Virginia Commonwealth University
May 10, 2010
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By Sharon Jones, M.Ed., and Sue Palko, M.Ed.

“Educating children with autism is a challenge for both parents and teachers. Each child with autism has unique abilities and challenges, and if taught properly by trained teachers using evidence-based practices, can develop to his or her full academic potential.” – Autism Advocate, 2007

One of the most critical and difficult roles of families and practitioners working with young children with autism spectrum disorder (ASD) is to wade through the multitude of available treatment strategies and then make decisions about which ones to use. It’s important not only to know which strategies are effective based on evidence, but also to make decisions about which treatments to use based on the individualized needs of each child and their families. These decisions can make the difference between whether or not the child makes progress. Given the current prevalence rate that one out of 91 children have ASD (Yavorcik, 2009), coupled with evidence that early intervention is effective (Diefendorf & Goode, 2005), there is an even greater need for families and practitioners to have research readily available so these decisions can be made as early as possible in the child’s life.

Young boy smiling at parents.

Evidence-based research evaluates the effectiveness of interventions for children with autism.

What is an evidence-based practice?

Decisions about whether or not an intervention works cannot be simply based on reports of success. We wish it were that easy, but it’s not. Evidence-based practices are those that have significant and convincing experimental support. These decisions are complex and require an in-depth analysis of research. In 2009, two different centers examined evidence-based practices in autism and published documents explaining their findings. The first one discussed in this article is the National Autism Center’s National Standards Report, to be referred to as “the research report” (National Autism Center, 2009). The second is a set of briefs published by the National Professional Development Center on Autism Spectrum Disorders (National Professional Development Center on Autism Spectrum Disorders, 2009). We will refer to these documents as “the briefs.” The purpose of both of these reports is to provide information that will guide families and practitioners in making treatment decisions.

What treatment categories were identified in the research report?

The research report provides information about the level of evidence that exists in support of current treatments for individuals with ASD. More than 7,000 research abstracts were reviewed during this project. The committee developed the Scientific Merit Rating Scale (SMRS) as a means of objectively evaluating research methods to determine if an intervention was effective for participants with ASD. The SMRS considered the following dimensions to determine the extent to which the interventions are effective: research design, measurement of the dependent and independent variable, participant eligibility and treatment generalization. The interventions were also rated to determine if the treatment effects were beneficial, ineffective, adverse or unknown. Four critical factors of evidence-based practices determined by SMRS were research findings, professional judgment, values and preferences of families, and the ability of treatment providers to correctly implement the intervention.

Because there are so many different types of interventions available for children with autism, intervention strategies were grouped into treatment categories. Similar treatments were grouped together in the same category. For example, the category of modeling includes live modeling and video modeling. A nice feature of this report is that each treatment category is described, along with a list of specific interventions, skills increased, behaviors decreased and age categories in which favorable outcomes were identified. Table 1 lists established interventions that are shown to work with children with ASD from birth through age 5, although they might also be appropriate for older children and youth. The full research report includes descriptions of each category and practices for other ages.

Established interventions as identified through the “National Standards Report:

Table 1

Intervention 0 to 2 years of age 3 to 5 years of age

Behavioral package

X

X

Antecedent package

 

X

Comprehensive behavioral treatment for young children

X

X

Joint attention intervention

X

X

Modeling

 

X

Naturalistic teaching strategies

X

X

Peer training package

 

X

Pivotal response treatment

 

X

Schedules

 

X

Self-management

 

X

What evidence-based interventions were identified by the briefs?

The briefs also developed a list of evidence-based practices. Efficacy had to be established through peer-reviewed research in scientific journals using research designs that were randomized or quasi-experimental, single subject or used a combination of evidence.

After reviewing the literature, the briefs identified 24 practices as evidence-based (see Table 2). Unlike the research report, they did not place them into categories of established, emerging, unestablished or ineffective/harmful. They simply listed the 24 interventions that met their definition and were shown to be effective for individuals with ASD. Although we are only listing interventions that are shown to work with young children with ASD, they might also be appropriate for older children and youth. It should be noted that the age categories are not the same in the briefs as in the research report. If you would like more information on any of the interventions listed in Table 2, click on the intervention name and it will take you to the brief that outlines the intervention, describes how it can be used for individuals with ASD and provides step-by-step directions for implementation.

Interventions as identified by the National Professional Development Center on Autism Spectrum Disorder:

How can you begin to use these practices in your work with young children with ASD?

Now that you know what the current evidence says about interventions that are proven successful for children with ASD, where do you go from here? Explore the links to the research to learn more about each intervention. Then, consider the child’s characteristics and the needs of the child and family. Meet with the child’s intervention team, including the family, to discuss the commonalities between the child and the proposed intervention. Develop a plan for implementing the new strategy that includes setting goals, developing a timeline, identifying materials needed, defining the adults’ roles and collecting data. Remember, there is no single intervention that will work for all children. But, the bigger your toolkit of evidence-based strategies, the greater success you will have as a practitioner or family member!

References
Autism Society of America (2007). 2008 presidential election ASA questions for the candidates. Autism Advocate, 4th Ed. Retrieved from http://www.autism-society.org/site/DocServer/asa-presidential-questions.pdf?docID=7302

Diefendorf, M., & Goode, C. The long-term economic benefits of high quality early childhood intervention programs. NECTAC Clearinghouse on Early Intervention and Early Childhood Special Education. Chapel Hill, NC: NECTAC.

National Autism Center (2009). National standards report. Randolph, M. A.: Author.

The National Professional Development Center on Autism Spectrum Disorders (2009). Evidence based practices. Retrieved from http://autismpdc.fpg.unc.edu/content/evidence-based-practices

Yavorcik, Carin (2009). National children’s health survey report finds autism prevalence now one in 91. Retrieved from http://www.autism-society.org/site/News2?page=NewsArticle&id=15065&news_iv_ctrl=1882

 

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