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: Communication/ Communication/ Wetherby et al., Early Social Interaction G1 language: language: 2006 project (ESI): routines- • CSBS behavior sample Social signals, mean Social signals, Country: based intervention in from children between ± SD: mean ± SD: US natural environments; ages 12-24 months and Gaze shifts: Gaze shifts: Practice individualized curriculum; again between 25-36 G1: 4.18 ± 1.67 G1: 5.18 ± 1.51 setting: parent-implemented months after 12 months G2: NA G2: 3.28 ± 1.71 Academic curriculum; recommended ESI Shared positive G1/BL: P = 0.091 Intervention setting: Home, classroom Enrollment period: NR Funding: U.S. Department of Education, Office of Special Education and Rehabilitation Services Author industry relationship disclosures: NR Design: Prospective case series 2 home visits/week • Provisional diagnosis of affect: G1/G2: P = 0.001 G1 also participated in autism or systemic G1: 1.88 ± 1.83 Shared positive parent-child playgroup observation of red flags G2: NA affect: guided by two of ASD during first Gaze/point follow: G1: 3.41 ± 2.00 interventionists thru the behavior sample G1: 0.35 ± 0.61 G2: 1.31 ± 1.38 FIRST WORDS project: • Age ≤ 24 months G2: NA G1/BL: P = 0.053 attended for 9 weeks • Family agreed to Rate of G1/G2: P = 0.005 during the ESI participate in ESI for 12 communicating, Gaze/point follow: intervention year months mean ± SD: G1: 1.29 ± 0.85 Assessments: • Family agreed to G1: 8.71 ± 5.36 G2: 0.61 ± 0.70 Pre- and post-intervention diagnostic evaluation of G2: NA G1/BL: P = 0.004 measures of social child at 36 months Communicative G1/G2: P = 0.014 communication; MSEL, G2: functions, mean ± Rate of VABS • CSBS DP behavior SD: communicating, Groups: sample from 25-36 Behavior regulation: mean ± SD: G1: intervention (enmonths G1: 3.59 ± 2.12 G1: 16.18 ± 2.56 tered study at age 2 and • No previous intervention G2: NA G2: 11.94 ± 5.51 received ESI for 1 year) services before behavior Social interaction: G1/BL: P < 0.001 G2: control (age 3) sample was videotaped G1: 0.65 ± 0.93 G1/G2: P = 0.007 Provider: G2: NA Communicative • Suspicion of ASD Speech language Joint attention: functions, mean ± • Family agreed to pathologists, early G1: 0.65 ± 0.93 SD: diagnostic evaluation at childhood education G2: NA Behavior 36 months specialist Communicative regulation: Exclusion criteria: Measure of treatment means inventory, G1: 5.53 ± 0.63 fidelity reported: • See inclusion criteria mean ± SD: G2: 4.11 ± 1.81 Age, months ± SD: Yes Gestures: G1/BL: P = 0.002 Co-interventions held Pre-ESI: G1:1.76 ± 1.15 G1/G2: P = 0.005 stable during treatment: G1: 18.19 ± 3.85 G2: NA Social interaction: NR Post-ESI: Consonants: G1: 2.29 ± 1.86 Concomitant therapies: G1: 30.72 ± 3.66 G1: 1.0 ± 1.37 G2: 0.89 ± 1.28 NR Upon recruitment: G2: NA G1/BL: P = 0.002 N at enrollment: G2: 31.61 ± 3.45 Words: G1/G2: P = 0.015 G1: 17 Mental age: G1: 0.18 ± 0.53 Joint attention: G2: 18 NR G2: NA G1: 2.94 ± 2.16 N at follow-up: Gender, %: Symbolic capacity, G2: 1.39 ± 1.54 G1: 17 Male: mean ± SD: G1/BL: P = 0.001 G2: 18 G1: 88 Understanding: G1/G2: P = 0.021 G2: 78 G1: 0.82 ± 1.38 Female: G2: NA G1: 12 G2: 22 Race/ethnicity, %: Caucasian: G1: 65 G2: 61 Wetherby et al., African-American: Inventory of actions: Communicative 2006 (continued) G1: 12 G1: 3.88 ± 2.0 means inventory, G2: 17 G2: NA mean ± SD: Hispanic: Actions to others: Gestures: C-294
Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Description Intervention Criteria/Population G1: 24 G2: 6 Asian: G1: 0 G2: 17 SES: Parent Education, years ± SD: Mother: G1: 15.7 ± 1.93 G2: 15.53± 1.63 Father: G1: 16.35 ± 2.5 G2: 15.41 ± 2.4 Hollinghead’s index of SES, mean ± SD: G1: 53.0 ± 10.42 G2: 52.94 ± 10.33 Diagnostic approach: In Study/Referral Diagnostic tool/method: MSEL, VABS interview edition, survey form; ADOS, DSM-IV-TR Diagnostic category: See inclusion criteria Other characteristics, age 3, mean ± SD: MSEL, mean ± SD: Non-verbal DQ: G1: 81.98 ± 23.93 G2: 64.23 ± 17.74 Verbal DQ: G1: 73.55 ± 26.16 G2: 56.07 ± 24.96 VABS score, mean ± SD: Communication: G1: 77.06 ± 19.76 G2: 62.76 ± 16.91 Daily living: G1: 75.88 ± 10.51 G2: 65.88 ± 19.53 Social: G1: 77.06 ± 16.35 G2: 64.41 ± 18.99 Wetherby et al., 2006 (continued) Motor: G1: 83.76 ± 14.32 G2: 71.88 ± 21.45 Adaptive behavior Composite: G1: 73.82 ± 14.73 G2: 64.71 ± 7.20 C-295 Baseline Measures Outcomes G1: 0.53 ± 0.8 G1: 3.76 ± 1.68 G2: NA G2: 2.72 ± 1.53 Language stage, n G1/BL: P = 0.001 (%): G1/G2: P = 0.064 Pre-verbal: Consonants: G1: 16 (94) G1: 4.71 ± 2.69 G2: NA G2: 3.72 ± 3.08 Verbal G1/BL: P < 0.001 Early one-word: G1/G2: P = 0.321 G1: 1 (6) Words: G2: NA G1: 6.00 ± 5.18 Late one-word: G2: 3.94 ± 4.40 G1: 0 G1/BL: P < 0.001 G2: NA G1/G2: P = 0.216 Multiword: Symbolic G1: 0 capacity, mean ± G2: NA SD: Total: Understanding: G1: 1 (6) G1: 4.24 ± 3.29 G2: NA G2: 2.00 ± 2.40 G1/BL: P < 0.001 G1/G2: P = 0.030 Inventory of actions: G1: 6.18 ± 2.90 G2: 5.00 ± 2.28 G1/BL: P = 0.011 G1/G2: P = 0.193 Actions to others: G1: 2.82 ± 1.70 G2: 2.56 ± 1.72 G1/BL: P < 0.001 G1/G2: P = 0.065 Language stage, n (%): Pre-verbal: G1: 4 (24) G2: 8 (44) Verbal early oneword: G1: 4 (24) G2: 5 (28) Late one-word: G1: 6 (35) G2: 2 (11) Multiword: G1: 3 (18) G2: 3 (17) Total: G1: 13 (77) G2: 10 (56) Harms: NR Modifiers: NR
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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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Therapies for Children With Autism Spectrum Disorders

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