This category of interventions tends to focus on development of skills in specific areas such as communication, cognition, social and motor and include those generally (though not exclusively) associated with speech pathology and occupational therapy.
Results of individual studies and systematic reviews are presented in Table 3.
Table 3: Review of recent (2005–May 2011) research literature on therapy based interventions and autism
Gulsrud, A.C., Kasari, C., Freeman, S. & Paparella, T. (2007). Children with autism’s response to novel stimuli while participating in interventions targeting joint attention or symbolic play skills. Autism, 11(6), 535–546.
Good quality study (4.49) comparing children’s responses to novel stimuli while participating in two different interventions targeting joint attention skills versus symbolic play skills, no control group.
Children in the intervention targeting joint attention responded significantly better socially, and engaged in coordinated joint looks when an unexpected stimulus was put in front of them compared to children in the symbolic play intervention.
Landa, R.J., Holman, K.C., O'Neill, A.H. & Stuart, E.A. (2011). Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: A randomized controlled trial. Journal of Child Psychology and Psychiatry, 52(1), 13–21.
Good quality study (4.57) with positive outcomes for both groups. The study compared 2 treatments. The interventions provided identical intensity (10 hours per week in classroom), student-to-teacher ratio, schedule, home-based parent training (1.5 hours per month), parent education (38 hours), and instructional strategies, except the Interpersonal Synchrony (IP) condition provided a supplementary curriculum targeting socially engaged imitation, joint attention, and affect sharing; measures of these were primary outcomes. The treatment group (IP) increased in engaged imitation (significant difference), and approached significance on formal measures of joint attention and affect sharing.
Wong, V.C. & Kwan, Q.K. (2010). Randomized controlled trial for early intervention for autism: a pilot study of the Autism 1-2-3 Project. Journal of Autism & Developmental Disorders, 40(6), 677–688.
Good quality study (3.69) of ‘Autism 1-2-3’ program – group, child and parent involvement. Significant change for communication and social interaction measured on ADOS. Limitations due to sample size, reporting of data.
Whalen, C., Ilan, A.B., Vaupel, M., Fielding, P., Macdonald, K., Cernich, S. & Symon, J. (2010). Efficacy of TeachTown: Basics computer-assisted intervention for the Intensive Comprehensive Autism Program in Los Angeles Unified School District. Autism: the international journal of research and practice, 14(3), 179–197.
Reasonable quality study (3.09) compared comprehensive program with comprehensive program + computer program (40 mins/day for 3 months). Significant improvements seen in receptive language for younger children only, no change in expressive language or developmental assessment.
Yoder, P.J. & Lieberman, R.G. (2010). Brief Report: Randomized test of the efficacy of picture exchange communication system on highly generalized picture exchanges in children with ASD. Journal of Autism & Developmental Disorders, 40(5), 629–632.
Good quality study (4.67) that looked at generalisation of PECS training. Compared PECS with ‘Responsive education, pre-linguistic milieu’ teaching and measured whether children used picture exchange in a generalised way post intervention. The PECS group showed significantly more picture exchange in a setting involving novel adults, toys and setting.
Summary of systematic reviews of treatments
Kagohara, D.M. (2010). Is video-based instruction effective in the rehabilitation of children with autism spectrum disorders? Developmental Neurorehabilitation, 13(2), 129–140.
Overall outcome: Video modelling studies. 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% were 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 research designs.
Preston, D. & Carter, M. (2009). A Review of the Efficacy of the Picture Exchange Communication System Intervention. Journal of Autism and Developmental Disorders, 39, 1471–1486
Overall outcome: based on 3 RCT studies of PECS, but nature and quantity of data arising from RCTs at this point in time is insufficient to draw firm conclusions regarding the PECS interventions
Stephenson, J. & Carter, M. (2009). The use of weighted vests with children with autism spectrum disorders and other disabilities. Journal of Autism & Developmental Disorders, 39(1), 105–114.
Overall outcome: Weighted vests are ineffective. Six studies were identified in this area, all with weak study design and methodological weaknesses.
Kokina, A. & Kern, L. (2010). Social Story interventions for students with autism spectrum disorders: a meta-analysis. Journal of Autism & Developmental Disorders, 40(7), 812–826.
Overall outcome: Social Stories is in the low/questionable category of effective interventions. No significant changes in outcomes are confirmed. All are single subject design studies covering a sample of 47 children. Studies were of low methodological quality.
van der Meer, L.A. & Rispoli, M. (2010). Communication interventions involving speech-generating devices for children with autism: a review of the literature. Developmental Neurorehabilitation, 13(4), 294-306.
Overall outcome: Only 4 /23 studies had ‘conclusive’ single-subject study designs comprising a total of 13 children. Two small studies had small positive effects, non-RCT studies. Despite this, the review identified several trends, including (a) a clear tendency for targeting requesting as the main communication skill taught, (b) that instructional approach reflects the communication skill being taught, (c) the need to incorporate generalisation and maintenance strategies into treatment procedures, and (d) the predominance of single-case designs and resulting limitation to individual outcomes.
Sinha, Y., Silove N., Williams, K.J. & Hayan, A. (2011). Auditory integration training and other sound therapies for autism spectrum disorders. Cochrane Database of Systematic Reviews. 1, 2011. No.: CD003681. 00075320-100000000-02670
Overall outcome: A recently updated Cochrane Systematic Review (highest level of evidence) reviewed 7 randomised controlled trial (RCT) studies of auditory integration therapies (AIT). The authors suggest that there is no evidence that auditory integration training or other sound based therapies are effective as a treatment for autism and state that AIT cannot be recommended for use at this time.
2.5.1 Summary of current research evidence for therapy based interventions
The current review adds little information to previous findings regarding therapy based interventions. Limitations still exist in the research literature regarding the effectiveness of social stories and communication interventions such as PECS and there is only a small amount of information regarding the use of speech generating devices. Despite documented sensory differences in people with autism and the need to consider sensory processing difficulties, there remains very limited evidence regarding sensory integration therapy with the early intervention age group. Systematic reviews of sensory based interventions including weighted vests and auditory integration therapy (AIT, also known as therapeutic listening or sound therapy) indicate that these interventions show no benefit to young children with autism. More intervention research across this field is required.