Autism

Overview

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Substantive changes at this update

Early intensive behavioural interventions: One systematic review added comparing early intensive behavioural interventions versus other therapy.[19] The review found that early intensive behavioural interventions improved group mean scores for IQ, comprehension, and adaptive behaviour. However individual outcomes were varied.[19] Categorisation unchanged (Likely to be beneficial).

Picture exchange communication system: Two RCTs added comparing the picture exchange communication system (PECS) versus prelinguistic milieu teaching, delayed PECS training, or control.[23][24][25] The first RCT found that PECS improved the frequency of non-imitative speech and words compared with prelinguistic milieu teaching.[23][24] The second RCT found that PECS improved the rate of initiations and the PECS use compared with no treatment, but it found no differences between groups on scores of speech frequency, communication, or language.[25] Categorisation unchanged (Likely to be beneficial).

Music therapy: New option for which we found no studies. Categorised as Unknown effectiveness.

Cognitive behavioural therapy: New option for which we found no studies. Categorised as Unknown effectiveness.

Facilitated communication: New option for which we found no studies. Categorised as Unknown effectiveness.

Melatonin: New option for which we found no studies. Categorised as Unknown effectiveness.

Risperidone: One systematic review added comparing risperidone versus placebo.[32] The review found that risperidone improved global function, irritability, social withdrawal, hyperactivity, stereotypy, and inappropriate speech compared with placebo. However, the review also reported that risperidone increased the risk of weight gain. One additional RCT added to the harms section reported that risperidone increased serum prolactin levels at 8 weeks, 6 months, and 22 months compared with placebo.[33] Categorisation unchanged (Trade-off between benefits and harms).

SSRIs: One systematic review added[34] including no RCTs or cohort studies that met our criteria. Categorisation unchanged (Trade-off between benefits and harms).

Olanzapine: New option for which we found no studies. Categorised as Unknown effectiveness.

Abstract

INTRODUCTION: Evidence for the efficacy of treatments for autism has improved in recent years. In this systematic review the evidence for both drug and non-drug treatments is appraised and clinical guidance is provided for their use. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of early intensive multidisciplinary intervention programmes in children with autism? What are the effects of dietary interventions in children with autism? What are the effects of drug treatments in children with autism? What are the effects of non-drug treatments in children with autism? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2009 (Clinical evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 30 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: applied behavioural analysis; auditory integration training; Autism Preschool Programme; casein-free diet; chelation; Child’s Talk programme; cognitive behavioural therapy; digestive enzymes; EarlyBird programme; facilitated communication; Floortime therapy; gluten-free diet; immunoglobulins; melatonin; memantine; methylphenidate; More Than Words programme; music therapy; olanzapine; omega-3 fish oil; picture exchange communication system; Portage scheme; probiotics; relationship development interventions; risperidone; secretin; selective serotonin reuptake inhibitors (SSRIs); sensory integration training; social stories; social skills training; Son-Rise programme; TEACCH; vitamin A; vitamin B6 (pyridoxine) plus magnesium; and vitamin C.

Cite as

Parr J. Autism. Systematic review 322. BMJ Clinical Evidence. . 2010 January. Accessed [date].

Latest citations

Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial. ( 10 January 2017 )

Metformin for Treatment of Overweight Induced by Atypical Antipsychotic Medication in Young People With Autism Spectrum Disorder: A Randomized Clinical Trial. ( 10 January 2017 )