Therapies for Children With Autism Spectrum Disorders

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Evidence Table. Therapies for children with ASD (continued) Study Description Intervention Author: Kasari et al., 2006 Kasari et al., 2008† Country: US Practice setting: Academic Intervention setting: School Enrollment period: NR Funding: NIH Author industry relationship disclosures: NR Design: Intervention: Symbolic play or joint attention intervention sessions for 30 minutes daily for 5-6 weeks Combination of adultdirected behavioral drill (approximately 5 minutes) and child-directed milieu teaching approach for approximately 20 minutes ABA and developmental procedures of responsive and interactive methods Semi-structured childdriven floor sessions with environmental adjustments to facilitate social and communicative attempts Number of sessions, mean ± SD: Inclusion/ Exclusion Criteria/ Population Inclusion criteria: • Diagnosis of autism on the ADI-R and ADOS • Age < 5 years old • Accessible for follow-up Exclusion criteria: • Seizures • Additional medical diagnoses (e.g., genetic syndromes) • Geographically inaccessible for followup visits • Did not plan to stay in the early intervention program for at least 4 weeks Age, months ± SD: Study entry: G1: 43.2 ± 7.05 G2: 42.67 ± 6.93 G3: 41.94 ± 4.93 C-144 Baseline Measures Outcomes mastered, n: G1: 107 Communication/ language: RDLS expressive language score, mean ± SD (range): G1: 20.60 ± 6.51 (17.55-23.65) G2: 21.43 ± 7.59 (17.97-24.89) G3:19.41 ± 7.70 (15.45-23.37) RDLS receptive language score, mean ± SD (range): G1: 20.55 ± 7.27 (17.15-23.95) G2: 21.00 ± 9.75 (16.56-25.44) G3: 17.53 ± 8.70 (13.06-22.00) Social skills: ESCS score, mean Objectives met per week, n: G1: 58 Cumulative number of objectives met each week: G1: (graph) Learn units per objective, mean (range): G1: 213 (103- 750) Weekly classwide mean learn units to criterion: G1: (graph) Students moving to lesser restrictive environments, %: G1: 95 Harms: NR Modifiers: NR Communication/ language: RDLS expressive language score, mean ± SD (range): Post-intervention: G1: 23.15 ± 6.43 (20.14-26.16) G2: 23.67 ± 8.78 (19.67-27.88) G3: 21.18 ± 9.11 (16.49-25.86) 12 month followup:† G1: 35.70 ± 12.57 (29.82-41.59) G2: 38.29 ± 15.03 (30.57-46.02) G3: 28.06 ± 13.52 (20.86-35.27) RDLS receptive
Evidence Table. Therapies for children with ASD (continued) Study Inclusion/ Exclusion Description Intervention Criteria/ Population RCT G1: 28.6 ± 15.6 Post-intervention: G2: 34.7 ± 16.4 G1: 44.68 ± 6.86 G1/G2: P = NS G2: 44.60 ± 6.61 Assessments: G3: 43.47 ± 5.06 MSEL, RDLS, ESCS, and 12 month follow-up: Structured Play G1: 58.25 ± 6.86 Assessment (parent G2: 57.59 ± 6.74 report); parent-child G3: 56.63 ± 4.70 observation (independent Mental age: assessors) collected pre- See baseline measures and post-intervention and Gender, n: at 6 and 12 months post- Male: intervention follow-up G1: 15 Groups: G2: 16 G1: joint attention G3: 15 G2: symbolic play Female: G3: controls G1: 5 Provider: G2: 5 Graduate students in G3: 2 education psychology Race/ethnicity, n (%): experienced with autistic White: children G1: 13 Measure of treatment G2: 14 fidelity reported: G3: 10 Yes Minority: Co-interventions held G1: 3 stable during treatment: G2: 6 NR G3: 7 Kasari et al., 2006 Kasari et al., 2008† (continued) Concomitant therapies: SES: NR Maternal education, n: N at enrollment: High school: G1: 20 G1: 0 G2: 21 G2: 3 G3: 17 G3: 2 N at 6 month follow-up:† Some college: G1: 20 G1: 2 G2: 19 G2: 4 G3: 17 G3: 4 N at 12 month follow- College/professional: up:† G1: 18 G1: 20 G2: 14 G2: 17 G3: 11 G3: 16 Household income: NR Diagnostic approach: In study Diagnostic tool/method: ADI-R, ADOS Diagnostic category, n (%): Autism: 58 (100) Other characteristics: NR C-145 Baseline Measures Outcomes ± SD: language score, Showing: mean ± SD G1: 0.10 ± 0.31 (range): G2: 0.52 ± 1.78 Post-intervention: G3: 0.35 ± 0.61 G1: 22.80 ± 6.90 Child joint attention (19.57-26.03) looks: G2: 24.12 ± 10.31 G1: 7.25 ± 6.05 (19.43-28.81) G2: 11.9 ± 9.07 G3: 18.76 ± 10.55 G3: 8.12 ± 6.75 (13.34-24.19) Pointing: G1: 12 month follow- 13.15 ± 14.95 G2: up:† 9.62 ± 12.81 G3: G1: 31.85 ± 9.21 7.82 ± 11.96 (27.54-36.16) Giving: G2: 35.06 ± 11.18 G1: 3.65 ± 3.44 (29.31-40.81) G2: 2.52 ± 3.06 G3: 27.31 ± 15.63 G3: 3.59 ± 3.45 (18.99-35.64) Responds joint Social Skills: attention: ESCS score, G1: 10.50 ± 5.42 mean ± SD: G2: 11.91 ± 9.07 Showing: G3: 10.53 ± 6.49 G1: 0.70 ± 1.19 G2: 1.29 ± 2.65 G3: 0.17 ± 0.53 G1/G2: P = NS G1/G3: P < 0.05 G2/G3: P < 0.05 ANOVA: time (P < 0.05) Joint attention Child joint initiations compo- attention looks: site, mean ± SD G1: 9.55 ± 7.88 (range):† G2: 12.14 ± 9.30 G1: 3.95 ± 2.33 G3: 10.35 ± 9.74 (2.86-5.04) G1/G2: P = NS G2: 4.32 ± 3.07 G1/G3: P = NS (2.92-5.71) G2/G3: P = NS G3: 3.29 ± 2.74 ANOVA: time (1.88-4.70) (P < 0.05) Joint attention Pointing: responses, mean ± G1: 4.65 ± 15.60 SD (range):† G2: 9.76 ± 10.21 G1: 10.05 ± 5.42 G3: 5.76 ± 7.57 (7.96-13.04) G1/G2: P = NS G2: 10.24 ± 5.59 G1/G3: P = NS (7.69-12.78) G2/G3: P = NS G3: 10.52 ± 6.49 ANOVA: time (7.19-13.87) (P = NS) Mother-child Giving: interaction, mean ± G1: 5.10 ± 3.54 SD: G2: 3.05 ± 2.27 Child joint attention G3: 3.59 ± 2.40 looks: G1/G2: P = NS G1: 2.45 ± 3.35 G1/G3: P = NS G2: 2.33 ± 2.67 G2/G3: P = NS G3: 2.76 ± 4.19 ANOVA: time
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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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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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