Therapies for Children With Autism Spectrum Disorders

education, children in the intensive behavior analytic group demonstrated significant
improvements in all areas assessed at followup, including an average IQ of 89 (41-point
improvement over baseline) and a 24-point difference from the combined mean of the other
intervention groups.
Significant differences between the eclectic and generic intervention groups were not present
at followup. Findings do suggest substantial improvement via an intensive approach for young
children with autism; however, important differences in group assignment at baseline, difficulties
with systematic measurement overtime, the lack of reported treatment fidelity or adherence
characteristics, and the small number of children in the comparison group limits the
interpretation of these findings.
These results were echoed in another study 105 of 42 children in which those receiving the
Lovaas program had significantly higher IQs (mean=87, gain of 25; mean=73, 14 points) and
adaptive behavior skills at outcome, compared with children in undefined community care.
Receptive language improvements were observed but were not significant, and expressive
language skills and socialization scores on the Vineland Adaptive Behavior Scale (VABS) were
not different for the two groups at year 3 outcome. Twelve of the 21 children in the behavioral
group had IQs >85 compared with 7 of 21 in the eclectic treatment group at outcome. Likewise,
more children in the Lovaas group were in typical schools subsequent to intervention (17 vs. 1);
although this specific outcome is potentially attributable to a wide variety of factors including
some that might correlate with differences in socioeconomic status and family constellation
evident between the groups.
One study 125 of two centers compared an eclectic approach (including the Developmental,
Individual-Difference, Relationship-Based/Floortime model, Treatment and Education of
Autistic and Communication related handicapped CHildren (TEACCH) and ABA-based
approaches) to UCLA/Lovaas-based intervention alone. Hours spent in the intervention were
consistent at 8 hours per day, and children were assessed over one year. Significant group
differences were noted in terms of both language/communication and reciprocal social
interaction domain scores on the Autism Diagnostic Observation Schedule (ADOS), with both
groups showing decreases in symptom tallies but more substantial decreases in the ABA group.
No significant differences in IQ change were reported. While demonstrating impact on certain
ADOS symptom scores, these changes were small, and more recent approaches suggest that
calculating an ASD severity score may be a more valuable and sensitive way for measuring
changes in ASD symptoms in response to intervention. 134 In a subsequent study on diagnostic
stability 124 with unclear sample overlap, most children receiving intervention continued to
display scores in the ASDs range on the ADOS (n=53) although some children’s classification
did shift.
Finally, one study tried to assess the role of intensity of the intervention on outcomes. Reed
and colleagues 103 studied the effectiveness of varying intensity of home-based Lovaas-based
programs offering primarily one-to-one teaching. High intensity interventions (n=14) were
defined as those provided for an average of 30 hours per week. Low intensity interventions
(n=13) were provided for on average 13 hours per week. Assignment to the particular
intervention modality was based on geographic location, and children in the high intensity group
had higher ability and cognitive scores and lower autism severity scores at baseline. Children
were assessed 9-10 months after initiation of intervention. Children receiving high intensity
intervention demonstrated statistically significant improvements in intellectual and educational
functioning from baseline. Children receiving low intensity intervention demonstrated
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