Therapies for Children With Autism Spectrum Disorders

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Evidence Table. Therapies for children with ASD Study Description Intervention Magiati et al., 2007 (continued) Inclusion/Exclusion Criteria/Population C-228 Baseline Measures Outcomes G2: 56.6 ± 4.8 (range): (52-67) (n=14) G1: 32.4 ± 8.2 G1/G2: P = 0.05 (20-55) VABS composite, G2: 29.4 ± 9.7 age equivalent, (17-49) months ± SD G1/G2: P = NS (range): VABS daily living, G1: 18.6 ± 5.4 standard score, (12-32) (n=26) mean (SD); G2: 17.3 ± 3.9 range: (12-26) (n=14) G1: 58.6 ± 8.4 G1/G2: P = NS (38-78) G2: 49.6 ± 12.4 (28-73) G1/G2: P = 0.06 Social skills: VABS socialization, age equivalent, months ± SD (range): G1: 25.1 ± 11.8 (12-61) G2: 20.2 ± 14 (7-53) G1/G2: P = NS VABS socialization, standard score, mean ± SD (range): G1: 61.8 ± 10.4 (41-90) G2: 56.7 ± 10.3 (47-82) G1/G2: P = NS Harms: NR Modifiers: Progress after 2 years was best predicted by baseline IQ (P < 0.001) and baseline PBVS score (P < 0.01); VABS and ADI-R total scores also contributed to the model (P < 0.05)
Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Baseline Description Intervention Criteria/Population Measures Outcomes Author: Intervention: Inclusion criteria: Problem behavior: Problem Shea et al., 2004 Risperidone oral solution • Physically healthy ABC score, mean ± behavior: Pandina et al., 1.0 mg/mL once daily in outpatients SD: ABC score, mean 2007† the morning at 0.01 • Ages 5-12 years Irritability: Country: mg/kg/day on treatment • DSM-IV Axis 1 diagnosis G1: 18.9 ± 8.8 Canada days 1-2, increased to of PDD G1a: 20.6 ± 8.1 Practice 0.02 mg/kg/day on day 3. • CARS total score ≥ 30 (n=24)† setting: Depending on response with or without mental G2: 21.2 ± 9.7 Academic, tertiary at day 8, could be retardation G2a: 21.6 ± 10.2† care hospital, increased in increments Exclusion criteria: Lethargy: pharmaceutical up to 0.02 mg/kg/day. • Schizophrenia G1: 13.7 ± 7.0 company, contract Thereafter adjusted at • Other psychotic G1a: 14 ± 6.8 research investigator’s discretion disorders (n=26)† organization weekly in increments ≤ G2: 14.3 ± 8.2 • Clinically relevant non- Intervention 0.02 mg/kg/day up to max neurologic disease G2a: 13 ± 8.6† setting: allowable dosage of 0.06 Stereotypic • Clinical significant Clinic mg/kg/day. behavior: laboratory abnormalities Enrollment Duration: days (range): G1: 7.9 ± 5.0 • Seizure disorder for period: G1: 52.7 (2-62) G1a: 8.4 ± 5.8 which they were NR G2: 49.6 (7-63) (n=25)† receiving one or more Funding: Planned: 8 weeks G2: 8.1 ± 5.6 anticonvulsants or had a Janssen-Ortho, Assessments: G2a: 9.4 ± 5.5† seizure within 3 months Inc., Canada; CGI-S completed at Hyperactivity/non- Johnson & intake by investigator • History of hypersencompliance: Johnson ESRS, VAS-MS (most sitivity to neuroleptics, G1: 27.3 ± 9.7 Pharmaceutical troublesome symptom) tardive dyskinesia, G1a: 29.2 ± 9.5 Research and CGI-C by investigator narcoleptic malignant (n=25)† Development weekly syndrome, drug or G2: 30.9 ± 8.8 Author industry ABC, N-CBRF (parent alcohol abuse, or HIV G2a: 33.6 ± 6.8 relationship version) completed infection (n=27)† disclosures: weekly by parent with • Used risperidone in the Inappropriate 1 of 7 investigator guidance last 3 months, previously speech: Janssen-Ortho (1) Groups: unresponsive or G1: 4.6 ± 3.4 5 of 5† G1: risperidone oral intolerant to risperidone G1a: 4.5 ± 3.7 Janssen (4) solution • Using a prohibited (n=26)† Janssen-Ortho (1) G2: placebo oral solution medication (including G2: 4.8 ± 3.7 Design: Ga: diagnosis of autism antipsychotics other than G2a: 4.5 ± 3.7† RCT Co-interventions held study medication, N-CBRF score, stable during treatment: antidepressants, lithium, parent rated, mean Yes α2-antagonists, ± SD: Frequency of contact clonidine, guanfacine, Adaptive/social:† during study: cholinesterase inhibitors, G1a: 3.8 ± 2.3 Weekly for 8 weeks psychostimulants, and (n=26) Concomitant therapies: naltrexone) G2a: 3.9 ± 2 At least one concomitant Age, years ± SD (range): Compliant/Calm:† medication, n (%): G1: 7.6 ± 2.3 (5-12) G1a: 6.8 ± 2.7 G1: 36 (90) G1a: 7.4 ± 2.4 (NR)† (n=25) G2: 26 (66.7) G2: 7.3 ± 2.3 (5-12) G2a: 6.2 ± 2.4 Medication, %: G2a: 7.1 ± 2.1 (NR)† (n=26) Analgesics: G1: 37.5 G2: 17.9 change ± SD: Irritability: G1: -12.1 ± 5.8 G2: -6.5 ± 8.4 G1/G2: P ≤ 0.001 Lethargy: G1: -8.6 ± 5.9 G2: -5.7 ± 6.9 G1/G2: P ≤ 0.01 Stereotypic Behavior: G1: -4.3 ± 3.8 G2: -2.4 ± 4.0 G1/G2: P ≤ 0.05 Hyperactivity/ noncompliance: G1: -14.9 ± 6.7 G2: -7.4 ± 9.7 G1/G2: P ≤ 0.001 Inappropriate speech: G1: -2.6 ± 2.6 G2: -1.6 ± 3.0 G1/G2: P ≤ 0.05 ABC score, mean ± SD: Irritability:† G1a: 7.2 ± 5.9 (n=24) G2a: 14.1 ± 11.3 G1a/G2a: P = 0.002 Lethargy: G1a: 4.7 ± 4.4 (n=26) G2a: 8.2 ± 8.9 G1a/G2a: P = 0.020 Stereotypic Behavior: G1a: 3.9 ± 4.2 (n=25) G2a: 6.9 ± 6.9 G1a/G2a: P = 0.053 Shea et al., 2004 Cough and cold Mental age: Conduct problem: Hyperactivity/ (continued) preparations: IQ score, n (%): G1: 16.8 ± 9.4 noncompliance: G1: 25 ≥ 85, normal: G1a: 17.2 ± 8 G1a: 13.3 ± 8.7 G2: 10.3 G1: 3/31 (9.7) (n=26)† (n=25) Antibiotics: G1a: 0† G2: 23.3 ± 12.0 G2a: 26.4 ± 12.8 C-229
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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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