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 Author: Intervention: Inclusion criteria: Commonly Commonly Dosman et al., Oral iron supplement: • Child had had ferritin occurring co- occurring co- 2007 6 mg elemental iron/kg/ measured previously as morbidities:morbidities: : Country: day; if it was anticipated part of routine diagnostic CGIS irritability, CGIS irritability, Canada that oral preparations assessment from autism mean: mean: Practice would not be accepted by at The Hospital for Sick G1: 1.19 (n=32) G1: 1.0 (n=32) setting: the child, iron Sprinkles Children’s tertiary level Medical: G1/BL: P = NS Academic (Supple-Forte) were Child Development SDSC restless sleep Medical: Intervention offered: two 30 mg Centre score (1-5), mean ± SDSC restless setting: sachets/day Exclusion criteria: SD: sleep score, Clinic Enrollment period: Average duration of treatment was 7.2 weeks (range 4-8 weeks) • Currently receiving iron supplement Age, years (range): G1: 3.7 ± 1.450 (n=32) G1c: 3.4 ± 1.60 showing improvement, n (%): NR Assessments: G1: 6.5 (2.67-10.75) SDSC restless G1: 7/24 (29) Funding: Prior to baseline and at Mental age: sleep, abnormal, %: G1/BL: P = 0.04 NR Author industry post-treatment, parents completed SDSC (26 NR Gender, n: G1: 77 SDSC delayed SDSC delayed sleep onset, n relationship disclosures: NR items), Periodic Leg Movements during Sleep scale (6 items), 3 day Male: 27/33 Female: 6/33 Race/ethnicity: sleep onset, n (%): G1: 14/31 (44) G1c: 5/8 (62.5) (%): G1: 11/31 (35) G1/BL: P = NS Design: Food Record, Nutritional NR Periodic Leg Periodic Leg Prospective case Supplement Log, and SES: Movements during Movements series irritability measure Maternal education: NR Sleep, children with during Sleep, (developed by authors Household income: NR mean score > 0.33, children with based on CGIS) Diagnostic approach: n (%): mean score > Baseline and post NR G1: 14/32 (44) 0.33, n (%): treatment growth Diagnostic tool/method: Dietary iron intake, G1: 12/32 (38) measures and blood ADI-R, ADOS, and clinical median mg/day G1/BL: P = NS samples were taken for serum ferritin and evaluation Diagnostic category: (range): G1a: 13.7 (4-39) Dietary iron intake, median transferrin receptor, mean NR corpuscular volume, G1b: 17.85 (7-43) Insufficient dietary mg/day (range): G1: NR hemoglobin, albumin, and iron intake, %: G1/BL: P = 0.32 vitamin B12 in the child G1a: 69 Ferritin, mean Groups: G1b: 35 μg/L (range): G1: iron intervention Ferritin, mean μg/L G1: 28.8 (6.6- Ga: preschool age (less (range): 103) than 6 years old) G1: 15.72 (4.2-39.0) G1/BL: P < 0.001 G1a: school age (6 or Low ferritin (< 10 Low ferritin ( 10 μg post- G1a/G1b: P = NS G1/BL: P = NS treatment Albumin below Albumin, below Gc: children on SSRI or normal levels, n: normal levels n: stimulant medication (and G1: 0/32 G1: NR completed SDSC) Vitamin B12 below Vitamin B12, Co-interventions held normal levels, n: below normal stable during treatment: G1: 0/32 levels, n: NR Frequency of contact during study: NR G1: 2/32 C-204
Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Baseline Description Intervention Criteria/Population Measures Outcomes Dosman et al., Concomitant therapies: Other characteristics, n Mean corpuscular Mean corpuscular 2007 (continued) NR (%): volume, fl ± SD: volume, mean N at enrollment: Any gastrointestinal G1: 80.8 ± 3.79 change fl (SE): G1: 43 symptom: 28/43 (65) Children with mean G1: 1.02 (0.30) G1a: 16 Constipation: 14/43 (33) corpuscular volume G1/BL: P = 0.002 G1ai: NR Loose stools: 14/43 (33) < 80 fl, n (%): Children with G1aii: NR Failure to thrive, abdominal G1: 14/33 (42) mean corpuscular G1b: 17 distension and pain, Hemoglobin, mean volume < 80 fl, n G1c: 8 excessive gas: 16/43 (37) gm/L ± SD: (%): N at follow-up: Seizures: 9/43 (21) G1: 125.6 ± 7.00 G1: 8/33 (24) G1: 33 Gluten and/or casein-free Children with serum Hemoglobin, G1a: 16 diet: 11/43 (26) concentration of mean change G1ai: NR SSRI: 7/43 (16) hemoglobin < 110 gm/L (SE): G1aii: NR Melatonin: 3/43 (7) gm/L (2-4 year olds) G1: 2.42 (1.06) G1b: 17 Antiepileptic: 4/43 (9) or < 120 gm/L (5-10 G1/BL: P = 0.029 G1c: NR Stimulant: 2/43 (5) year olds), %: Children with Antihistamine: 3/43 (7) G1: 3/33 (9) serum Vitamin supplement: 14/43 Transferrin receptor, concentration of (33) mean μg/mL ± SD hemoglobin < 110 Nutritional supplement: (range): gm/L (2-4 year 7/43 (16) G1: 5.43 ± 1.49 olds) or < 120 Ferritin < 50 μg/L: 43/43 (3.46-9.94) (n=25) gm/L (5-10 year (100) Children with serum olds), %: Iron supplementation, n: transferrin receptor G1: 1/33 (3) Iron suspension: 23/33 > 8.3 μg/mL, n (%): Transferrin Sprinkles: 10/33 G1: 1/25 (4) receptor, mean Gastrointestinal symptoms, change μg/mL n (%): 23/33 (76) (SE): Number of G1: 0.06 (0.24) gastrointenstinal G1/BL: P = NS symptoms, mean: Children with G1: 1.9 serum transferrin G1ai: 3.3 receptor > 8.3 G1aii: 0.8 μg/mL, n (%): G1: 1/25 (4) Harms: Withdrew due to AEs, n: 2/43 Treatment-related AEs, n (%): Any symptom: 13/33 (39) Gastrointestinal symptom: 9/33 (27) Constipation: 4/33 (12) Loose stools: 6/33 (18) Abdominal pain: 1/33 (3) Decreased appetite: 1/33 (3) Dosman et al., Stained teeth: 2007 (continued) 2/33 (6) Increased night waking: 1/33 (3) C-205
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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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