Therapies for Children With Autism Spectrum Disorders

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Evidence Table. Therapies for children with ASD (continued) Study Description Intervention Inclusion/ Exclusion Criteria/ Population Comments: *Computed using Bonferroni adjusted post-hoc ANOVA **with age in months as the covariate Author: Intervention: Vismara et al., 2009 Country: US Practice setting: Academic Intervention setting: Varied including children’s hospital, clinical-research university, private intervention agency and a public school Enrollment period: NR Funding: NIH, gift from anonymous foundation Author industry relationship disclosures: NR Design: Case series Early Start Denver Model (ESDM); incorporates the Denver model (a relationship and play-based developmental intervention) and Pivotal Response Training (ABA application to optimize motivation to increase communication, language, and play skills) Phase I: direct intervention of the ESDM included manualized instruction in the teaching principles, intervention techniques, goal development and data collection methods, and fidelity system (5 months) Phase II: parent coaching of the ESDM included teaching therapists to educate parents on how to carry out the ESDM principles (5 months) Both training phases consisted of an initial baseline session followed by three training conditions, each lasting approximately 5-6 weeks: (i) selfinstruction with the training materials using print and video materials provided on a DVD; (ii) a 10 hour didactic training seminar for direct treatment and a 3 hour didactic training seminar for parent coaching; and (iii) four hours of team supervision for specific discussion of each site’s Inclusion criteria: • Age 12-60 months • Diagnosis of ASD • No significant health concerns • No serious or specific medical, genetic, neurological, or sensory condition • Parental consent for videotaping • At least 75% parental attendance if the family continued onto the parent training phase • No participation in additional services exceeding 10 hours per week during the study Exclusion criteria: • See inclusion criteria Age, months ± SD: G1a: 33 ± 7.3 G1b: 33 ± 7.7 G2a: 33 ± 4.4 G2b: 31 ± 6 Mental age: NR Gender: NR Race/ethnicity: NR SES: Maternal education: NR Household income: NR Diagnostic approach: Referral Diagnostic tool/method: Initially diagnosed by community clinicians independent of this study, confirmed by trained physician or psychologist Diagnostic Tool: DSM-IV, ADOS C-102 Baseline Measures Outcomes Overall: ANCOVA:** treatment (P < 0.0002; partial ɳ 2 = 0.346) Harms: NR Modifiers: NR Overall ratings: Social skills: MSEL develop- Number of words, mental age, months phase I, mean ± SD: (SE): Receptive language: G1i: 10.3 (4.63) G1a: 22 ± 13 G1ii: 21.4 (4.63) G1b: 14 ± 9.2 G1iii: 13.5 (4.63) G2a: 15 ± 12.3 G1i/BL: P = NS G2b: 15 ± 12.8 G1i/G1ii: P < 0.01 Expressive G1ii/G1iii: P < language: 0.05 G1a: 23 ± 10 Number of words, G1b: 16 ± 6.9 phase II, mean ± G2a: 13 ± 11 SD: G2b: 14 ± 12.5 G2i: 15.5 ± 10.99 ADOS score, G2ii: 20.89 ± 16.1 module 1, mean ± G2iii: 28.22 ± SD: 23.42 G1a: 13 ± 4.4 G2i/G2ii/G2iii/BL: G1b: 15 ± 4.9 P = NS G2a: 17 ± 3.9 Number of imita- G2b: 15 ± 5.3 tions, mean ± SD: Social skills: G1i: NR Number of words, G1ii: NR phase I, mean (SE): G1iii: NR G1: 9.5 (4.63) G2i: 11 ± 8.38 Number of words, G2ii: 13.56 ± 9.81 phase II, mean ± G2iii: 8.11 ± 9.83 SD: G1i/G1ii/G1iii/BL: G2: 22.29 ± 27.13 P = NS Number of imita- G2i/G2ii/G2iii/BL: tions, mean ± SD: P = NS G1: NR Attention score, G2: 14.57 ± 10.67 mean ± SD: Attention score, G1i: NR** mean ± SD: G1ii: NR** G1: NR G1iii: NR** G2: 3.00 ± 0.75 G2i: 3.26 ± 0.66 Social initiations, G2ii: 3.46 ± 0.63 mean ± SD: G2iii: 3.54 ± 0.79 G1: NR G1i/BL: P < 0.05 G2: 2.84 ± 0.45 G1i/G1ii+G1iii: P Therapist treatment < 0.05 fidelity, score, mean G1ii/G1iii: P = NS (SE): G2i/G2ii/G2iii/BL: G1a: NR** P = NS
Evidence Table. Therapies for children with ASD (continued) Study Inclusion/ Exclusion Description Intervention Criteria/ Population training cases. These Diagnostic category, n three training conditions (%): were provided sequentially to all ten therapists at four sites, two remote via telehealth conferencing Autism: 32 (100) Vismara et al., 2009 (continued) Assessments: MSEL adminisitered at start of study; therapists’ and parents’ fidelity of implementation of the ESDM (all measures of fidelity increased over time), frequency of child social communicative behaviors, CBRS, and therapist satisfaction (conducted once postintervention) Groups: G1: phase I G2: phase II Ga: live Gb: telehealth Gi: self-instruction Gii: didactic seminar Giii: team supervision Provider(s): • Psychologists • SLP • Autism specialist • OT • Case manager • Program director • Early childhood special educator • Behavior specialist Measure of treatment fidelity reported: Yes Co-interventions held stable during treatment: NR Concomitant therapies: NR N at enrollment: Total: 32 N at follow-up: Total: 29 N used for analysis:* G1a: 5 G1b: 5 G2a: 5 G2b: 5 Other characteristics: NR C-103 Baseline Measures Outcomes G1b: NR** Social initiations, Therapist-parent mean ± SD: coaching fidelity G1i: NR** score, mean (SE): G1ii: NR** G2a: NR** G1iii: NR** G2b: NR** G2i: 3.07 ± 0.51 G2ii: 3.14 ± 0.60 G2iii: 3.13 ± 0.68 Parent fidelity score, G1i/BL: P < 0.05 mean (SE): G1i/G1ii+G1iii: P G2a: NR** < 0.05 G2b: NR** G1ii/G1iii: P = NS G2i/G2ii/G2iii/BL: P = NS Therapist treatment fidelity, score, mean (SE): G1ai: NR** G1aii: NR** G1aiii: NR** G1bi: NR** G1bii: NR** G1biii: NR** G1a/G1b: P = NS G1i/BL: P < 0.05 G1i/G1ii+G1iii: P = 0.05 G1ii/G1iii: P = NS Therapist-parent coaching fidelity score, mean (SE): G2ai: NR** G2aii: NR** G2aiii: NR** G2bi: NR** G2bii: NR** G2biii: NR** G2a/G2b: P = NS G2i/BL: P < 0.05 G2i/G2ii: P = 0.001 G2ii/G2iii: P = NS Parent fidelity score, mean (SE): G2ai: NR** G2aii: NR** G2aiii: NR** G2bi: NR** G2bii: NR** G2biii: NR** G2a/G2b: P = NS G2/BL: P < 0.05 Harms: NR
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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
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62. Dosman CF, Drmic IE, Brian JA,
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104. Ben-Itzchak E and Zachor DA. T
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142. Tyminski RF and Moore PJ. The
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177. Aman MG, McDougle CJ, Scahill
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214. Correia CT, Almeida JP, Santos
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252. Akhondzadeh S, Tajdar H, Moham
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290. Dawson G, Rogers S, Munson J,
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Acronyms/Abbreviations ABA Applied
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Appendix A. Exact Search Strings an
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Table A2. PsycINFO search strategie
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Therapies for Children with Autism
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Therapies for Children with ASD Sys
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Appendix C. Evidence Tables Tables
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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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