89. Therapies For Autism Spectrum Disorders

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89. Therapies For Autism Spectrum Disorders

 

 

CATEGORY:Alternative Medicines 300 Courses

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Syllabus

Executive Summary…………………………………………………………………………………………………….ES-1
Introduction……………………………………………………………………………………………………………………..1
Need for Evidence for Treatment of Autism Spectrum Disorders in Children……………………1
Behavioral Interventions…………………………………………………………………………………………4
Educational Interventions ……………………………………………………………………………………….5
Medical and Related Interventions …………………………………………………………………………..6
Allied Health Interventions……………………………………………………………………………………..9
Complementary and Alternative Medicine (CAM) Interventions……………………………….11
Importance of This Review……………………………………………………………………………………12
Scope of This Evidence Report………………………………………………………………………………12
Key Questions and Analytic Framework …………………………………………………………………….13
Key Questions……………………………………………………………………………………………………..13
Analytic Framework for Therapies for Children With ASDs……………………………………..14
Organization of This Evidence Report ……………………………………………………………………14
Technical Expert Panel (TEP) ……………………………………………………………………………….15
Uses of This Report ……………………………………………………………………………………………..15
Methods…………………………………………………………………………………………………………………………17
Literature Review Methods……………………………………………………………………………………….17
Inclusion and Exclusion Criteria…………………………………………………………………………….17
Literature Search and Retrieval Process………………………………………………………………….19
Categorization of Interventions………………………………………………………………………………19
Literature Synthesis………………………………………………………………………………………………….21
Development of Evidence Table and Data Abstraction Process …………………………………21
Assessing Methodological Quality of Individual Studies…………………………………………..22
Strength of Available Evidence ……………………………………………………………………………..27
Results…………………………………………………………………………………………………………………………..28
Article Selection ………………………………………………………………………………………………………28
KQ1. Effects of Treatment on Core and Commonly Associated Symptoms in Children
With ASDs: Behavioral Interventions ………………………………………………………………………..29
Early Intensive Behavioral and Developmental Interventions ……………………………………30
Social Skills Interventions…………………………………………………………………………………….37
Play-/Interaction-Based Interventions …………………………………………………………………….42
Behavioral Interventions Focused on Associated Behaviors………………………………………45
Other Behavioral Interventions………………………………………………………………………………50
KQ1. Effects of Treatment on Core and Commonly Associated Symptoms in Children
With ASDs: Educational Interventions ………………………………………………………………………52
TEACCH…………………………………………………………………………………………………………….53
Broad-Based Educational Approaches ……………………………………………………………………55
Computer-Based Educational Approaches………………………………………………………………57
KQ1. Effects of Treatment on Core and Commonly Associated Symptoms in Children
With ASDs: Medical Interventions ……………………………………………………………………………59
Antipsychotics……………………………………………………………………………………………………..60
Serotonin Reuptake Inhibitors……………………………………………………………………………….67
Stimulants and Other Medications To Treat Hyperactivity………………………………………..70
Secretin ………………………………………………………………………………………………………………72

Dietary and Other Medical Interventions ………………………………………………………………..73
KQ1. Effects of Treatment on Core and Commonly Associated Symptoms in Children
With ASDs: Allied Health Interventions……………………………………………………………………..77
Language Interventions…………………………………………………………………………………………78
Sensory- and Auditory-Focused Interventions …………………………………………………………80
Additional Allied Health Interventions……………………………………………………………………83
KQ1. Effects of Treatment on Core and Commonly Associated Symptoms in Children
With ASDs: Complementary and Alternative Medicine (CAM) Interventions ………………..84
CAM Interventions ………………………………………………………………………………………………84
KQ2. Modifiers of Treatment Outcomes……………………………………………………………………..87
Behavioral Interventions……………………………………………………………………………………….88
Educational Interventions ……………………………………………………………………………………..91
Medical Interventions …………………………………………………………………………………………..91
CAM Interventions ………………………………………………………………………………………………93
KQ3. Early Results in the Treatment Phase That Predict Outcomes……………………………….93
Early Identifiable Changes Predicting Response/Outcome ………………………………………..93
KQ4. End of Treatment Effects That Predict Outcomes………………………………………………..93
KQ5. Generalization of Treatment Effects…………………………………………………………………..94
KQ6. Drivers of Treatment Effects…………………………………………………………………………….95
KQ7. Treatment Approaches in Children Under Age Two at Risk for Diagnosis
of ASDs………………………………………………………………………………………………………………….95
Discussion……………………………………………………………………………………………………………………..98
Outcomes and Strength of Evidence of Therapies………………………………………………………..99
Effectiveness of Behavioral Interventions……………………………………………………………….99
Effectiveness of Educational Interventions ……………………………………………………………106
Effectiveness of Medical and Related Interventions ……………………………………………….107
Effectiveness of Allied Health Interventions………………………………………………………….110
Effectiveness of CAM Interventions …………………………………………………………………….112
Assessment of Domains for Strength of Evidence ………………………………………………….112
KQ2. Modifiers of Treatment Outcomes …………………………………………………………………..115
KQ3. Early Results in the Treatment Phase That Predict Outcomes……………………………..117
KQ4. End of Treatment Effects That Predict Outcomes………………………………………………117
KQ5. Generalization of Treatment Effects…………………………………………………………………118
KQ6. Drivers of Treatment Effects…………………………………………………………………………..118
KQ7. Treatment Approaches in Children Under Age Two at Risk for ASDs…………………118
Quality Considerations……………………………………………………………………………………………118
Applicability………………………………………………………………………………………………………….119
Review of Systematic Reviews………………………………………………………………………………..120
Future Research……………………………………………………………………………………………………..121
State of the Literature………………………………………………………………………………………….121
Gaps in Areas of Research…………………………………………………………………………………..122
Methodologic Issues …………………………………………………………………………………………..124
Conclusions…………………………………………………………………………………………………………..125
References……………………………………………………………………………………………………………………128
Acronyms/Abbreviations……………………………………………………………………………………………….145

Tables

Table A. Description of interventions…………………………………………………………………………….ES-2
Table 1. Description of behavioral interventions addressed in the report …………………………………4
Table 2. Description of educational interventions addressed in the report………………………………..6
Table 3. Description of medical and related interventions addressed in the report…………………….8
Table 4. Description of allied health interventions addressed in the report……………………………..11
Table 5. Description of CAM interventions addressed in the report ………………………………………12
Table 6. Inclusion and exclusion criteria ……………………………………………………………………………17
Table 7. Overview of diagnostic tools used in quality scoring hierarchy………………………………..23
Table 8. Quality scoring algorithm …………………………………………………………………………………..26
Table 9. Overview of behavioral studies …………………………………………………………………………..30
Table 10. Outcomes of early intensive behavioral and developmental interventions ………………35
Table 11. Outcomes of RCTs of social skills behavioral interventions ………………………………….41
Table 12. Outcomes of RCTs assessing play-/interaction-based interventions………………………..45
Table 13. Studies assessing interventions targeting conditions commonly associated
with ASDs……………………………………………………………………………………………………………………..47
Table 14. Overview of educational studies…………………………………………………………………………53
Table 15. Outcomes of studies assessing educational interventions ………………………………………58
Table 16. Overview of studies of medical interventions ……………………………………………………..60
Table 17. Outcomes of RCTs of antipsychotic medications for challenging and repetitive
behaviors……………………………………………………………………………………………………………………….63
Table 18. Outcomes of studies of SRIs for the treatment of repetitive and challenging behaviors
in ASDs ………………………………………………………………………………………………………………………..68
Table 19. Harms frequently reported in studies of medical interventions ………………………………70
Table 20. Outcomes of studies of stimulants for the treatment of hyperactivity in ASDs ………..72
Table 21. Outcomes of RCTs of dietary supplements for the treatment of ASDs ……………………74
Table 22. Outcomes of RCTs of additional medical interventions for the treatment of ASDs ….75
Table 23. Overview of allied health studies ……………………………………………………………………….78
Table 24. Outcomes of RCTs of auditory/music interventions for the treatment of ASDs ……….82
Table 25. Overview of CAM studies ………………………………………………………………………………..85
Table 26. Outcomes of interventions for children at risk for diagnosis of ASDs …………………….97
Table 27. Summary of results of studies of early intensive behavioral and developmental
approaches……………………………………………………………………………………………………………………101
Table 28. Summary of results of social skills interventions………………………………………………..103
Table 29. Summary of results of studies of play-/interaction-based interventions………………….104
Table 30. Summary of results of studies targeting behaviors commonly associated
with ASDs……………………………………………………………………………………………………………………105
Table 31. Summary of results of studies of other behavioral interventions …………………………..106
Table 32. Summary of results of educational interventions ………………………………………………..107
Table 33. Summary of results of medical studies………………………………………………………………108
Table 34. Summary of results of allied health studies………………………………………………………..111
Table 35. Summary of results of CAM studies………………………………………………………………….112
Table 36. Intervention, strength of evidence domains, and strength of evidence
for key outcomes…………………………………………………………………………………………………………..113
Table 37. Interventions/outcomes with insufficient strength of evidence
by outcomes assessed…………………………………………………………………………………………………….114

Figures
Figure A. Analytic framework for therapies for children with ASDs …………………………………ES-4
Figure B. Disposition of articles addressing therapies for children with ASDs……………………ES-6
Figure 1. Analytic framework for therapies for children with ASDs……………………………………..14
Figure 2. Disposition of articles addressing therapies for children with ASDs………………………..29
Appendixes
Appendix A. Exact Search Strings and Results
Appendix B. Sample Data Abstraction Forms
Appendix C. Evidence Table
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

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