P < parent completed the during Phase II mean ± SD: 0.001 PDD-BI and SAS (at • Continue to stay well G1: 16.6 ± 8.5 G2/BL: P < 0.01 onset and completion of hydrated G2: 14.9 ± 6.8 Social skills: Phase II); Parental Global Exclusion criteria: PDD-BI Social ATEC Impressions questionnaire pragmatic problems, Sociability, mean • See inclusion criteria (post-treatment only, mean ± SD: ± SD: Age, years:† answers range from -3 G1: 16.9 ± 9.2 (n=25) G1: 12.1 ± 6.5 G1: 6.7 “much worse” to +3 “much G2: 13.9 ± 7.5 G2: 11.2 ± 6.5 G2: 6.5 better”); clinician working G1/BL: P < Mental age: with child to complete 0.001 NR ATEC for the child (post- G2/BL: P < 0.05 treatment only) Adams et al., Groups: Gender, n:† AWP/C Social PDD-BI Social 2009 (A) G1: treatment (7 rounds Male: approach behaviors, pragma-tic Adams et al., of treatment) G1: 24 mean ± SD: problems, mean 2009 (B)† G2: placebo (1 round G2: 14 G1: 63.8 ± 20.6 ± SD: (continued) of treatment followed by 6 Female: (n=25) G1: 14.5 ± 9.2 rounds of placebo) G1: 2 G2: 68.2 ± 25.4 G2: 9.9 ± 7.5 Provider(s): G2: 1 ADOS Sociability, G1/BL: P = NS NR Race/ethnicity: mean: G2/BL: P < 0.01 Measure of treatment NR G1: 9.3 AWP/C Social fidelity reported: SES: G2: 8.1 approach Yes Maternal education: NR ADOS behaviors, mean Co-interventions held Household income: NR Communication + ± SD: stable during treatment: Diagnostic approach: sociability, mean: G1: 70.8 ± 23.6 NR Referral G1: 17 G2: 72.6 ± 20.2 Concomitant therapies: Diagnostic tool/method: G2: 14.7 G1/BL: P < 0.01 NR Initially diagnosed by G2/BL: P = NS N at enrollment: community clinicians Communication/ ADOS Phase 1: 82 independent of this study, language: Sociability, mean Phase 2 :49 confirmed by ADOS- PDD-BI (% change): N at follow-up: certified evaluator Semantic/pragmatic G1: 8.3 (-10) C-28
Evidence Table. Therapies for children with ASD (continued) Study Inclusion/ Exclusion Baseline Description Intervention Criteria/ Population Measures Outcomes Phase 1: 65 Diagnostic Tool: problems: G2: 7.9 (-2) G1: 26 ADOS G1: 15.2 ± 7.6 n=25) G1/BL: P < 0.01 G2: 15 Diagnostic category, %:† G2: 11.1 ± 5.6 G2/BL: P = NS Autism: AWP/C Express ADOS G1: 96 (phono-logical + Communication G2: 100 semantic pragmatic), + sociability, Asperger’s: mean ± SD: mean (% G1: 4 G1: 41.4 ± 28.2 change): G2: 0 (n=25) G1: 15.4 (-9) Other characteristics: G2: 44 ± 34.9 G2: 13.7 (-7) NR AWP/C Learning, G1/BL: P < memory, and 0.001 receptive language, mean ± SD: G2/BL: P = NS G1: 22.7 ± 8.1 (n=25) Communication G2: 23.2 ± 10.1 /language: PDD-BI ADOS Semantic/prag- Communication, matic problems, mean: mean ± SD: G1: 7.8 G1: 12.5 ± 7.3 G2: 6.7 G2: 9.6 ± 4.5 ADOS G1/BL: P = NS Communication + G2/BL: P = NS sociability, mean: AWP/C Express, G1: 17 mean ± SD: G2: 14.7 G1: 43.6 ± 27.1 G2: 51.3 ± 31.5 G1/BL: P = NS G2/BL: P < 0.05 Adams et al., Problem behavior: AWP/C 2009 (A) PDD-BI Learning, Adams et al., Ritualisms/resistance memory, and 2009 (B)† to change, mean ± receptive (continued) SD: language, mean G1: 13.9 ± 10.5 ± SD: (n=25) G1: 25.4 ± 8.7 G2: 15 ± 8.5 G2: 26.5 ± 8.9 PDD-BI Arousal G1/BL: P < 0.05 regulation problems, mean ± SD: G2/BL: P < 0.01 G1: 17.9 ± 9 (n=25) ADOS G2: 14.9 ± 6.6 Communication, PDD-BI mean (% Aggressiveness, change): mean ± SD: G1: 7.1 (-9) G1: 13.4 ± 9.8 (n=25) G2: 5.9 (-11) G2: 11.4 ± 8.1 G1/BL: P = NS Adaptive behavior: G2/BL: P = NS ATEC ADOS Health/physical Communication behavior, mean ± SD: + sociability, G1: 29.9 ± 14.4 mean (% G2: 21.5 ± 9.4 change): PDD-BI Specific G1: 15.4 (-9) fears, mean ± SD: G2: 13.7 (-7) G1: 21.7 ± 16 (n=25) G1/BL: P < C-29
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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
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limited followup, lack of comparati
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individual intervention is warrante
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selecting participants for their st
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studies lacked an arm that consider
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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
Page 189 and 190: Appendix C. Evidence Tables Tables
Page 191 and 192: Evidence Table. Therapies for child
Page 215: 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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