Consensus Panels

Rush & Frances (2000) developed the expert consensus guidelines for psychiatric and behavioural problems. Fifty-six behavioural and 51 pharmacological experts were invited to participate; 86 % and 88 % replied respectively. They asked the raters to rate a series of statements concerning a variety of psychosocial treatments.

When asked to rate appropriate assessment methods, direct observation and functional assessment were identified as first-line choices in the assessment of psychiatric and behavioural problems. When asked to identify the most appropriate methods of psychosocial interventions there were large and significant differences between different treatment methods. Applied behaviour analysis (ABA), managing the environment and client and family education all received average ratings of 8 on a 9-point scale. All identified as first-rank treatments and significantly more effective then other treatment methods. Cognitive behaviour therapy, classical behaviour therapy and supportative counselling were identified as second-rank treatments and received average ratings of approximately 5. Psychotherapy was identified as the least effective treatment and received an average rating of only 3. These results were broadly replicated for ratings of treatment of aggression and self-injury, psychiatric disorders and across individuals with mild or moderate and severe or profound intellectual disabilities. Thus, the results of the expert consensus guidelines provided strong support for differentiation between the effectiveness of different treatment methods and strong and uniform support for the effectiveness of behavioural methods over counselling and psychotherapy.

The New York Department of Health (1999a, 1999b, 1999c) conducted an expert panel review of the effectiveness of intervention for pre-school children with autism and pervasive developmental disorders. The guidelines were based on a systematic review of the scientific literature, involved operationalised criteria for including and excluding studies in the review and involved a panel of expert readers to identify and review the papers. A wide range of behavioural and non-behavioural interventions was identified. The review provided a rating of the status of their conclusions; for example some were identified as panel consensus and others were identified as evidence based. They gave their conclusions in unequivocal terms by stating that certain therapies were recommended or not recommended.

The panel concluded that early behavioural intervention for children was strongly recommended and should include at least 20 hours per week. Applied behaviour analysis was also identified as an effective method for young children with autism. The panel made recommendations concerning clear operational definitions of target behaviours, use of reinforcer assessments, functional assessments, planning for generalisation, parents and peer training and so on. They also recommended that ABA was an effective intervention to reduce mal-adaptive behaviours, to teach social interactions and promote language skills. The strength of the evidence for specific conclusions varied widely from a strong evidence base - at least to well-designed studies - to panel consensus. This is perhaps unsurprising given the very narrow age range that the panel reviewed.

The panel was also clear on the effectiveness of other interventions. Floor time, sensory integration therapy, music therapy, touch therapy, auditory integration therapy, facilitated communication, hormone therapies, immunological therapies, anti-yeast therapies, vitamin therapies and dietary therapies were all specifically not recommended for use with children with autism and pervasive developmental disorders (PDD) aged 0 to 3 years! There was no evidence base to support their use.



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