Some medical and behavioral treatments show promise for reducing certain behaviors in children with autism spectrum disorders (ASDs), but more research is needed to assess the potential benefits and harms, according to a new report funded by HHS’ Agency for Healthcare Research and Quality (AHRQ). The research results were published online in the journal Pediatrics.
The comparative effectiveness report found that two commonly used medications—risperidone and aripiprazole—show benefit in reducing some behaviors, including emotional distress, aggression, hyperactivity and self-injury. However, these medicines are associated with significant side effects, such as rapid weight gain and drowsiness. The review found that no medications used for ASDs improved social behaviors or communication skills. The report also found that several medications show promise and should be studied further, but that secretin, which has been studied extensively, has shown no effectiveness.
Children with ASDs have difficulty in social interaction, behavior, and communication. Some children with ASDs may also have impaired cognitive skills and sensory perception. Based on limited evidence, behavioral interventions also showed promise for improving some symptoms and behaviors, but their effects varied. For example, early intensive behavioral and developmental interventions seemed to improve cognitive performance, language skills, and adaptive behavior in some groups of children, the report found.
Other interventions, which focused on parent training and cognitive behavioral therapy, may be useful for children with ASDs to improve social communication, language use and potentially symptom severity, researchers said.
“Autism spectrum disorders are frustrating and challenging for patients, their families and caregivers,” said AHRQ Director Carolyn M. Clancy, M.D. “This report will help parents and clinicians understand their options and design a course of treatment that is consistent with their goals and values.”
Researchers at the Vanderbilt Evidence-based Practice Center in Nashville, TN, who prepared the report for AHRQ, noted that further research is needed to identify which children are likely to benefit from particular interventions. The authors also were critical of the fact that current studies contain few comparisons of medical interventions with behavioral interventions as well as combinations of the two, despite the fact that most children undergo multiple treatments at the same time.
Because of these limitations in the available evidence, researchers were not able to compare treatments and interventions to each other. In addition, they noted that every case of ASD is different and did not conclude that one type of treatment is superior.
ASDs—which include autistic disorder, Asperger syndrome, and pervasive developmental disorder-not otherwise specified—affect an estimated 1 in every 110 children in the United States. Treatment goals for ASDs often focus on improving social communication and addressing certain behaviors. Other treatments also target anxiety, attention difficulties, and sensory difficulties. Goals for treatment often vary by child.
The report, Comparative Effectiveness of Therapies for Children with Autism Spectrum Disorders, is the latest comparative effectiveness review from AHRQ’s Effective Health Care program is available at http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct”productid=656.
The Effective Health Care program sponsors the development of evidence reports and technology assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. The program, authorized by the Medicare Prescription Drug, Improvement and Modernization Act, represents an important Federal effort to compare alternative treatments for health conditions and make the findings public. The program is intended to help patients, doctors, nurses, pharmacists and others choose the most effective treatments. Information can be found at http://www.effectivehealthcare.ahrq.gov.
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Treatments Show Promise in Reducing Autism-related Behaviors, but Some Have Significant Side Effects. Press Release, April 4, 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/press/pr2011/autismpr.htm