Therapies for Children with Autism Spectrum Disorders: Appendices: Comparative Effectiveness Review Number 26

?Therapies for Children With Autism Spectrum Disorders: Appendices? (see also ?Therapies for Children With Autism Spectrum Disorders: Main Report?) - Autism spectrum disorders (ASDs) are common neurodevelopmental disorders, with an estimated prevalence of one in 110 children in the United States. ASDs have multiple etiologies involving both genetic and environmental risk factors. Among the environmental risk factors that may contribute to ASD risk are advanced parental age and prematurity. Disorders within the autism spectrum include Autistic Disorder, Asperger syndrome, and Pervasive Developmental Disorder, Not Otherwise Specified. Individuals with ASDs have significant impairments in social interaction, behavior, and communication. These impairments include a lack of reciprocal social interaction and joint attention; dysfunctional or absent communication and language skills; lack of spontaneous or pretend play; intense preoccupation with particular concepts or things; and repetitive behaviors or movements. Children with ASDs may also have impaired cognitive skills and sensory perception. ASDs are often accompanied by other conditions such as seizure disorders, hyperactivity, and anxiety. The expression and severity of symptoms of ASDs differ widely, and treatments include a range of behavioral, psychosocial, educational, medical, and complementary approaches that vary by a child?s age and developmental status. Treatment for ASDs focuses on improving core deficits in social communication, as well as addressing challenging behaviors to improve functional engagement in developmentally appropriate activities. In addition to addressing core deficits, treatments are provided for difficulties associated with the disorder (anxiety, attention difficulties, sensory difficulties, etc.). Individual goals for treatment vary for different children and may include combinations of therapies. Key questions presented were: KQ1. Among children ages 2-12 with ASDs, what are the short- and long-term effects of available behavioral, educational, family, medical, allied health, or CAM treatment approaches? KQ1a. What are the effects on core symptoms (e.g., social deficits, communication deficits, and repetitive behaviors) in the short term (6 months or less)? KQ1b. What are the effects on commonly associated symptoms (e.g., motor, sensory, medical, mood/anxiety, irritability, and hyperactivity) in the short term (6 months or less)? KQ1c. What are the longer term effects (6 months or more) on core symptoms (e.g., social deficits, communication deficits, and repetitive behaviors)? KQ1d. What are the longer term effects (6 months or more) on commonly associated symptoms? KQ2. Among children ages 2-12, what are the modifiers of outcome for different treatments or approaches? KQ2a. Is the effectiveness of the therapies reviewed affected by the frequency, duration, and intensity of the intervention? KQ2b. Is the effectiveness of the therapies reviewed affected by the training and/or experience of the individual providing the therapy? KQ2c. What characteristics, if any, of the child modify the effectiveness of the therapies reviewed? KQ2d. What characteristics, if any, of the family modify the effectiveness of the therapies reviewed? KQ3. Are there any identifiable changes early in the treatment phase that predict treatment outcomes? KQ4. What is the evidence that effects measured at the end of the treatment phase predict long-term functional outcomes? KQ5. What is the evidence that specific intervention effects measured in the treatment context generalize to other contexts (e.g., people, places, materials)? KQ6. What evidence supports specific components of treatment as driving outcomes, either within a single treatment or across treatments? KQ7. What evidence supports the use of a specific treatment approach in children under the age of 2 who are at high risk of developing autism based upon behavioral, medical, or genetic risk factors?