Review of the Research to Identify the Most Effective Models of Practice in Early Intervention for Children with Autism Spectrum Disorders
Peters-Scheffer 2010 A meta-analytic study on the effectiveness of comprehensive ABA-based early intervention programs for children with ASD Research in ASD 5(1): 60-69
comprehensive search performed (Medline, PsychInfo, ERIC), manual search of journals and search of bibliographies
intervention to address all 3 core deficits in autism using ABA
studies with a pre-test post-test control group only
ASD (using DSM III, III-R, IV) or AD and PDD-NOS via ICD 10
children <10 yr at onset
standardized measures and quantitative outcomes, standardized mean differences compared.
published in English between 1980–2009.11 studies included; one RCT; rest non-randomised with rep-test post-test control grp.
Two independent reviews selecting studies (IOA 100%).
Study quality (Downs and Black checklist, 1998), independent reviewers. Mean quality score 24.65/32 (sd= 1.29; range 23-27).
EIBI group out performed control group on all dependent variables. Full scale on non-verbal IQ improved in EIBI grp 11.98 and 11.09 points more than control groups, respectively. In receptive and expressive language average increases were 1394 and 15.21 points more, respectively. EIBI surpassed control group on composite adaptive behaviour, comm., daily living skills and socialization subscales by 5.92, 10.44, 5.48, 4.96 points more, respectively. Effect sizes (ES) were medium for adaptive behaviour: daily living subscale (0.68) and high for IQ (2) , non-verbal IQ (0.98), adaptive behaviour (0.91), receptive (2.91) and expressive language (1.1), adaptive behaviour: communication subscale (1.32) and adaptive behaviour: socialization scale (1.49). These large effect sizes reflect clinical significance.
Interpret results cautiously as there was publication bias identified with the expressive language outcome studies and quite high statistical heterogeneity possibly due to differences in characteristics of the treatment (setting, amount of supervision), participants (age at Tx onset, IQ at Tx onset, diagnosis) and methodology (small sample sizes, non-randomised approaches, non-uniform assessment tools, quasi-experimental designs, lack of equivalent groups, lack of adequate fidelity, selection bias, comparison group differences).
Virues-Ortega 2010: Applied Behavior analytic intervention for autism in early childhood: meta-analysis, meta-regression and dose response meta-analysis of multiple outcomes
non-peer reviewed studies
ABA not implement according to major features of approach (referenced)
Focus of intervention was specific rather than general
Intervention did not meet >10hours/wk and no less than 45 weeks duration
Not formally diagnosed according to ADIR, ADOS, DSM IV
Single subject design or intervention less than 5 subjects
study was epidemiological
reported non-standardised outcomes
no pre-test measurement
subject selection bias evident
mean and SD not availableComprehensive lit search (Medline, PsychINfo, Cochrane Centre). Search strategy provided (1985-2009). References lists of reviews searched.
Independent screener of papers, IR agreement 90%. Twenty-two studies included.
Independent screening of methodological quality (Downs and Black 1989); IR agreement 95%.
All meta-analysis subject to statistical heterogeneity (I2 = 68-88%) and publication bias (p<0.02) .
Kagorah D. Is video-based instruction effective in the rehabilitation of children with
autism spectrum disorders? 2007. Developmental Neurorehabilitation 13(2):129-140.
Reviewed intervention studies on the use of video-based instruction for teaching adaptive behaviours to children with autism spectrum disorders (ASD).
Forty-four studies encompassing 49 experiments met the inclusion criteria. The studies targeted a range of adaptive behaviours and academic skills.
Difficult to draw conclusions due to only 1–3 participants in any one included study having ASD. Also mean age of included sample was 7.6 years although 55% were school age (6–12 years) and 30% (3–5 years).
Most studies reported positive results, but the certainty of evidence was not strong for all of the studies due to reliance on pre-experimental designs. Most studies assessed outcomes of social and communication skills, not adaptive behaviours. Most studies performed video based instruction in home or school settings, not community settings where instruction is required. A wide range of models were used for video instruction making it difficult to determine which model works best in which setting. Furthermore few studies looked at video-based instruction independent of additional strategies making it difficult to determine effects specific to video-based instruction.
Followed systematic reviews methods (Higgins 2006).
Comprehensive search strategy used (all key databases) plus hand searches of bibliographies
Two independent reviewers of search and for quality assessment with a validated scale (Jadad, 1996, Chalmers, 1981, Smith 2007).
Six Controlled trials (4 RCT, 2 CCT) published between 2006–2009
135 participants, median sample size 20
variable control groups
quality criteria (0 low, 5 high): 1 study 2/5, 2studies 1/5, 3 studies 0/5
Majority of children in this review were >7yrs, therefore will exclude at this stage. The one study that had children with mean age 6 yrs (4–8) had a quality score of 0/5 and therefore will not offer any further information to this review.
Preston D. A Review of the Efficacy of the Picture Exchange Communication System Intervention. J Autism Dev Disord (2009) 39:1471–1486
Wallace & Rogers, Intervening in infancy: implications for autism spectrum disorders. J Child Psychology & Psychiatry. 2010. 51(12): 1300-1320.
Comprehensive search strategy including search of PsychInfo and Pub Med databases, hand search of reviews
32 controlled, high-quality experimental studies.
article published in a peer-reviewed journal
article described a well-designed, controlled intervention efficacy study involving infants or toddlers with significant risk of prematurity, developmental delay including Down syndrome, risk of intellectual disability
study participants were in the age range of 0–3 years
paper reported sufficient data to calculate effect sizes.
Two independent reviewers of studies including rating of studies by level of evidence type 1-type 6 (Nathan and Gorman, 2002):
Type 1 Studies are randomized, prospectively designed clinical trials which use randomly assigned comparison groups and all critical design requirements.
Type 2 Studies are clinical trials using a comparison group to test an intervention. These have some significant flaws but not critical design flaws that would prevent one from using the data to answer a study question. This category also includes single-subject designs.
Most efficacious interventions routinely use a combination of four specific intervention procedures, include:
Communication interventions involving speech-generating devices for children with autism: A review of the literature. LJ van Der Meer. Developmental Neurorehabilitation, August 2010; 13(4): 294–306
Comprehensive search strategy using 6 different databases including CINAHL, MEDLINE, ERIC plus manual searches of reference lists. 23 studies identified between 1998–2009. Two Independent reviewers to identify included studies.
children (<18 years of age) with ASD (9.8%), autism, (66.7%), PDD-NOS (23.5%)
intervention involving SGDs defined as implementing one or more therapeutic/ teaching procedures for the purpose of trying to increase or improve the child’s communication skills or abilities through the use of a SGD. Examples could include teaching a child to use an SGD to (a) make requests, (b) spell words or (c) repair a communicative breakdown
quality assessment criteria not clear
51 children aged 3–16 years (mean 7.7 yrs)Overall outcome:
Only 4 /23 studies had ‘conclusive’ single-subject study designs comprising a total of 13 children.
No RCTs have been performed in this area.
Outcome of comprehensive psycho-educational interventions for young children with autism
Eikeseth. S. 2009. Research in Developmental Disabilities 30 (2009) 158–178.
Evaluated comprehensive psycho-educational research on early intervention for children with autism. Twenty-five outcome studies were identified.
Twenty studies evaluated behavioural treatment, 3 studies evaluated TEACCH and 2 studies evaluated the Colorado Health Sciences Project.
Looked at scientific merit (Highest 1, lowest 3) and magnitude of treatment (Highest 1; lowest 4)
Scientific merit: (only 1 study with scientific merit 1: Smith, 2000)
Studies relevant to current review see below: all scientific merit 2, criteria include:
Magnitude of treatment criteria:
surveyed well known books and literature review
incorporated models from NAC report
experts in the field
Defined by 6 criteria:
model description published in a refereed journal article
a single procedural guide, manual to define model
clear theoretical or conceptual framework that is published
address multiple developmental or behavioural domains that represent core features of autism
model must be intensive (25hrs/week or more), extends for 9–10 months, and planned engagement consistent with mode.
implemented at least at one site in the US.
Four evaluators with extensive training and experience related to ASD. Standard telephone Ix to CTM director (30–90min) and summarised outcomes according to evaluation criteria. Used American Evaluation Association guidelines combined with guidelines from leaders in ASD Tx field. Polit testings of evaluation performed. Inter rater agreement 83%
Operationalisation: Interventions documented and published such that others can use them
Implementation measures: Fidelity implementation measure developed plus some evidence of reliability and validity.
Replication: Model adopted and replicated by others, provided with initial training but otherwise independent of CTM developer
Type of empirical evidence: Evidence of efficacy must appear in different venues, strongest being a peer-reviewed journal, then book chapters or reports from CTM developers
Scored 0 lowest to 5 highest
Overall this was a descriptive review of studies (Level I to III) that looked at a range of interventions which fall in the domain of occupational therapy. Majority of studies described were performed before 2005, outside this review’s study criteria. Also as no clear independent standardised quality assessment was performed on included studies, the level of scientific rigour is likely to vary among studies making it difficult to make comparisons or draw clear conclusions. Few studies were completed by occupational therapists, rather the author has attempted to interpret the outcomes and apply to occupational therapy practice.
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