Therapies for Children With Autism Spectrum Disorders

Pivotal Response Training and other behavioral approaches (Group Intensive Family
Training). 116
Summary of the literature. Of the 34 papers in this section 100-130 comprising 30 unique studies,
11 were fair, and 19 were poor. Outcomes of RCTs and cohort studies rated fair in quality are
summarized in Table 10.
Studies of UCLA/Lovaas-based approaches. The one RCT on the UCLA/Lovaas treatment that
met inclusion criteria had fair quality. 114 This study compared a clinic-based method to a parent
program, and targeted children at about 36 months of age. The study 114 was the first attempted
replication of Lovaas’ manualized intervention to use random assignment, a standardized
assessment battery, and explicit accounting of intervention hours. It included 28 children with a
mean intelligence quotient (IQ) of 51 randomized to either an intensive treatment group
(UCLA/Lovaas model with an average of 25 hours per week of individual treatment per year
with reduced intervention over next 1 to2 years) or a parent-training group (3-9 months of parent
training). Gains in IQ were much more tempered than that of Lovaas’ original noncontrolled
study. 21 Children in the treatment group gained a mean of 15 IQ points in comparison to the
relatively stable cognitive functioning of the control group, although average IQ in the treatment
group remained in the impaired range. Most of the children who demonstrated large gains in IQ
were within the subgroup diagnosed with Pervasive Development Disorder-Not Otherwise
Specified (PDD-NOS), whereas children with classically defined Autistic Disorder demonstrated
modest improvements.
Two children in the experimental group (vs. one in the control) achieved the “best outcome”
or “recovery” status previously defined by Lovaas. No post-treatment group differences were
seen in adaptive behavior or challenging behavior. Thus, while replicating improvements in
cognitive ability for some children with ASDs within the repeated discrete trial teaching inherent
to UCLA/Lovaas method, the study in fact demonstrated a less dramatic impact for the
population of children for whom this approach is often recommended (i.e., children with
classically defined Autistic Disorder) compared with what was previously reported.
Seven prospective cohort studies and nonrandomized trials were available on UCLA/Lovaasbased
methodologies, but none made the same comparisons either in terms of interventions or
populations. Hayward and colleagues 126,132 examined the progress of children receiving either
intensive clinic directed UCLA/Lovaas-based intervention (n=23; mean age=36 months; 37
hours of weekly treatment) or an intensive parent-managed model (n=23; mean age=34 months;
34 hours of weekly treatment) over the course of one year in the United Kingdom. Group
assignment was based solely on geographic location. At follow up, both groups had improved
significantly in IQ (16 point gain), nonverbal IQ (10 points), language use/understanding, and
most areas of adaptive functioning with the exception of daily living skills but there were no
differences between the groups.
Two studies compared intensive center-based treatment to community care. Howard and
colleagues 129 studied preschool-aged children receiving intensive behavior analytic treatment
(n=29, 1:1 treatment for 25-40 hours per week), intensive “eclectic” intervention (n =16, higher
teacher-student ratio intervention for approximately 30 hours per week), and children receiving
general intervention in public early intervention programs (n=16, combined methods, small
groups, 15 hours per week). Groups were assigned via educational placement teams that
specifically included parent input. Controlling for age at diagnosis and combined parental
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