Therapies for Children With Autism Spectrum Disorders

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Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Description Intervention Criteria/Population Author: Intervention: Ben Itzchak and Center-based ABA Zachor, 2007 program with one-on-one Country: therapy with behavioral Israel therapists for at least 35 Practice hours/week and setting: behavioral methods used Academic at home by parents Intervention Assessments: setting: Pre- and post-treatment Clinic and home (1 year): ADI-R, ADOS, Enrollment BSID-II, Stanford-Binet period: Intelligence Scale, 4 NR Funding: Israeli Ministry of Education Author industry relationship disclosures: NR Design: Prospective case series Note: See related studies: Ben Itzchak et al., 2007, Zachor et al., 2007, Zachor et al., 2009 (overlap among these not clear) th Inclusion criteria: • Age < 32 months • Diagnosed with autism Exclusion criteria: • Certain comorbidities (e.g., seizure disorder; genetic syndromes) Age, mean months (range): 26.6 (20-32) Mental age: NR Gender, n (%): ed. Male: 23 (92) Developmental-behavioral Female: 2 (8) scales, all administered Race/ethnicity: by therapists and scores NR provided by blinded raters SES: Groups: Maternal education: NR G1: intervention Household income: NR Ga: low-IQ (50-70) at Diagnostic approach: baseline In Study Gb: high-IQ (71-103) at Diagnostic tool/method: baseline ADI-R, ADOS protocols, Gc: score ≥ 16 on ADOS- and DSM-IV criteria for module I reciprocal-social autism assessed by an interaction (low social) independent clinician Gd: score < 16 on ADOS- Diagnostic category, n module I reciprocal-social (%): interaction (high social) Autism: 25 (100) Provider: PDD-NOS: 0 Planning and supervision Aspergers: 0 by trained behavior ana- Other characteristics, n lyst; provided by skilled (%): behavioral therapists and Expressive vocabulary < by parents 10 words, n: 24 Measure of treatment Expressive vocabulary: fidelity reported: two-word utterances, n: 1 No Co-interventions held stable during treatment: NR Concomitant therapies: NR N at enrollment: G1: 25 G1a: 12 G1b: 12 G1c: 12 G1d: 12 N at follow-up: G1: 25 Ben Itzchak and Zachor, 2007 (continued) C-190 Baseline Measures Outcomes Social skills: Social skills: Play skills score, Play skills score, mean ± SD: mean ± SD: G1: 0.92 ± 1.19 G1: 3.16 ± 1.62 G1a: 0.33 ± 0.89 G1a: 2.08 ± 1.44 G1b: 1.33 ± 1.15 G1b: 4.17 ± 1.11 G1c: 0.67 ± 1.15 G1c: 2.33 ± 1.37 G1d: 1.25 ± 1.21 G1d: 4.00 ± 1.53 Communication/ G1/BL: P < 0.001 language: G1a/BL: P < Imitation score, 0.001 mean ± SD: G1b/BL: P < G1: 2.36 ± 2.61 0.001 G1a: 0.91 ± 1.73 G1c/BL: P < G1b: 3.42 ± 2.54 0.001 G1c: 1.08 ± 1.72 G1d/BL: P < G1d: 3.83 ± 2.69 0.001 Receptive language G1a/G1b: P = score, mean ± SD: 0.07 G1: 1.64 ± 1.87 G1c/G1d: P = NS G1a: 0.67 ± 1.15 Communication/ G1b: 2.42 ± 2.02 language: G1c: 1.00 ± 1.28 Imitation score, G1d: 2.41 ± 2.15 mean ± SD: Expressive G1: 8.00 ± 1.44 language, mean ± G1a: 7.08 ± 1.62 SD: G1b: 8.83 ± 0.39 G1: 0.76 ±1.69 G1c: 7.50 ± 1.44 G1a: 0.83 ± 0.28 G1d: 8.41 ± 2.62 G1b: 1.25 ± 2.22 G1/BL: P < 0.001 G1c: 0.25 ± 0.45 G1a/BL: P < G1d: 1.33 ± 2.31 0.001 Nonverbal skills, G1b/BL: P < mean ± SD: 0.001 G1: 0.80 ± 0.76 G1c/BL: P < G1a: 0.42 ± 0.51 0.001 G1b: 1.08 ± 0.79 G1d/BL: P < G1c: 0.58 ± 0.51 0.001 G1d: 1.08 ± 0.90 G1a/G1b: P < Repetitive 0.01 behavior: G1c/G1d: P < Stereotyped behaviors, mean ± SD: G1: 6.48 ± 3.23 G1a: 7.58 ± 2.97 G1b: 5.92 ± 2.91 G1c: 7.58 ± 2.27 G1d: 5.42 ± 3.87 0.05 Educational/ cognitive/ academic attainment: IQ, mean ± SD: G1: 70.67 ± 17.01 Receptive language, mean ± SD: G1: 6.28 ± 2.34 G1a: 4.75 ± 2.26 G1b: 7.58 ± 1.31
Evidence Table. Therapies for children with ASD Study Description Intervention Ben Itzchak and Zachor, 2007 (continued) Inclusion/Exclusion Criteria/Population C-191 Baseline Measures Outcomes G1a: 61.00 ± 12.10 G1c: 4.91 ± 2.19 G1b: 80.45 ± 15.15 G1d: 7.58 ± 1.78 G1/BL: P < 0.001 G1a/BL: P < 0.001 G1b/BL: P < 0.001 G1c/BL: P < 0.001 G1d/BL: P < 0.001 G1a/G1b: P < 0.05 G1c/G1d: P = NS Expressive language, mean ± SD: G1: 5.84 ± 3.69 G1a: 3.67 ± 3.14 G1b: 7.67 ± 3.08 G1c: 3.50 ± 3.12 G1d: 7.92 ± 2.91 G1/BL: P < 0.001 G1a/BL: P < 0.001 G1b/BL: P < 0.001 G1c/BL: P < 0.001 G1d/BL: P < 0.001 G1a/G1b: P = NS G1c/G1d: P = 0.09 Nonverbal skills, mean ± SD: G1: 2.00 ± 0.76 G1a: 1.50 ± 0.52 G1b: 2.42 ± 0.67 G1c: 1.58 ± 0.51 G1d: 2.42 ± 0.79 G1/BL: P < 0.001 G1a/BL: P < 0.001 G1b/BL: P < 0.001 G1c/BL: P < 0.001 G1d/BL: P < 0.001 G1a/G1b: P = NS G1c/G1d: P = NS Repetitive behavior: Stereotyped behaviors, mean ± SD:
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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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3085. Shafer MS, Egel AL and Neef N
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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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3407. Thunberg G, Ahlsen E and Sand
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3522. Vitiello B. Recent NIMH clini
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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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