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: Bibby et al., 2002 Parent-managed Country: behavioral intervention UK patterned after UCLA Practice workshop model setting: Groups: Academic G1: intervention Intervention G1a: children with an setting: early (before or within 3 Home Enrollment period: September 1998 to May 2000 Funding: Autism and Developmental Disorders Education Research Ltd. Author industry relationship disclosures: NR Design: Prospective case series months of intervention start) IQ score G1b: children with an early (before or within 3 months of intervention start) VABS G1c: children at a minimum age of 72 months after at least 24 months behavioral intervention Assessments: Conducted by seven psychology graduates with ≥ 12 months postgraduate experience working with children with autism with same age range as groups IQ scores (assessed by primary assessors, research assistants, third author and psychologist), Bayley Scales of Infant Development (2 nd ed.), WPPSI-R, WISC-III, Reynell Developmental Language Scales (3 rd Inclusion criteria: Overall ratings: Overall ratings: • Children with autism Sum pathology Sum pathology whose parents who score, early, mean score, 12 months, sought legal advice from points: mean points: the first author G1: 4.9 G1: 2.2 concerning public Social skills: G1/BL: P < 0.01 funding for behavioral VABS socialization Social skills: interventions score, mean: VABS socializa- Exclusion criteria: G1: 62.8 tion score, 12 • Unable to arrange for VABS socialization, months, mean: assessment developmental age, G1: 65.9 • Additional diagnosis of months: G1/BL: P = NS cerebral palsy G1: 26.3 VABS socializa- • Rett’s disorder Communication/ tion, 12 months, Age, mean months ± SD: language: developmental Study entry: VABS communica- age, months: G1a: 43.4 ± 12.6 tion score, mean: G1: 36.2 Follow-up: G1: 66.9 G1/BL: P < 0.01 G1c: 85.5 ± 11.7 VABS communica- Communication/ Mental age, months: tion, developmental language: G1a: 21.3 (n=17) age, months: VABS communi- Gender, n: G1: 35.2 cation score, 12 Male: 55 Reynell develop- months, mean: Female: 11 mental language G1: 70.3 Race/ethnicity: scale, months: G1c: 66.3 NR Comprehension: G1/BL: P < 0.05 SES: G1: 31.9 VABS communi- Maternal education: NR Expressive: cation, 12 months, Household income: NR G1: 31.2 developmental Diagnostic approach: Adaptive behavior: age, months: Referral VABS composite G1: 47.5 Diagnostic tool/method: score, early, mean: G1c: 63.0 NR G1b: 54.5 G1/BL: P < 0.01 Diagnostic category, n VABS composite Reynell develop- (%): score, mean: mental language Autism: 58 G1: 58.8 scale, 12 months, EK PDD-NOS: 2 VABS composite, months: ed.), VABS (survey form Aspergers: 0 developmental age, Comprehension: from Interview Edition months: G1: 37.5 (assessed by trained Other characteristics: rater), ADI-R (assessed Age at beginning of by research assistants) treatment, months ± SD: Provider: 45.0 ± 11.2 Parent-managed Duration of behavioral approach with care treatment at time of study provided by consultants, entry, n (%): family members, and < 12 months: 11 (18) volunteers (19-20% UCLA 12-24 months: 31 (52) Level II, 29-35% PhD or > 24 months: 18 (30) registered clinical psy- G1: 31.8 G1/BL: P < 0.01 VABS daily living Expressive: score, mean: G1: 35.7 G1: 59.0 G1/BL: P < 0.01 VABS daily living, Adaptive developmental age, behavior: months: VABS composite G1:33.7 scores, 12 months, mean: G1: 61.0 G1b: 63.4 chologist level without G1c: 55.2 meeting UCLA criteria, 47-51% MA or BA level paraprofessionals) G1/BL: P = NS Bibby et al., 2002 Measure of treatment Secondary diagnoses of VABS maladaptive VABS composite, (continued) fidelity reported: additional neurological behavior score, 12 months, No disorders or epilepsy, n: 0 mean: developmental C-366
Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Baseline Description Intervention Criteria/Population Measures Outcomes Co-interventions held G1: 16.3 age, months: stable during treatment: Hours of one-to-one Educational/ G1: 41.4 No treatment received at cognitive/ G1/BL: P < 0.01 Concomitant therapies, follow-up, mean ± SD: academic VABS daily living %: G1c: 4743 ± 1508 attainment: score, 12 months, At least one other inter- IQ, early, mean: mean: vention chosen by parents Weekly hours of one-to- G1a: 50.8 G1: 56.9 (e.g., diets, vitamins, one treatment received at IQ, mean: G1c: 50.4 minerals, secretin, follow-up, mean ± SD: G1: 57.6 G1/BL: P = NS homeopathic G1c: 23.7 ± 10.4 Mental age, months: VABS daily living, preparations, sensory G1: 34.0 12 months, treatments): 81 Duration of treatment at Merrill-Palmer developmental N at enrollment: follow-up, months ± SD: mental age, mean age, months: G1: 75 G1c: 36.8 ± 10.3 months: G1: 41.3 G1a: 22* G1: 48.8 G1/BL: P < 0.01 G1b: 21* Weekly hours of school VABS N at follow-up: attendance at follow-up, maladaptive G1: 60 mean ± SD: behavior score, G1c: 42* G1c: 15.9 ± 11.0 12 months, mean: G1: 15.2 School placement at G1/BL: P = NS follow-up, n:** Educational/ Attending special cognitive/ education setting with one- academic on-one assistance: 9 attainment: Attending special IQ, 12 months, education setting with no mean: one-on-one assistance: 4 G1: 58.5 (n=58) Mainstream for at least part G1a: 55.0 of school week with full- G1/BL: P = NS time individual adult IQ > 85, 12 support: months, n: G1c: 23 G1: 10/66 Mainstream for at least part IQ, 12 months, of school week with part- mean ± SD (95% time individual adult CI) support: G1c: 53.1 ± 20.0 G1c: 2 (46.8-59.4) Mainstream for at least part Merrill-Palmer of school week with no mental age, 12 individual adult support months, mean (educationally normal months: functioning): G1: 55.6 G1c: 0 G1c: 58.3 G1/BL: P < 0.01 Mental age, 12 months, months: G1: 39.4 (n=51) G1/BL: P < 0.01 Bibby et al., 2002 Harms: (continued) NR Modifiers: There was a significant correlation between early IQ and IQ at study C-367
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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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Page 503 and 504: Evidence Table. Therapies for child
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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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