Therapies for Children With Autism Spectrum Disorders

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Evidence Table. Therapies for children with ASD Study Description Intervention Author: Howard et al., 2005 Country: US Practice setting: Academic Intervention setting: G1: Home, School, and Community G2: School G3: School Enrollment period: 1996-2003 Funding: Valley Mountain Regional Center Region 6 Autism Connection and California State University, Stanislaus Author industry relationship disclosures: NR Design: Prospective cohort Intervention: Intensive behavior analytic treatment with individualized goals and objectives 25-30 hours/week 1:1 intervention for children 3 years of age 50-100 learning opportunities/hour via discrete trial, incidental teaching, and other behavior analytic procedures Parents received training in basic behavior analytic strategies and implemented programs with children outside regular intervention hours, with agency staff meeting 1-2 times/month. Assessments Conducted by experienced psychologists and speech and language pathologists who were independent contractors Inclusion/Exclusion Criteria/Population Inclusion criteria: • Diagnosed with autistic disorder or PDD-NOS according to DSM-IV criteria by qualified independent examiner prior to 48 months of age • Entry in an intervention program prior to 48 months of age • English as primary spoken language in child’s home • No significant medical condition other than autistic disorder or PDD- NOS • No prior treatment >100 hours. • Referred from non-profit agencies (“regional centers’) under contract with CA dept of Developmental services for developmental disability case management Exclusion criteria: See inclusion criteria Age, mean/months ± SD: At diagnosis: G1: 30.48 ± 5.96 G2: 39.31 ± 5.52 G3: 34.94 ± 5.18 At intake: C-306 Baseline Measures Outcomes Intake conducted within 2 months of treatment entry Overall ratings: Composite Standard Scores, mean ± SD: G1: 70.46 ± 11.85 G2: 69.81 ± 10.48 G3: 71.62 ± 10.47 Social skills: Standard Scores, mean ± SD: G1: 72.79 ± 11.26 G2: 75.50 ± 14.25 G3: 75.07 ± 12.09 Age equivalents (months), mean ± SD: G1: 16.39 ± 4.89 G2: 22.06 ± 10.62 G3: 19.60 ± 5.68 Learning rates prior to intake, mean age equivalents per year ± SD: G1: 0.54 ± 0.18 G2: 0.58 ± 0.23 G3: 0.58 ± 0.19 Communication/ language: Standard Scores, mean ± SD: G1: 66.18 ±10.02 Weight gain: Fluoxetine: 0/39 (0) Placebo: 1/36 (2.8) Anorexia: Fluoxetine: 6/39 (15.4) Placebo: 4/36 (11.1) Proportion of subjects having dosage reduction on the two treatment due to AEs was not statistically significant (P = 0.289) Modifiers: NR Follow-up testing conducted at an average 14 months after treatment entry Overall ratings: Composite Standard Scores, mean ± SD: G1: 81.32 ± 11.14 (P < 0.01 compared to G2/G3 mean) G2: 69.25 ± 12.91 G3: 68.25 ± 9.86 Social skills: Standard Scores, mean ± SD: G1: 82.08 ± 11.73 (P < 0.01 compared to G2/G3 mean) G2: 75.00 ± 18.01 G3: 70.56 ± 11.77 Age equivalents (months), mean ± SD: G1: 32.04 ± 10.23 (P < 0.05 compared to G2/G3 mean) G2: 30.06 ± 16.10 G3: 24.81 ± 7.23 Learning rates
Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Description Intervention Criteria/Population with the local regional center and who were not involved in delivering treatment to any of the children in the study • BSID-2 nd G1: 30.86 ± 5.16 G2: 37.44 ± 5.68 G3: 34.56 ± 6.53 At follow-up: G1: 45.66 ± 6.24 Edition G2: 50.69 ± 5.64 • WISC-R G3: 49.25 ± 6.81 • Developmental Profile- II Mental age: • SB-FE • MPS • RDLS • VABS- Interview Edition See baseline measures Howard et al., 2005 (continued) Other (received by few children): • DAS • Development Assessment of Young Children • PEP-R • LIPS • PPVT-III • Expressive Vocabulary Test • Sequenced Inventory of Communication Development-Revised • PLS-3 • Rossetti Infant-Toddler Language Scale • Receptive-Expressive Emergent Language Scales-Revised • EOWPVT • ROWPVT • Denver Developmental Screening Test II • Rockford Infant Development Evaluation Scales Groups: G1: intensive behavior analytic intervention G2: intensive eclectic treatment G3: non-intensive public early intervention Gender: G1: M, n (%): 25 (86) F, n (%): 4 (14) G2: M, n (%): 13 (81) F, n (%):3 (19) G3: M, n (%): 16 (100) F, n (%): 0 (0) Race/ethnicity, n (%): G1: Both parents Caucasian: 21 (72) One or both parents Hispanic: 4 (14) Other: 4 (14) G2: (percents only account for known) Both parents Caucasian: 6 (50) One or both parents Hispanic: 3 (25) Other: 3 (25) Unknown: 4 (33) G3: (percents only account for known) Both parents Caucasian: 8 (57%) One or both parents Hispanic: 4 (29) Other: 2 (14) Unknown: 2 (17) SES: Maternal education, mean ± SD: G1: 14.10 ± 2.34 G2: 13.00 ± 1.83 C-307 Baseline Measures Outcomes G2: 63.69 ± 9.68 between intake G3: 66.20 ± 8.70 and follow-up, Age equivalents mean age (months), mean ± equivalents per SD: year ± SD: G1: 14.90 ± 4.32 G1: 1.04 ± 0.74 G2: 16.19 + 6.44 (P < 0.05 G3: 16.53 ± 5.25 compared to Learning rates prior G2/G3 mean) to intake, mean age G2: 0.60 ± 0.94 equivalents per year G3: 0.40 ± 0.67 ± SD: G1: 0.49 ± 0.15 G2: 0.43 ± 0.15 G3: 0.49 ± 0.15 Receptive: Communication/ Standard Scores, language: mean ± SD: Standard Scores, G1: 52.16 ± 18.44 mean ± SD: G2: 45.38 ± 14.97 G1: 85.44 ± 14.73 G3: 49.00 ± 13.61 (P < 0.01 Age equivalents compared to (months), mean ± G2/G3 mean) SD: G2: 64.13 ± 14.18 G1:14.57 ± 5.82 G3: 68.69 ± 14.18 G2:16.81 ± 5.36 Age equivalents G3:16.60 ± 5.34 (months), mean ± Learning rates prior SD: to intake, mean age G1: 36.60 ± 12.23 equivalents per year (P < 0.01 ± SD: compared to G1: 0.48 ± 0.21 G2/G3 mean) G2: 0.45 ± 0.15 G2: 23.88 ± 11.82 G3: 0.48 ± 0.12 G3: 26.13 ± 8.74 Learning rates between intake and follow-up, mean age equivalents per year ± SD: G1: 1.43 ± 0.72 (P < 0.01 compared to G2/G3 mean) G2: 0.56 ± 0.76 G3: 0.69 ± 0.70 Expressive: Standard Scores, mean ± SD: G1: 51.88 ±12.91 G2: 43.88 ± 6.69 G3: 48.77 ± 11.61 Age equivalents (months), mean ± SD: G1: 14.76 ± 4.72 G2: 16.38 ± 2.99 G3: 17.87 ± 5.45 Learning rates prior to intake, mean age equivalents per year ± SD: G1: 0.49 ± 0.16 G2: 0.44 ± 0.06 G3: 0.53 ± 0.17 Motor skills: Standard Scores, Receptive: Standard Scores, mean ± SD: G1: 71.31 ± 22.72 (P < 0.05 compared to G2/G3 mean) G2: 49.93 ± 19.62 G3: 49.21 ± 16.08 Age equivalents
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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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3464. Turner-Brown LM, Perry TD, Di
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3492. Van Der Putt R, Dineen C, Jan
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3522. Vitiello B. Recent NIMH clini
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3553. Walenski M, Mostofsky SH, Gid
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3581. Weber RC and Thorpe J. Teachi
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3637. Williams B. Mental handicap n
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Appendix F. Approach to Categorizin
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APPENDIX G. Discussion of Recent Sy
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one a casein free regime. Diets wer
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outcome data as Type 6, defined as
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Yes—no disclosures to make G7 Bai
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Table G1. Characteristics of recent
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Random assignment Appropriate compa
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Study Group design Random assignmen
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APPENDIX I. Applicability Summary T
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Social skills (continued) Domain De
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Therapies for Children With Autism Spectrum Disorders

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