Therapies for Children With Autism Spectrum Disorders

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Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Baseline Description Intervention Criteria/Population Measures Outcomes Owens et al., Concomitant therapies, SES: VABS communi- 2008 (continued) n (%): Maternal education: NR cation score, G1: Household income: NR mean ± SD Speech and language: Diagnostic approach: G1: 91.88 ± 18.83 G1: 3 (19) Referral, diagnosis was G2: 83.13 ± 16.34 G2: 4 (27) confirmed in study G3: 76.06 ± 17.17 G3: 7 (44) Diagnostic tool/method: G1/BL: P = NS OT: ADI-R for G1 and G2; SCQ G2/BL: P < 0.01 G1: 0 for G3 G3/BL: P = NS G2: 0 Diagnostic category, n G1/G2: P = NS G3: 4 (25) (%): G1/G3: P = NS GF/CF diet: High functioning autism: G2/G3: P = NS G1: 1 (6) G1: 5 (31) VABS G2: 0 G2: 1 (7) maladaptive G3: 1 (6) G3: 2 (13) behaviors score, N at enrollment: Aspergers: mean ± SD G1: 16 (in 5 groups) G1: 8 (50) G1: 13.81 ± 5.23 G2: 15 (in 5 groups) G2: 8 (53) G2: 16.69 ± 5.79 G3: 16 G3: 11 (69) G3: 22.75 ± 5.52 N at follow-up: ASD: G1/BL: P < 0.05 G1: 16 G1: 2 (13) G2/BL: P = NS G2: 15 G2: 4 (27) G3/BL: P = NS G3: 16 G3: 2 (13) G1/G2: P = NS Autism: G1/G3: P < 0.05 G1: 1 (6) G2/G3: P < 0.05 G2: 2 (13) Harms: G3: 1 (6) NR Other characteristics: Modifiers: Educational support, n (%): Part-time TA: G1: 4 (25) G2: 4 (27) G3: 8 (50) Full time TA: G1: 7 (44) G2: 4 (27) G3: 2 (12.5) Inclusion unit: G1: 1 (6) G2: 3 (20) G3: 2 (12.5) NR Comments: *Participants initially only recruited for G1 and G2; G3 participants were recruited at a later date as part of another study and asked if their data could be used for this study in a no intervention control group sample. **In an unspecified subset of 21 of the 31 children in groups G1 and G2. C-162
Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Baseline Description Intervention Criteria/Population Measures Outcomes Author: Intervention: Inclusion criteria: Overall ratings: Overall ratings: Perry et al., Ontario IBI, 20 to 40 • entry assessment within CARS, n, mean ± CARS, n, mean ± 2008 hours a week throughout 3 months of entry SD: SD: Country: Canada Practice setting: Academic the year in a variety of • another assessment G1: 275, 36.09 ± settings (home, center, (usually at exit) 5.09 and integrated child care) • diagnosis of autism or a G1a: 68, 33.48 ± using structured disorder toward the 4.35 behavioral teaching based severe end of the autism G1b: 105, 35.71 ± on the principles of spectrum 4.43 applied behavior analysis G1c: 79, 38.91 ± G1: 275, 31.26 ± 5.31 P < 0.001 G1a: 68, 26.99 ± 4.93 P < 0.001 G1b: 105, 31.62 ± Intervention setting: home, duration ranged from 4 to Exclusion criteria: 47 months (mean 18 • see inclusion criteria months) 5.37 CARS symptom 4.14 P < 0.001 G1c: 79, 34.85 ± clinic, or child care center Enrollment Age, mean/yrs (range in months): 4.5 (20-86) severity, n: Not quite autism range: 24 4.61 P < 0.001 main effect of time: P < 0.001 period: Mild/moderate reported NR autism range: 145 reductions (P < Program data: 0.001) on each 2000-2006 Severe autism individual items of range: 106 the CARS (with the exception of item XIV (P = 0.055)) Funding: Ontario Ministry of Children and Youth Services Author industry relationship disclosures: NR Design: Retrospective case series Assessments: CARS, VABS, and cognitive (most commonly used: MSEL, BSID, WPPSI, SB-FE) “typically conducted by assessment staff of the central agency”(p.627). Seven categories of progress/outcomes were generated based on all available information including developmental rates, VABS ABC, cognitive standard scores, and CARS. Groups: G1: IBI G1a: higher functioning (VABS ABC ≥ 60) G1b: intermediate functioning (VABS ABC between 50 and 59) G1c: lower functioning (VABS ABC ≤ 49) Provider: Instructor-therapists (virtually all had a college or university level education and all received same initial IBI training) who were supervised by Senior Therapists (had a Master’s degree and/or were Board Certified Behavior Analysts) Measure of treatment fidelity reported: No Mental age, n, mean/months ± SD (range): (Combined scores from MSEL, BSID, WPPSI, and SB:FE) G1: 151, 22.92 ± 10.96 (3- 60) G1a: 44, 28.24 ± 11.46 G1b: 66, 21.51 ± 10.61 G1c: 33, 17.64 ± 6.84 P < 0.001 Gender, n (%): M: 276 (83) F: 56 (17) Race/ethnicity, n (%): NR SES: Maternal education: NR Household income: NR Diagnostic approach: In Study Diagnostic tool/method: DSM-IV Diagnostic category, n (%): Autism 194 (58) PDD-NOS 46 (14) ASD/PDD 92 (28) Other characteristics: NR C-163 VABS/ABC, n, mean age equivalent ± SD: G1: 279, 16.81 ± 6.46 G1a: 72, 21.80 ± 7.96 G1b: 115, 16.16 ± 5.25 G1c: 9, 13.73 ± 3.73 VABS/ABC, n, mean standard score ± SD: G1: 274, 54.77 ± 9.24 G1a: 70, 66.90 ± 6.76 G1b: 116, 54.55 ± 3.00 G1c: 86, 45.65 ± 3.30 CARS symptom severity changes, n (%): Non-autism remained nonautism: 19 (79) Non-autism to mild/moderate: 5 (21) Mild moderate to non-autism: 59 (41) Mild/moderate remained mild/moderate: 76 (52) Mild/moderate to severe: 10 (7) Severe to nonautism: 16 (15) Severe to mild/moderate: 63 (59) Severe remained severe: 27 (26) Children initially scoring in autism range changed to milder category: 138 (50)
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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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