American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

American Academy of Pediatrics; Council on Children with Disabilities
Management of Children With Autism Spectrum Disorders

Myers, S. M., & Johnson, C. P. (2007).
Pediatrics, 120(5), 1162–1182.

AGREE Rating: Recommended with Provisos

Description:

This guideline provides recommendations for the management of children with autism spectrum disorder (ASD). The target audience of this guideline is pediatricians. In place of formal recommendations, conclusive statements regarding the level of evidence supporting a specific treatment are included. 

Recommendations:

  • Treatment
    • Cognition/Language 
      • General Findings
        • The guideline authors provide the following recommendations regarding comprehensive programs for children with ASD:
          • initiation of early intervention when ASD diagnosis is suspected rather than deferring until diagnosis is definitive;
          • systematically planned intensive intervention for at least 25 hours per week, 12 months per year;
          • a low student-to-teacher ratio;
          • family inclusion;
          • opportunities for interaction with typically developing peers;
          • ongoing progress measurement and documentation;
          • strong structural element;
          • strategies for generalization and maintenance;
          • use of assessment-based curricula that address various components of communication, social skills, self-management, and responsibility and independence (p. 1164).
      • Applied Behavioral Analysis (ABA) - “Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups” (p. 1164).  
      • Auditory/Sensory Integration Training - “…[T]he efficacy of [Sensory Integration (SI)] therapy has not been demonstrated objectively”; however, intervention that promotes “sensory” abilities “may be helpful as a part of an overall program that uses desired sensory experiences to calm the child, reinforce a desired behavior, or help with transitions between activities” (p. 1166).
      • Augmentative & Alternative Communication (AAC)
        • General Findings and Speech Generaing Devices - Augmentative and alternative communication (AAC) has been shown to often be effective with children with ASD and some nonverbal individuals may benefit from voice-output communication aids. Additionally, there is some evidence that AAC may stimulate some children with ASD to learn speech (p. 1165).
      • Denver Model - “Several studies [of the Denver model] have demonstrated improvements in cognitive, motor, play, and social skills beyond what should be expected on the basis of initial developmental rates… but controlled trials are lacking” (p. 1165).
      • Greenspan/DIR/Floortime - “Published evidence of the efficacy of the DIR model is limited to an unblinded review of case records (with significant methodological flaws…) and a descriptive follow-up study of a small subset (8%) of the original group of patients” (p. 1165).
      • Peer Mediated/Implemented - There is descriptive and anecdotal support for the use of social skills groups, social stories, peer-mediation, play, and leisure curricula (p. 1166).
      • Pragmatic/Social Skills - Some evidence supports the use of traditional and naturalistic behavioral approaches to teach social skills (p. 1165). “A social skills curriculum should target responding to the social overtures of other children and adults, initiating social behavior, minimizing stereotyped perseverative behavior while using a flexible and varied repertoire of responses, and self-managing new and established skills” (p. 1166).
      • Relationship Development Intervention (RDI) - “Evidence of the efficacy of RDI is anecdotal; published empirical scientific research is lacking at this time” (p. 1165).
      • Social Skills Groups & Social Stories - There is descriptive and anecdotal support for the use of social skills groups, social stories, peer-mediation, play, and leisure curricula (p. 1166).
      • TEACCH - “Several reports have documented progress in children who have received TEACCH services as well as parent satisfaction and improvement in parent teaching skills, but these reports were not from controlled studies of treatment outcomes” (p. 1164).
    • Speech   
      • Augmentative and Alternative Communicaiton (AAC)
        • General Findings - Augmentative and alternative communication (AAC) has been shown to often be effective with children with ASD and some nonverbal individuals may benefit from voice-output communication aids. Additionally, there is some evidence that AAC may stimulate some children with ASD to learn speech (p. 1165).
  • Service Delivery
    • Dosage and Format 
      • The guideline authors provide the following recommendations regarding comprehensive programs for children with ASD: 
        • initiation of early intervention when ASD diagnosis is suspected rather than deferring until diagnosis is definitive; 
        • systematically planned intensive intervention for at least 25 hours per week, 12 months per year;  
        • a low student-to-teacher ratio;  
        • family inclusion;  
        • opportunities for interaction with typically developing peers;  
        • ongoing progress measurement and documentation;  
        • strong structural element;  
        • strategies for generalization and maintenance;  
        •  use of assessment-based curricula that address various components of communication, social skills, self-management, and responsibility and independence (p. 1164).  
    • Setting and Provider 
      • SLP treatment is most likely to be effective when delivered in close collaboration with teachers, support personnel, families, and peers as opposed to traditional, pull-out, low-intensity service delivery (p. 1165).   

Keywords: Autism Spectrum Disorders

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Added to Compendium: November 2010

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