Therapies for Children With Autism Spectrum Disorders

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Table 13. Studies assessing interventions targeting conditions commonly associated with ASDs (continued) Author, year, country Groups, N enrollment / N final Study quality Wood et al. 170,171 2009, US G1: Building confidence CBT program, 17/17 G2: Wait list control, 23/23 Quality: Fair Sofronoff et al. 168 2007, Australia G1: CBT, 24/24 G2: Wait list control, 21/21 Note: for children with Asperger disorder and anger management difficulties Quality: Fair Sofronoff et al. 169 2005, Australia G1: Child only CBT, 23/22 G2: Wait list, 23/20 G3: Child and Parent CBT, 25/24 Note: Children with Asperger disorder and anxiety symptoms Quality: Fair Aman et al. 177 2009, US G1: Risperidone, 49/40 G2: Risperidone + parent training, 75/55 Quality: Fair Age, mean/yrs ± SD IQ, mean ± SD G1: 9.18 ±1.42 G2: 9.22 ±1.57 NR G1: 10.79 ± 1.12 G2: 10.77 ± 0.87 G1: 105.24 ± 22.3 G2: 108.7 ± 21.6 G1: 10.56 ± 0.99 G2: 10.75 ± 1.04 G3: 10.54 ± 1.26 G1: 107.5 ± 27.3 G2: 101 ± 27.2 G3: 105.6 ± 21.2 G1: 7.5 ± 2.80 G2: 7.38 ± 2.21 NR 48 Key outcomes • 92.9% of children in the intervention condition met criteria for positive treatment response. • 64.3% of children in G1 no longer met criteria for any anxiety disorder on the ADIS. • MASC scores were significantly lower (i.e., reduction in anxiety) in G1 than in G2 post-test (p
SCAS-P=Spence Child Anxiety Scale-Parent version; SRS=Social Responsiveness Scale; SD=standard deviation; SWQ=Social Worries Questionnaire A series of papers examined CBT approaches delivered directly to children and via parent training. CBT provided by graduate students in psychology was assessed in high functioning children with Asperger disorder with comparisons made across two intervention conditions (child-only and parent-plus-child) and waitlist controls. 169,176 Significant improvements in Spence Child Anxiety Scale-Parent scores were observed for both intervention groups on the total score and separation anxiety, obsessive compulsive disorder, social phobia, panic, and generalized anxiety scales; significant improvement on the personal injury scale was observed for the parent-plus-child intervention group. No significant differences were observed from baseline to six-week followup in the waitlist control group. On the Social Worries Questionnaire, there were significant improvement in scores between baseline and six-week followup observed for both intervention groups, but not for the waitlist control group. Similarly, children in both intervention groups generated more strategies to cope with anxiety at six-week followup than at baseline, while children in the waitlist control group did not. Both intervention groups scored better than the wait-list control group at followup, and children in the parent-plus-child condition scored better than children from the child-only groups at followup. A separate study of the same intervention 168 to examine the impact of CBT-based treatment on anger management difficulties in high-functioning (i.e., average IQ above 100) children ages ten to fourteen years with Asperger syndrome found similarly positive results. Parent training in using CBT approaches 174,175 for parents of children ages six to twelve years with Asperger syndrome diagnoses includes psychoeducation, comic strip conversations and social stories introduction, and management techniques for externalizing behaviors, rigid behaviors, and anxiety. In studies of this approach, parents who attended a one-day workshop or who participated in six weekly one-hour individual sessions reported fewer challenging behaviors at both one-month post-treatment and three-month followup relative to baseline, while there were no significant differences over time for the waiting list control group. Parents from both intervention groups also reported significantly fewer challenging behaviors in their children, decreased challenging behavior intensity and improved social skills at both time points. At three-month followup, individual session participants reported significantly lower intensity of challenging behaviors relative to both the waiting list control group and workshop intervention group; the workshop group no longer showed differences from the control group by three-month followup in terms of parental report of child challenging behavior intensity. The Research Units on Pediatric Psychopharmacology (RUPP) Autism Network first reported on the feasibility of a parent-training program for parents of children with autism spectrum disorders ages 4 to 13 years who were on stable medications for behavior problems. 172 The parent training protocol consisted of 11 required sessions covering topics including prevention strategies, schedules, reinforcement, planned ignoring, compliance training, functional communication training, teaching techniques, and generalization. Two home visits were always conducted, four optional sessions were available, and booster sessions were provided to parents in later weeks; parent training was administered according to a structured curriculum. Outcome measures related to child functioning included the Home Situations Questionnaire , the Aberrant Behavior Checklist (ABC), the Clinical Global Impressions – Improvement Scale (CGI-I), the VABS, and the Assessment of Basic Language and Learning Skills. Results indicated significant decrease in noncompliance on the Home Situations Questionnaire over the 49
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Comparative Effectiveness Review Nu
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This report is based on research co
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Acknowledgments We are indebted to
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Therapies for Children With Autism
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Dietary and Other Medical Intervent
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Figures Figure A. Analytic framewor
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Table A. Description of interventio
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Analytic Framework Figure A. Analyt
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Strength of evidence. The degree of
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epetitive behavior showed improveme
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subgroups of children, although the
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We encourage investigators to provi
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9. Remington B, Hastings RP, Kovsho
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46. Green J, Charman T, McConachie
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82. Reaven JA, Blakeley-Smith A, Ni
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Page 35 and 36: Introduction Need for Evidence for
Page 37 and 38: Interventions intended primarily to
Page 39 and 40: Table 1. Description of behavioral
Page 41 and 42: Serotonin reuptake inhibitors. Sero
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Page 47 and 48: Key Questions and Analytic Framewor
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Page 51 and 52: Methods This chapter documents proc
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Page 55 and 56: Additional behavioral interventions
Page 57 and 58: 1. Did the study employ a group des
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Page 85 and 86: Summary of the literature. Jarusiew
Page 87 and 88: Table 14. Overview of educational s
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Page 101 and 102: Serotonin Reuptake Inhibitors SRIs
Page 103 and 104: One prospective case series of esci
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Page 109 and 110: Summary of the literature-other int
Page 111 and 112: withdrew after the first six weeks;
Page 113 and 114: therefore described separately belo
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and are based on consideration of f
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Few studies directly comparing the
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Strength of evidence. The strength
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While individual studies of CBT and
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Table 32. Summary of results of edu
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Table 33. Summary of results of med
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strength of this reviewed literatur
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Table 36. Intervention, strength of
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Table 37. Interventions/outcomes wi
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gains. 104 Other studies have seen
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percent of behavioral studies repor
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limited followup, lack of comparati
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individual intervention is warrante
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selecting participants for their st
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studies lacked an arm that consider
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23. Kanner L. Autistic Disturbances
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62. Dosman CF, Drmic IE, Brian JA,
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104. Ben-Itzchak E and Zachor DA. T
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142. Tyminski RF and Moore PJ. The
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177. Aman MG, McDougle CJ, Scahill
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214. Correia CT, Almeida JP, Santos
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252. Akhondzadeh S, Tajdar H, Moham
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290. Dawson G, Rogers S, Munson J,
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Acronyms/Abbreviations ABA Applied
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Appendix A. Exact Search Strings an
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Table A2. PsycINFO search strategie
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Therapies for Children with Autism
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Therapies for Children with ASD Sys
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Appendix C. Evidence Tables Tables
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Evidence Table. Therapies for child
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Country: US Practice setting: Clini
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Dunn-Geier et al., 2000 (continued)
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Evidence Table: Therapies for Child
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Appendix D. List of Excluded Studie
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31. Aarsland D, Cummings JL and Lar
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59. Ahearn WH, Clark KM, Gardenier
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89. Allison DB, Basile VC and MacDo
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118. Ando H, Yoshimura I and Wakaba
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146. Atkinson RP, Jenson WR, Rovner
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177. Bakare MO, Agomoh AO, Ebigbo P
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204. Baron-Cohen S, Scott FJ, Allis
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233. Bebko JM, Perry A and Bryson S
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262. Bergmann F, Stepp H, Metzger R
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291. Birkan B, McClannahan LE and K
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319. Boddy F, Rowan EN, Lett D, et
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348. Bouma R and Schweitzer R. The
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376. Broadstock M, Doughty C and Eg
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404. Brudnak MA. Application of gen
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432. Buitelaar JK. Why have drug tr
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460. Butler DE, Nordin IC, L’Ital
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489. Campbell M, Locascio JJ, Choro
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517. Caronna EB, Augustyn M and Zuc
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546. Case-Smith J and Miller H. Occ
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574. Charlop MH, Burgio LD, Iwata B
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602. Cheng CW, Cho SH, Taylor M, et
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631. Cicero FR and Pfadt A. Investi
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662. Collier D and Reid G. A compar
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691. Coskun M, Karakoc S, Kircelli
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718. Cullen LA, Barlow JH and Cushw
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748. Davidovitch M, Holtzman G and
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777. DeLeon IG, Fisher WW and Marhe
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805. Devlin SD, Harber MM. Collabor
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834. Doherty K, Fitzgerald M and Ma
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863. Dudley LL, Johnson C and Barne
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893. Dybvik AC. Autism and the Incl
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924. Elder JH. In-home communicatio
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953. Erickson CA, Posey DJ, Stigler
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979. Faja S, Aylward E, Bernier R,
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1008. Ferri R, Elia M, Agarwal N, e
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1037. Fisher W, Kerbeshian J and Bu
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1066. Fragala-Pinkham M, Haley SM a
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1095. Furneaux B. Keeping the balan
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1124. Garcaa-Villamisar D, Wehman P
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1152. Ghezzi PM. Discrete Trials Te
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1180. Goin-Kochel RP, Myers BJ and
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1210. Gordon R, Handleman JS and Ha
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1239. Grimaldi BL. The central role
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1268. Guptill JT, Booker AB, Gibbs
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1296. Hamdan-Allen G. Brief report:
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1324. Hare DJ, Jones JPR and Paine
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1356. Harrison S and Berry L. Valui
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1386. Heilbrun AB, Jr., Blum N and
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1414. Hetzroni OE and Shalem U. Fro
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1443. Holburn CS. Counter the mistr
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1473. Horner RH, Carr EG, Strain PS
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1504. Hughes C, Soares-Boucaud I, H
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1533. Ijichi S and Ijichi N. Beyond
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1562. James SJ, Cutler P, Melnyk S,
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1591. Johnson CR, Butter EM, Handen
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1619. Joyce PR. The medical model-w
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1647. Karmali I, Greer RD, Nuzzolo-
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1673. Kelly AB, Garnett MS, Attwood
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1702. Kielinen M, Linna SL and Moil
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1731. Klin A, Lin DJ, Gorrindo P, e
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1761. Koegel RL and Frea WD. Treatm
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1790. Kolmen BK, Feldman HM, Handen
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1819. Kratochvil CJ, Findling RL, M
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1846. Lam MK and Rao N. Developing
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1874. Lattimore LP, Parsons MB and
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1903. Lee PC. Verification of a sim
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1932. Lerman DC, Vorndran C, Addiso
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1960. Licciardello CC, Harchik AE a
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1989. Liptak GS, Orlando M, Yinglin
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2015. Lorimer PA, Simpson RL, Myles
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2043. Luiselli JK, Kane A, Treml T,
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2071. MacFarlane JR and Kanaya T. W
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2099. Malone RP, Maislin G, Choudhu
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2127. Marin FZ. CAM versus nucleopl
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2157. Martineau J, Roux S, Adrien J
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2185. Matson JL and Lo Vullo SV. A
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2213. McCabe H. The Importance of P
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2240. McDougle CJ, Holmes JP, Carls
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2267. McHale SM, Olley JG, Marcus L
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2296. Merlo LJ, Lehmkuhl HD, Geffke
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2325. Minderaa RB, Anderson GM, Vol
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2354. Montgomery JM, Duncan CR and
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2385. Morrison RS, Sainato DM, Benc
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2413. Munesue T, Ono Y, Mutoh K, et
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2445. Napolitano DA, Tessing JL, Mc
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2474. Niederhofer H and Pittschiele
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2501. Nwora AJ and Gee BM. A case s
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2530. Olive ML, Lang RB and Davis T
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2559. Owens JA, Rosen CL and Mindel
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2589. Pansegrouw I and Alant E. Com
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2618. Paul C, Williams KE, Riegel K
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2646. Perry R, Nobler MS and Campbe
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2675. Piazza CC, Hagopian LP, Hughe
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2704. Poon L, Partika N and Bolman
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2734. Prizant BM. Speech-language p
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2764. Rapp JT, Vollmer TR, St. Pete
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2792. Reed P, Broomfield L, McHugh
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2819. Remington G, Sloman L, Konsta
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2849. Ringdahl JE, Kitsukawa K, And
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2877. Rogers SJ. Interventions that
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2908. Rossignol DA. Novel and emerg
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2939. Rutter M, Kreppner J, Croft C
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2967. Sandt D. Social Stories for S
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2994. Scanlon K. Art therapy with a
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3023. Schneider CK, Melmed RD, Bars
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3054. Schwartz IS, Sandall SR, Garf
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3085. Shafer MS, Egel AL and Neef N
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3115. Shipley-Benamou R, Lutzker JR
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3143. Siller M and Sigman M. The be
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3173. Smith C, Felce D, Jones E, et
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3202. Snyder A, Bossomaier T and Mi
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3230. Spero MH. The emancipation of
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3259. Stephens CE. Spontaneous imit
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3289. Strambi M, Longini M, Hayek J
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3318. Suzumura K. How an autistic b
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3346. Tager-Flusberg H and Calkins
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3376. Taylor I, O’Reilly M and La
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3407. Thunberg G, Ahlsen E and Sand
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3435. Trembath D, Balandin S, Toghe
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3464. Turner-Brown LM, Perry TD, Di
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3492. Van Der Putt R, Dineen C, Jan
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3522. Vitiello B. Recent NIMH clini
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3553. Walenski M, Mostofsky SH, Gid
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3581. Weber RC and Thorpe J. Teachi
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3610. Wheeler JJ, Baggett BA, Fox J
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3637. Williams B. Mental handicap n
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3669. Wimpory D, Chadwick P and Nas
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3698. Worth S and Reynolds S. The A
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3728. Young JM, Krantz PJ, McClanna
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3759. Zuddas A, Di Martino A, Mugli
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Appendix F. Approach to Categorizin
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APPENDIX G. Discussion of Recent Sy
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one a casein free regime. Diets wer
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outcome data as Type 6, defined as
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Yes—no disclosures to make G7 Bai
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Table G1. Characteristics of recent
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Random assignment Appropriate compa
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Study Group design Random assignmen
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APPENDIX I. Applicability Summary T
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Social skills (continued) Domain De
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