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Evidenced-Based Interventions For Children With Autism Spectrum Disorder
Evidenced-Based Interventions For Children With Autism Spectrum Disorder
This paper reviews evidenced-based interventions for children with professionals in an interdisciplinary autism center. An emphasis
autism spectrum disorders (ASD) across the disciplines of psychol- was placed on results of the National Autism Center's National
ogy, speech-language pathology, occupational therapy, and devel- Standards Project. Results and Conclusions: within each discipline,
opmental pediatrics. Background: rates of ASD diagnoses have interventions exist that vary in level of evidenced-based support.
been steadily rising over the past 2 decades. There are a wide Although disciplines may differ in their definitions of evidence-
range of therapies and interventions, of varying levels of evidence, based treatments, it is important for each discipline to strive to offer
across disciplines that are now available to treat children with and promote practices with the best evidenced-based support
ASD. The field has moved toward a greater emphasis on the identi- according to each field's standards.
fication and utilization of evidenced-based treatments. Methods: a
review and summary of recent literature was conducted by Curr Probl Pediatr Adolesc Health Care 2018; 48:234!249
Introduction among males (26.6 per 1000) than among females (6.6
per 1000).2 The documented rise in the prevalence of
utism spectrum disorder (ASD) is a neurode-
A velopmental condition characterized by per-
vasive deficits in social interaction and
ASD is a much-debated topic, and may be linked to
improvement in diagnostic tools, increasing awareness of
the disorder, and/or an increase in incidence over time.
communication, as well as the presence of rigid and/or The manifestation and severity of symptoms of ASD
repetitive behaviors or sensory concerns that impact the vary widely, with treatment typically focusing on the
individual’s functioning and development. Individuals core features of ASD such as: deficits in social commu-
with this disorder may experience symptoms with or with- nication or social interactions, restricted behaviors, sen-
out intellectual or language impairment. The term sory concerns, or on co-occurring challenging behaviors
“spectrum” is used to capture the wide array of sympto- that impact the development of functional skills and
mology seen across age and developmental levels.1 independence. Symptom presentation and treatment may
According to the Center for Disease Control and Preven- be further complicated by medical concerns such as: epi-
tion’s 2018 published data, approximately 1 in 59 children lepsy, sleep problems, and gastrointestinal problems, as
in the United States are diagnosed with ASD, with well as intellectual/cognitive impairment, and, in some
reported prevalence in all racial, ethnic, and socioeco- children, the presence of challenging maladaptive behav-
nomic groups. ASD is about 4 times more common iors such as hyperactivity, anxiety, irritability, self-
injury, and aggression.3 Effective treatment for children
From the The Kelly O’Leary Center for Autism Spectrum Disorders, Cin- with ASD involves an interdisciplinary approach. It
cinnati Children’s Hospital Medical Center, University of Cincinnati Col- includes a combination of educational interventions, psy-
lege of Medicine, 3333 Burnet Avenue MLC 4002, Cincinnati, OH 45229, chological/behavioral therapies, speech-language ther-
United States.
*Corresponding author. Julia Anixt
apy, occupational/physical therapy, and medical
E-mail: julia.anixt@cchmc.org treatments (e.g., psychopharmacology). The focus of this
Curr Probl Pediatr Adolesc Health Care 2018;48:234!249 paper is on the non-pharmacologic treatments and thera-
1538-5442/$ -see front matter pies that support optimal outcomes for children and ado-
! 2018 Published by Elsevier Inc.
https://doi.org/10.1016/j.cppeds.2018.08.014 lescents with ASD.
Established
" Antecedent Package* " Schedules
" Behavioral Package* " Self-management
" Comprehensive Behavioral Treatment for Young Children " Story-based Intervention Package
" Joint Attention Intervention Behavioral Interventions*
" Modeling Cognitive Behavioral Intervention Package
" Naturalistic Teaching Strategies Language Training (Production)
" Peer Training Package Parent Training
" Pivotal Response Treatment Scripting
Social Skills Package
Emerging
" Augmentative and Alternative Communication Device " Music Therapy
" Cognitive Behavioral Intervention Package " Peer-mediated Instructional Arrangement
" Developmental Relationship-based Treatment " Picture Exchange Communication System
" Exercise " Reductive Package
" Exposure Package " Scripting
" Imitation-based Interaction " Sign Instruction
" Initiation Training " Social Communication Intervention
" Language Training (Production) " Social Skills Package
" Language Training (Production and Understanding) " Structured Teaching
" Massage/Touch Therapy " Technology-based Treatment
" Multi-component Package " Theory of Mind Training
Functional Communication Training
Unestablished
" Academic Interventions Movement-based Intervention
" Auditory Integration Training SENSE Theatre Intervention
" Facilitated Communication Sensory Intervention Package
" Gluten-free/Casein-free diet Shock Therapy
" Sensory Integrative Package Social Behavioral Learning Strategy
Animal-assisted Therapy Social Cognition Intervention
Concept Mapping Social Thinking Intervention
DIR/Floor Time
+Bulleted items include interventions listed in NSP and NSP2.
++Italics indicate NSP2 categorization only.
++Bold and italics indicates movement from Emerging to Established.
*In NSP2, Antecedent Package and Behavioral Package were combined into Behavioral Interventions.
30-months, including the use of ASD-specific screen- free, caregiver-tested online and print materials
ing tools at ages 18 and 24-months.11 Despite the designed to support caregivers, clinicians and profes-
AAP’s 2006 recommendations for developmental sionals in early childhood settings to recognize devel-
screening, a 2014 report from the Centers for Disease opmental red flags.15
Control and Prevention (CDC) demonstrated that When a child “fails” a developmental screening,
reported use of screening tools for young children is he or she should be referred to a developmental-
mixed.12 Less than half of pediatricians in a 2011 behavioral or neurodevelopmental pediatrician,
study reported consistently using a standardized child neurologist, child psychiatrist, psychologist,
developmental screening tool.13 Parents/caregivers or other developmental specialist for additional
report low rates of engagement with healthcare clini- evaluation, diagnosis, and treatment. In an interdis-
cians in their child’s developmental screening pro- ciplinary center, the developmental pediatrician, or
cess.14 To assist clinicians who engage with families other consulting developmental expert, oversees the
in the developmental surveillance and screening of care of the patient by (1) establishing a diagnosis of
children, the CDC launched the “Learn the Signs. Act ASD (often with the support of a team of psycholo-
Early.” public health initiative. This initiative includes gists and other allied health professionals such as