Therapies for Children With Autism Spectrum Disorders

hyperactivity, inattention, challenging behaviors, and depression ratings. However changes on
each scale fell short of statistical significance in comparison with the control group. A second
parent-focused RCT addressed the Stepping Stones Triple P Parenting Program, 153,154 which
focuses on managing children’s behavior by considering the function of the behavior and uses
procedures such as descriptive praise, planned ignoring, skill acquisition, and communication.
Parents of the children in the treatment group reported statistically significant decreases in
child challenging behavior on the Eyberg Child Behavior Inventory Intensity and Problem
Scales. Wait-list controls eventually received the same treatment, and parents of children in this
group also reported statistically significant decreases in child challenging behavior on both
Eyberg Child Behavior Inventory scales. At six-month follow up, the treatment group maintained
gains on both the Eyberg scales.
The additional studies in this section included three RCTs that compared the effects of
imitation and contingent responsiveness. 163-165 Contingently responsive behavior refers to the
adult responding to the child’s initiations by either commenting back or gesturing within the play
context. In the first phase, the child entered the room with an adult present holding a neutral
facial expression. During Phase 2, the adult interacted with the child by using either imitation or
contingently responsive behavior in response to the child’s behavior. The third phase mimicked
Phase 1, and the fourth and final phase included a spontaneous play interaction. Each of these
four phases was three minutes in duration.
Each of the three RCTs included 20 children randomly assigned to either the imitation group
or the contingently responsive group, 163-165 Significantly greater effects were seen in the
imitation group compared with the contingent responsiveness groups in all three studies.
Improvements included spending more time engaged with both objects and adults, 163 a greater
reduction in motor activity, 165 and more social interest. 164
Two RCTs, 155-157 one of which was fair quality, 155,156 and two case series 158,167 focused on the
potential for interventions based on joint attention or symbolic play. Generally speaking,
interventions with a joint attention focus did result in improvements in tasks based on joint
attention. In the first RCT, 157 all groups improved in coordinated joint looks over time. No
differences were found in pointing to a toy or giving a toy to an adult to share in any group. Both
Joint Attention and Symbolic Play groups improved in the following areas compared with
controls: showing toys to an adult, shared looks between a toy and the child’s mother, and
symbolic play skills.
Compared with other groups, the Joint Attention group showed more improvement in
responding to joint attention over time. With respect to mother-child interactions (generalization)
assessing the same outcome areas, the Joint Attention group had significantly greater
improvement than the Symbolic Play group in giving and showing a toy. Children in the Joint
Attention group engaged in more child-initiated joint engagement than those in the control
group. The Symbolic Play group showed significantly greater improvement on the Structured
Play Assessment than did the control group for overall mastered level of play. In the second
RCT, 157 significantly more children in the Joint Attention group engaged in coordinated looks
during the final stimulus presentation (76.5 percent) than in the Symbolic Play group
(38.9 percent). Children in the Joint Attention group engaged in significantly longer periods of
coordinated looks between the person in the room and the stimulus presentations across the three
time periods.
A second RCT155,156 comparing joint attention and symbolic play interventions included
58 children with autism between 3 and 4 years of age. Investigators assessed language
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