Young children with pervasive developmental disorder were randomly assigned to intensive treatment or parent training. The intensive treatment group (7 with autism, 8 with pervasive developmental disorder not otherwise specified--NOS) averaged 24.52 hours per week of individual treatment for one year, gradually reducing hours over the next 1 to 2 years. The parent training group (7 with autism, 6 with pervasive developmental disorder NOS) received 3 to 9 months of parent training. The groups appeared similar at intake on all measures; however, at follow-up the intensive treatment group outperformed the parent training group on measures of intelligence, visual-spatial skills, language, and academics, though not adaptive functioning or behavior problems. Children with pervasive developmental disorder NOS may have gained more than those with autism.

To address methodological challenges in research on psychosocial interventions for autism spectrum disorder (ASD), a model was developed for systematically validating and disseminating interventions in a sequence of steps. First, initial efficacy studies are conducted to establish interventions as promising. Next, promising interventions are assembled into a manual, which undergoes pilot-testing. Then, randomized clinical trials test efficacy under controlled conditions. Finally, effectiveness studies evaluate outcomes in community settings. Guidelines for research designs at each step are presented. Based on the model, current priorities in ASD research include (a) preparation for efficacy and effectiveness trials by developing manuals for interventions that have shown promise and (b) initial efficacy studies on interventions for core features of ASD such as social reciprocity.

Discrete trial training (DTT) is a method for individualizing and simplifying instruction to enhance children's learning. For children with autism, DTT is especially useful for teaching new forms of behavior (e.g., speech sounds or motor movements that the child previously could not make) and new discriminations (e.g., responding correctly to different requests). DTT can also be used to teach more advanced skills and manage disruptive behavior. However, several cautions about DTT are noteworthy: First, the method must be combined with other interventions to enable children to initiate the use of their skills and display these skills across settings. Second, early in treatment, children with autism may require many hours of DTT per week, although controversy exists over precisely how much is appropriate. Third, to implement DTT effectively, teachers must have specialized training. Despite these limitations, DTT is one of the most important instructional methods for children with autism.

This study was designed to evaluate 1 year of intensive treatment for 4- to 7-year-old children with autism. An independent clinician assigned children to either behavioral treatment (n = 13) or eclectic treatment (n = 12). Assignment was based on availability of personnel to supervise treatment and was not influenced by child characteristics or family preference. The two treatment groups received similar amounts of treatment (M = 28.52 hours per week at the child's school). Children in the behavioral treatment group made significantly larger gains on standardized tests than did children in the eclectic treatment group. Results suggest that some 4- to 7-year-olds may make large gains with intensive behavioral treatment, that such treatment can be successfully implemented in school settings, and that specific aspects of behavioral treatment (not just its intensity) may account for favorable outcomes.

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IMPORTANCE Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials. OBJECTIVE To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior. DESIGN, SETTING, AND PARTICIPANTS This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91

This study extends findings on the effects of intensive applied behavior analytic treatment for children with autism who began treatment at a mean age of 5.5 years. The behavioral treatment group (n = 13, 8 boys) was compared to an eclectic treatment group (n = 12, 11 boys). Assignment to groups was made independently based on the availability of qualified supervisors. Both behavioral and eclectic treatment took place in public kindergartens and elementary schools for typically developing children. At a mean age of 8 years, 2 months, the behavioral treatment group showed larger increases in IQ and adaptive functioning than did the eclectic group. The behavioral treatment group also displayed fewer aberrant behaviors and social problems at follow-up. Results suggest that behavioral treatment was effective for children with autism in the study.

This evidence base update examines the level of empirical support for interventions for children with autism spectrum disorder (ASD) younger than 5 years old. It focuses on research published since a previous review in this journal (Rogers & Vismara, 2008). We identified psychological or behavioral interventions that had been manualized and evaluated in either (a) experimental or quasi-experimental group studies or (b) systematic reviews of single-subject studies. We extracted data from all studies that met these criteria and were published after the previous review. Interventions were categorized across two dimensions. First, primary theoretical principles included applied behavior analysis (ABA), developmental social-pragmatic (DSP), or both. Second, practice elements included scope (comprehensive or focused), modality (individual intervention with the child, parent training, or classrooms), and intervention targets (e.g., spoken language or alternative and augmentative communication). We classified two interventions as well-established (individual, comprehensive ABA and teacher-implemented, focused ABA þ DSP), 3 as probably efficacious (individual, focused ABA for augmentative and alternative communication; individual, focused ABA þ DSP; and focused DSP parent training), and 5 as possibly efficacious (individual, comprehensive ABA þ DSP; comprehensive ABA classrooms; focused ABA for spoken communication; focused ABA parent training; and teacher-implemented, focused DSP). The evidence base for ASD interventions has grown substantially since 2008. An increasing number of interventions have some empirical support; others are emerging as potentially efficacious. Priorities for future research include improving outcome measures, developing interventions for understudied ASD symptoms (e.g., repetitive behaviors), pinpointing mechanisms of action in interventions, and adapting interventions for implementation with fidelity by community providers.Autism spectrum disorder (ASD) is defined by difficulties with reciprocal social communication and stereotyped interests or behaviors (American Psychiatric Association [APA], 2013) that usually emerge in early childhood. About one third of children with ASD have delays in cognitive development and daily living skills (Autism and Developmental Disabilities Monitoring Network, 2014). Co-occurring behavior problems (tantrums, aggression, self-injury, impulsivity, anxiety, extreme food selectivity, insomnia) and medical conditions (e.g., seizure disorder, gastrointestinal disturbance) are also common. Although ASD almost always persists across the lifespan, early intervention can alleviate symptoms (Rogers & Vismara, 2008).ASD has a prenatal origin related to genetic risk and environmental events; however, the precise etiology has not been determined (Volkmar, Paul, Rogers, & Pelphrey, 2014). Although once considered rare, ASD is now estimated to occur in approximately 1 in 68 individuals (Autism and Developmental Disabilities Monitoring Network, 2014). It remains unknown whethe...