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.