2011-11-12

Autism Treatments - American Academy of Pediatrics: relationship-based intervention evidence is lacking


Developmental Models


"Developmental models are based on use of developmental theory to organize hypotheses regarding the fundamental nature of ASDs and design approaches to address the deficits. 
Relationship-focused early intervention models include Greenspan and Wieder's developmental, individual-difference, relationship-based (DIR) model, Gutstein and Sheely's relationship-development intervention (RDI), and the responsive-teaching (RT) curriculum developed by Mahoney et al. The DIR approach focuses on (1) “floor-time” play sessions and other strategies that are purported to enhance relationships and emotional and social interactions to facilitate emotional and cognitive growth and development and (2) therapies to remediate “biologically based processing capacities,” such as auditory processing and language, motor planning and sequencing, sensory modulation, and visual-spatial processing. Published evidence of the efficacy of the DIR model is limited to an unblinded review of case records (with significant methodologic flaws, including inadequate documentation of the intervention, comparison to a suboptimal control group, and lack of documentation of treatment integrity and how outcomes were assessed by informal procedures) and a descriptive follow-up study of a small subset (8%) of the original group of patients. RDI focuses on activities that elicit interactive behaviors with the goal of engaging the child in a social relationship so that he or she discovers the value of positive interpersonal activity and becomes more motivated to learn the skills necessary to sustain these relationships. Some reviewers have praised the face validity of this model, which targets the core impairment in social reciprocity. However, the evidence of efficacy of RDI is anecdotal; published empirical scientific research is lacking at this time."




Complete work: AMERICAN ACADEMY OF PEDIATRICS, Management of Children With Autism Spectrum Disorders BY Scott M. Myers, MD, Chris Plauché Johnson, MD, MEd, the Council on Children With Disabilities.