Therapies for Children With Autism Spectrum Disorders

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Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Description Intervention G2: 1 (5) Homeopathic intervention: G1: 2 (9) G2: 1 (5) 24 month follow-up: In mainstream school: G1: 17 (74) G2: 10 (48) Special needs school: G1: 5 (22) G2: 11 (52) TEACHH principles in school settings: G1: 3 (13) G2: 11 (52) PECS: G1: NR G2: 16 (76) Sign language/Makaton: G1: NR G2: 10 (48) Speech therapy: G1: 6 (26) G2: 10 (48) Dietary intervention: G1: 12 (52) G2: 6 (29) Prescription medications: G1: 1 (4) G2: 4 (19) Vitamin injection or highdose vitamins: G1: 7 (30) G2: 1 (5) Homeopathic intervention: G1: 1 (4) G2: 1 (5) N at enrollment: G1: 23 G2: 21 N at follow-up: G1: 23 G2: 21 Criteria/Population C-246 Baseline Measures Outcomes In G1, 6 improved most on IQ tests (more than 23.94 points) vs. 6 whose IQ scores decreased: improved IQ associated with higher IQ, higher MA, higher VBS composite, communication, and social skills scores, lower vineland motor skills scores, more behavior problems on both maternal and paternal DBC, more autism symptoms on DBC, fewer intervention hours in year two
Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Baseline Description Intervention Criteria/Population Measures Outcomes Author: Intervention: Inclusion criteria: Educational/ Educational/ Rickards et al., Home-based program: • Delays in two or more cognitive/ cognitive/ 2007 1 of 2 specialist preschool areas of development academic academic Country: teachers visited each based on play observa- attainment: attainment: Australia family weekly for 1-1.5 tions, parental interview, IQ score, mean ± IQ score, mean ± Practice hours for 12 months. Time and information supplied SD: SD: setting: was spent discussing by referring agency G1: 60.2 ± 20 G1: 64.9 ± 22.2 Academic protocols developed at Exclusion criteria: G1a: 55.7 ± 22.1 G1a: 57.2 ± 21.9 Intervention the centers, and • Diagnosis of cerebral G1b: 67 ± 14.4 G1b: 76.4 ± 17.9 setting: developing new goals and palsy G2: 60.6 ± 21.8 G2: 57.1 ± 22.4 Clinic (child strategies as needed. • Families with inadequate G2a: 52.9 ± 18.3 G2a: 48.6 ± 17.5 development and Included parent training English language skills G2b: 80.8 ± 17.4 G2b: 79.4 ± 18.8 early intervention and adapting home Age, months ± SD: G1/G2: P = NS G1+G2/BL: P = center) environment for the needs G1: 44.6 ± 6.1 Problem behavior: NS Enrollment of the child. Addressed G2: 43.1 ± 6.5 Behavior Rating G1/G2: P = 0.007 period: daily living skills, how to Mental age: Scale score, mean ± G1a/BL: P = NS May 2000 to respond to behavior, how NR SD G1b/BL: P = NS December 2003 to provide choices. Gender, n (%): G1: 98 ± 17.1 G2a/BL: P = NS Funding: Center-based program: Male: (n=29) G2b/BL: P = NS Murdoch children in both the home- G1: 24 (80) G2: 98.3 ± 13.4 G1a/G2a: P = Children’s based program and G2: 23 (79) (n=28) 0.09 Research Institute control groups participa- Female: G1/G2: P = NS G1b/G2b: P = and the Jack ted in one of two center- G1: 6 (20) Behavior Screening 0.08 Brockhoff based programs. This G2: 6 (21) Questionnaire, Change in IQ, n: Foundation consisted of 5 hours Race/ethnicity: mean ± SD: Improved: Author industry spread over two weekly NR G1: 11.3 ± 4.9 G1: 12 relationship sessions and included an SES: G2: 9.6 ± 4.4 (n=28) G2: 3 disclosures: individualized program for Maternal education < 12 G1/G2: P = NS No change: NR each child determined by years, n (%): Preschool Behavior G1: 10 Design: the child’s developmental G1: 14 (48.3) Checklist score, G2: 16 RCT level, learning style, and G2: 14 (50) mean ± SD: Deteriorated: interests. Training Social status, Daniel Scale G1: 19.2 ± 10.4 G1: 8 techniques included score, n (%): (n=27) G2: 10 chaining, variety, High (1-4): G1a: 22.1 ± 11 No change: repetition, sequencing, G1: 9 (30) (n=16) G1: 10 and reward systems. The G2: 11 (37.9) G1b: 15 ± 8.2 G2: 16 major principle was to Low (4.1-7.0): (n=11) G1/G2: P = 0.03 learn through play; G1: 21 (70) G2: 17.4 ± 10.8 Problem communication systems G2: 18 (62.1) (n=26) behavior: (PECS), behavior Diagnostic approach: G2a: 22 ± 9.7 Behavior Rating modification techniques, In Study (n=18) Scale score, speech and OT were Diagnostic tool/method: G2b: 7.1 ± 3.4 (n=8) mean ± SD provided as needed. DSM-IV or ADI-R & ADOS G1/G2: P = NS G1: 105.8 ± 13.2 Assessments: Diagnostic category, n Adaptive behavior: (n=29) Baseline and 13 months (%): VABS composite G2: 100.8 ± 11.2 (mean for both groups). ASD: score, mean ± SD: (n=28) Cognitive development G1: 18 (60) G1: 61.2 ± 18.8 G1+G2/BL: P = either by BSID-II or by G2: 21 (72.4) G2: 55 ± 14.6 0.01 WPPSI-R Developmental delay: (n=28) G1/G2: P = NS Adaptive behavior by G1: 7 (23.3) G1/G2: P = NS VABS parent interview G2: 2 (6.9) Bayley Behavior Rating Scale by psychologist Rickards et al., Behavior Screening Language delay: Behavior 2007 (continued) Questionnaire competed G1: 5 (16.7) Screening by parents G2: 6 (20.7) Questionnaire, Preschool Behavior Other characteristics: mean ± SD: C-247
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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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