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: Educational/ Educational/ Sallows et al., Intensive clinic-directed • Recruited through local cognitive/ cognitive/ 2005 vs. less intensive parent- birth-3 special education academic academic Country: directed groups using programs attainment: attainment: US Practice setting: Academic Intervention setting: Clinic Enrollment period: 1996 to 1997 Funding: NIH Author industry relationship disclosures: NR Design: RCT treatment based on UCLA • Age 24-42 months at FSIQ, mean ± SD FSIQ, mean ± SD model (without aversives intake G1: 50.85 ± 10.57 G1: 73.08 ± 33.08 and the addition of proc- • Ratio estimate of mental G2: 52.10 ± 8.98 G2: 79.60 ± 21.80 edures from subsequent age/chronological age by Ga: 55.27 ± 8.96 Ga: 103.73 ± approaches) Mental Development Gb: 47.83 ± 9.37 13.35 Clinic-directed treatment Index ≥ 35 Nonverbal IQ, mean Gb: 50.42 ± 6.98 parents had 6-10 hours/ • Neurologically within ± SD: Ga/BL: P < 0.01 week of 2-3 hour in-home “normal” limits as G1: 70.58 ± 16.54 Gb/BL: P = NS consultation sessions with determined by a G2: 82.67 ± 14.94 ANOVA: time a senior therapist, team pediatric neurologist Ga: 83.56 ± 14.84 (P < 0.01)* meetings for 1 hour per • Diagnosis of autism by Gb: 69.83 ± 15.93 Verbal IQ, mean ± week, and an hour-long independent child Communication/ SD: progress review per week psychiatrists familiar with language: G1: 78.00 ± 33.48 for 1-2 years and every autism and known for VABS communica- G2: 76.30 ± 26.66 other month thereafter; their experience tion score, mean ± Ga: 101.45 ± parent-directed treatment • Met DSM-IV criteria for SD 18.72 had one 3 hour consulta- autism as determined by G1: 57.46 ± 4.97 Gb: 47.44 ± 2.06 tion session with a senior trained examiner G2: 63.20 ± 5.58 Ga/BL: P < 0.01 therapist every 2 weeks, Exclusion criteria: Ga: 60.82 ± 4.02 Gb/BL: P = NS team meetings for 1 hour • See inclusion criteria Gb: 59.17 ± 7.22 ANOVA: time every 1-2 weeks, and an Age, months ± SD: RDLS score, mean (P < 0.01)* hour-long progress review Pre-test: ± SD: PIQ, mean ± SD: every other month G1: 33.23 ± 3.89 Receptive language: G1: 84.90 ± 25.86 Duration: 4 years G2: 34.20 ± 5.06 G1: 38.85 ± 6.09 G2: 90.70 ± 20.72 Frequency, 1:1 direct During treatment: G2: 38.78 ± 6.44 Ga: 107.55 ± 9.44 treatment, hours/week ± G1: 35.00 ± 4.86 Ga: 39.30 ± 6.91 Gb: 63.67 ± 8.43 SD: G2: 37.10 ± 5.36 Gb: 38.42 ± 5.59 Ga/BL: P < 0.01 Year 1: Post-test: Expressive Gb/BL: P < 0.01 G1: 38.60 ± 2.91 G1: 83.23 ± 8.92 language: ANOVA: time G2: 31.67 ± 5.81 G2: 82.50 ± 6.61 G1: 47.92 ± 6.17 (P < 0.01)* Year 2: Mental age: G2: 48.44 ± 6.96 Nonverbal IQ, G1: 36.55 ± 3.83 See baseline measures Ga: 49.90 ± 7.75 mean ± SD G2: 30.88 ± 4.04 Gender, n (%): Gb: 47.50 ± 6.54 G1: 77.58 ± 25.24 Assessments: Adaptive behavior: G2: 89.44 ± 18.35 Male: BSID, Merrill-Palmer G1: 11 (84.6) VABS score, mean Ga:108.78 ± scales, RDLS, VABS G2: 8 (80) ± SD: 10.96 communication, daily Female: Daily living skills: Gb: 67.70 ± 12.35 living and socials skills, G1: 2 (15.4) G1: 63.92 ± 5.53 Ga/BL: P = NS WASI, WISC-III, Leiter R, G2: 2 (20) G2: 64.20 ± 3.68 Gb/BL: P = NS Clinical Evaluation of Race/ethnicity: Ga: 66.45 ± 4.25 ANOVA: time Language Fundamentals NR Gb: 61.83 ± 4.20 (P = NS)* administered by invest- SES: Composite: tigator or independent G1: 59.54 ± 5.31 Maternal education to BA psychologist at pre- level, n (%): G2: 60.90 ± 5.94 treatment and annually for G1: 9/12 (75) Ga: 61.73 ± 4.59 4 years G2: 9/10 (90) Gb: 58.67 ± 6.09 Sallows et al., ADI-R administered by Paternal education to BA Social skills: Personality 2005 (continued) investigator/psychologist level, n (%): VABS socialization Inventory for and Personality Inventory G1: 10/12 (83.3) score, mean ± SD: Children, parent for Children completed by G2: 6/9 (66.7) G1: 58.38 ± 6.17 rated, cognitive parent after 3 years Household income, median G2: 60.30 ± 5.76 development treatment (range): Ga: 61.55 ± 6.58 score, mean ± Child Behavior Checklist G1: $62,000 ($35,000- Gb: 57.08 ± 4.63 SD: C-322
Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Baseline Description Intervention Criteria/Population Measures Outcomes and VABS completed by $100,000+) ADI-R score, mean Ga: 64.18 ± 13.65 parents and teachers after G2: $59,000 ($30,000- ± SD: Gb: 97.55 ± 18.77 4 years treatment; $100,000+) Social skills: Ga/Gb: P < 0.01 teachers administered Diagnostic approach: G1: 17.54 ± 3.73 Child Behavior Woodcock Johnson III See inclusion criteria G2: 18.90 ± 1.14 Checklist, parent tests of Achievement for Diagnostic tool/method: Ga: 16.45 ± 3.26 rated, thought subjects at age 7 in DSM-IV Gb: 19.67 ± 1.55 problems score, regular education classes Diagnostic category, n Communication: mean ± SD: UCLA Early Learning (%): G1: 12.85 ± 2.44 Ga: 65.64 ± 9.87 Measure administered in Autism: 23 (100) G2: 12.90 ± 1.22 Gb: 70.42 ± 7.92 first 6 months of treatment PDD-NOS: 0 Ga: 11.00 ± 3.54 Ga/Gb: P = NS by investigator Aspergers: 0 Gb: 13.75 ± 0.60 Communication/ Groups: Other characteristics: Repetitive language: G1: clinic-directed One-parent families, n (%): behavior: VABS communi- G2: parent-directed G1: 0/13 (0) ADI-R ritualistic cation score, Ga: rapid learners by G2: 1/10 (10) score, mean ± SD: mean ± SD: Early Learning Measure Number of siblings, mean: G1: 5.38 ± 1.69 G1: 73.69 ± 32.32 Gb: moderate learners by G1: 2 G2: 6.40 ± 1.11 G2: 81.40 ± 24.33 Early Learning Measure G2: 2 Ga: 5.91 ± 1.62 Ga: 105.09 ± Provider: Non-verbal, n (%): Gb: 5.92 ± 1.44 12.83 18 or older with minimum G1: 8/13 (62) Gb: 51.33 ± 10.94 of 1 year college and 30 G2: 2/10 (20) Ga/BL: P < 0.01 hours of training Gb/BL: P < 0.05 Measure of treatment ANOVA: time fidelity reported: (P < 0.05)* Yes VABS communi- Co-interventions held cation, teacher stable during treatment: rated, mean ± SD: NR Ga: 94.44 ± 13.97 Concomitant therapies: Gb: 58.58 ± 7.90 NR Ga/Gb: P < 0.01 N at enrollment: RDLS score, G1: 13 mean ± SD: G2: 11 Receptive N at follow-up: language: G1: 13 G1: 55.85 ± 36.23 G1a: 5 G2: 65.78 ± 25.81 G1b: 8 Ga: 93.60 ± 12.64 G2: 10 Gb: 31.83 ± 9.87 G2a: 6 Ga/BL: P < 0.01 G2b: 4 Gb/BL: P = NS ANOVA: time (P < 0.01)* Sallows et al., Expressive 2005 (continued) language: G1: 53.38 ± 31.91 G2: 59.22 ± 25.13 Ga: 85.70 ± 15.07 Gb: 30.83 ± 5.89 Ga/BL: P < 0.01 Gb/BL: P < 0.01 ANOVA: time (P = NS)* ADI-R communication score, mean ± SD: G1: 8.08 ± 6.91 C-323
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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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1095. Furneaux B. Keeping the balan
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1124. Garcaa-Villamisar D, Wehman P
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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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1647. Karmali I, Greer RD, Nuzzolo-
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1702. Kielinen M, Linna SL and Moil
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1989. Liptak GS, Orlando M, Yinglin
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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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Therapies for Children With Autism Spectrum Disorders

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