Gabriels et al., 2001 and 2007

Study DescriptionInterventionInclusion/Exclusion
Criteria/Population
Baseline MeasuresOutcomes
Author:
Gabriels et al., 2001 and 2007
Country:
US

Practice setting:
Academic

Intervention setting: home, school, clinic
Enrollment period:
NR
Funding:
Agency/NR
Author industry relationship disclosures:
NR
Design:
2001:
Retrospective cohort with some prospective data collection
2007: Prospective case series
Intervention:
Combination of variety of treatments (e.g., TEACCH, LEAP or DENVER Model) from community providers over a period of 37 months (1st follow up) or 5 years (2nd follow-up)

Assessments:
2001: Assessment records were requested, photocopied, placed in the participant’s file, and reviewed upon completion of testing

Participants, with parent(s) present, completed testing in up to 3 sessions; MSEL, PLS- III, & during 3rd session, subtests of Woodcock- Johnson Revised Tests of Achievement and ADOS- G

Participants were evaluated by a team of study evaluators, consisting of a psychology postdoctoral fellow, a psychology intern, and a speech-language clinical fellow

2007: Leiter International Performance Scale- Revised (LIPS-R), VABS, CCIF, Expressive One- Word Picture Vocabulary Test-Revised (EOWPVT- R), and PPVT-III
Inclusion criteria:
  • Current diagnosis of autistic disorder or PDD- NOS
  • At least 22 months post- diagnosis
  • Available standardized intellectual and/or language functioning scores at time of diagnosis
Exclusion criteria:
  • History of traumatic brain injury
  • History of seizure disorder, fragile X, or other known genetic or biologic problems
    No additional psychiatric disorders
Age at diagnosis, mean months ± SD (range):
30.6 ± 7.27 (20–47)
Age at 1st follow-up, mean months ± SD (range): 68.7 ± 10.11 (44– 88)
G1a: 69±9.3
G1b: 68±11.5
Mean age at 2nd follow- up: 11.42
Age at 2nd follow-up, mean years ± SD:
G1c: 10.69 ± 0.72
G1d: 10.88 ± 0.74
Mental age:
NR
Gender, n:
M: 12 (10 at 2nd follow-up)
F: 5 (4 at 2nd follow-up)

Race/ethnicity, n:
Anglo: 14 (at 1st and 2nd follow-up)
African American/Native American: 1
Hispanic: 1
Asian: 1 (1 non-Anglo ethnicity at 2nd follow-up)

SES:
Maternal education: NR
Educational/cognitive/academic attainment:
Cognitive quotient at diagnosis (n=16), mean ± SD (range):
57.81 ± 25.88 (25.00–128.00)
G1a: 68.50 ± 30.78
G1b: 47.12 ± 15.06
Communication/language:
Language quotient at diagnosis (n=15), mean ± SD (range):
42.46 ± 16.11 (5.00– 72.00)
G1a (n=7): 47.42 ± 12.48
G1b: 28.12 ± 18.43
Social skills:
VABS
Socialization at 1st follow-up, mean ± SD:
G1c: 64.75 ± 16.97
G1d: 38.50 ± 11.54

VABS
Socialization at 2nd follow-up, mean ± SD:
G1c: 84.38 ± 10.97
G1d: 39.33 ± 11.98

VABS
Socialization age equivalent at 2nd follow-up, mean years ± SD:
G1c: 5.54 ± 1.72
G1d: 1.78 ± 0.86

Communication/language:
Language quotient at 1st follow-up, mean ± SD (range): 57.64 ± 31.96 (16.00– 119.00)
G1a: 82.11 ± 22.23 (significant increase compared with baseline, P = 0.01)
G1b: 30.12 ± 11.61

EOWPT standard score at 2nd follow-up, mean± SD:
G1c: 112.13 ± 9.09
G1d: 59.83 ± 11.84 (t(12) = 9.38, P < 0.001, G1c vs. G1d)
Groups:
G1a: children with developmental IQ ≥64 at 1st follow-up
G1b: children with developmental IQ ≤ 48 at 1st follow-up
G1c: children with nonverbal intelligence (NVIQ) ≥ 97 at 2nd follow-up
G1d: children with NVIQ score ≤ 56 at 2nd follow-up

Provider:
Community providers; details not reported

Measure of treatment fidelity reported:
No

Co-interventions held stable during treatment:
Yes

Therapies at 1st follow-up (parent report data), n:
Structured home program:
G1a: 5
G1b: 5
Private speech therapy:
G1a: 9
G1b: 7
Private occupational therapy:
G1a: 5
G1b: 5
Current public special education classroom:
G1a: 5
G1b: 6
Current public integrated classroom with special education services:
G1a: 3
G1b: 2
Current public integrated classroom (no special education services):
G1a: 1
G1b: 0
Social tutoring:
G1a: 1
G1b: 0
Household income: NR

Hollingshead at 1st follow- up, mean ± SD (range):
56.25 ± 10.68 (27.00– 66.00)
G1a: 54.88 ±12.6040
G1b: 57.75 ± 8.61

Hollingshead at 2nd follow- up, mean ± SD:
G1c: 58.63 ± 4.17
G1d: 56.00 ± 8.07
Diagnostic approach:
In Study

Diagnostic tool/method:
Initial diagnosis by clinic multidisciplinary team including a psychiatrist or psychologist with extensive experience in diagnosing early childhood autism; children re-diagnosed at time of first follow-up study using ADOS-G

Diagnostic category at 1st follow-up, n:
Autism: 15
PDD-NOS: 2

Diagnostic category at 2nd follow-up, n:
Autism: 12
PDD-NOS: 2

Other characteristics:
Age began treatment, mean months ± SD:
G1a: 33 ± 8.7
G1b: 31 ± 5.9

Total hours of treatment per month at 1st follow-up, mean ± SD:
G1a: 103.22 ± 66.33
G1b: 76.25 ± 48.10

Mean school-based treatment hours/week ± SD at 2nd follow-up:
G1c: 31.2 ± 3.8
G1d: 33.8 ± 2.1
PPVT-III standard score at 2nd follow-up, mean ± SD:
G1c: 101.50 ± 12.62
G1d: 46.83 ± 16.74 (t(12) = 6.99, P < 0.001, G1c vs. G1d)

VABS Communication score at 1st follow- up, mean ± SD:
G1c: 92.63 ± 13.16
G1d: 37.17 ± 19.94

VABS Communication score at 2nd follow-up, mean ± SD:
G1c: 115.50 ± 7.93
G1d: 49.83 ± 27.12

VABS Communication age-equivalent at 2nd follow-up, mean years ± SD:
G1c: 8.49 ± 2.56
G1d: 2.46 ± 1.62

Adaptive behavior:
Adaptive quotient at 1st follow-up, mean ± SD
G1a: 80.77 ± 14.28
G1b: 37.75 ± 16.26
P ≥ 0.01
Vision therapy:
G1a: 2
G1b: 1
Music therapy:
G1a: 1*
G1b: 1
Cranio-sacral:
G1a: 1*
G1b: 0
Kinesiology:
G1a: 1*
G1b: 0
Homeopathy:
G1a: 1*
G1b: 0
Horseback riding therapy:
G1a: 1*
G1b: 0
Sensory learning therapy:
G1a: 1*
G1b: 0
*same child received all these therapies; additional details on treatment overlap not reported

School-based therapies at 2nd follow-up (parent report data), n:
Special education class only:
G1c: 0
G1d: 1
Integrated class (no special education):
G1c: 7
G1d: 0
Mixed (special education and integrated classes):
G1c: 1
G1d: 5
Speech therapy:
G1c: 4
G1d: 5
Occupational therapy:
G1c: 2
G1d: 4
1:1 paraprofessional:
G1c: 3
G1d: 3
Music therapy:
G1c: 0
G1d: 1
Social skills group:
G1c: 3
G1d: 1
Mean private treatment hours/week ± SD at 2nd follow-up:
G1c: 1.7 ± 2.4
G1d: 1.8 ± 3.2
VABS standard composite score at 2nd follow-up, mean ± SD:
G1c: 67.38 ± 16.24
G1d: 27.67 ± 9.35 (F(1,12) = 33.67, P < 0.001, G1c vs. G1d)

VABS raw composite, 1st follow-up, mean ± SD:
G1c: 238.25 ± 46.89
G1d: 127.00 ± 50.32 (P < 0.001, G1c vs. G1d)

VABS raw composite, 2nd follow-up, mean ± SD:
G1c: 300.75 ± 45.30
G1d: 128.00 ± 34.19 (P < 0.001, G1c vs. G1d)

VABS Daily Living at 1st follow-up, mean ± SD:
G1c: 80.13 ± 20.21
G1d: 51.33 ± 21.18

VABS Daily Living at 2nd follow-up, mean ± SD:
G1c: 109.25 ± 37.91
G1d: 63.83 ± 24.31

VABS Daily Living age equivalent at 2nd follow-up, mean/years ± SD
G1c: 7.77 ± 2.65
G1d: 3.35 ± 1.46
Private therapies at 2nd follow-up (parent report data), n:
Home trainer:
G1c: 1
G1d: 1
Speech therapy:
G1c: 0
G1d: 2
Occupational therapy:
G1c: 0
G1d: 1
Social tutoring/group:
G1c: 2
G1d: 1
Family therapy:
G1c: 2
G1d: 0
Parent support group:
G1c: 1
G1d: 1
Respite care:
G1c: 0
G1d: 5
N at enrollment:
17
N at 1st follow-up (at least 22 months post- diagnosis): 17
G1a: 9
G1b: 8

N at 2nd follow-up: 14
G1c: 8
G1d: 6
Educational/cognitive/academic attainment:
Cognitive quotient at 1st follow-up, mean ± SD (range): 62.94 ± 30.79 (25.00– 126.00)
G1a: 87.11 ± 20.50
G1b: 35.75 ± 9.51 (G1b significant decrease compared with baseline, p=.03)
G1a vs. G1b: P < 0.01

Academic quotient at 1st follow-up, mean ± SD:
G1a: 113.11 ± 30.58
G1b: 66.38 ± 18.86
P ≤ 0.01

Non-Verbal IQ at 2nd follow-up, mean ± SD
G1c: 110.13 ± 18.47
G1d: 43.17 ± 10.59

Non-Verbal IQ > adaptive ability
G1c: t(14) = 4.92, P < 0.001;
G1d: t(10) = 2.69, P = 0.02

Within G1c:
Age equivalent score for Socialization < communication subscale score (mean diff = 2.86, P = 0.006)
Within G1d: Daily Living age equivalent score > communication subscale (mean diff = 0.89, P = 0.004)

Harms:
NR

Modifiers:
Correlations between the number and intensity of individual, group, and total treatment hours and outcomes at 1st follow-up were all nonsignificant (P > 0.05)

Initial development IQ scores correlated significantly with 1st follow-up developmental IQ scores (r = 0.70, P < 0.01), language scores (r= 0.69, P < 0.01) academic scores (r = 0.74, P < 0.01) and adaptive functioning (r =0.57, P = 0.02)

Initial language scores were not significantly correlated with 1st follow-up outcome measures (P > 0.05)

Finance and business strains significantly greater in G1b vs. G1a (F (1,14) = 6.27, P = 0.025)
Trend toward significant difference (P = 0.06) between G1a and G1b regarding extended family social support, mean ± SD:
G1a: 9.22 ± 3.30)
G1b: 11.62 ± 0.52

Change in developmental IQ over time:
Significant interaction overall :F (1,15) = 17.26, P < 0.01
G1a showed significant increase in Developmental IQ from time 1 to 1st follow up (F = 10.46, P = 0.01)
G1b showed significant decrease in developmental IQ (F = 7.02, P =0.03)
At 1st follow-up, developmental IQ scores significantly different from each other (F = 48.51, P < 0.01)

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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