Therapies for Children With Autism Spectrum Disorders

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Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Baseline Description Intervention Criteria/Population Measures Outcomes Author: Intervention: Inclusion criteria: Overall ratings: Adaptive Levy et al., Single IV dose of human • Children in the age CARS total score, behavior: 2003 synthetic secretin range of 3-8 years with mean ± SD: CSBS standard Country: (2CU/kg) to a maximum ASD as diagnosed by G1: 34.1 ± 3.13 score, period 1, US dose of 75 CU injected ADI-R G2: 37.32 ± 6.23 mean change ± Practice slowly over 1 minute Exclusion criteria: G1/G2: P = 0.02 SD: setting: Infusions separated by a • Significant hearing or CARS score < 37 G1: 0.14 ± 8.28 Academic 6-week washout period vision loss (mild-moderate), %: G2: -0.27 ± 7.36 Intervention Assessments: • Other neurological G1: 84 CSBS standard setting: GBRS completed by disorders (e.g., cerebral G2: 55 score, period 2, Clinic families and teachers or palsy, phenylketonuria, G1/G2: P = 0.003 mean change Enrollment therapists; daily log of tuberous sclerosis, Adaptive behavior: from BL ± SD: period: gastrointestinal symptoms neurofibromatosis, VABS communica- G1: 2.19 ± 7.73 NR completed by parents; seizure disorder) tion standard score, G2: -0.70 ± 7.90 Funding: CSBS completed by study • Genetic disorder mean ± SD: Ritvo global NIH, MRDDRC examiners at BL and two • Prematurity (< 32 weeks G1: 54.50 ± 14.03 score, period 1, Author industry weeks after each infusion; gestation) G2: 54.44 ± 13.81 mean change ± relationship Ritvo Real-life Rating • Diagnosis of coeliac G1/G2: P = NS SD: disclosures: Scale completed by study disease or other CSBS standard G1: 0.01 ± 1.35 NR examiners at BL and two gastrointestinal disease, score, mean ± SD: G2: -0.18 ± 0.79 Design: weeks after each infusion; associated with G1: 72.75 ± 7.86 Ritvo global RCT (double-blind occurrence of adverse malabsorption G2: 75.03 ± 10.65 score, period 2, cross-over) effects monitored • Previous treatment with G1/G2: P = NS mean change throughout the study secretin Ritvo subscale from BL ± SD: Groups: score, mean ± SD: G1: 0.12 ± 0.66 • Anaemia and plumbism G1: infusion of secretin Sensory motor: G2: -0.27 ± 0.96 Age, months ± SD: followed by placebo six G1: 0.46 ± 0.06 GBRS score, G1: 70.65 ± 18.2 G2: weeks later G2: 0.41 ± 0.06 teacher-rated, 76.53 ± 14.33 G2: infusion of placebo G1/G2: P = NS period 1, mean Age, range: followed by secretin six Social relatedness: change ± SD: 43-103 weeks later G1: 1.03 ± 0.06 G1: 0.34 ± 0.72 Mental age: Co-interventions held G2:1.16 ± 0.06 G2: 0.14 ± 0.71 NR stable during treatment: G1/G2: P = NS GBRS score, Gender, %: NR Affect: teacher-rated, Male: Frequency of contact G1: 0.64 ± 0.10 period 1, mean G1: 87 during study: G2: 0.74 ± 0.10 change ± SD: G2: 74 Families & teachers or G1/G2: P = NS G1: 0.33 ± 1.01 Female: therapists completed Sensory: G2: 0.29 ± 1.06 G1: 13 GBRS weekly G1: 0.61 ± 0.05 GBRS score, G2: 26 Concomitant therapies, G2: 0.68 ± 0.05 parent-rated, Race/ethnicity, %: n: G1/G2: P = NS period 1, mean Caucasian: Prozac: Language: change ± SD: G1: 87 G1: 3* G1: 0.80 ± 0.04 CARS < 37: G2: 94 G2: 1 G2: 0.88 ± 0.05 G1: 0.20 ± 0.76 SES: Adderall: G1/G2: P = NS (n=25) Maternal education: NR G1: 0 G2: 0.30 ± 0.71 Household income: NR G2: 2 (n=14) Diagnostic approach: Risperidone CARS ≥ 37: In Study G1: 1 G1: 0.73 ± 0.60 Diagnostic tool/method: G2: 0 (n=5) ADI-R Guanfacine: G2: 0.14 ± 0.58 G1: 1* G2: 2 (n=16) Levy et al., Methylphenidate: Diagnostic category, n GBRS score, 2003 (continued) G1: 0 (%): parent-rated, G2: 2 Autism: 61 (100) period 2, mean N at enrollment: PDD-NOS: NR change from BL ± C-358
Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Description Intervention Criteria/Population G1: 31 Aspergers: NR G1a: 26 Other characteristics, %: G1b: 5 GI symptoms: G2: 31 G1: 63 G2a: 16 G2b: 15 N at follow-up: G1: 30 G1a: NR G1b: NR G2: 31 G2a: 16 G2b: 15 G2: 50 Comments: *One child in G1 received both prozac and guanfacine. Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Description Intervention Criteria/Population Author: Magiati et Intervention: Inclusion criteria: al., 2003 Picture Exchange • Diagnosis of Autism Communication system • Special schools with a Country: UK Practice setting: Academic (PECS). Assessment full dedicated provision carried out in the 2 month for children with ASD period prior to training • No or minimal prior with rates of change experience of PECS measured during 2 month Exclusion criteria: periods over 6 months • Very well developed following training ( time1 / verbal skills BL, time2, time3, time 4) • Any increase of Behavioral difficulties • See inclusion criteria Intervention setting: School Enrollment period: NR Funding: Agency: Three Guineas Trust, UK Author industry relationship disclosures: NR Assessments: Teachers completed initial measures of children’s communicative ability 2 mos before onset of PECS training; same assessments completed immediately after PECS workshop and at 2 monthly intervals Age, mean/yrs ± SD (range): Both groups: 7.66 ± 2 (5- 12) Mental age: NR Gender: M, n (%): 29 (85.3) F, n (%): 5 (14.7) C-359 Baseline Measures Outcomes SD: CARS < 37: G1: 0.74 ± 0.86 (n=24) G2: 0.19 ± 1.08 (n=13) CARS ≥ 37: G1: 0.00 ± 0.42 (n=5) G2: 0.30 ± 0.70 (n=16) Harms: Adverse events, n: Elevated LFT: 3 Hyperactivity: 2 Emotional lability: 1 Fractures: 2 Stomach ache: 1 Modifiers: CARS by treatment interaction for parent-rated GBRS (P = 0.0001) Baseline Measures Outcomes Vineland scores: Vineland scores: Age equivalent, NR mean/yrs:mos ± SD, PECS, mean ± (range): SD: Level: 4.58 ± 1.26 Communication: 1:6 (P = 0.001) ± 7, (0:8-2:8) Vocabulary: 4.31 Daily living skills: 2:7 ±1.12 ± 7, (1:4-3:9) (P = 0.001) Socialization: 1:6 ± Frequency: 4.71 7, (0:7-2:10) ±1.59 PECS, mean ± SD: (P = 0.001) Level: 0.91 ± 1.26 Number of signs: Vocabulary: 0.85 ± 1.62 ± 1.56 1.18 (P = 0.01) Frequency: 1.65 ± Number of words: 1.89 3.21 ± 2.01 Number of signs: (P = 0.001) 1.18 ± 1.31 Number of Number of words: phrases: 1.53 ± 2.53 ± 2.19 1.98 Number of phrases: (P = 0.02)
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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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Therapies for Children With Autism Spectrum Disorders

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