Therapies for Children With Autism Spectrum Disorders

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Evidence Table. Therapies for children with ASD (continued) Study Description Intervention Author: Osborne et al., 2008 Country: UK Practice setting: Academic Intervention setting: Home, school Enrollment period: 2003 to 2005 Funding: South East Regional Special Education Needs Partnership Author industry relationship disclosures: NR Design: Prospective cohort Intervention: Teaching interventions: reinforcement (ABA-like with 1:1 in-home antecedent-behaviorconseuquence discrete trial training, with reinforcement), nursery (classes of 6-8 children with postgrad-trained teacher, plus 2-3 learning support assistants; some TEACCH methodology), speech/language, and parent training (on what is ASD and how to manage behaviors) Intervention types, n (%): Reinforcement: 49 (75) Nursery: 36 (55) Speech/language: 31 (48) Parent training: 11 (17) Reinforcement: 49 (75) Nursery: 36 (55) Number of interventions, n (%): 1: 21 (32) 2: 27 (42) 3: 16 (25) 4: 1 (1) Hours of intervention by type, mean ± SD (range):* Reinforcement: 13.5 ± 10.7 (1-35) Nursery: 8.1 ± 5.5 (1-23) Speech/language: 1.2 ± 0.7 (1-3) Parent training: 4.2 ± 2.3 (1-10) Total intervention hours/ week: mean ± SD (range): 15.6 ± 9.2 (2-40) Groups: G1: low intensity (< 15.6 hours/week) intervention G2: high intensity (> 15.6 Inclusion/ Exclusion Criteria/ Population Inclusion criteria: • Age 2.6-4.0 years • At the start of their first teaching intervention • Independent prior ASD diagnosis from specialist pediatrician • Initial referral from a general medical practitioner • Statement of special education needs related to ASD from local education authorities Exclusion criteria: • See inclusion criteria Age, years (range): NR (2.6-4.0) Mental age: See developmental age in baseline measures Gender, n (%): Male: 59 (90.1) Female: 6 (9.9) Race/ethnicity: NR SES: Maternal education, %: Secondary (16 yrs): 8 Tertiary (18 yrs): 33 Degree: 59 Postgraduate: 0 Paternal education, %: Secondary (16 yrs): 17 Tertiary (18 yrs): 17 Degree: 33 Postgraduate: 33 Maternal occupation, %: Unskilled/laborer: 33 Skilled/technical: 8 Managerial: 8 Unemployed/career houseworker: 50 Paternal occupation, %: Unskilled/laborer: 8 Skilled/technical: 17 C-158 Baseline Measures Outcomes Modifiers: No significant difference in rate of favorable response by type of stimulant used. No association between type of stimulant used and occurrence of side effects Overall ratings: GARS score, mean ± SD: G1a: 90.7 ± 19.8 G1b: 95.8 ± 11.8 G2a: 90.7 ± 13.7 G2b: 90.6 ± 19.0 G1a/G1b/G2a/G2b: P = NS Adaptive behavior: VABS score, mean ± SD: G1a: 55.6 ± 4.7 G1b: 56.6 ± 6.2 G2a: 57.0 ± 6.6 G2b: 58.6 ± 11.0 G1a/G1b/G2a/G2b: P = NS VABS developmental age, months ± SD: G1a: 18.1 ± 3.6 G1b: 17.4 ± 6.7 G2a: 18.1 ± 5.4 G2b: 20.7 ± 13.6 G1a/G1b/G2a/G2b: P = NS Educational/ cognitive/ academic attainment: PEP-R score, mean ± SD: G1a: 51.3 ± 11.9 G1b: 53.7 ± 22.1 G2a: 54.0 ± 12.2 G2b: 57.2 ± 20.2 G1a/G1b/G2a/G2b: P = NS PEP-R developmental age, months ± SD: G1a: 21.7 ± 6.3 G1b: 21.9 ± 11.8 G2a: 21.9 ± 6.0 G2b: 25.2 ± 16.1 Adaptive behavior: VABS score, 9-10 months, mean change ± SD: G1a: NR** G1b: NR** G2a: NR** G2b: NR** G1a/G1b: P = NS G2a/G2b: P < 0.05 G1a/G2a: P < 0.05 G1b/G2b: P = NS VABS developmental age, 9-10 months, months ± SD: G1a: NR** G1b: NR** G2a: NR** G2b: NR** G1a/G1b: P = NS G2a/G2b: P = NS G1a/G2a: P = NS G1b/G2b: P = NS Educational/ cognitive/ academic attainment: PEP-R score, 9- 10 months, mean change ± SD: G1a: NR** G1b: NR** G2a: NR** G2b: NR** G1a/G1b: P = NS G2a/G2b: P = NS G1a/G2a: P < 0.05 G1b/G2b: P = NS
Evidence Table. Therapies for children with ASD (continued) Study Inclusion/ Exclusion Description Intervention Criteria/ Population hours/week) intervention Managerial: 75 Ga: parenting stress (self- Unemployed/career reported) below median houseworker: 0 Gb: parenting stress (selfreported) above median Osborne et al., Provider: Marital status,%: 2008 (continued) Teachers, tutors (2-9, Married: 83 mean 4.2 ± 1.6), and/or Separated/divorced: 17 parents Household income: NR Assessment: Diagnostic approach: • Autism severity by Referral from specialized GARS pediatrician based on • Intellectual functioning clinical judgment, often by PEP-R with psychometric data • Educational In study confirmation achievement by BAS-2 Diagnostic tool/method: • Adaptive behavior and GARS social functioning by Diagnostic category, n VABS (%): • Self-report parental Autism: 65 (100) stress by QRS-F Other characteristics: • All testing conducted NR by an educational psychologist blind to intervention Measure of treatment fidelity reported: No Co-interventions held stable during treatment: No Concomitant therapies, %: Dietary interventions: 60 Fringe crystal treatment: 1.5 N at enrollment: Total: 65 G1a: 25 G1b: 20 G2a: 9 G2b: 11 N at follow-up: Total: 65 G1a: 25 G1b: 20 G2a: 9 G2b: 11 Osborne et al., 2008 (continued) C-159 Baseline Measures Outcomes G1a/G1b/G2a/G2b: P = NS BAS-II score, mean ± SD: G1a: 53.4 ± 9.1 G1b: 56.8 ± 14.0 G2a: 57.7 ± 19.0 G2b: 59.3 ± 20.7 G1a/G1b/G2a/G2b: P = NS BAS-II developmental age, months ± SD: G1a: 22.5 ± 5.5 G1b: 23.2 ± 9.7 G2a: 23.9 ± 11.2 G2b: 27.0 ± 18.4 G1a/G1b/G2a/G2b: P = NS Parenting Stress: QRS score, mean ± SD: G1a: 23.4 ± 5.3 G1b: 33.3 ± 4.7 G2a: 25.1 ± 4.4 G2b: 32.5 ± 4.1 PEP-R developmental age, 9-10 months, months ± SD: G1a: NR** G1b: NR** G2a: NR** G2b: NR** G1a/G1b: P = NS G2a/G2b: P = NS G1a/G2a: P < 0.05 G1b/G2b: P = NS BAS-II score, 9-10 months, mean change ± SD: G1a: NR** G1b: NR** G2a: NR** G2b: NR** G1a/G1b: P = NS G2a/G2b: P < 0.05 G1a/G2a: P < 0.01 G1b/G2b: P = NS BAS-II developmental age, 9-10 months, months ± SD: G1a: NR** G1b: NR** G2a: NR** G2b: NR** G1a/G1b: P = NS G2a/G2b: P < 0.001 G1a/G2a: P < 0.001 G1b/G2b: P = NS Harms: NR Modifiers: Baseline QRS score was not associated with intervention intensity. MANOVAs showed a significant effect of intervention
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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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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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3637. Williams B. Mental handicap n
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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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