Evidence-Based Practice for Children with Autism

Evidence-Based Practice for Children with Autism

Supporting children and youth with autism spectrum disorder (ASD) requires individualized and effective intervention strategies. It is very important for parents and professionals to be knowledgeable about evidence-based approaches to adequately address the needs of students with autism and to help minimize the gap between research and practice. Although the resources for determining best practices in autism are more extensive and accessible than in previous years, professionals face the challenge of being able to accurately identify these evidence-based strategies. 

The rapid growth of the scientific literature on ASD has also made it difficult to stay up-to-date with research findings. Unfortunately, many proponents of ASD treatments make claims of cure or recovery, but provide little scientific evidence of effectiveness. These interventions appear in books and on websites that describe them as “cutting-edge therapies” for autism. Consequently, professionals and families need to have a reliable source for identifying practices that have been shown, through scientific research, to be effective with children and youth with ASD. Evidence-based research provides a starting point for determining what interventions are most likely to be effective in achieving the desired outcomes for an individual.

Developing and implementing effective interventions and treatment for students with autism requires that they be evidence-based and supported by science. All interventions and treatments should be based on sound theoretical constructs, robust methodologies, and empirical studies of effectiveness. An evidence-based practice can be defined as a strategy, intervention, treatment, or teaching program that has met rigorous peer review and other standards and has a history of producing consistent positive results when experimentally tested and published in peer-reviewed professional journals. It excludes evidence that is supported by anecdotal reports, case studies, and publication in non-refereed journals, magazines, internet, and other media outlets.

Systematic Research Reviews

Systematic research reviews play an important role in summarizing and synthesizing the knowledge base for determining what interventions are most likely to be effective in achieving the desired outcomes for children and youth with ASD. For example, ASAT-Association for Science in Autism Treatment provides research synopses of a wide range of autism treatments for families and professionals to make informed choices before considering intervention/treatment options. Likewise, there are two major resources available to school professionals that provide a listing, along with systematic reviews, of evidence-based interventions and practices for students with ASD: the National Autism Center’s (NAC; 2015) second phase of the National Standards Project (NSP-2), which reviewed research studies to identify established interventions for individuals with ASD, and the NationalProfessional Development Center on Autism Spectrum Disorders (NPDC on ASD,2015; Wong et al., 2014), which also analyzed numerous research studies and identified evidence-based practices for students with autism. Although both reviews were conducted independently, their findings are very similar and reflect a convergence across these two data sources. According to the NAC and NPDC, the following are evidence-based practices/interventions for ASD:

Behavioral Interventions: These interventions are based on behavioral principles and are designed to reduce problem behavior and teach functional alternative behaviors.

Cognitive Behavioral Intervention: Cognitive behavioral interventions are designed to change negative or unrealistic thought patterns and behaviors with the goal of positively influencing emotions and life functioning.

Modeling: This intervention relies on an adult or peer providing a demonstration (live and video) of a target behavior to the person learning a new skill, so that person can then imitate the model.

Naturalistic Interventions: These interventions 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.

Parent-Implemented Intervention: Parents provide individualized intervention to their child to improve/increase a wide variety of skills such as communication, play, or self-help, and/or to reduce challenging behavior. Parent training can take many forms, including individual training, group training, support groups, and training manuals.

Pivotal Response Training (PRT): PRT is a naturalistic intervention model that targets pivotal areas of a child's development, such as motivation, responsivity to multiple cues, self-management, and social initiations.

Peer-Mediated Instruction: Teachers/service providers systematically teach typically developing peers to interact with and/or help children and youth with ASD to acquire new behavior, communication, and social skills. Common names include peer networks, circle of friends, and peer-initiation training.

Scripting: This intervention involves developing a verbal and/or written script about a specific skill or situation which serves as a model for the child with ASD.

Self-Management: Self-management 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.

Social Narratives: These interventions identify a target behavior and involve a written description of the situation under which specific behaviors are expected to occur. The most well-known story-based intervention is Social Stories™.

Social Skills Training: Social skills training involves group or individual instruction designed to teach learners with ASD ways to appropriately interact with peers, adults, and other individuals.

Visual Support: Any visual display that supports the learner engaging in a desired behavior or skills independent of prompts. Examples of visual supports include pictures, written words, schedules, maps, labels, organization systems, scripts, and timelines.

Systematic reviews synthesize the results of multiple studies and provide school professionals with summaries of the best available research evidence to help guide decision-making and support intervention practice. It must be stated, however, that 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. Because no two individuals are alike, no one program exists that will meet the needs of every person with autism. Additionally, children with autism learn differently than typical peers or children with other types of developmental disabilities. The success of the intervention depends on the interaction between the age of the child, his or her developmental level and individual characteristics, strength of the intervention, and competency of the professional. Each child is different and what works for one may not work for another. 

Research findings are only one component of evidence-based practice to consider when selecting interventions. The selection of a specific intervention should be based on goals developed from a comprehensive developmental assessment as well as professional judgment and the values and preferences of parents, caregivers, and the individual with ASD. Lastly, parents and professionals should exercise caution when considering interventions and treatments that (a) are based on overly simplified scientific theories; (b) make claims of recovery and/or cure; (c) use case reports or anecdotal data rather than scientific studies; (d) lack peer-reviewed references or deny the need for controlled research studies; or (e) are advertised to have no potential or reported adverse effects. 

Adapted from Wilkinson, L. A. (2017).  A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

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Key References

ASAT - Association for Science in Autism Treatment

National Autism Center (2015). Findings and conclusions: National standards project, phase 2.Randolph, MA: Author.

National Professional Development Center on Autism Spectrum Disorders. (2015). Evidence-BasedPractices.

Wilkinson, L. A. (2017). A best practice guide to assessment and intervention for autism spectrum disorder in schools (Second Edition), London and Philadelphia: Jessica Kingsley Publishers.

Wong, C., Odom, S. L.,Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S… Schultz, T. R. (2014). Evidence-based practices for children, youth, and young adults with AutismSpectrum Disorder. Chapel Hill: The University of North Carolina, Frank PorterGraham Child Development Institute, Autism Evidence-Based Practice ReviewGroup.

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books,  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a text in the APA School Psychology Book Series,  Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).