A Treatment for Autism Severity Doesn't Work

Some treatments for autism have been efficacious for noncore symptoms, such as irritability (N Engl J Med 2002; 347:314), but not for core symptoms (JW Psychiatry Jan 11 2010). Given the increasing prevalence of autistic spectrum disorders (ASDs) and the improved ability to diagnose them in preschool children, the study of early interventions is a public health priority. To examine the effect of parent-mediated, communication-focused treatment, which uses trained therapists and videography to improve parent–child interactions, researchers randomized 152 participants with core autism (age range, 24–59 months) to the intervention plus treatment as usual (TAU) or TAU only.

Randomization was stratified by age (above or below 42 months) and baseline severity. The intervention was administered in 2-hour sessions, biweekly for 6 months and then monthly for another 6 months. Therapists' fidelity to treatment was tested. At 13 months, blinded evaluators conducted comprehensive assessments. Analyses controlled for demographic factors and baseline language abilities and severity scores.

Treatment fidelity was high, and dropout was similarly low in both groups (4%). At 13 weeks, the groups did not differ significantly in autism severity, the primary outcome. The percentage of changed diagnoses was similar in both groups (ASD diagnoses: intervention group, 30%; TAU-only group, 24%; nonspectrum: intervention group, 4%; TAU-only group, 7%). The intervention group showed significant improvement from baseline on parent–child interactions (synchrony, dual attention, and children's initiations), a secondary outcome.