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November 9, 2020

Intervention Recommendations for Children With Autism in Light of a Changing Evidence Base

Author Affiliations
  • 1Department of Special Education, University of Texas at Austin, Austin
  • 2Lynch School of Education and Human Development, Boston College, Newton, Massachusetts
  • 3Vanderbilt Brain Institute, Vanderbilt Kennedy Center, Frist Center for Autism and Innovation, Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Pediatr. 2021;175(4):341-342. doi:10.1001/jamapediatrics.2020.4730

In the wake of a rapid transformation of the evidence base regarding autism interventions, the American Academy of Pediatrics (AAP) recently updated guidance on the identification, evaluation, and support of children with autism.1 This guidance is undoubtedly a useful resource for pediatricians serving this population. It does not, however, highlight some notable new evidence on the choice of intervention approach or provide specific recommendations regarding intervention intensity, although it does imply that more intensive services can generally be expected to yield greater improvements. At approximately the same time that AAP guidelines were updated, our team completed a systematic review and meta-analysis2 of all quasi-experimental and randomized studies (known to us) that evaluate any outcome of any intervention for young children (up to age 8 years) with autism. In this Viewpoint, we seek to augment the recent AAP statement by offering medical professionals a brief background on common intervention recommendations, a summary of recent findings, and corresponding additional guidance on intervention intensity and variety. While our recommendations align with several points made by the AAP working group, they diverge to some degree in their emphasis and description of the present evidence base on intervention approach and intensity for young children with autism.

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2 Comments for this article
Autism interventions
Charles brill, MD | Thomas Jefferson University
I did not see any mention of treating high functioning autistic patients (Asperger's) and others differently, or expecting different outcomes.
A Potential Ounce of Prevention of Need for Some Interventions
Frank Sterle Jr. |
I believe that much greater student-body understanding of Autism Spectrum Disorder — including high(er) and low(er) functioning autism — through school curriculum could simultaneously educate and exhibit/induce compassion towards students living 'on the spectrum'. It may also, by extension, result in a reduced need for interventions.

I would like to see secondary-high-school child-development science curriculum implemented, which would include psychology and neurodiversity lessons, albeit not overly complicated. It would explain to students how, among other aspects of the condition, people with ASD (including those with higher functioning autism) are often deemed willfully ‘difficult’ and socially incongruent — and mistreated
accordingly — when in fact such behavior is really not a choice. Maybe as a result, students with ASD feel compelled to “camouflage,” a term used to describe their attempts at appearing to naturally fit in, which is known to cause their already high anxiety and/or depression levels to worsen.

Autism spectrum disorder accompanied by adverse childhood experience trauma — unchecked chronic bullying, for example — can readily lead to chronic substance abuse as a form of self-medicating. If the adolescent is also highly sensitive, both the drug-induced euphoria and, conversely, the come-down effect or return to their burdensome reality will be heightened thus making the substance-use more addicting.

That could then require far more intensive intervention.