More therapy for autistic children isn't always better
By Louise Kinross
More intensive therapy for autistic children is not associated with better outcomes in development, according to a new study in JAMA Pediatrics.
The meta-analysis of 144 early childhood intervention studies involved over 9,000 children up to the age of eight. Behavioural, developmental, naturalistic developmental behavioural, and technology-based approaches were included, and daily intensity, duration, and the total number of hours over the course of the intervention were studied.
“We failed to find robust evidence that intervention amount was associated with intervention effects, regardless of intervention approach or outcome type,” the authors write.
"While some children and families may thrive with intensive intervention, other children may not," says lead author Micheal Sandbank, an assistant professor in the Department of Health Sciences at the UNC School of Medicine.
The scientists do not suggest that children not receive treatment and support. "There's probably a minimum amount of intervention needed to provide any benefit at all, and an optimal amount that is dependent on the child," Micheal says. “Unfortunately, right now, we don’t have clear evidence as to what that amount should be."
Clinicians routinely recommend 20 to 40 hours per week, but the evidence supporting that amount of therapy "is not as robust as it might seem in guidelines, and… this recommendation should not be [providers’] default," Micheal says.
When children don't thrive with intense therapy it's important that parents and clinicians don't stick with it because they believe it's the gold standard.
"Providers need to remember that high amounts of intervention compete with other important childhood activities like rest, recreation and participation in daily family and community routines,” Micheal says. She recommends "practitioners consider what amount of intervention would be developmentally appropriate for the child and supportive to the family."
The study did not determine the best dose of therapy. "Although met-analysis is a useful tool for looking across studies, it cannot offer definitive answers" on that question, Micheal says. “I'd like to see more primary studies, high quality randomized controlled trials that systematically examine the effects of intervention intensity separately from intervention approach. I’m writing a grant now to pursue that line of research.”
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