Therapies for Children With Autism Spectrum Disorders

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Evidence Table. Therapies for children with ASD (continued) Study Inclusion/ Exclusion Description Intervention Criteria/ Population NR overlays chosen for clarity matrices), mean ± SD: Author industry vs. favorite color. G1: NR relationship Experiment 3 detected G2: 67.0 ± 5.3 disclosures: changes in visual stimuli G3: 75.8 ± 16.2 1 of 3 with and without colored Gender, n (%): British Medical overlays in children with Male: Research Council high and low functioning G1: 18 (100) (royalties for ability. G2: 12 (75) intuitive overlays) Assessments: G3: NR Design: BPVS, rate of reading Female: Prospective case test, symptoms of visual G1: 0 series stress (out of five) G2: 4 (25) Groups: G3: NR G1: Experiment 1 Race/ethnicity: G2: Experiment 2 NR G3: Experiment 3 SES: Ga: colored overlay, Maternal education: NR chosen for clarity Household income: NR Gb: colored overlay, Diagnostic approach: chosen as favorite Referral Gc: no colored overlay Diagnostic tool/method: Provider: NR NR Diagnostic category, n Measure of treatment (%): fidelity reported: ASD: No G1: 18 (100) Co-interventions held G2: 16 (100) stable during treatment: G3: 26 (100) NR Concomitant therapies: NR N at enrollment:* G1: 18 G2: 16 G3: 26 Other characteristics: NR Ludlow et al., 2008 (continued) N at follow-up:* G1: 18 G2: 16 G3: 26 C-154 Baseline Measures Outcomes minute, mean ± SD: G2a: 72.3 ± 29.2 G2b: 65.4 ± 29.7 G2c: 57.8 ± 36.8 G2a/G2c: P < 0.05 G2b/G2c: P < 0.05 G2a/G2b: P < 0.05 Experiment 3: Accuracy (out of 30) in sample matching task, mean ± SD: G3a: 26.8 ± 4.4 G3c: 26.4 ± 3.9 G3a/G3c: P = NS Time taken to complete sample matching task, seconds ± SD: G3a: 112.9 ± 57.0 G3c: 135.7 ± 60.1 G3a/G3c: P < 0.05 Harms: NR Modifiers: Experiment 3: There were no significant differences between low functioning and high functioning children with ASD. There was also no significant correlation between age or Raven’s matrices scores and time taken with or without overlays. Comments: *None of the partipants in Experiment 2 participated in Experiment 1 or 3, but 13 of the participants from Experiment 1 also participated in Experiment 3. Author: Meguid et al., 2008 Country: Egypt Practice setting: Academic Intervention setting: Clinic Enrollment period: Intervention: Efalex supplement (blend of high DHA fish oil and evening primrose oil containing both omega 3 and 6 fatty acids as well as vitamin E) Children with autism (G1) received 2 capsules twice per day for 3 months; the controls (G2) were healthy and received no treatment or placebo Inclusion criteria: • Autism based on DSM- IV criteria and CARS scores • Good physical health • Not currently taking medications or essential fatty acid supplements during study • Agree not to make changes in treatments for autism (medical, nutritional, behavioral, Overall ratings: CARS score, mean ± SD: G1: 39.5 ± 3.86 Medical: PUFA levels, mean ± SD: Linolenic: G1: 0.86 ± 0.44 G2: 3.2 ± 0.72 G1/G2: P < 0.0001 DHA: G1: 0.95 ± 0.2 Overall ratings: CARS score, mean ± SD: G1: 32.7 ± 3.37 G1/BL: P < 0.0001 Medical: PUFA levels, mean ± SD: Linolenic: G1: 1.76 ± 0.56 G1/BL: P < 0.0001
Evidence Table. Therapies for children with ASD (continued) Study Inclusion/ Exclusion Description Intervention Criteria/ Population NR Assessments: dietary) during the three Funding: Blood levels of free months of the study NR PUFAs estimated from Exclusion criteria: Author industry dried blood spot using • See inclusion criteria relationship tandem mass spectro- Age, yrs (range): disclosures: metry; CARS at baseline NR (3-11) NR and follow-up (3 months Mental age: Design: after treatment) NR Non-randomized Groups: Gender, n (%): controlled trial G1: children with autism Male: 18 (60) G2: healthy children, Female: 12 (40) same age and gender Race/ethnicity: Co-interventions held NR stable during treatment: SES: NR Maternal education: NR Frequency of contact Household income: NR during study: Diagnostic approach: NR Referral Concomitant therapies: Department of Children None with Special Needs N at enrollment: Diagnostic tool/method: G1: 30 (28 families) DSM-IV and CARS G2: 30 Diagnostic category, n N at follow-up: (%): G1: 30 Autism: 30 (100) G2: NA Other characteristics: NR Meguid et al., 2008 (continued) Author: Nickels et al., 2008 Country: US Intervention: Inclusion criteria: Population-based study of • Research identified stimulant medication use autism in treatment of autism • Resident of Olmsted symptoms County, MN upon C-155 Baseline Measures Outcomes G2: 2.85 ± 0.65 DHA: G1/G2: P < 0.0001 G1: 1.69 ± 0.42 Linoleic: G1/BL: P < G1: 1.75 ± 0.46 0.0001 G2: 2.77 ± 0.64 Linoleic: G1/G2: P < 0.0001 G1: 2.32 ± 0.41 Arachidonic: G1/BL: P < G1: 2.5 ± 0.5 0.0001 G2: 4.65 ± 0.5 Arachidonic: G1/G2: P < 0.0001 G1: 3.23 ± 0.49 AA/DHA: G1/BL: P < G1: 2.77 ± 0.84 0.0001 G2: 1.71 ± 0.4 AA/DHA: G1/G2: P < 0.0001 G1: 2.01 ± 0.53 G1/BL: P < 0.0001 Harms: NR Modifiers: Correlation between CARS and baseline PUFA level, no significant improvement in autistic behavior (n=10): Linolenic: -0.471 (P > 0.05) DHA: -0.670 (P < 0.05) Linoleic: -0.118 (P > 0.05) AA: 0.115 (P > 0.05) Correlation between CARS and posttreatment PUFA level, no significant improvement in autistic behavior (n=10): Linolenic: 0.395 (P > 0.05) DHA: -0.541 (P > 0.05) Linoleic: -0.287 (P > 0.05) AA: 0.262 (P > 0.05) Overall measures: Overall measures: Medication use, n Duration of treat- (%): ment, years ± SD Psychopharma- (range): cologic treatment: G1: 4.0 ± 3.9
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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
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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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