Benefits of autism therapies explored
Vanderbilt researchers studying behavioral, medical, educational, and other interventions for children with autism spectrum disorders found evidence that a few therapies, including two antipsychotic medications, show some positive results.
However, much more research is needed — particularly to identify which specific treatments are most helpful for specific children — and the investigators also reveal a striking lack of evidence for a number of therapies used to treat children with autism.
Jeremy Veenstra-VanderWeele, M.D.
Zachary Warren, Ph.D.
Melissa McPheeters, Ph.D.
Their findings were included in three papers from a report published online in the journal Pediatrics, and will appear in the May issue. The full report can be found online at http://www.effectivehealthcare.ahrq.gov.
Researchers at the Vanderbilt Evidence-based Practice Center performed a systematic review of studies between 2000 and May 2010 on early interventions in children under age 12. The work was funded by the Agency for Healthcare Research and Quality (AHRQ).
“The most important finding from the review of the literature is that much work remains to be done to understand how available treatments affect children with autism spectrum disorders,” said Jeremy Veenstra-VanderWeele, M.D., assistant professor of Psychiatry, Pediatrics and Pharmacology and co-author of the report.
“In autism research, like in other areas, we need to be careful to draw conclusions only after we have sufficient evidence to make a clear judgment. Too often, we reach premature closure, thinking that we know something before the data are really clear.”
Autism spectrum disorders (ASDs) affect a child's behavior, communication and social interaction. Among the most common ASDs are Autistic disorder, Asperger's syndrome and Pervasive Developmental Disorder — Not Otherwise Specified (PDD-NOS). Therapies and treatment vary from child to child.
In the report, evidence shows the use of two atypical antipsychotic medicines, risperidone and aripiprazole, help address challenging and repetitive behaviors. But the medicines should be reserved for children with severe impairment or risk of injury because of potential side effects, including drowsiness and significant weight gain. No medications improved social behaviors or communication skills.
Also, of several studies reviewed, two behavioral and developmental therapies — the University of California Los Angeles/Lovaas approach and the Early Start Denver model — showed improvements in language, adaptive, cognitive and educational outcomes in individual studies. Not enough research has been conducted to be confident about how effective the interventions are, or for which children.
In addition, less intensive interventions that provide parent training also may be useful for younger children.
“The more high quality information we can disseminate to parents and clinicians, the better,” said Zachary Warren, Ph.D., director of the Treatment and Research Institute for Autism Spectrum Disorders (TRIAD) at the Vanderbilt Kennedy Center and also a co-author.
“Many parents want to do everything they can to help their child — it's a tricky position to be in. There is a lot of information that is helpful, and some that is not so helpful. We are only going to get better and better at identifying specific interventions for children, but much work remains to be done.”
Vanderbilt researchers hope the report is a stepping point, adding to the ongoing discourse about how to best care for children with autism.
“We have a long way to go but we do have information as a starting point,” said Melissa McPheeters, Ph.D., co-director of the Vanderbilt Evidence-based Practice Center and one of the authors. “This report identifies areas where there are positive results as well as directions for future research to build on the work that has been done so far.”