Report Reviews Evidence on ASD Treatment A new report suggests that there is an undefined subgroup of children ages 2–12 for whom early and intensive behavioral interventions may elicit robust gains in cognitive, language, and adaptive outcomes, although others may not demonstrate marked improvement. The report cautions, however, that there is little or no comparative evidence ... Features
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Features  |   September 01, 2011
Report Reviews Evidence on ASD Treatment
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Special Populations / Autism Spectrum / Features
Features   |   September 01, 2011
Report Reviews Evidence on ASD Treatment
The ASHA Leader, September 2011, Vol. 16, 20. doi:10.1044/leader.FTR7.16112011.20
The ASHA Leader, September 2011, Vol. 16, 20. doi:10.1044/leader.FTR7.16112011.20
A new report suggests that there is an undefined subgroup of children ages 2–12 for whom early and intensive behavioral interventions may elicit robust gains in cognitive, language, and adaptive outcomes, although others may not demonstrate marked improvement. The report cautions, however, that there is little or no comparative evidence on which to make treatment decisions for autism spectrum disorders (ASDs).
Two summary guides based on the report are available to help clinicians and parents make treatment and management decisions for children with ASDs.
Comparative Effectiveness Review: Therapies for Children with Autism Spectrum Disorders,published by the U.S. Department of Education’s Agency for Healthcare Research and Quality (AHRQ), includes a systematic review of 10 years of evidence on therapies for children ages 2 to 12 with ASDs. According to the report, there is some evidence to guide choices among medical interventions (for challenging and repetitive behaviors) and early intensive behavioral interventions, but there is little or no comparative evidence on which to make decisions about medical interventions for social or communication symptoms; most behavioral interventions; and educational, allied health (including speech-language), and complementary and alternative medicine (CAM) interventions.
The report emphasizes that efforts toward early intervention for ASDs have been encouraging, and that research evidence on the effectiveness of therapies for ASDs has shown promise in some areas. The full report, the two guides, and a continuing education module are available for free in print (e-mail ahrqpubs@ahrq.hhs.gov) or available online at the Effective Health Care Program website.
Key Findings
The clinician guide,Comparative Effectiveness of Therapies for Children with Autism Spectrum Disorders, summarizes key clinical findings:
  • Early intensive behavioral and developmental interventions improve cognitive, language, and adaptive outcomes in certain subgroups of children.

  • The evidence is insufficient to understand the effectiveness, benefits, or adverse events from any other behavioral interventions.

  • Aripiprazole and risperidone reduce challenging and repetitive behaviors but are associated with significant side effects.

  • Secretin does not improve language, cognition, behavior, communication, autism symptom severity, or socialization.

  • The evidence is insufficient to understand the effectiveness and benefits from all other medical interventions, including serotonin-reuptake inhibitors and stimulant medications.

  • The evidence is insufficient to understand the adverse events from all other medical interventions.

  • The evidence is insufficient to understand the effectiveness, benefits, or adverse events from any educational, allied health, or CAM interventions.

Gaps in Knowledge
There are no or few studies that describe:
  • Direct comparisons of the effects of different treatment approaches, and their practical effectiveness or feasibility beyond research studies.

  • Which children are likely to benefit from particular interventions.

  • Generalization of treatment effects, components of multicomponent therapies that drive effectiveness, and predictors of treatment success.

  • Specific treatments to use in children younger than 2 years who are at high risk of developing an ASD.

  • Any harms associated with behavioral, educational, allied health, or CAM interventions.

Future Research Needs
The report and guide call for continuing improvements in methodological rigor in the field, including consistent use of standardized, validated outcome measure(s) for each treatment target; thorough descriptions of study participants and interventions; large, publicly funded, multi-site studies of interventions across all treatment types; studies with extended follow-up times; and research on medical interventions.
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FROM THIS ISSUE
September 2011
Volume 16, Issue 11