Perry et al., 2008

Study DescriptionInterventionInclusion/Exclusion
Criteria/Population
Baseline MeasuresOutcomes
Author:
Perry et al., 2008

Country:
Canada

Practice setting:
Academic

Intervention setting: home, clinic, or child care center

Enrollment period:
NR
Program data:
2000–2006

Funding:
Ontario Ministry of Children and Youth Services
Author industry relationship disclosures:
NR

Design:
Retrospective case series
Intervention:
Ontario IBI, 20 to 40 hours a week throughout the year in a variety of settings (home, center, and integrated child care) using structured behavioral teaching based on the principles of applied behavior analysis duration ranged from 4 to 47 months (mean 18 months)

Assessments:
CARS, VABS, and cognitive (most commonly used: MSEL, BSID, WPPSI, SB-FE) “typically conducted by assessment staff of the central agency”(p.627). Seven categories of progress/outcomes were generated based on all available information including developmental rates, VABS ABC, cognitive standard scores, and CARS.

Groups:
G1: IBI
G1a: higher functioning (VABS ABC ≥ 60)
G1b: intermediate functioning (VABS ABC between 50 and 59)
G1c: lower functioning (VABS ABC ≤ 49)

Provider:
Instructor-therapists (virtually all had a college or university level education and all received same initial IBI training) who were supervised by Senior Therapists (had a Master’s degree and/or were Board Certified Behavior Analysts)

Measure of treatment fidelity reported:
No
Inclusion criteria:
  • entry assessment within 3 months of entry
  • another assessment (usually at exit)
  • diagnosis of autism or a disorder toward the severe end of the autism spectrum
Exclusion criteria:
  • see inclusion criteria
Age, mean/yrs (range in months):
4.5 (20–86)

Mental age, n, mean/months ± SD (range):
(Combined scores from MSEL, BSID, WPPSI, and SB:FE)
G1: 151, 22.92 ± 10.96 (3–60)
G1a: 44, 28.24 ± 11.46
G1b: 66, 21.51 ± 10.61
G1c: 33, 17.64 ± 6.84
P < 0.001

Gender, n (%):
M: 276 (83)
F: 56 (17)

Race/ethnicity, n (%):
NR

SES:
Maternal education: NR

Household income: NR

Diagnostic approach:
In Study

Diagnostic tool/method:
DSM-IV

Diagnostic category, n (%):
Autism 194 (58)
PDD-NOS 46 (14)
ASD/PDD 92 (28)

Other characteristics:
NR
Overall ratings:
CARS, n, mean ± SD:
G1: 275, 36.09 ± 5.09
G1a: 68, 33.48 ± 4.35
G1b: 105, 35.71 ± 4.43
G1c: 79, 38.91 ± 5.37

CARS symptom severity, n:
Not quite autism range: 24

Mild/moderate autism range: 145

Severe autism range: 106

VABS/ABC, n, mean age equivalent ± SD:
G1: 279, 16.81 ± 6.46
G1a: 72, 21.80 ± 7.96
G1b: 115, 16.16 ± 5.25
G1c: 9, 13.73 ± 3.73

VABS/ABC, n, mean standard score ± SD:
G1: 274, 54.77 ± 9.24
G1a: 70, 66.90 ± 6.76
G1b: 116, 54.55 ± 3.00
G1c: 86, 45.65 ± 3.30
Overall ratings:
CARS, n, mean ± SD:
G1: 275, 31.26 ± 5.31
P < 0.001
G1a: 68, 26.99 ± 4.93
P < 0.001
G1b: 105, 31.62 ± 4.14
P < 0.001
G1c: 79, 34.85 ± 4.61
P < 0.001
main effect of time: P < 0.001 reported reductions (P < 0.001) on each individual items of the CARS (with the exception of item XIV (P = 0.055))

CARS symptom severity changes, n (%):
Non-autism remained non-autism: 19 (79)
Non-autism to mild/moderate: 5 (21)
Mild moderate to non-autism: 59 (41)
Mild/moderate remained mild/moderate: 76 (52)
Mild/moderate to severe: 10 (7)
Severe to non-autism: 16 (15)
Severe to mild/moderate: 63 (59)
Severe remained severe: 27 (26)
Children initially scoring in autism range changed to milder category: 138 (50)
Co-interventions held stable during treatment:
NR

Concomitant therapies:
NR

N at enrollment:
G1: 332
G1a: 78
G1b: 126
G1c: 96

N at follow-up:
G1: 332
G1a: 78
G1b: 126
G1c: 96
Social skills:
VABS Socialization domain, n, mean age equivalent ± SD:
G1: 279, 13.71 ± 6.34
G1a: 72, 18.60 ± 7.62
G1b: 115, 13.15 ± 5.37
G1c: 91, 10.56 ± 3.50

VABS Socialization domain, n, mean standard score ± SD:
G1: 274, 56.69 ± 7.82
G1a: 70, 66.10 ± 8.68
G1b: 116, 55.49 ± 3.66
G1c: 86, 50.83 ± 2.47

Communication/ language:
VABS
Communication domain, n, mean age equivalent ± SD:
G1: 281, 15.65 ± 8.86
G1a: 72, 22.29 ± 12.01
G1b: 115, 14.33 ± 6.24
G1c: 92, 12.18 ± 5.54

VABS
Communication domain, n, mean standard score ± SD:
G1: 273, 53.92 ± 11.34
G1a: 70, 68.23 ± 11.09
G1b: 116, 52.47 ± 4.30
G1c: 85, 44.51 ± 4.54
VABS/ABC, n, mean age equivalent ± SD:
G1: 279, 29.71 ± 14.21
P < 0.001
G1a: 72, 43.70 ± 14.48
P < 0.001
G1b: 115, 28.12 ± 10.83
P < 0.001
G1c: 91, 20.83 ± 8.20
P < 0.001
main effect of time P < 0.001

VABS/ABC, n, mean standard score ± SD:
G1: 274, 56.26 ± 16.20
P = 0.02
G1a: 70, 75.79 ± 14.47
P < 0.001
G1b: 116, 54.28 ± 9.42
P = NS
G1c: 86, 43.69 ± 7.32
P = 0.007
main effect of time P < 0.001

Categories of progress/ outcome, n (%):
Average functioning:
G1: 32 (10.8)
G1a: 25 (32.5)
G1b: 5 (4.2)
G1c: 0

Substantial improvement:
G1: 43 (14.5)
G1a: 19 (24.7)
G1b: 16 (13.4)
G1c: 6 (6.5)
Adaptive behavior:
VABS Daily Living Skills domain, n, mean age equivalent ± SD:
G1: 282, 20.90 ± 6.70
G1a: 73, 24.19 ± 8.25
G1b: 115, 20.99 ± 6.16
G1c: 92, 18.29 ± 4.58

VABS Daily Living Skills domain, n, mean standard score ± SD:
G1: 274, 53.84 ± 12.10
G1a: 70, 66.36 ± 9.24
G1b: 116, 55.68 ± 5.24
G1c: 86, 41.99 ± 7.73

Motor skills:
VABS Motor domain, n, mean age equivalent ± SD:
G1: 167, 27.45 ± 7.59
G1a: 58, 28.71 ± 7.02
G1b: 69, 26.87 ± 7.60
G1c: 40, 26.63 ± 8.28

VABS Motor domain, n, mean standard score ± SD:
G1: 138, 66.33 ± 13.95
G1a: 52, 76.94 ± 12.41
G1b: 66, 61.92 ± 10.10
G1c: 20, 53.30 ± 9.29
Clinically significant improvement:
G1: 90 (30.4)
G1a: 18 (23.4)
G1b: 43 (36.1)
G1c: 28 (30.4)

Less autistic:
G1: 31 (10.5)
G1a: 4 (5.2)
G1b: 11(9.2)
G1c: 14 (15.2)

Minimal improvement:
G1: 25 (8.4)
G1a: 4 (5.2)
G1b: 7 (5.9)
G1c: 14 (15.2)

No change:
G1: 55 (18.6)
G1a: 5 (6.5)
G1b: 27 (22.7)
G1c: 22 (23.9)

Worse:
G1: 20 (6.8)
G1a: 2 (2.6)
G1b: 10 (8.4)
G1c: 8 (8.7)
P < 0.001

Social skills:
VABS
Socialization domain, n, mean age equivalent ± SD:
G1: 279, 24.28 ± 13.59
P < 0.001
G1a: 72, 36.65 ± 14.99
P < 0.001
G1b: 115, 22.58 ± 10.72
P < 0.001
G1c: 91, 16.79 ± 7.89
P < 0.001
main effect of time P < 0.001
Educational/ cognitive/ academic attainment:
FS IQ, n, mean ± SD:
G1: 127, 47.42 ± 19.47
G1a: 40, 62.05 ± 15.99
G1b: 56, 43.44 ± 17.28
G1c: 26, 31.08 ± 9.90

Rate of developmental score, n, mean ± SD:
G1: 278, 0.32 ± 0.12)
G1a: 72, 0.47 ± 0.12
G1b: 114, 0.31 ± 0.06
G1c: 91, 0.22 ± 0.06
VABS
Socialization domain, n, mean standard score ± SD:
G1: 274, 58.91 ± 12.07
P < 0.001
G1a: 70, 72.11 ± 13.11
P = 0.001
G1b: 116, 56.82 ± 7.69
P = NS
G1c: 86, 51.63 ± 4.87
P = NS
main effect of time P < 0.001

Communication/ language:
VABS
Communication domain, n, mean age equivalent ± SD:
G1: 281, 32.12 ± 19.94
P < 0.001
G1a: 72, 52.31 ± 19.09
P < 0.001
G1b: 115, 29.26 ± 15.85
P < 0.001
G1c: 92, 20.30 ± 11.95
P < 0.001
main effect of time P < 0.001
VABS
Communication domain, n, mean standard score ± SD:
G1: 273, 59.13 ± 2216
P < 0.001
G1a: 70, 86.00 ± 20.45
P < 0.001
G1b: 116, 55.14 ± 14.09
P < 0.022
G1c: 85, 43.09 ± 8.60
P = NS
main effect for time P < 0.001

Adaptive behavior:
VABS Daily Living Skills domain, n, mean age equivalent ± SD:
G1: 282, 32.60 ± 12.43
P < 0.001
G1a: 73, 42.21 ± 14.77
P < 0.001
G1b: 115, 32.50 ± 9.68
P < 0.001
G1c: 92, 25.24 ± 7.52
P < 0.001
main effect of time P < 0.001
VABS Daily Living Skills domain, n, mean standard score ± SD:
G1: 274, 50.68 ± 17.89
P < 0.001
G1a: 70, 69.26 ± 16.62
P = NS
G1b: 116, 50.89 ± 10.74
P < 0.001
G1c: 86, 36.00 ± 11.03
P < 0.001
main effect of time P < 0.001

Motor skills:
VABS Motor domain, n, mean age equivalent ± SD:
G1: 167, 43.52 ± 14.51
P < 0.001
G1a: 58, 50.98 ± 13.10
P < 0.001
G1b: 69, 42.12 ± 12.89
P < 0.001
G1c: 40, 35.13 ± 14.04
P < 0.001
main effect of time P < 0.001

VABS Motor domain, n, mean standard score ± SD:
G1: 138, 68.47 ± 20.56
P = NS
G1a: 52, 82.31 ± 18.10
G1b: 66, 62.08 ± 17.78
G1c: 20, 53.60 ± 13.72
main effect of time P = NS
Educational/ cognitive/ academic attainment:
Mental age (Combined scores from MSEL, BSID, WPPSI, and SB-FE) mean/months ± SD:
G1: 127, 41.40 ± 17.33
P < 0.001
G1a: 40, 54.77 ± 12.65
P < 0.001
G1b: 55, 38.40 ± 15.46
P < 0.001
G1c: 26, 25.56 ± 11.64
P = 0.002
main effect of time P < 0.001

Mental age changes, n (%):
Gain of more than 12 months: 77 (61)
Gain of 24 months or greater: 40 (32) Reduction of more than 12 months: 1 (0.8)
Remained within 12 month of intake level: 48 (38)

FS IQ mean ± SD:
G1: 127, 59.28 ± 27.34
P < 0.001
G1a: 40, 82.67 ± 21.12
P < 0.001
G1b: 56, 53.74 ± 22.52
P < 0.001
G1c: 26, 33.08 ± 15.44
P = NS
main effect for time P < 0.001
IQ changes, n (%):
Increased by 15 points or more: 49 (39)
Increased by 30 points or more: 22 (17)
Decreased by 15 or more points: 3 (2)
Remained within 15 points of initial score: 75 (59)

Rate of developmental score, n, mean ± SD:
G1: 278, 0.77 ± 0.76
P < 0.001
G1a: 72, 1.16 ± 0.95
P < 0.001
G1b: 114, 0.66 ± 0.59
P < 0.001
G1c: 91, 0.59 ± 0.69
P < 0.001
main effect of time P < 0.001

Developmental rate at or above typical development, n (%):
G1a: 38 (53)
G1b: 34 (30)
G1c: 14 (15)

Harms:
NR

Modifiers:
CARS: group × time interaction:
P = 0.004

FSIQ: group × time interaction:
P < 0.001
MA: group × time interaction:
P < 0.001

VABS
Communication age equivalent, standard scores: group × time interaction:
P < 0.001, P < 0.001

VABS Daily Living age equivalent, standard score: group × time interaction:
P < 0.001, P < 0.001

VABS
Socialization age equivalent, standard score group × time interaction:
P < 0.001, P < 0.001

VABS Motor age equivalent, standard score group × time interaction:
P < 0.001, P = NS

VABS/ABC age equivalent, standard score group × time interaction:
P < 0.001, P < 0.001.
Developmental rate, group × time interaction:
P = 0.006

From: Appendix C, Evidence Tables

Cover of Therapies for Children With Autism Spectrum Disorders
Therapies for Children With Autism Spectrum Disorders.
Comparative Effectiveness Reviews, No. 26.
Warren Z, Veenstra-VanderWeele J, Stone W, et al.

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