Therapies for Children With Autism Spectrum Disorders

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Table 17. Outcomes of RCTs of antipsychotic medications for challenging and repetitive behaviors (continued) Author, year, country Groups, N enrollment / N final Study quality RUPP 201,202,204-209 2002, US G1:risperidone, 49/49 G2:placebo, 52/52 Quality: Good Marcus et al. 215 2009, US G1: aripiprazole 5 mg, 53/44 G2:aripiprazole 10 mg, 59/49 G3:aripiprazole 15, 54/47 G4:placebo, 52/38 Quality: Good Mean age, years ± SD Overall 8.8 ± 2.7 G1: 9 ± 2.8 G2: 10±3.2 G3: 9.5±3.1 G4: 10.2±3.1 Mean IQ ±SD Outcome measure/Baseline scores, mean ±SD Overall, N(%) ≥Avg: 3 (7) Borderline: 8 (17) Mild or moderate retardation: 20 (43) Severe retardation: 15 (33) 64 ABC-C-Irritability: G1: 26.2 ± 7.9 G2: 25.5 ± 6.6 ABC-C-Hyperactivity/ Noncompliance: G1: 31.8 ± 9.6 G2: 32.3 ± 8.5 ABC-Stereotypic behavior: G1:10.6 ± 4.9 G2: 9.0 ± 4.4 CYBOCS: G1: 15.51 ± 2.73 G2: 15.18 ± 3.88 NR ABC-C-Irritability: G1: 28.6 ± 7.6 G2: 28.2 ± 7.4 G3: 28.9 ± 6.4 G4: 28 ± 6.9 ABC-C-Hyperactivity/ Noncompliance: G1: 33.1 ± 1.4 G2: 33.7 ± 1.3 G3: 32.2 ± 1.4 G4: 31.0 ± 1.4 ABC-C-Stereotypic: G1: 11.4 ± 0.8 G2: 11.6 ± 0.8 G3: 11.6 ± 0.8 G4: 10.7 ± 0.8 CYBOCS: G1: 13.9 ± 0.6 G2: 13.5 ± 0.5 G3: 14.1 ± 0.5 G4: 13.7 ± 0.6 Outcome measure/Posttreatment scores a , mean ± SD ABC-C-Irritability: G1: 11.3 ± 7.4 G2: 21.9 ± 9.5 p
Table 17. Outcomes of RCTs of antipsychotic medications for challenging and repetitive behaviors (continued) Author, year, country Groups, N enrollment / N final Study quality Owen et al. 216 2009, US G1: aripiprazole, 47/39 G2: placebo, 51/36 Quality: Good Mean age, years ± SD G1: 9.7 ± 3.2 G2: 8.8 ± 2.6 Mean IQ ±SD Outcome measure/Baseline scores, mean ±SD NR ABC-C-Irritability: G1: 29.6 ± 6.4 G2: 30.2 ± 6.5 ABC-C-Hyperactivity/ Noncompliance: G1: 34.1 G2: 34.7 ABC-C-Stereotypic: G1: 11.9 G2: 10.7 CYBOCS: G1: 12.8 G2: 13.7 65 Outcome measure/Posttreatment scores a , mean ± SD Change in: ABC-Irritability (change): G1: -12.9 G2: -5.0 P< 0.001 ABC-C-Hyperactivity/ Noncompliance (change): G1: -12.7 G2: -2.8 P< 0.001 ABC-C-Stereotypic (change): G1: -4.8 G2: -2.0 p< 0.001 CYBOCS (change): G1: -3.8 G2: -0.8 p< 0.001 CYBOCS (change): G1: -3.8 G2: -0.8 p< 0.001 a Decrease in scores on outcome measures indicates improvement in behavior assessed. ABC-C=Aberrant Behavior Checklist- Community Version; CGI-I=Clinical Global Impression-Irritability; CYBOCS=Children’s Yale-Brown Obsessive Compulsive Scale; NR=not reported; RUPP=Research Units on Pediatric Psychopharmacology Case series data, including that from the risperidone arm and open label extension of the RUPP RCT, 203 indicated results consistent with the risperidone arms of the RCTs. 177,203,206,208,214 Aripiprazole. We identified two eight-week randomized, controlled trials of aripiprazole in children with ASDs (Table 17). 215,216 The manufacturer of aripiprazole sponsored both studies. The primary outcome for these studies was challenging behavior indexed by the ABC-C Irritability subscale. These studies included a total of 213 subjects in aripiprazole arms and 103 subjects in placebo arms within the intent to treat analyses. One study used a fixed dose design with one placebo arm and three arms corresponding to 5, 10, and 15 mg per day of aripiprazole, 215 with all subjects beginning at two mg per day with forced titration weekly to the next dose until they reached their goal dose. The other study used a dose titration schedule with weekly progression from 2 mg to 5 mg, 10 mg, and 15 mg per day following clinical judgment. 216 In these two studies, baseline ratings of irritability were similar across aripiprazole (ABC-C-I 28.2-29.6) and placebo (ABC-C-Irritability 28.0-30.8) arms. Decreases in ABC-C Irritability were significantly greater for the aripiprazole arms in both studies, with improvements of 12.4-14.4, in comparison to the placebo arms, with improvements of 5.0-8.4. The trial with differing set doses of aripiprazole demonstrated increasing response with increasing dose. 215 Overall, the results of the trial that used titration following clinical judgment were more pronounced. 216
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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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120. Masi G, Cosenza A, Mucci M, et
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157. Evangeliou A, Vlachonikolis I,
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Introduction Need for Evidence for
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Interventions intended primarily to
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Table 1. Description of behavioral
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Serotonin reuptake inhibitors. Sero
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Table 3. Description of medical and
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Table 4. Description of allied heal
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Page 51 and 52: Methods This chapter documents proc
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Page 57 and 58: 1. Did the study employ a group des
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Page 81 and 82: Schedule for Affective Disorders an
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Page 85 and 86: Summary of the literature. Jarusiew
Page 87 and 88: Table 14. Overview of educational s
Page 89 and 90: on the Ankara Developmental Screeni
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Page 97: that this somnolence improved over
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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Page 135 and 136: Few studies directly comparing the
Page 137 and 138: Strength of evidence. The strength
Page 139 and 140: While individual studies of CBT and
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Page 145 and 146: strength of this reviewed literatur
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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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