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: Overall ratings: Overall ratings: Remington et al., Home-based early inter- • Autism diagnosis from DBC total score, DBC total score, 2007 vention for two years, ADI-R mean ± SD: mean ± SD: Country: UK Practice setting: Academic Intervention setting: Home, school, clinic Enrollment period: NR Funding: UK Health Foundation Author industry relationship disclosures: NR Design: Cohort, prospective 25.6 ± 4.8 hours/week • Previously diagnosed Maternal report: Maternal report: (range 18.4-34.0 hours); with autism by an G1: 50.26 ± 22.75 G1: 44.70 ± 24.20 one-on-one intervention independent clinician, or G2: 67.81 ± 18.77 G2: 60.62 ± 24.72 provided by parents and suspected autism Paternal report: Paternal report: 3-5 trained tutors; pro- diagnosis G1: 46.67 ± 22.15 G1: 45.19 ± 20.94 grams used discrete trial • Age 30-42 months at G2: 57.57 ± 15.67 G2: 55.20 ± 19.44 training and incorporated enrollment DBC autism score, DBC autism generalization procedures • Children lived in the mean ± SD: score, mean ± (specific programming family home Maternal report: SD: individualized for each Exclusion criteria: G1: 22.22 ± 9.54 Maternal report: child), participants were • Other chronic or serious G2: 31.14 ± 9.22 G1: 18.91 ± 10.29 identified based on parent medical conditions that Paternal report: G2: 26.76 ± 11.21 preference for EIBI would interfere with G1: 22.33 ± 9.92 Paternal report: (funded either publicly consistency of inter- G2: 26.29 ± 8.90 G1: 19.50 ± 8.80 n=13 or purchased vention ASQ score, mean ± G2: 24.00 ± 11.60 privately n=10) Age, months ± SD: SD: ASQ score, mean Controls had local G1: 35.7 ± 4.0 Maternal report: ± SD: education authorities’ G2: 38.4 ± 4.4 G1: 19.26 ± 4.93 Maternal report: standard treatment for two G1/G2: P < 0.05 G2: 21.14 ± 5.47 G1: 15.96 ± 5.63 years; in general not Mental age: Paternal report: G2: 19.29 ± 7.22 intensive or delivered See baseline measures G1: 20.88 ± 4.54 Paternal report: one-to-one Gender: G2: 21.07 ± 6.41 G1: 19.88 ± 6.16 Assessments: NR Social skills: G2: 19.47 ± 7.46 Performance-based tests Race/ethnicity: NCBRF positive Social skills: administered at family NR social behavior NCBRF positive home, parents mailed SES: score, mean ± SD: social behavior questionnaires, telephone University education, Maternal report: score, mean ± interviews using VABS maternal, n (%): G1: 10.57 ± 4.24 SD: approximately 1 week G1: 10/23 (43) G2: 9.29 ± 3.47 Maternal report: prior to the children’s 60 G2: 4/21 (19) Paternal report: G1: 15.30 ± 4.69 minute assessment visits Household income: NR G1: 8.94 ± 3.47 G2: 11.86 ± 4.84 at 3 time points (baseline, Mother working, n (%): G2: 8.73 ± 3.67 G1/G2: P = 0.004 1 and 2 year follow-up); Full time: Communication/ Paternal report: ADI administered by first G1: 0 language: G1: 12.60 ± 4.06 author, ESCS, BSID or G2: 0 ESCS joint attention G2: 11.20 ± 5.19 Stanford Binet, and RDLS Part time: score, mean ± SD: G1/G2: P = 0.053 were administered by a G1: 7 (30.4) Initiating: Communication/ Master’s level psycho- G2: 7 (33.3) G1: 3.33 ± 4.40 language: metrician Fathers (living in the family G2: 3.63 ± 4.92 ESCS joint Groups: home) working, n (%): Responding: attention score, G1: EIBI intervention Full time: G1: 5.29 ± 3.62 mean ± SD: G2: treatment as usual G1: 19/20 (95) G2: 5.94 ± 3.91 Initiating: through public funds G2: 17/20 (85) Reynell verbal G1: 11.76 ± 9.41 Provider: Part time: comprehension G2: 11.19 ± 13.86 Parents and trained G1: 0 score obtained, n: G1/G2: P = NS tutors, supervised by G2: 1/20 (5) G1: 4 Responding: more experienced Diagnostic approach: G2: 3 G1: 11.29 ± 3.47 behavior analysts, in Referral G1/G2: P = NS G2: 10.06 ± 4.99 some cases a consultant G1/G2: P < 0.05 with PhD experience in behavior analysis C-244
Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Description Intervention Criteria/Population Remington et al., Measure of treatment Diagnostic tool/method: 2007 (continued) fidelity reported: ADI-R No Diagnostic category, n Co-interventions held (%): stable during treatment: Autism : 44 (100) Yes PDD-NOS: NR Concomitant therapies, Aspergers: NR n (%): Other characteristics: Baseline: Speech therapy: G1: 15 (65) G2: 12 (57) Dietary intervention: G1: 11 (48) G2: 3 (14) Prescription medications: G1: 1 (4) G2: 1 (5) Vitamin injection or highdose vitamins: G1: 6 (26) G2: 0 Homeopathic intervention: G1: 5 (22) G2: 5 (24) 12 month follow-up: In mainstream school: G1: 13 (57) G2: 6 (48) Special needs school: G1: 0 G2: 9 (43) Mixed school: G1: 0 G2: 2 (10) TEACHH principles in school settings: G1: 2 (9) G2: 8 (38) PECS: G1: NR G2: 14 (67) Sign language/Makaton: G1: NR G2: 5 (24) Speech therapy: G1: 5 (22) G2: 14 (67) Dietary intervention: G1: 14 (61) G2: 4 (19) Prescription medications: G1: 4 (17) G2: 5 (24) NR Remington et al., Vitamin injection or high- 2007 (continued) dose vitamins: G1: 10 (44) C-245 Baseline Measures Outcomes Reynell expressive Reynell verbal language score comprehension obtained, n: score obtained, n: G1: 2 G1: 21 G2: 1 G2: 11 G1/G2: P = NS G1/G2: P < 0.005 Adaptive behavior: Reynell VABS score, mean expressive ± SD: language score Composite: obtained, n: G1: 114.78 ± 26.89 G1: 21 G2: 113.57 ± 29.78 G2: 10 Communication: G1/G2: P < 0.005 G1: 23.52 ± 11.35 Adaptive G2: 21.62 ± 10.81 behavior: Daily living skills: VABS score, G1: 24.13 ± 7.49 mean ± SD: G2: 25.43 ± 10.56 Composite: Social skills: G1: 202.83 ± G1: 29.57 ± 6.65 61.98 G2: 28.29 ± 7.48 G2: 182.86 ± Motor skills: 58.89 G1: 37.57 ± 6.37 Communication: G2: 38.24 ± 7.06 G1: 54.74 ± 24.43 Educational/ G2: 46.00 ± 24.51 cognitive/ Daily living skills: academic G1: 50.22 ± 16.46 attainment: G2: 44.67 ± 16.99 IQ, Bayley and SB- G1/G2: P < 0.05 IV, mean ± SD: Social skills: G1: 61.43 ± 16.43 G1: 43.52 ± 15.94 G2: 62.33 ± 16.64 G2: 41.48 ± 14.52 Mental age, months Motor skills: ± SD: G1: 54.35 ± 9.12 G1: 22.04 ± 6.89 G2: 50.71 ± 8.21 G2: 23.71 ± 6.00 G1/G2: P < 0.05 Educational/ cognitive/ academic attainment: IQ, Bayley and SB-IV, mean ± SD: G1: 73.48 ± 27.28 G2: 60.14 ± 27.76 G1/G2: P < 0.01 Mental age, months ± SD: G1: 44.39 ± 16.39 G2: 38.00 ± 17.44 G1/G2: P < 0.01 Harms: NR Modifiers:
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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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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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3054. Schwartz IS, Sandall SR, Garf
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3085. Shafer MS, Egel AL and Neef N
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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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3698. Worth S and Reynolds S. The A
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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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