Experts Weigh in on Autism Programs

Autism interventions get some guidelines from an expert panel

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) There are many programs for kids with autism spectrum disorders (ASD). An expert panel recently created some best practice guidelines for these programs.

The experts agreed that programs should cover all the core problem areas for kids with ASD, like language, social skills and behavior. They also suggested programs should start soon after diagnosis, involve family members and have an intensive weekly schedule.

These guidelines can help parents make choices about programs for their child.

"Ask a psychiatrist about programs in your area."

The Combating Autism Act of 2006 called for work on autism interventions.  The Southern California Evidence-based Practice Center of the RAND Corporation in Santa Monica, Calif. were contracted to review and create guidelines for non-medical interventions.

A summary report, with lead author Margaret A. Maglione, MPP, of RAND Corp., explained the process and guidelines that were agreed upon.

Non-medical interventions are those that are not based on medicine, such as behavioral interventions, therapies and other programs designed to help kids with ASD.

First, 314 published studies were reviewed.  Each program was given a rating based on the research for how well it worked.

The researchers looked at studies with at least 10 kids or teens with ASD. Studies included applied behavioral analysis (ABA), developmental programs and combined behavioral developmental programs.

All the programs received a moderate to low rating based on published studies. In other words, more research could change the belief about how effective the programs are.

None of the programs had enough good research to be given a high level of confidence. Programs based on ABA or that used ABA in combination with developmental programs had the best ratings.

Then the report of the evidence was sent to a panel of experts on autism.  The panel included 18 people who were practicing doctors, clinical psychologists, researchers and parents (some who are founding members of autism activist groups).

In a two day meeting, the panel was asked to create guidelines about what ASD programs should contain and to rate how important those guidelines are.

The panel used the summary of research and their own personal experiences and expertise to make the guidelines.

They concluded that good programs should target the following areas: social communication, language, plays skills, maladaptive behavior (like rigid behaviors) and family involvement.

Their guidelines for programs were:

  • Children should start on an intervention program within 60 days of detection of ASD.
  • Programs should be customized to the needs of the individual. 
  • Programs should address family needs and allow for family involvement.
  • Children with ASD should spend 25 hours a week in programs.
  • Older people with ASD should be involved in comprehensive programs but more research is needed to determine how many hours a week are needed.

There was some disagreement within the panel about the number of hours a week kids should be working a program. About 50 percent of the panel agreed with the 25 hours per week recommendation, but the other half thought more research is needed to know how many hours are best.

The panel also made recommendations for programs that target specific issues. They said the Picture Exchange Communication System (PECS) can be used for kids with limited or no language when they don’t respond to other programs.

They also said that auditory integration therapy does not appear to be effective because four out of the five studies showed no effect. 

They urged all programs should have a plan for tracking changes in skills and symptoms. 

The authors concluded making good comprehensive programs available to all kids with ASD is needed but costly.

The guidelines of the panel are designed to guide future research and development for programs. Parents can use these guidelines to help make choices about programs for their child.

dailyRx News spoke with Glen Elliott, MD, PhD, a child psychiatrist about this report. He said, “This is an important overview of non-medical interventions for autism that parents are apt to find both helpful and frustrating—helpful, because it nicely describes the array of services being proffered and frustrating because of the relative dearth of evidence for truly effective treatments.”

This report was published in November in Pediatrics. The authors declare no competing financial interests.

Reviewed by: 
Review Date: 
January 2, 2013
Last Updated:
January 5, 2013