Behavioural and Developmental Interventions for Autism Spectrum Disorder: A Clinical Systematic Review
PLoS One
Ospina, M. B., Krebs Seida, J., et al. (2008).
PLoS One, 3(11), e3755.
This systematic review investigates the effects of a variety of behavioral and developmental interventions (e.g., communication-focused interventions, developmental approaches, applied behavior analysis, environmental modification, social skills) on a range of outcomes (e.g., language, social skills, adaptive behaviors) in children on the autism spectrum.
Alberta Centre for Child, Family and Community Research (Canada)
1977-2007
Randomized controlled trials, controlled clinical trials, observational analytical studies
101
For communication-focused interventions (i.e., computer-assisted instruction, Picture Exchange Communication System [PECS], and sign language training), positive effects were noted for emotional recognition, verbal IQ, attention, and close generalization tasks. Sign language training had positive effects on communication outcomes such as "articulation competence, oral language, nonverbal communication, and child-initiated speech. There is also some suggestion that sign language training may be most effective when combined with other modalities" (p. 24). The results of PECS compared to regular instruction showed significant gains in initiations and dyadic interactions.
"Overall conclusions for developmental interventions [e.g., milieu teaching, More than Words, incidental teaching, relationship-based interventions] are elusive due to the varied nature of the modalities, discrepant results across modalities, and limited evidence for each" (p. 27).
For sensory motor interventions (e.g., auditory integration training, sensory integration), "the results for communication-related outcomes are contradictory, and no effect was reported for intellectual functioning" (p. 24). Overall, "the evidence is either limited or inconsistent for this group of interventions to support their use in clinical practice" (p. 27).
A meta-analysis combining findings from a "few, methodologically weak studies with few participant and relatively short-term follow-up" 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 (p. 28).
Findings suggested the following regarding Lovaas therapy in children on the autism spectrum: <br />
<ul>
<li>The effects of discrete trial training were inconsistent across studies.</li>
<li>Compared to standard care instruction, Lovaas therapy yielded better outcomes in adaptive function with a weighed mean difference (WMD) of 11.8; 95% CI [6.94, 16.67]. Other significant outcomes included overall intellectual functioning (SMD = 0.95; 95% CI [0.44, 1.46]), language comprehension (WMD= 12.84; 95% CI [6.38, 19.3]), expressive language (WMD = 15.05; 95% CI [6.19, 23.90]), communication and interactions (WMD = 16.63; 95% CI [11.25, 22.01]) , and socialization skills (WMD = 9.17; 95% CI [2.16, 16.19)]. Results were limited due to methodologically weak studies with few participants.</li>
<li>No significant differences were indicated when compared to Developmental Individual-difference relationship-based intervention (DIR).</li>
<li>High intensity Lovaas showed greater effects than low-intensity Lovaas in intellectual functioning and communication skills.</li>
</ul>
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).
For integrative programs, "studies evaluating social skills programs produced inconsistent findings; there were no identifiable patterns in the outcomes examined. Individual studies that evaluated [Treatment and Education of Autistic and Related Communication Handicapped Children] TEACCH consistently reported significant findings for a variety of outcomes including ... 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. Overall, "the evidence to support the use of these interventions [i.e., integrative programs] is limited or inconsistent across studies" (p. 27).
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).
"The limited evidence supports Social Stories™ for short-term improvements of social symptoms ... among school-aged children" (p. 27).
With regard 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). Overall, "the evidence supporting the use of contemporary ABA approaches is variable and there is no evidence to suggest that one approach is more effective than another" (p. 27).
