Medical experts say they need more proof before they can fully support current interventions to help children with autism disorders.
Scientists associated with the RAND Corporation found a mixed bag of evidence for the myraid of current interventions. They say this finding highlights the need for well-designed studies to better evaluate the therapies.
The need for strong research is paramount as autism spectrum disorders have emerged as a major public health issue, with the number of children diagnosed with an autism spectrum disorder in the United States is estimated to be 500,000 to 673,000.
Scientists found that when they evaluated the past research on a wide variety of interventions aimed at improving core deficits in social/communication, language, behavior and adaptive skills, the evidence of efficacy ranged from moderate to insufficient.
Their findings are published in the journal Pediatrics.
“We reviewed the evidence that exists for widely used interventions for autism and found there was no more than moderate evidence demonstrating the benefits of any of the approaches,” said Margaret Maglione, the study’s lead author.
“What’s needed are new, well-designed studies that are large enough to tease out the effects of different components and which types of children are best suited for the interventions.”
The study concludes that head-to-head trials of competing autism treatments are needed to identify which programs are superior and additional work should follow study participants long-term to further examine the effectiveness of treatments.
As a part of the study methodology, researchers closely examined information from more than 100 studies that contained at least 10 children or adolescents.
The information was reviewed by an expert panel of practitioners, researchers and parents charged to systematically evaluate the level of evidence for behavioral autism treatments. The experts reviewed a wide array of current interventions and sought to develop priorities for future research.
Panelists agreed there was enough evidence to endorse the use of applied behavioral analysis, integrated behavioral/developmental programs, the Picture Exchange Communication System and various social skills interventions for Asperger’s syndrome and high-functioning autism.
In addition, they agreed that children with autism spectrum disorders should have access to at least 25 hours per week of comprehensive interventions (often called “intensive early intervention”) to address social communication, language, play skills and maladaptive behavior.
No treatment was supported by evidence considered stronger than “moderate.” This suggests that treatments in this category are supported by reasonable evidence, but include the caveat that further research may change the confidence about the results.
In contrast, a treatment supported by a high level of evidence is unlikely to be changed by further research. So, work still needs to be done before experts totally endorse even the promising interventions.
Based on the gaps in the evidence, the panel recommends that future research focus on assessment and monitoring of treatment outcomes, address the needs of preverbal and nonverbal children, and identify the most effective strategies, doses and duration of therapy needed to improve core deficits.
Importantly, other than programs for social skills among Asperger’s or high-functioning autism, research on adolescents and young adults was notably lacking. The absence of sound research for this important population segment has led the panel to recommend that research on interventions to aid adolescents and young adults be a priority population.
Although researchers found moderate evidence that comprehensive intervention programs are effective at improving cognitive abilities among children with an autism disorder—specifically in the areas of language, adaptive skills and IQ — evidence did not support one program over the others.
The study also found there was moderate evidence that auditory integration training is not effective, and there was insufficient evidence about the efficacy of augmentative and alternative communication devices.
The expert panel could not come to consensus about the scientific evidence for sensory integration, deep pressure therapy and exercise.
Source: Rand Corporation