Are Children Severely Affected by Autism Spectrum Disorder Underrepresented in Treatment Studies? An Analysis of the Literature.
Amy Stedman, Briana Taylor, Michael Erard and 2 others
PMID 30536112WHAT IT FOUND
Autism treatment studies increasingly exclude severely affected children.
Communication ability is rarely reported, and when it is, dozens of different measures are used. This makes it difficult to know if published trials actually apply to non-verbal or intellectually disabled patients.
Key findings
01Each year between 1990 and 2013, the likelihood of including severely affected children in autism treatment studies decreased by 16.5%.
02Communication ability was reported in less than half of the studies, and when reported, 32 different measures were used across the literature.
03Pharmacological studies were nearly three times more likely to include severely affected individuals than other types of treatment studies.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The analysis focused only on treatment studies for children, so findings may not apply to adult research or non-intervention studies. Single-subject designs were excluded, which are common in behavioral interventions and often involve severely affected children. The definition of 'severely affected' relied on a liberal operationalization (impairment in at least one domain), which might include some participants who are not severely affected in all areas. The time period covered was 1991 to 2013, so recent trends in inclusion may differ.
The easy way to misread this
Do not assume that a lack of severely affected participants means the treatment is ineffective for them. The exclusion reflects research bias and difficulty in recruitment, not necessarily a lack of clinical benefit. However, the evidence for these treatments in severe populations is weak because it is often missing.