Sunday, April 10, 2011

Best Practice Report: Evidence-Based Interventions/Treatments

Supporting children with ASD requires individualized and effective intervention strategies. With few exceptions, the evidence base for interventions for students with ASD is in the formative stage. Robust, impartial research is needed to determine which interventions are most effective and with which students. While children with ASD share a number of similar behavioral and other characteristics, every child is unique. Intervention approaches must be sensitive to their uniqueness and individuality. The following effectiveness ratings for selected interventions and treatments should be considered a “snapshot” in time and are intended to reflect the scientific evidence published in peer-reviewed journals. Each intervention is rated for effectiveness, both positive and negative, providing a classification which identifies the level of scientific evidence which supports or does not support its use. For example, interventions that are “well established” have strong empirical support in the scientific literature. Interventions having an “emerging and effective” level of support are considered promising and have become or are emerging as important features of many programs. However, they require additional objective verification. Those with a lack of empirical data (no evidence) do not infer that the intervention or treatment is ineffective, but rather that efficacy has not been objectively demonstrated or validated. Lastly, those rated as having “negative evidence,” may cause harm and are not recommended for use.
Well Established:
Early Intensive Behavioral Intervention (EIBI)               
Effective Evidence:
Positive Behavior Support (PBS)
Picture Exchange Communication System (PECS)
Cognitive Behavioral Therapy (CBT)
Peer-Mediated Strategies
Emerging and Effective Evidence:
Social Stories                                                                               
Visual Schedule/Support
Incidental Teaching                                                                     
Pivotal Response Training (PRT)
Social Skills Training                
No Evidence:
Sensory Integration Therapy (SI)
Negative Evidence/Not Recommended:
Auditory Integration Training (AIT)
Facilitated Communication (FC)
It is important to note that there is considerable overlap between the many different treatment approaches. For example, strategies based on applied behavioral analysis (ABA) are an integral part of many interventions, such as early intensive behavioral intervention (EIBI), picture exchange communication system (PECS), and pivotal response treatment (PRT). The success of the intervention depends on the interaction between the age of the child, his or her developmental level and individual characteristics, the strength of the treatment and competency of the interventionalist. These ratings are not intended as an endorsement or a recommendation as to whether or not a specific intervention is suitable for a particular child with ASD. Each child is different and what works for one may not work for another. Different approaches to intervention have been found to be effective for children with autism, and no comparative research has been conducted that demonstrates one approach is superior to another. The selection of a specific intervention should be based on goals developed from a comprehensive assessment. A description of the aforementioned interventions and treatments are available from Wilkinson (2010). A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools.

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