Why autism therapies have an evidence problem

 Less than a third of the studies that test ABA-related interventions are randomized controlled trials, according to Project AIM. And single-case designs make up the bulk of studies included in national reports issued to U.S. clinicians. For example, the 2021 National Clearinghouse on Autism Evidence and Practice (NCAEP) report deemed 28 practices evidence-based, including many behavioral interventions, yet 85 percent of the studies reviewed are a single-case design. So too, the 2015 National Standards Report (NSP) identified 14 effective interventions for autistic children, adolescents and young adults but draws on a set of studies of which 73 percent are single-case.

Read/listen to more at Spectrum.

Mapping the futures of autistic children

Yet researchers have assembled a rich body of data about how autistic people do over time and can provide certain kinds of nuanced projections. The work points to several broad life trajectories for autistic children — rough sketches of how a child’s adolescence and adulthood may unfold. The data also point to subtle, early behavioral markers of future growth or difficulties in specific areas, as well as genetic variants that affect the arc of a child’s trajectory. Some of the research could help clinicians gauge an autistic child’s risk of having mental health challenges such as anxiety and depression as well. 

Such forecasts can give families a general idea of how to plan for the years ahead. “No matter what the outcome is going to be, that unknown is really challenging for families,” says Anne Arnett, a child psychologist at the University of Washington in Seattle. “When you can take away the unknown, or at least give them some idea of what to expect over time, that can be an intervention in and of itself to help families prepare.” The predictions can also point clinicians to therapies that enable children to build on their strengths as they try to ease the children’s difficulties. “There’s a lot of variability in brain growth, and it’s really worth pursuing early interventions to try to support that brain growth,” Arnett says.

Read more here at Spectrum. 

Study finds toddlers with ASD do not differ in progress made in comparison of two treatment types

A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that the type of one-on-one treatment plans delivered to toddlers, aged 12-30 months, diagnosed with autism spectrum disorder (ASD) did not lead to any significantly different outcomes. Neither the type of evidence-based intervention provided, nor the number of hours of therapy were shown to have an impact.

The treatments, or intervention methods, delivered by specialized staff to the very young, during the study were either the Early Intensive Behavioral Intervention (EIBI) or Early Start Denver Model (ESDM). The researchers found negligible overall effects on receptive or expressive language development, nonverbal abilities, or autism symptom severity after one year of direct intervention, which also included twice-monthly parental coaching. 

"Our results should reassure parents who do not have access to the exact treatment type or the number of treatment hours that they would ideally like their recently diagnosed toddlers to receive," said Sally Rogers, PhD, lead author of the study and Professor Emeritus at the UC Davis Department of Psychiatry and Behavioral Sciences, and the MIND Institute. "Given the lack of differences across these four groups, it may well be that it's the common elements rather than the differences that are resulting in children's similar progress."

Read more here. 

We examined the research evidence on 111 autism early intervention approaches. Here’s what we found.

We organised the dizzying range of interventions out there into nine categories. Categorising them this way can help parents, clinicians and policy makers find a common language.

The nine categories are:

1. behavioural interventions (such as Early Intensive Behavioural Intervention)
2. developmental interventions (such as Paediatric Autism Communication Therapy) 
3. naturalistic developmental and behavioural interventions (such as Early Start Denver Model)
4. sensory-based interventions (such as Ayres Sensory Integration®, or sensory “diets”)
5. technology-based interventions (such as apps or gaming-style interventions);
6. animal-assisted interventions 
7. cognitive behaviour therapy 
8. Treatment and Education of Autistic and related Communication-handicapped Children (the TEACCH program) and
9. other interventions that do not fit in these categories.

Read more here. 

Low standards corrode quality of popular autism therapy

 Rapid growth and inadequate standards in the ‘applied behavior analysis’ industry may put vulnerable children in the hands of poorly prepared technicians.

Read more here at Spectrum. 

Cannabis and autism, explained

Over the past decade, autistic people and their families have increasingly experimented with medical marijuana and products derived from it. Many hope these compounds will alleviate a range of autism-related traits and problems. But scientists are still in the early stages of rigorous research into marijuana’s safety and effectiveness, which means that people who pursue it as treatment must rely mostly on anecdotal information from friends and message boards for guidance.

Here we explain what researchers know about the safety and effectiveness of cannabis for autism and related conditions

Read more here at Spectrum. 

Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder

The purpose of this report is to describe a set of practices that have clear evidence of positive effects with autistic children and youth. The report is the third iteration of a systematic review that has examined the intervention literature (extending the coverage to articles published between 1990 and 2017.) 

Think of it as a guide, not a Bible. The criteria for inclusion are not particularly high: 

Hence, "Sensory Integration" made it in with a total of three studies. 


Read the document here. 

New Autism Study: Gluten-free Diet Does Not Help Autistic Children

The new study, just published in the Journal of Autism and Developmental Disorders, is the first randomized, well-controlled study of gluten-free diets in children with autism. The scientists, all from the University of Warsaw, Poland, recruited 66 children, and assigned half of them at random to a gluten-free diet. The other half were given a normal diet, with at least one meal a day containing gluten, for 6 months. The children ranged from 3 to 5 years old. After 6 months, the scientists evaluated all children using multiple standardized measurements of autistic behavior.

The results were very clear: the study found no difference between the diets. None of the core symptoms of ASD were different between children in the two groups, and there were no differences in gastrointestinal symptoms either. 

Read more here. 

Psychopharmacology and Autism Spectrum Disorder

Read more here. 

STUDY SHOWS POPULAR AUTISM INTERVENTION DOESN'T BOOST COMMUNICATION SKILLS AS WELL AS CLAIMED

A popular and respected intervention for young people with autism may not necessarily result in the benefits often claimed, especially in improving communication skills, researchers at the University of Kansas have found. While pivotal response treatment, known as PRT, can be effective in improving certain skills, a review of published research on the treatment has shown evidence does not support claims that it improves untaught communication skills.

Read more here. 

How much behavioral therapy does an autistic child need?

In 1987, psychologist Ole Ivar Lovaas reported that the optimal ‘dose’ for an autism therapy he had developed was 40 hours a week. The intensive therapy, a type of applied behavior analysis (ABA), led to “normal” functioning for 9 of 19 children with autism in his study, he said1. Just 10 hours of the therapy produced small benefits. Small controlled trials of Lovaas’ therapy, however, did not fully replicate his findings on dose2,3.

The form of ABA Lovaas tested has become the most widely used autism therapy — despite controversy about its approach and findings — and 40 hours became a treatment goal for many families. ABA agencies typically market services at that intensity. And this year, that goal was formalized by the Behavior Analyst Certification Board, which recommended 30 to 40 hours of treatment per week for autistic children who need help in several areas, such as cognition, communication or social functioning. (They recommend fewer hours for children with fewer needs.)

Receiving 40 hours of weekly therapy is essentially a full-time job for a 3-year-old.

Still, people tend to believe that, regardless of the treatment, more is always better. But is it?

Read more here at Spectrum. 

Studies of autism treatments lack standard yardsticks

Clinical trials of autism treatments rarely use a consistent set of tools to measure efficacy, a new study suggests1. Instead, researchers generally design questionnaires specific to their study goals, and 69 percent of these tools are used only once.

The lack of consistency could obscure positive results. “Losing even one treatment that could possibly be helpful, just because we don’t use the right instruments, is a big loss,” says study investigator Natascia Brondino, assistant professor at the University of Pavia in Italy.

This variability also makes it difficult to compare treatments, or even the same treatment across studies.

Read more here at Spectrum. 

Therapy improves speech in autistic children with language delay

A behavioral therapy called pivotal response treatment (PRT) boosts the communication skills of autistic children with language delay better than do standard speech and autism therapies, a small study suggests1.

PRT therapists use various strategies to motivate autistic children to talk during play. For instance, they may name a toy that a child shows interest in, but hand it over only if the child then requests it by name. They also teach parents to use similar strategies in their daily routines.

The treatment has been shown to improve communication skills and ease autism traits when therapists implement it2. It is also effective when trained parents deliver it3. The new work explores its effectiveness when both parents and therapists are involved, as the therapy’s creators intended.

Read more here at Spectrum. 

ASD Intervention: How Do We Measure Effectiveness?

Question 1: “What behaviors should change as a result of the intervention?”

Virtually any ASD intervention that is truly effective will result in observable change in behavior. For example, a speech intervention may very well result in increased spoken language (e.g., novel words, greater rate of utterances). An academic intervention should result in specific new academic skills (e.g., independent proficiency with particular math operations). An exercise purported to decrease the occurrence of challenging behavior will, if effective, result in a lower rate of specific challenging behaviors (e.g., tantrums, self-injury). 

As “consumers” of ASD interventions, you and your family member have every right to expect that the marketer will identify specific, objective, and measurable changes in behaviors that indicate treatment efficacy. Scientists refer to such definitions as “operational definitions” – these are definitions that are written using observable and measurable terms. If the marketer insists on using ill-defined, “fuzzy” descriptions of treatment benefit (e.g., “increased sense of well-being”, “greater focus and intentionality”, an increased “inner balance” or “regulation”), then “Buyer Beware!” These kinds of outcome goals will leave you guessing about treatment effect. Insist that operational definitions of target behaviors be agreed upon prior to starting the intervention.

Read more here at ASAT. 

Supplements, worms and stool: How families are trying to game the gut to treat autism traits

Every two weeks, Alex Chinitz swallows the strangest of brews: fruit juice with 20 to 30 larvae of Hymenolepis diminuta mixed in. That fancy Latin word is the name of a helminth — a tapeworm, to be precise — that can grow to 30 centimeters.

Research on the microbiome — the collection of microbes that live in and on the body — is still in its infancy, says Mauro Costa-Mattioli, professor of neuroscience at Baylor College of Medicine in Houston, Texas. Just the idea that microbes could influence the brain was “unthinkable a few years ago,” he says. The pace of research has accelerated over the past few years, but microbe-based medicines are not yet in sight.

Still, many parents and clinicians are not waiting. A growing number are experimenting with specialized diets, probiotics, stool transplants and parasites, trying to game the gut to address core autism traits. About 19 percent of physicians surveyed in 2009 said they recommend probiotics to the autistic people they treat. An unpublished survey of 100 people found 2 adults trying stool transplants at home for autism.

These unregulated therapies can be costly and unpredictable — and they pose significant, even life-threatening, risks. Home-grown stool transplants and parasites, for example, can introduce deadly infections. This month, the U.S. Food and Drug Administration issued a safety alert about fecal transplantsafter two recipients contracted an antibiotic-resistant infection and one of them died.

Read more here at Spectrum. 

Tech firm’s ‘Superpower Glass’ for autism not so super, experts say

A California-based healthcare company is poised to market its ‘Superpower Glass,’ high-tech eyeglasses that use software intended to improve autistic children’s social skills.

The company, Cognoa, announced in February that the U.S. Food and Drug Administration had granted the therapy ‘breakthrough status,’ meaning it can move quickly through the agency’s approval process. And an open-label clinical trial published in March suggests that the technology temporarily improved the social skills of a group of 40 autistic children1.

But some experts, including several who declined to speak on the record, say the trial was poorly designed and the effects small and temporary.

According to parent reports, autistic children who used the glasses improved more on a social-skills portion of the Vineland Adaptive Behavior Scales than did controls. But there was no significant difference between the two groups on another test of social skills, and on two emotion-recognition tests. And six weeks after the treatment ended, the children’s social improvements on the Vineland had disappeared.

“It’s hard to know how much to make of it,” says James Rehg, professor of interactive computing at the Georgia Institute of Technology in Atlanta. “It doesn’t look like at this point it was a slam dunk.”

Rehg says he would have more faith in the treatment if the effects had lasted or if the children had shown improvement on the other tests.

One reason the results are weak may be that the treatment targets the wrong problem, some experts say: Autistic children may not have trouble recognizing emotions.

Read more here at Spectrum. 

Children who outgrow autism label end up with other diagnoses

Nearly all children who lose their autism diagnosis have other conditions, such as anxiety and language and behavioral disorders, a new study suggests1. Many also require support at school.

About 9 percent of children diagnosed with autism later don’t meet criteria for the condition. Parent reports and some medical records have suggested that these children often still have other issues, such as language problems and attention difficulties.

Read more here at Spectrum. 

Long-term benefit of Microbiota Transfer Therapy on autism symptoms and gut microbiota

Many studies have reported abnormal gut microbiota in individuals with Autism Spectrum Disorders (ASD), suggesting a link between gut microbiome and autism-like behaviors. Modifying the gut microbiome is a potential route to improve gastrointestinal (GI) and behavioral symptoms in children with ASD, and fecal microbiota transplant could transform the dysbiotic gut microbiome toward a healthy one by delivering a large number of commensal microbes from a healthy donor.

We previously performed an open-label trial of Microbiota Transfer Therapy (MTT) that combined antibiotics, a bowel cleanse, a stomach-acid suppressant, and fecal microbiota transplant, and observed significant improvements in GI symptoms, autism-related symptoms, and gut microbiota.

Here, we report on a follow-up with the same 18 participants two years after treatment was completed. Notably, most improvements in GI symptoms were maintained, and autism-related symptoms improved even more after the end of treatment. Important changes in gut microbiota at the end of treatment remained at follow-up, including significant increases in bacterial diversity and relative abundances of Bifidobacteria and Prevotella. Our observations demonstrate the long-term safety and efficacy of MTT as a potential therapy to treat children with ASD who have GI problems, and warrant a double-blind, placebo-controlled trial in the future

Read more here at Nature.

False hope for autism in the stem-cell underground

Parents of autistic children are paying tens of thousands of dollars for stem cell therapies that often use medical waste. Despite the dangers, regulators have been slow to act.

Read more here at Spectrum. 

After Other Options Fail, A Family Tries Medical Marijuana For Son With Autism

"The research basis for a lot of the hopes for using medical marijuana for autism - it's really minimal," says David G. Amaral, a psychologist and research director of the M.I.N.D. Institute at University of California, Davis. (M.I.N.D. stands for Medical Investigation of Neurodevelopmental Disorders.) "I mean there's very meager clinical evidence for effectiveness."

Meager evidence because there have been no large clinical trials to determine whether marijuana or its compounds are effective — or safe — in treating children with autism.

"Unless there's a clinical trial done in the right way and showing the safety, No. 1, of the drug," Amaral says, "and then the benefit of it ... it may be that families are wasting their time — and maybe exposing their family members to a potentially dangerous situation."

That's not to say that marijuana doesn't hold promise for autism treatment. In fact, the first large-scale clinical trial in the U.S. to test the idea is just getting underway at Montefiore Medical Center in New York.

Read or listen to more here at NPR.