Therapies for Children With Autism Spectrum Disorders

statistically significant changes in educational functioning and nonsignificant improvement in
cognitive functioning. The only significant difference between the groups was in improved
educational functioning associated with high intensity interventions. No group differences were
found in autism severity, cognitive functioning, or adaptive behavior functioning.
Three additional cohort studies 101,106,130 of UCLA/Lovaas-based methodologies provided
inconsistent data on the benefit of behavioral approaches, but all three had substantial risk of bias
and were thereby rated as poor quality in this report. Nonetheless, they suggest that behavioral
approaches may have promise for bolstering aspects of cognitive, language and adaptive
functioning in preschool children with ASDs.
Case series of early intervention approaches 104,113,118,119,131 had mixed results, likely in part
due to the substantial heterogeneity of interventions examined even within individual studies,
little or no control of concomitant interventions, and poor fidelity to any given approach.
Outcomes in these studies were more likely to be parent-reported and not based on validated
tools.
Several chart reviews and other retrospective analyses have been used to understand
treatment patterns and effects. 111,112,115,121-123 Interpretation of findings is most appropriately
confined to noting that some children receiving intervention have displayed improvements
during intervention in cognitive, adaptive, and autism-specific impairments, that characteristics
of starting treatment and baseline abilities are correlated with improvement in some instances,
and heterogeneity in terms of improvement is quite common. We do not describe these studies
here, but details on all of them are available in the evidence table in Appendix C.
One chart review, 122 however, does provide some evidence for the feasibility of providing
intensive behavioral interventions on a larger scale as it reviews data on 322 children served in a
large service catchment area. Given the methodological limits including lack of a clearly defined
intervention characteristics/protocol, lack of a comparison group, retrospective collection, and
lack of key measures for certain children at certain times, the intervention results are limited.
However, the study suggests the feasibility of providing intensive intervention to a large group of
children.
Studies of intensive parent training approaches. Of the seven studies 100,108,109,116,117,120,128 on
parent training, four 100,108,109,120 included comparison groups and had fair 100,108,109 or poor 120
quality. Three were RCTs, 100,108,109 including one pilot study 108 with a report of a later
implementation of the intervention including different participants. 100 Drew et al. 109 compared
the effects of a home-based, parent-delivered intervention aimed at improving social
communication and managing challenging behavior for 12 children with ASDs with a
community-based control intervention group of 12 children (mean age 23 months at start of
treatment).
Components of the interventions for social communication included developing joint
attention, teaching routines, and play activities promoting interaction. Reinforcement techniques,
including for alternative behaviors, were used to address challenging behaviors. Training was
conducted at home visits (3 hours weekly for 6 weeks), with parents asked to engage in
intervention activities for a half to1 hour daily. One year after treatment initiation, the parent
training group reported that their children used more words than the community group. There
were no group differences on nonverbal intelligence quotient (NVIQ), autism symptom severity,
or words/gestures observed during followup assessment. Unexpectedly, the treatment group lost
IQ points during the study; whereas the control group demonstrated relatively stable cognitive
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