Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review.

<h4>Background</h4>Much controversy exists regarding the clinical efficacy of behavioural and developmental interventions for improving the core symptoms of autism spectrum disorders (ASD). We conducted a systematic review to summarize the evidence on the effectiveness of behavioural and...

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Autores principales:	Maria B Ospina, Jennifer Krebs Seida, Brenda Clark, Mohammad Karkhaneh, Lisa Hartling, Lisa Tjosvold, Ben Vandermeer, Veronica Smith
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2008
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/fff1be369efd4c3bb8b30b01cc6e42d6
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spelling	oai:doaj.org-article:fff1be369efd4c3bb8b30b01cc6e42d62021-12-02T20:12:18ZBehavioural and developmental interventions for autism spectrum disorder: a clinical systematic review.1932-620310.1371/journal.pone.0003755https://doaj.org/article/fff1be369efd4c3bb8b30b01cc6e42d62008-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/19015734/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Much controversy exists regarding the clinical efficacy of behavioural and developmental interventions for improving the core symptoms of autism spectrum disorders (ASD). We conducted a systematic review to summarize the evidence on the effectiveness of behavioural and developmental interventions for ASD.<h4>Methods and findings</h4>Comprehensive searches were conducted in 22 electronic databases through May 2007. Further information was obtained through hand searching journals, searching reference lists, databases of theses and dissertations, and contacting experts in the field. Experimental and observational analytic studies were included if they were written in English and reported the efficacy of any behavioural or developmental intervention for individuals with ASD. Two independent reviewers made the final study selection, extracted data, and reached consensus on study quality. Results were summarized descriptively and, where possible, meta-analyses of the study results were conducted. One-hundred-and-one studies at predominantly high risk of bias that reported inconsistent results across various interventions were included in the review. Meta-analyses of three controlled clinical trials showed that Lovaas treatment was superior to special education on measures of adaptive behaviour, communication and interaction, comprehensive language, daily living skills, expressive language, overall intellectual functioning and socialization. High-intensity Lovaas was superior to low-intensity Lovaas on measures of intellectual functioning in two retrospective cohort studies. Pooling the results of two randomized controlled trials favoured developmental approaches based on initiative interaction compared to contingency interaction in the amount of time spent in stereotyped behaviours and distal social behaviour, but the effect sizes were not clinically significant. No statistically significant differences were found for: Lovaas versus special education for non-verbal intellectual functioning; Lovaas versus Developmental Individual-difference relationship-based intervention for communication skills; computer assisted instruction versus no treatment for facial expression recognition; and TEACCH versus standard care for imitation skills and eye-hand integration.<h4>Conclusions</h4>While this review suggests that Lovaas may improve some core symptoms of ASD compared to special education, these findings are based on pooling of a few, methodologically weak studies with few participants and relatively short-term follow-up. As no definitive behavioural or developmental intervention improves all symptoms for all individuals with ASD, it is recommended that clinical management be guided by individual needs and availability of resources.Maria B OspinaMaria B OspinaJennifer Krebs SeidaBrenda ClarkMohammad KarkhanehLisa HartlingLisa TjosvoldBen VandermeerVeronica SmithPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 3, Iss 11, p e3755 (2008)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Maria B Ospina Maria B Ospina Jennifer Krebs Seida Brenda Clark Mohammad Karkhaneh Lisa Hartling Lisa Tjosvold Ben Vandermeer Veronica Smith Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review.
description	<h4>Background</h4>Much controversy exists regarding the clinical efficacy of behavioural and developmental interventions for improving the core symptoms of autism spectrum disorders (ASD). We conducted a systematic review to summarize the evidence on the effectiveness of behavioural and developmental interventions for ASD.<h4>Methods and findings</h4>Comprehensive searches were conducted in 22 electronic databases through May 2007. Further information was obtained through hand searching journals, searching reference lists, databases of theses and dissertations, and contacting experts in the field. Experimental and observational analytic studies were included if they were written in English and reported the efficacy of any behavioural or developmental intervention for individuals with ASD. Two independent reviewers made the final study selection, extracted data, and reached consensus on study quality. Results were summarized descriptively and, where possible, meta-analyses of the study results were conducted. One-hundred-and-one studies at predominantly high risk of bias that reported inconsistent results across various interventions were included in the review. Meta-analyses of three controlled clinical trials showed that Lovaas treatment was superior to special education on measures of adaptive behaviour, communication and interaction, comprehensive language, daily living skills, expressive language, overall intellectual functioning and socialization. High-intensity Lovaas was superior to low-intensity Lovaas on measures of intellectual functioning in two retrospective cohort studies. Pooling the results of two randomized controlled trials favoured developmental approaches based on initiative interaction compared to contingency interaction in the amount of time spent in stereotyped behaviours and distal social behaviour, but the effect sizes were not clinically significant. No statistically significant differences were found for: Lovaas versus special education for non-verbal intellectual functioning; Lovaas versus Developmental Individual-difference relationship-based intervention for communication skills; computer assisted instruction versus no treatment for facial expression recognition; and TEACCH versus standard care for imitation skills and eye-hand integration.<h4>Conclusions</h4>While this review suggests that Lovaas may improve some core symptoms of ASD compared to special education, these findings are based on pooling of a few, methodologically weak studies with few participants and relatively short-term follow-up. As no definitive behavioural or developmental intervention improves all symptoms for all individuals with ASD, it is recommended that clinical management be guided by individual needs and availability of resources.
format	article
author	Maria B Ospina Maria B Ospina Jennifer Krebs Seida Brenda Clark Mohammad Karkhaneh Lisa Hartling Lisa Tjosvold Ben Vandermeer Veronica Smith
author_facet	Maria B Ospina Maria B Ospina Jennifer Krebs Seida Brenda Clark Mohammad Karkhaneh Lisa Hartling Lisa Tjosvold Ben Vandermeer Veronica Smith
author_sort	Maria B Ospina
title	Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review.
title_short	Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review.
title_full	Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review.
title_fullStr	Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review.
title_full_unstemmed	Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review.
title_sort	behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review.
publisher	Public Library of Science (PLoS)
publishDate	2008
url	https://doaj.org/article/fff1be369efd4c3bb8b30b01cc6e42d6
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Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review.

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