Recent statistics from the
Centers for Disease Control and Prevention (CDC) indicate that one in every 68
school-age children in the U.S. has an autism spectrum disorder (ASD). Over the
past 10 years the prevalence rates have risen steadily, from one in 150, to one
in 110, and now to one in every 68 children. This represents a 78 percent
increase in the number of children identified with an autism spectrum disorder
(ASD) over the past decade.
Families, educators, and
service providers are faced with an ever increasing amount of confusing and
often conflicting information about the myriad treatments and interventions
available for autism. Intervention approaches and nontraditional therapies for
ASD are routinely discussed by researchers, parents and professionals. Many
approaches feature testimonials, anecdotal, and unverified reports that promise
cures, or at the very least, dramatic improvement and recovery. Unfortunately, parents,
caregivers, educators, and practitioners are often exposed to unsubstantiated,
pseudoscientific theories, and related clinical practices that are ineffective
and compete with validated treatments. The time, effort, and financial
resources spent on ineffective treatments can also create an additional burden
on families and practitioners. As a result, there continues to be an urgent
need for evidence-based guidance on providing treatment to children and youth
with autism spectrum disorders (ASD). Understanding treatment options and
making informed decisions for children and youth with ASD are critical. How do
we differentiate scientifically validated treatment approaches from those that
are unproven and/or potentially ineffective? Where do parents and professionals
find credible, research-based information on the most effective treatments for autism
spectrum disorders (ASD)?
To answer these questions,
the National Autism Center completed an unprecedented multi-year project, the National Standards Project,
to establish a set of standards for effective, research-validated educational
and behavioral interventions for children and youth on the spectrum. The Project
included the support and guidance of an expert panel
composed of nationally recognized scholars, researchers, and other leaders
representing diverse fields of study. The culmination of this rigorous
multi-year endeavor represents the most comprehensive analysis available to
date about treatments for children and adolescents with ASD. The National Standards
Report provides a single, authoritative source of guidance for parents,
caregivers, educators, and practitioners to make informed treatment decisions and
distinguish research supported treatment approaches from treatments that are
unproven and/or potentially ineffective.
This groundbreaking report
covers a broad range of applied treatments and identifies the level of
scientific evidence available for each. It includes 775 research studies, the
largest number of studies ever reviewed. For the first time, service providers,
educators, caregivers and parents can find specific information about the age
groups, treatment targets, and diagnostic populations to which these treatments
have been applied. The findings include the identification of eleven (11)
“established’ treatments; twenty-two (22) “emerging” treatments; and five (5)
“unestablished” treatments. This information is especially important to service
providers, educators, caregivers and parents as it identifies evidence-based
treatments and provides standards and guidelines on making treatment choices
for children and adolescents with ASD. Interventions or treatments identified
as categories of “established” or effective treatments are listed below. More
detailed descriptions of each category are available from the National
Standards Report.
• Antecedent Package
(These interventions involve the modification of situational events that
precede the occurrence of a target behavior in order to increase the likelihood
of success or reduce the likelihood of problems occurring. Strategies include
applied behavior analysis (ABA) and positive behavior support).
• Behavioral Package (These
interventions are based on behavioral principles and are designed to reduce
problem behavior and teach functional alternative behaviors).
• Comprehensive Behavioral
Treatment for Young Children (These programs involve early behavioral
interventions that target a range of essential skills (e.g., communication,
social) and involve a combination of applied behavior analytic procedures
(e.g., discrete trial, incidental teaching). They are often termed ABA programs
or early intensive behavioral intervention).
• Joint Attention
Intervention (Joint attention refers to behavior of two individuals
simultaneously focusing on and object or activity. These interventions involve
building foundational skills involved in regulating the behaviors of others by
teaching a child to respond to the nonverbal bids of others or to initiate
joint attention interactions).
• Modeling (These
interventions rely on an adult or peer providing a demonstration of the target
behavior. The goal of modeling (live and video) is to correctly demonstrate a
target behavior to the person learning a new skill, so that person can then
imitate the model).
• Naturalistic Teaching
Strategies (These teaching strategies primarily involve child-directed
interactions to teach real-life skills (communication, interpersonal, and play
skills) in natural environments. Examples include incidental teaching, milieu
teaching, and embedded teaching).
• Peer Training Package (These
interventions facilitate growth for children with ASD by training peers on how
to initiate and respond during social interactions with a child on the spectrum.
Common names include peer networks, circle of friends, and peer-initiation
training).
• Pivotal Response
Treatment (This treatment is also referred to as Pivotal Response Teaching and focuses
on teaching children to respond to various teaching opportunities within their
own natural environment, and to increase independence from prompting. Pivotal behavioral
areas include motivation, self-initiation, and self-management).
• Schedules (This
intervention involves presentation of a task list to increase independence,
improve self-regulation skills, and allow the child to plan for upcoming activities.
Schedules may be presented in multiple formats (e.g., photos or pictures, written
or typed words, 3-D objects).
• Self-management (These strategies
involve teaching individuals with ASD to evaluate and record the
occurrence/nonoccurrence of a target behavior and secure reinforcement. The
objective is to be aware of and regulate their own behavior so they will
require little or no assistance from adults).
• Story-based Intervention
package (These interventions identify a target behavior and involve a written
description of the situation under which specific behaviors are expected to occur.
Most stories aim to improve perspective-taking skills and may be supplemented
with additional components (e.g., reinforcement, prompting, and discussion).
The most well known story-based intervention is Social Stories).
Treatment selection should
be made by a multidisciplinary team of individuals who are in the position to
evaluate the unique needs and history of the child or youth with ASD. The above
referenced “established” treatments have sufficient evidence of effectiveness
and should be given serious consideration by decision-making teams. It should
be noted, however, that research findings are not the only factor involved when
selecting an intervention. Professional judgment and the values and preferences
of parents, caregivers, and the individual are also important. Complete information
about the Project’s treatment effect ratings, Strength of Evidence
Classification System, limitations, and future directions for the scientific
community is available from the National
Standards Report.
The National Autism Center
is dedicated to serving children and adolescents with Autism Spectrum Disorders
(ASD) by providing reliable information, promoting best practices, and offering
comprehensive resources for families, practitioners, and communities. An
advocate for evidence-based treatment approaches, the Center identifies
effective programming and shares practical information with families about how
to respond to the challenges they face. The Center also conducts applied
research and develops training and service models for practitioners. Finally,
the Center works to shape public policy concerning ASD and its treatment
through the development and dissemination of National
Standards of Practice.
National Research Council
(2001). Educating children with autism. Committee on Educational Interventions
for Children Autism, Division of Behavioral and Social Sciences and Education.
Washington, DC: National Academy Press.
New
York State Department of Health Early Intervention Program (1999). Clinical
practice guideline: Report of the recommendations. Autism/Pervasive
developmental disorders, New York State Department of Health Early Intervention
Program assessment, and intervention for young children. Albany, NY: New York
State Department of Health Early Intervention Program.
Lee A. Wilkinson, PhD,
CPsychol, NCSP, AFBPsS is a licensed and nationally certified school
psychologist, chartered psychologist, registered psychologist, and certified cognitive-behavioral
therapist. He is also a university educator and trainer, and has published
widely on the topic of autism spectrum disorders both in the US and internationally. Dr. Wilkinson is author of
the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism
and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers.
He is also editor of a recent volume in the American Psychological Association
(APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based
Assessment and Intervention in Schools and author of the new book, Overcoming Anxiety and Depression on the Autism Spectrum: A
Self-Help Guide Using CBT.
