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: Social skills: Overall: Kroeger et al., In both interventions • 4-6 years old Number of initiating Parent satis- 2007 Country: US (direct teaching and play activities), the child participates for a total of • Diagnosed with Autistic disorder Exclusion criteria: behaviors: G1: NR* G2: NR* faction rating, mean: G1: 5.69 Practice 15 hours in 15 group • Other autism spectrum G1/G2: P = NS setting: sessions, which include: disorders (i.e. Asperger’s Number of respon- Academic • Beginning and ending disorder, Rett’s disorder, ding behaviors: Intervention circle times childhood disintegrative G1: NR* setting: • Visual schedules during disorder, and pervasive G2: NR* Clinic each session to developmental disorder, G1/G2: P = NS Enrollment transition activities NOS) Number of inter- period: • 2:1 student to facilitator Age, months ± SD: acting behaviors: NR ratio G1: 65.00 ± 12.25 G1: NR* Funding: • Secondary (social) G2: 61.42 ± 9.15 G2: NR* Xavier reinforcement for Mental age: G1/G2: P = NS University prosocial behaviors NR Mentoring and • Behavior management Gender, n: Project Chair for inappropriate Male: Award, Autism behaviors G1: 9 Society of Greater • Introduction of identical G2: 11 Cincinnati Student toys and materials Female: Researcher Grant commensurate with the G1: 4 Design: video modeling G2: 1 RCT curriculum Race/ethnicity, n: In the direct teaching Caucasian: intervention, children G1: 9 participated in the video G2: 12 modeling curriculum and African American: received primary (edible) G1: 4 rein-forcement during the G2: 0 course of the video SES: modeling Maternal education: NR In the play activities Household income: NR intervention, children Diagnostic approach: engaged in supervised Referral free play during the Diagnostic tool/method: middle portion of the By developmental session instead of video pediatrician following modeling routine multidisciplinary Assessments: assessment: parent and a Parent satisfaction variety of autism and survey; Social Interaction developmental standar- Observation Code dized assessments videotape data conducted by corre- Groups: sponding professionals G1: direct teaching Diagnostic category, n G2: play activities (%): Provider: Autism: 25 (100) Group supervisor and facilitators G2: 5.67 G1/G2: P = NS Social skills: Number of initiating behaviors: G1: NR* G2: NR* ANOVA: time (P = 0.001), treatment (0.020) η 2 = 0.215 Number of responding behaviors: G1: NR* G2: NR* ANOVA: time (P = 0.005), treatment (P = 0.003) η 2 = 0.328 Number of interacting behaviors: G1: NR* G2: NR* ANOVA: time (P = 0.002), treatment (P = 0.006); η 2 = 0.288 Harms: NR Modifiers: NR Kroeger et al., Mean # of sessions Other characteristics: 2007 (continued) attended: GARS score, mean ± SD: G1: 14.08 G1: 92.15 ± 15.24 G2: 14.42 G2: 92.58 ± 9.66 Measure of treatment G1/G2: P = NS fidelity reported: Non-verbal C-224
Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Description Intervention Criteria/Population No G1: 2 Co-interventions held stable during treatment: NR Concomitant therapies: NR N at enrollment: G1: 14 G2: 13 N at follow-up: G1: 13 G2: 12 G2: 2 Comments: *Data only illustrated graphically Author: Intervention: Magiati et al., 2007 Country: UK Practice setting: Academic Intervention setting: Community Enrollment period: July 1998 to July 2002 Funding: Local educational authorities Author industry relationship disclosures: None Design: Prospective cohort Early Intensive Behavioral Intervention: children received 1:1 home teaching using discrete trial techniques and Verbal Behavior; 27 families attended an initial workshop of 1-3 days Nursery: eclectic intervention, emphasizing structure, visual cues, individualized teaching, and contact with families (most commonly reported TEACCH, PECS, Makatan, and SPELL) Duration of treatment, months ± SD (range): G1: 25.5 ± 1.04 (23-27) G2: 26.0 ± 1.5 (23-27) Total hours of intervention, mean ± SD: G1: 3,415 ± 444 G2: 2,266 ± 533 Hours of intervention per week, mean ± SD (range): First week: G1: 32.4 ± 6.4 (18-40) G2: 25.6 ± 6.4 (15-30) G1/G2: P < 0.001 Last week: G1: 33.2 ± 3.5 (26-40) G2: 27.4 ± 4.2 (19-30) G1/G2: P < 0.001 Assessments: BSID, WPPSI, MPS, VABS, BPVS-II, Word Picture Vocabulary Test- Revised, Symbolic Play Test-II, Test of Pretend Play, administered at home or school by Inclusion criteria: • Age 22-54 months • Independent professional diagnosis of autism/ASD confirmed by ADI-R • No major medical diagnoses • English main language at home • Living within 3 hours of London • Enrolled in either EIBI home-based program or specialist autismspecific school-based nursery provision for a minimum of 15 hours per week • Receiving no other intensive treatment Exclusion criteria: • See inclusion criteria Age, months ± SD: G1: 38 ± 7.2 G2: 42.5 ± 7.8 Mental age, mean ± SD (range): See baseline measures Gender, n (%): Male: G1: 27 (96.4) G2: 12 (75) Female: G1: 1 (3.6) G2: 4 (25) Race/ethnicity, n (%): White: G1: 21 (47) G2: 11 (69) Mixed: G1: 4 (9) C-225 Baseline Measures Outcomes Overall measures: VABS composite, standard score, mean ± SD (range): G1: 59.6 ± 6.2 (50-72) (n=26) G2: 55.4 ± 5.4 (47-64) (n=14) G1/G2: P = 0.04 ADI-R total algorithm score, mean ± SD (range): G1: 36.4 ± 6.7 (18-46) (n=26) G2: 40 ± 6.9 (18-46) (n=15) G1/G2: P = NS Educational/ cognitive/ academic attainment: Mental age, months ± SD (range): G1: 31.4 ± 11.1 (5-55 ) G2: 29.1 ± 13.1 (9-48) G1/G2: P = NS IQ, mean ± SD (range): G1: 83 ± 27.9 (16-138) G2: 65.2 ± 26.9 (27-112 ) G1/G2: P = 0.04 Symbolic play test score, developmental age, months ± SD (range): G1: 18.8 ± 8 (12-36) (n=27) G2: 19.2 ± 8.6 (12-34) Overall measures: VABS composite, age equivalent, months ± SD (range): G1: 32.6 ± 10.2 (19-58) G2: 26.1 ± 12.4 (11-48) G1/G2: P = NS VABS composite, standard score, mean ± SD (range): G1: 57.5 ± 10.1 (41-79) G2: 48.6 ± 10.7 (35-72) G1/G2: P = NS ADI-R total algorithm score, mean ± SD (range): G1: 30.7 ± 8.8 (13-40) (n=26) G2: 34.9 ± 9.9 (11-48) G1/G2: P = NS Educational/ cognitive/ academic attainment: Mental age, months ± SD (range): G1: 49.2 ± 9.8 (29-70) G2: 44.7 ± 14.1 (17-67) (n=15) G1/G2: P = NS IQ, mean ± SD (range): G1: 78.4 ± 17.6
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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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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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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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