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Therapies for Children With Autism Spectrum Disorder
Comparative Effectiveness Review, No. 137
Investigators: Amy S Weitlauf, PhD, Melissa L McPheeters, PhD, MPH, Brittany Peters, MD, Nila Sathe, MA, MLIS, Rebekah Travis, PsyD, Rachel Aiello, PhD, Edwin Williamson, MD, Jeremy Veenstra-VanderWeele, MD, Shanthi Krishnaswami, MBBS, MPH, Rebecca Jerome, MLIS, MPH, and Zachary Warren, PhD.
Author Information and AffiliationsStructured Abstract
Objective:
We updated a prior systematic review of interventions for children (0–12 years) with autism spectrum disorder (ASD), focusing on recent studies of behavioral interventions.
Data sources:
We searched the MEDLINE® (PubMed®), PsycInfo, and Educational Resources Information Clearinghouse (ERIC) databases as well as the reference lists of included studies and recent systematic reviews. We conducted the search in December 2013.
Methods:
We included comparative studies (with treatment and comparison groups) of behavioral interventions with at least 10 participants with ASD in the update, and made our conclusions based on the cumulative comparative evidence across the original report and update. Two investigators independently screened studies against predetermined inclusion criteria and independently rated the quality of included studies.
Results:
We included 65 unique studies comprising 48 randomized trials and 17 nonrandomized comparative studies (19 good, 39 fair, and 7 poor quality) published since the prior review. The quality of studies improved compared with that reported in the earlier review; however, our assessment of the strength of evidence (SOE), our confidence in the stability of effects of interventions in the face of future research, remains low for many intervention/outcome pairs. Early intervention based on high-intensity applied behavior analysis over extended timeframes was associated with improvement in cognitive functioning and language skills (moderate SOE for improvements in both outcomes) relative to community controls in some groups of young children. The magnitude of these effects varied across studies, potentially reflecting poorly understood modifying characteristics related to subgroups of children. Early intensive parent training programs modified parenting behaviors during interactions; however, data were more limited about their ability to improve developmental skills beyond language gains for some children (low SOE for positive effects on language). Social skills interventions varied in scope and intensity and showed some positive effects on social behaviors for older children in small studies (low SOE for positive effects on social skills). Studies of play/interaction-based approaches reported that joint attention interventions may demonstrate positive outcomes in preschool-age children with ASD when targeting joint attention skills (moderate SOE); data on the effects of such interventions in other areas were limited (low SOE for positive effects on play skills, language, social skills). Studies examining the effects of cognitive behavioral therapy on anxiety reported positive results in older children with IQs ≥70 (high SOE for improvements in anxiety in this population). Smaller short-term studies of other interventions reported some improvements in areas such as sleep and communication, but data were too sparse to assess their overall effectiveness.
Conclusions:
A growing evidence base suggests that behavioral interventions can be associated with positive outcomes for children with ASD. Despite improvements in the quality of the included literature, a need remains for studies of interventions across settings and continued improvements in methodologic rigor. Substantial scientific advances are needed to enhance our understanding of which interventions are most effective for specific children with ASD and to isolate elements or components of interventions most associated with effects.
Contents
- Preface
- Acknowledgments
- Technical Expert Panel
- Peer Reviewers
- Executive Summary
- Introduction
- Methods
- Topic Development and Refinement
- Analytic Framework
- Literature Search Strategy
- Process for Study Selection
- Screening of Studies
- Data Extraction and Data Management
- Individual Study Quality Assessment
- Data Synthesis
- Grading the Body of Evidence for Each Key Question
- Applicability
- Peer Review and Public Commentary
- Results
- Results of Literature Searches and Description of Included Studies
- KQ1 Effects of Behavioral Interventions on Core and Commonly Associated Symptoms in Children With ASD
- KQ2 Modifiers of Treatment Effects
- KQ3 Treatment Phase Changes That Predict Outcomes
- KQ4 Treatment Effects That Predict Long-Term Outcomes
- KQ5 Generalization of Treatment Effects
- KQ6 Treatment Components That Drive Outcomes
- KQ7 Treatment Approaches for Children Under Age 2 at Risk for Diagnosis of ASD
- Discussion
- References
- Abbreviations
- Appendix A Search Strategies
- Appendix B Screening and Quality Assessment Forms
- Appendix C Evidence Table
- Appendix D Quality of the Literature
- Appendix E Excluded Studies
- Appendix F Characteristics and Outcomes of Studies of Early Intensive Behavioral and Developmental Interventions
- Appendix G Applicability Tables
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2012-00009-I. Prepared by: Vanderbilt Evidence-based Practice Center, Nashville, TN
Suggested citation:
Weitlauf AS, McPheeters ML, Peters B, Sathe N, Travis R, Aiello R, Williamson E, Veenstra-VanderWeele J, Krishnaswami S, Jerome R, Warren Z. Therapies for Children With Autism Spectrum Disorder: Behavioral Interventions Update. Comparative Effectiveness Review No. 137. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2012-00009-I.) AHRQ Publication No. 14-EHC036-EF. Rockville, MD: Agency for Healthcare Research and Quality; August 2014. 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. 290-2012-00009-I). The findings and conclusions in this document are those of the authors, 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 decisionmakers—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 the application of 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.
This report may periodically be assessed for the urgency to update. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at: www.effectivehealthcare.ahrq.gov. Search on the title of the report.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
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.ahrq.gov
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