American Speech-Language-Hearing Association

EBP Compendium: Summary of Systematic Review

Alberta Centre for Child, Family and Community Research (Canada)
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.

Indicators of Review Quality:

The review addresses a clearly focused question 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

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) 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: 1977-2007

Findings:

Conclusions:

  • Treatment
    • Cognition/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).
      • 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).

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

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Added to Compendium: December 2011

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