Therapies for Children With Autism Spectrum Disorders

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period: NR Funding: Children’s Hospital Eastern Ontario Research Institute; PA Woodward’s Foundation; Children at Risk Ottawa Author industry relationship disclosures: NR Design: RCT, double blind, placebo controlled; stratified by site and age Dunn-Geier et al., 2000 (continued) list, GI symptoms and side effect questionnaire designed for study completed by parents; CARS administered by observer in clinic Groups: G1: secretin G2: placebo (saline) Co-interventions held stable during treatment: Yes Frequency of contact during study: At baseline; injection (up to 1.5 hours postinjection); and 3 week follow-up Concomitant therapies, n (%): ABA: G1: 15 (33) G2: 24 (51) Speech: G1: 37 (79) G2: 34 (72) Floor time: G1: 5 (12) G2: 4 (10) Magnesium B6: G1: 1 (2) G2: 4 (9) DMG3: G1: 2 (5) G2: 3 (6) School/preschool placement: G1: 41 (91) G2: 42 (91) Medication: G1: 9 (19) G2: 5 (11) N at enrollment: G1: 47 G2: 48 N at follow-up: G1: 47 G2: 48 pediatrician and a registered psychologist experienced in the field of PDD Exclusion criteria: • Patients with recognizable neurological or genetic disorder • Pancreatic or liver disorder • Allergy to lidocaine or prilocaine • Previous use of secretin • Any treatment initiated or changed within the 2 months immediately before enrollment • Any treatment planned to begin within the 3 weeks after injection Age, years ± SD: G1: 5.1 ± 1.2 G2: 5.1 ± 1.4 Mental age: NR Gender, n (%): Male: G1: 42 (89) G2: 46 (96) Female: G1: 5 (11) G2: 2 (4) Race/ethnicity, n (%): White: G1: 34 (72) G2: 41 (85) SES: NR Diagnostic approach: In study Diagnostic tool/method: CARS, DSM-IV Diagnostic category, n (%): Autism: 95 (100) PDD-NOS: 0 Aspergers: 0 Other characteristics: Height, cm ± SD: G1: 108.6 ± 8.4 G2: 111.2 ± 9.9 Weight, kg ± SD: G1: 19.8 ± 3.5 G2: 21.3 ± 6.1 Seizure, n (%): G1: 3 (6) G2: 2 (4) Abnormal CT, n (%): G1: 1 (2) C-410 object use score, mean ± SD: G1: 17.5 ± 9.4 G2: 17.0 ± 8.7 Social skills: Autism Behavior Checklist socialization score, mean ± SD: G1: 14.7 ± 5.9 G2: 15.3 ± 5.4 Autism Behavior Checklist social related-ness score, mean ± SD: G1: 19.1 ± 8.3 G2: 19.1 ± 8.6 Communication/ language: PLS total score, mean ± SD G1: 25.2 ± 11.8 G2: 31.0 ± 15.6 PLS auditory comprehension score, mean ± SD: G1: 12.2 ± 7.5 G2: 16.2 ± 19.2 PLS expressive communication score, mean ± SD: G1: 12.9 ± 4.8 G2: 14.6 ± 7.0 ABC language score, mean ± SD: G1: 13.3 ± 7.6 G2: 13.5 ± 6.7 Medical: Number of GI problems, mean ± SD: G1: 1.0 ± 1.1 G2: 1.2 ± 1.2 Sensory: Autism Behavior Checklist sensory score, mean ± SD: G1: 13.3 ± 7.4 G2: 13.9 ± 6.5 Autism Behvaior Checklist body and object use score, mean change (SE): G1: -2.6 (0.9) G2: -2.7 (0.9) G1/G2: P = 0.89 Social skills: Autism Behavior Checklist socialization score, mean change (SE): G1: -2.5 (0.6) G2: -2.1 (0.8) G1/G2: P = 0.64 Autism Behavior Checklist social relatedness score, mean change (SE): G1: -3.9 (1.0) G2: -4.0 (1.0) G1/G2: P = 0.90 Communication/ language: PLS total score, mean change (SE): G1: 2.4 (0.8) G2: 1.1 (0.6) G1/G2: P = 0.25 PLS auditory comprehension score, mean change (SE): G1: 1.5 (0.6) G2: 0.6 (0.4) G1/G2: P = 0.2 PLS expressive communication score, mean change (SE): G1: 0.6 (0.4) G2: 0.6 (0.4) G1/G2: P = 0.93 Improvement on PLS- 3 scale ≥ 4 (small), n (%): G1: 16 (34) G2: 10 (21) G1/G2: P = 0.17 Improvement on PLS- 3 scale ≥ 6 (moderate/large), n (%) G1: 8 (17) G2: 4 (8) G1/G2: P = 0.23 Autism Behavior
Dunn-Geier et al., 2000 (continued) Author: Harris et al., 2000 Country: US Practice setting: Academic Intervention setting: Classroom Enrollment period: 1990 to 1992 Funding: NR Author industry relationship Intervention: Intensive applied behavioral analysis treatment program, 35- 45 hours weekly, 5 days a week for 12-months. Each family was expected to provide an additional 10 to 15 hours a week of home-based instruction. Questionnaire sent to parents about current educational placement. Assessments: IQ & CARS included in follow-up questionnaire 7 years after entry into preschool classroom of G2: 1 (2) Cognitive measure, mean ± SD: G1: 38.1 ± 19.4 G2: 39.8 ± 16.2 Inclusion criteria: • Met DSM-III-R criteria for autism by outside source and confirmed by clinical psychologist at intake • Entered Douglass Developmental Disabilities Center between 1990-1992 • Every child with data on pre, post IQ data, CARS at baseline and age at admission Exclusion criteria: • See Inclusion criteria Age at admission, mean/mos (range): C-411 Overall measures: CARS, mean (range): G1: 34.17 (range 30-40) Educational/ cognitive/ academic attainment: Stanford Binet (IQ), mean (range): G1: 59 (range 35- 109) Checklist language score, mean change (SE): G1: -0.9 (0.6) G2: -1.8 (1.0) G1/G2: P = 0.46 Medical: Number of GI problems, mean change (SE): G1: -0.4 (0.2) G2: -0.2 (0.1) G1/G2: P = 0.35 Sensory: Autism Behavior Checklist sensory score, mean change (SE): G1: -2.4 (0.8) G2: -2.7 (0.9) G1/G2: P = 0.77 Harms: Tachycardia: 0 Edema/swelling: 0 Headache: 0 Dizziness/lightheadedness: 0 Nausea/vomiting: 0 Skin rash/pruritis: 0 Abdominal pain: 0 Flushing G1: 3 G2: 4 Modifiers: Mean difference between groups for PLS-3 total score is still not significant when analysis is limited to patients with at least one GI problem. Educational/ cognitive/ academic attainment: IQ, mean: 77.59 Harms: NR Modifiers: Significant association between age at admission and academic placement r(25) = 0.658, P < 0.005 (younger students more likely to be in
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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 547 and 548: Evidence Table. Therapies for child
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Page 607 and 608: Appendix D. List of Excluded Studie
Page 609 and 610: 31. Aarsland D, Cummings JL and Lar
Page 611 and 612: 59. Ahearn WH, Clark KM, Gardenier
Page 613 and 614: 89. Allison DB, Basile VC and MacDo
Page 615 and 616: 118. Ando H, Yoshimura I and Wakaba
Page 617 and 618: 146. Atkinson RP, Jenson WR, Rovner
Page 619 and 620: 177. Bakare MO, Agomoh AO, Ebigbo P
Page 621 and 622: 204. Baron-Cohen S, Scott FJ, Allis
Page 623 and 624: 233. Bebko JM, Perry A and Bryson S
Page 625 and 626: 262. Bergmann F, Stepp H, Metzger R
Page 627 and 628: 291. Birkan B, McClannahan LE and K
Page 629 and 630: 319. Boddy F, Rowan EN, Lett D, et
Page 631 and 632: 348. Bouma R and Schweitzer R. The
Page 633 and 634: 376. Broadstock M, Doughty C and Eg
Page 635 and 636: 404. Brudnak MA. Application of gen
Page 637 and 638: 432. Buitelaar JK. Why have drug tr
Page 639 and 640: 460. Butler DE, Nordin IC, L’Ital
Page 641 and 642: 489. Campbell M, Locascio JJ, Choro
Page 643 and 644: 517. Caronna EB, Augustyn M and Zuc
Page 645 and 646: 546. Case-Smith J and Miller H. Occ
Page 647 and 648: 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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