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Summary of Systematic Review

Behavioural and Developmental Interventions for Autism Spectrum Disorder: A Clinical Systematic Review
Ospina, M. B., Krebs Seida, J., et al. (2008).
PLoS ONE, 3(11), e3755.

This review meets the criteria for a high-quality evidence-based systematic review.

Indicators of Review Quality:

The review states a clearly focused question or aim No
Criteria for inclusion of studies are provided Yes
Search strategy is described in sufficient detail for replication Yes
Included studies are assessed for study quality Yes
Quality assessments are reproducible Yes
Characteristics of the included studies are provided Yes

Description:
This is a review of experimental and observational studies investigating the effects of behavioral and developmental interventions for children with autism spectrum disorders (ASD).

Question(s)/Aim(s) Addressed:
Question not specifically stated.

Population:
Infants, toddlers, children, and adolescents with autism, progressive developmental disorder, Asperger's syndrome, or autistic symptoms.

Intervention/Assessment:
Interventions included applied behavior analysis (ABA), communication-focused interventions, contemporary ABA, developmental approaches, environmental modification, integrative programs, sensory motor and social skills interventions.

Number of Studies Included:
101

Years Included:
1977 to 2007

Conclusions:

Autism Spectrum Disorders

  • Treatment

    • Cognition/Language 

      • General Findings - This review demonstrates a lack of agreement across studies on the effects these interventions may have on various outcomes. “Despite evidence, there is no clear answer regarding the most effective therapy to improve symptoms associated with ASD” (p. 26).

      • ABA/Discrete Trial/LOVAAS

        • The effects of discrete trial training were inconsistent across studies. Lovaas therapy, compared to standard care or regular instruction, yielded better outcomes in intellectual functioning, language comprehension, and communication skills. High–intensity Lovaas showed greater effects than low-intensity Lovaas in intellectual functioning and communication skills (p. 4).

        • A meta-analysis combining findings from a “few, methodologically weak studies with few participant and relatively short-term follow-up” (p. 28) found that Lovaas (compared to special education) produced better outcomes in overall intellectual functioning, adaptive behavior, communication and interaction, comprehensive language, expressive language, and socialization but not in non-verbal intellectual functioning. Pooled results of 2 randomized controlled trials showed no significant differences in communication skills between Lovaas treatment and Developmental Individual-difference Relationship-based interventions (DIR).

        • “There is limited and inconclusive evidence for various combinations of discrete trial training, incidental teaching, pivotal response training, and milieu teaching” (p. 24).

      • AAC: Sign Language

        • There was evidence that sign language was beneficial to communication-related outcomes such as articulation competence, oral language, nonverbal communication, and child initiated speech and may be more effective when paired with other communication modalities (p. 24).

      • Auditory Integration/Sensory Integration

        • For sensory motor interventions, “The evidence is either limited or inconsistent for this group of interventions to support their use in clinical practice” (p. 27).

      • Computer-Based Instruction

        • “…[T]he meta-analysis results were not statistically significant for the comparison between computer assisted instruction and no treatment on measures of facial expression recognition” (pp. 26-27).

      • DIR/Floortime

        • Pooled results of two randomized controlled trials showed no significant differences in communication skills between Lovaas treatment and Developmental Individual-difference Relationship-based interventions (DIR).

      • Incidental Teaching

        • “There is limited and inconclusive evidence for various combinations of discrete trial training, incidental teaching, pivotal response training, and milieu teaching” (p. 24).

      • Milieu

        • “There is limited and inconclusive evidence for various combinations of discrete trial training, incidental teaching, pivotal response training, and milieu teaching” (p. 24).

      • Pivotal Response

        • “There is limited and inconclusive evidence for various combinations of discrete trial training, incidental teaching, pivotal response training, and milieu teaching, and some evidence that pivotal response training may be beneficial for communication and social interactions” (p. 24).

      • Social Stories

        • “The limited evidence supports Social Stories™ for short-term improvements of social symptoms associated with ASD among school-aged children” (p. 27).

      • TEACCH

        • “Individual studies that evaluated TEACCH consistently reported significant findings for a variety of outcomes including but not limited to fine motor and gross motor skills, cognitive performance, social adaptive functioning, and communication” (p. 24).

        • Results from the meta-analysis revealed no significant difference between TEACCH and standard care on imitation skills.
    • Speech

      • AAC: Sign Language

        • This review demonstrates a lack of agreement across studies on the effects these interventions may have on various outcomes. “Despite evidence, there is no clear answer regarding the most effective therapy to improve symptoms associated with ASD” (p. 26).

        • There was evidence that sign language was beneficial to communication-related outcomes such as articulation competence, oral language, nonverbal communication, and child initiated speech and may be more effective when paired with other communication modalities (p. 24).

Social Communication Disorders

  • Treatment

    • Cognition/Language 

      • Auditory/Sensory Integration training

        • Sensory motor interventions (i.e., creative dance and horse riding) resulted in significant social gains (p. 24).

      • Behavioral Interventions/Techniques

        • Incidental Teaching

          • In regards to contemporary applied behavioral analysis (ABA) interventions, "there is limited and inconclusive evidence for various combinations of discrete trial training, incidental teaching, pivotal response training, and milieu teaching, and some evidence that pivotal response training may be beneficial for communication and social interaction" (p. 24).

          • In the realm of developmental interventions (e.g., incidental teaching, response training), mixed effects on social communication outcomes (e.g., social interaction, joint attention) were noted (p. 24).

        • Milieu Therapy

          • In regards to contemporary applied behavioral analysis (ABA) interventions, "there is limited and inconclusive evidence for various combinations of discrete trial training, incidental teaching, pivotal response training, and milieu teaching, and some evidence that pivotal response training may be beneficial for communication and social interaction" (p. 24).

        • Pivotal Response Training

          • In regards to contemporary applied behavioral analysis (ABA) interventions, "there is limited and inconclusive evidence for various combinations of discrete trial training, incidental teaching, pivotal response training, and milieu teaching, and some evidence that pivotal response training may be beneficial for communication and social interaction" (p. 24).

      • Pragmatics/Social Skills Treatments

        • Social Stories

          • The bulk of studies of the Social Stories™ intervention had statistically significant results for a variety of outcomes related to social interaction (p. 24).

      • TEACCH

        • Integrative programs, such as Lego therapy and TEACCH, resulted in improvements in social skills and social adaptive functioning (p. 24).

Sponsoring Body:
Alberta Centre for Child, Family and Community Research (Canada)

Keywords:
Behavioral Treatments, Relationship-Based Intervention, Autism Spectrum Disorders

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