Intensive behavior programs for autism spectrum disorders were moderately effective at improving core deficits, particularly when started shortly after diagnosis, but additional and stronger research on these programs is needed, a systematic review found.

A policy statement from the Evidence-based Practice Center on behavioral interventions for autism found that programs offering comprehensive, intense, and long-duration interventions started shortly after diagnosis and for at least 25 hours a week may offer the best outcomes, according to Margaret Maglione, MPP, of the Southern California Evidence-based Practice Center in Santa Monica, and colleagues.

Interventions should address social communication, language, play skills, and maladaptive behavior, they wrote online in Pediatrics.

The authors also noted that much of the evidence supporting individual programs was moderate to insufficient in strength and, as a result, they could not support one behavioral technique over others.

“Given the scope of the problem, there is a pressing need to clarify effective practices and to highlight gaps for additional intervention development,” they said.

The study and development of a policy statement were the result of the Combating Autism Act of 2006. The Maternal and Child Health Bureau of the U.S. Health Resources and Services Administration funded investigations into treatment for physical and behavioral aspects of treating autism.

The behavioral treatment statement included guidelines on nonmedical interventions “that address cognitive function and core deficits in children with autism and recommend priorities for future research.” It was written by an 18-member multidisciplinary panel with backgrounds in psychology, developmental pediatrics, child psychiatry, and education, as well as parents of children with autism.

The panel reviewed 33 systematic reviews and 68 intervention studies that included data on children or adolescents, included specific outcome data on participants with autism, reported outcome data on cognitive function or core deficits (including communication, language, social skills, behavior, restricted interest, and adaptive skills), and had a sample size of at least 10.

Interventions in each study were evaluated for strength and rated high, moderate, low, or insufficient.

Guidelines were drafted based on input from the panel, the Evidence-based Practice Center, researchers at the University of California Los Angeles, and parents of children with autism.

None of the interventions were of high strength.

Interventions of moderate strength included comprehensive intervention programs that are effective at improving core deficits, had greater intensity of treatment (in hours per week), and longer duration (in months). This also included autonomous social skills programs for high-functioning children and adolescents and Picture Exchange Communication System programs for children with little or no verbal language.

The authors suggested a number of characteristics needed to develop future comprehensive programs, such as addressing deficits in:

  Social communication, including appropriate joint attention capability or inability to respond to one’s name
  Language, including lack of or delay in developing functional language, echolalia, or repetitive use of language
  Play skills, including lack of spontaneous make-believe play, lack of social interest, and excessive interest in one type of play
  Adaptive function and behavior, including excessive preoccupation with specific objects and rituals, difficulty adjusting to minor schedule changes, and aggression to others or property and self-injurious behavior

The program, they also suggested, should offer ongoing parent education in specific intervention techniques applied, which would “help transfer the newly acquired skills to home and community settings.”

They added that “timely treatment can help maximize the impact of interventions on young children’s development and prevent further developmental delays or deterioration of functioning in older individuals.”

They concluded that “none of the evidence reaches the level of high strength according to established standards,” and recommended that “additional large, well-designed, controlled trials” be carried out.

They also emphasized that “not all children who attend these programs will make significant gains regarding core deficits; the scientific literature is not clear as to which individual participant characteristics are associated with success of various approaches.”

Primary source: Pediatrics
Source reference: Maglione MA, et al “Nonmedical interventions for children with ASD: recommended guidelines and further research needs” Pediatrics 2012; 130(S2): S169-S178; DOI: 10.1542/peds.2012-09000.