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Therapies for Children With Autism Spectrum Disorders
Comparative Effectiveness Reviews, No. 26
Investigators: Zachary Warren, PhD, Jeremy Veenstra-VanderWeele, MD, Wendy Stone, PhD, Jennifer L Bruzek, PhD, Allison S Nahmias, MEd, Jennifer H Foss-Feig, MA, Rebecca N Jerome, MLIS, MPH, Shanthi Krishnaswami, MBBS, MPH, Nila A Sathe, MA, MLIS, Allison M Glasser, BA, Tanya Surawicz, MPH, and Melissa L McPheeters, PhD, MPH.
Author Information and AffiliationsStructured Abstract
Objectives:
The Vanderbilt Evidence-based Practice Center systematically reviewed evidence on therapies for children ages 2 to 12 with autism spectrum disorders (ASDs). We focused on treatment outcomes, modifiers of treatment effectiveness, evidence for generalization of outcomes to other contexts, and evidence to support treatment decisions in children ages 0–2 at risk for an ASD diagnosis.
Data:
We searched MEDLINE,® ERIC, and PsycInfo.®
Review Methods:
We included studies published in English from January 2000 to May 2010. We excluded medical studies with fewer than 30 participants; behavioral, educational, and allied health studies with fewer than 10 participants; and studies lacking relevance to treatment for ASDs.
Results:
Of 159 unique studies included, 13 were good quality, 56 were fair, and 90 poor. The antipsychotic drugs risperidone and aripiprazole demonstrate improvement in challenging behavior that includes emotional distress, aggression, hyperactivity, and self-injury, but both have high incidence of harms. No current medical interventions demonstrate clear benefit for social or communication symptoms in ASDs. Evidence supports early intensive behavioral and developmental intervention, including the University of California, Los Angeles (UCLA)/Lovaas model and Early Start Denver Model (ESDM) for improving cognitive performance, language skills, and adaptive behavior in some groups of children. Data are preliminary but promising for intensive intervention in children under age 2. All of these studies need to be replicated, and specific focus is needed to characterize which children are most likely to benefit. Evidence suggests that interventions focusing on providing parent training and cognitive behavioral therapy (CBT) for bolstering social skills and managing challenging behaviors may be useful for children with ASDs to improve social communication, language use, and potentially, symptom severity. The Treatment and Education of Autistic and Communication related handicapped CHildren (TEACCH) program demonstrated some improvements in motor skills and cognitive measures. Little evidence is available to assess other behavioral interventions, allied health therapies, or complementary and alternative medicine. Information is lacking on modifiers of effectiveness, generalization of effects outside the treatment context, components of multicomponent therapies that drive effectiveness, and predictors of treatment success.
Conclusions:
Medical interventions including risperidone and aripiprazole show benefit for reducing challenging behaviors in some children with ASDs, but side effects are significant. Some behavioral and educational interventions that vary widely in terms of scope, target, and intensity have demonstrated effects, but the lack of consistent data limits our understanding of whether these interventions are linked to specific clinically meaningful changes in functioning. The needs for continuing improvements in methodologic rigor in the field and for larger multisite studies of existing interventions are substantial. Better characterization of children in these studies to target treatment plans is imperative.
Contents
- Preface
- Acknowledgments
- Technical Expert Panel
- Executive Summary
- Introduction
- Methods
- Results
- Article Selection
- KQ1 Effects of Treatment on Core and Commonly Associated Symptoms in Children With ASDs: Behavioral Interventions
- KQ1 Effects of Treatment on Core and Commonly Associated Symptoms in Children With ASDs: Educational Interventions
- KQ1 Effects of Treatment on Core and Commonly Associated Symptoms in Children With ASDs: Medical Interventions
- KQ1 Effects of Treatment on Core and Commonly Associated Symptoms in Children With ASDs: Allied Health Interventions
- KQ1 Effects of Treatment on Core and Commonly Associated Symptoms in Children With ASDs: Complementary and Alternative Medicine (CAM)
- KQ2 Modifiers of Treatment Outcomes
- KQ3 Early Results in the Treatment Phase That Predict Outcomes
- KQ4 End of Treatment Effects That Predict Outcomes
- KQ5 Generalization of Treatment Effects
- KQ6 Drivers of Treatment Effects
- KQ7 Treatment Approaches for Children Under Age Two at Risk for Diagnosis of ASDs
- Discussion
- Outcomes and Strength of Evidence of Therapies
- KQ2 Modifiers of Treatment Outcomes
- KQ3 Early Results in the Treatment Phase That Predict Outcomes
- KQ4 End of Treatment Effects That Predict Outcomes
- KQ5 Generalization of Treatment Effects
- KQ6 Drivers of Treatment Effects
- KQ7 Treatment Approaches in Children Under Age Two at Risk for ASDs
- Quality Considerations
- Applicability
- Review of Systematic Reviews
- Future Research
- Conclusions
- References
- Acronyms/Abbreviations
- Appendixes
- Appendix A Exact Search Strings and Results
- Appendix B Sample Data Abstraction Forms
- Appendix C Evidence Tables
- Appendix D List of Excluded Studies
- Appendix E List of Peer Reviewers
- Appendix F Approach to Categorizing Study Designs
- Appendix G Discussion of Recent Systematic Reviews of Therapies for Children with ASDs
- Appendix H Quality of the Literature
- Appendix I Applicability Summary Tables
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10065-I, Prepared by: Vanderbilt Evidence-based Practice Center, Nashville, TN
Suggested citation:
Warren Z, Veenstra-VanderWeele J, Stone W, Bruzek JL, Nahmias AS, Foss-Feig JH, Jerome RN, Krishnaswami S, Sathe NA, Glasser AM, Surawicz T, McPheeters ML. Therapies for Children With Autism Spectrum Disorders. Comparative Effectiveness Review No. 26. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publication No. 11-EHC029-EF. Rockville, MD: Agency for Healthcare Research and Quality. April 2011. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Vanderbilt Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10065-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
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