Little evidence supports autism treatment options in adolescents

Vanderbilt University researchers studying interventions for adolescents and young adults with autism are reporting today that there is insufficient evidence to support findings, good or bad, for the therapies currently used.

Although the prevalence of autism is on the rise, much remains to be discovered when it comes to interventions for this population, the researchers concluded.

“Overall, there is very little evidence in all areas of care for adolescents and young adults with autism, and it is urgent that more rigorous studies be developed and conducted,” said Melissa McPheeters, Ph.D., M.P.H., director of Vanderbilt’s Evidence-Based Practice Center and senior author of the report, a systematic review of therapies published by the Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ).

Zachary Warren, Ph.D., director of the Vanderbilt Kennedy Center’s Treatment and Research Institute for Autism Spectrum Disorders, said, “There are growing numbers of adolescents and adults with autism in need of substantial support. Without a stronger evidence base, it is very hard to know which interventions will yield the most meaningful outcomes for individuals with autism and their families.”

Key findings:

The researchers systematically screened more than 4,500 studies and reviewed the 32 studies published from January 1980 to December 2011 on therapies for people ages 13 to 30 with autism spectrum disorders. They focused on the outcomes, including harms and adverse effects, of interventions, including medical, behavioral, educational and vocational.

• Some evidence revealed that treatments could improve social skills and educational outcomes such as vocabulary or reading, but the studies were generally small and had limited follow-up.

• Limited evidence supports the use of medical interventions in adolescents and young adults with autism. The most consistent findings were identified for the effects of antipsychotic medications on reducing problem behaviors that tend to occur with autism, such as irritability and aggression. Harms associated with medications included sedation and weight gain.

• Only five articles tested vocational interventions, all of which suggested that certain vocational interventions may be effective for certain individuals, but each study had significant flaws that limited the researchers’ confidence in their conclusions. The researchers’ findings on vocational interventions will be featured in the Aug. 27 issue of Pediatrics.

As recently as the 1970s, autism was believed to affect just one in 2,000 children, but newly released data from the Centers for Disease Control and Prevention (CDC) estimates that one in 88 children has an autism spectrum disorder. Boys with autism outnumber girls 5-to-1, which estimates that one in 54 boys in the United States have autism.

“With more and more youth with autism leaving high school and entering the adult world, there is urgent need for evidence-based interventions that can improve their quality of life and functioning,” said Julie Lounds Taylor, Ph.D., assistant professor of Pediatrics and Special Education and lead author of the report.

Additional investigators on this report include Jeremy Veenstra-VanderWeele, M.D., assistant professor of Psychiatry, Pediatrics and Pharmacology and Kennedy Center investigator; Dwayne Dove, M.D., Ph.D., fellow in Developmental-Behavioral Pediatrics; Nila Sathe, M.S., M.L.I.S., program manager, Institute for Medicine and Public Health; and Rebecca Jerome, M.L.I.S., M.P.H., assistant director, Eskind Biomedical Library.

Their research, published in the report, Interventions for Adolescents and Young Adults with Autism Spectrum Disorders, was funded by the Agency for Healthcare Research and Quality’s Effective Health Care Program and conducted through Vanderbilt’s Evidence-Based Practice Center.