Therapies for Children With Autism Spectrum Disorders

abilities. This finding is further confounded by a significantly higher IQ present in the treatment
group at initiation of the study.
Aldred et al. 108 compared a parent-based intervention focused on advancing social
communication skills within interactions (n = 14, median age 51 months) to treatment as usual
(n=14, median age 48 months). Parents participated in initial workshops, monthly intervention
sessions where videotaped interactions were reviewed, and 6 months of maintenance visits
(approximately once every 2 months). Twelve months after baseline, blinded evaluations showed
improvements on ADOS scores, with substantial improvement within the social domain,
increased expressive vocabulary, as well as improved communication-related behaviors coded
during interactions. Language gains were most prominent in younger, lower-functioning
children. A lack of standardized measures of developmental performance, including baseline
cognitive skills, as well as challenges in understanding and defining “treatment as usual” limit
interpretation of the findings.
In a report of a later intervention of this model, 152 children between the ages of 2 and 4
years were randomized to treatment as usual or treatment as usual plus parent training in social
communication. 100 Time in “treatment as usual” interventions was similar across groups as were
the types of interventions employed. Similar numbers of children in both groups experienced
diagnostic shifts from core autism to other diagnoses on the ASDs spectrum as diagnosed on the
ADOS-G. Teacher ratings of language and communication after intervention were not
significantly different between groups, though ratings of parent-child interactions by independent
assessors were positive for children in the social communication group. Parent ratings of
language and social communication were also more positive for the social communication group.
Stahmer and Gist 120 examined the effects of an explicit parent education support group with a
parent education program focusing on Pivotal Response Training, a treatment program designed
to enhance core skill areas in autism using naturalistic interactions. Parents met with the
intervention provider weekly for 12 weeks and were taught techniques for presenting clear
instructions, following and supplementing child choice, and providing direct/naturalistic
reinforcement. Involvement in the 12-week intervention was successful in changing parenting
techniques and perceived language gain. However, the lack of randomization, wide variation in
children served, the lack of objectively assessed changes in child behavior, and the small number
of participating limit the reported results.
Table 10. Outcomes of early intensive behavioral and developmental interventions
Author, year, country Age, mean (months) ±SD
Key outcomes
Groups, N enrollment/N
final
Study quality
IQ, mean ± SD
UCLA/Lovaas-based approaches
Hayward et al. 126,132
G1: 35.7 ± 6.2
• No significant group differences at followup.
2009, UK
G2: 34.4 ± 5.7
• Improvements in both groups in IQ, non-verbal IQ,
language use/understanding, and most areas of
G1: Intensive clinic-based NR
adaptive functioning, with the exception of daily
UCLA/Lovaas-based
intervention, 23/20
G2: Intensive parentmanaged
treatment, 21/19
living skills.
Quality: Fair
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