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Two New AHRQ Reports Address Autism Therapies, Fetal Surgery

April 7, 2011

Two new reports came out of the AHRQ Evidence-Based Practice Center at Vanderbilt this week, one a review of the effectiveness of various therapies for children with autism spectrum disorders, and the other a technical brief on maternal-fetal surgical procedures.

I’m always enthused to see new reports coming out of this EPC, because even if I haven’t personally worked on the topic, my colleagues have – and they’re great, smart folks. And, hey, the gracious acknowledgement in the autism report doesn’t hurt, either. 🙂 [page iv]

The autism review looked at literature from the last 10 years in order to evaluate therapies in children ages 2-12 years with autism spectrum disorders. The therapies considered include behavioral, educational, drug, speech/language, dietary, alternative, and other interventions.

The body of literature available on this topic seems to be lacking – of the 159 studies considered for the review, the authors characterize the quality of only 13 as good, while 90 were considered poor quality; they note that “The needs for continuing improvements in methodologic rigor in the field and for larger multisite studies of existing interventions are substantial.” The overall conclusion was:

Medical interventions including risperidone and aripiprazole show benefit for reducing challenging behaviors in some children with ASDs, but side effects are significant. Some behavioral and educational interventions that vary widely in terms of scope, target, and intensity have demonstrated effects, but the lack of consistent data limits our understanding of whether these interventions are linked to specific clinically meaningful changes in functioning.

Because so many interventions were considered, I don’t want to try to detail them all here, but the full report is freely available as a PDF for those who are interested.

The maternal-fetal surgery report looked at the last 30 years of literature on fetal surgical procedures for congenital diaphragmatic hernia, cardiac malformations, myelomeningocele, obstructive uropathy, sacrococcygeal teratoma, twin-twin transfusion syndrome, and thoracic lesions. Not too surprisingly, a need for longer term and better studies was found – much of the literature in this area consists of case studies and cohorts, with randomized trials being rare. The authors explain:

While developing rapidly, research on fetal surgical procedures has not achieved the typical level of quality of studies and aggregate strength of the evidence used to reach definitive conclusions about care and policy. Overall momentum is toward more robust research and rigorous, more consistent documentation of outcomes over longer periods of time.

In other words, the existing literature is not ideal, but we think it’s going to get better.

One item of concern I’d like to highlight is the authors’ finding that “Near absence of maternal outcome assessment, including a significant lack of data on future maternal reproductive health, is especially concerning.”

It’s a fairly technical report, but is also freely available for those interested in more details on the state of the science in fetal surgery for each of the aforementioned conditions.

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