Short Description: Which Treatments for Autism Spectrum Disorders Actually Work?
Background: The overwhelming prevalence of autism and autism spectrum disorders (ASDs) has led to almost countless interventions for children and adolescents with these diagnoses. They range from school based educational programs, to medications, to alternative therapies like acupuncture and massage. Anecdotally, some of these interventions do wonders for some kids, but do we really have scientific proof that any of them work? A recent review by the federal Agency for Healthcare Research and Quality examined the evidence for a number of interventions. After wading through more than 4,000 studies related to therapies for children with ASDs, the agency found 183 articles that could be considered based on their rigorous standards (which took into account factors such as age of participants, study size, if the research was original, and whether the data was presented in a way that could be abstracted). All types of study designs except single case reports were considered. The review looked at studies of behavioral, educational, medical, allied health (such as occupational and speech therapy), and complementary interventions. The researchers aimed to answer questions related to outcomes and generalizability of results. What did they find? Not much. The only interventions that showed strongevidence of effectiveness were risperidone (Risperdal) and aripiprazole (Abilify) for behavioral problems related to ASDs, but not for the social and communication issues that accompany them. It should be noted, too, the researchers found equally strong evidence that these two meds can cause major side effects, recommending they are best for kids with “severe impairment or risk of injury.” There was some evidence that “early and intensive” behavioral interventions led to improvements in cognitive performance, language skills, and adaptive behavior skills when compared to “eclectic treatments.” However, these things have not been compared in any head to head trials. Researchers found the evidence to be insufficient for social skills training, play therapy, cognitive behavioral therapy, sensory or auditory integration, speech and language therapy, and complementary medicine (Warren Z et al, Comparative Effectiveness Review 2011;Review Number 26).
TCPR's Take: The conclusion of this study is not that most therapies don’t work, it is that there isn’t sufficient evidence to say whether they do or don’t. It shouldn’t be a big surprise that the most compelling evidence is for medical interventions, since this is where you are most likely to find the best study designs, such as randomized controlled studies. (Talk, play, occupational and physical therapies are very hard to blind participants to.) If you have a free month on your calendar, you can read the 900 page report on the AHRQ website at: http://bit.ly/lGILSR. The 20-page summary simplifies the results: http://bit.ly/f1q2jY.