Evidence-Based Interventions for Autism

The National Autism Center has released its review and analysis of interventions for autism spectrum disorder (ASD) based on research conducted in the field from 2007 to 2012. The second phase of the National Standards Project (NSP2) provides an update to the summary of empirical intervention literature evaluated by Phase 1 of the National Standards Project (or NSP1) published in 2009. The National Standards Project is the only systematic review of ASD interventions for individuals across the lifespan based on behavioral and educational studies.

The primary goal of the Project was to provide critical information about which interventions/treatments have been shown to be effective for children, adolescents, and young adults with ASD. Nationally recognized experts in autism, as well as other leaders representing diverse fields of study, were involved in both phases of the National Standards Project and guided the process of evaluation. Dozens of article reviewers analyzed 1,165 studies related to interventions for ASD throughout both phases of the project. The combined the results of Phases 1 and 2 have produced the largest compilation of studies reviewed to date.

Interventions

The interventions were subsequently categorized as 1) Established, and producing beneficial outcomes known to be effective; 2) Emerging, with some evidence of effectiveness, but still requiring more research, and 3) Unestablished, and having little or no evidence of effectiveness. NSP2 updated the original findings, added information, and determined whether any of the Emerging interventions in NSP1 had moved into the Established or Unestablished categories.

For children, adolescents, and young adults under 22 years of age, the researchers identified fourteen (14) “Established’ interventions; eighteen (18) “Emerging” interventions; and thirteen (13) “Unestablished” interventions. 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. The following interventions (alphabetically) were identified as falling into the “Established” level of evidence and have the most research support, produce beneficial outcomes, and are known to be effective.

• Behavioral Interventions
• Cognitive Behavioral Intervention 
• Comprehensive Behavioral Treatment for Young Children
• Language Training (Production)
• Modeling
• Natural Teaching Strategies
• Parent Training
• Peer Training 
• Pivotal Response Training
• Schedules
• Scripting
• Self-Management
• Social Skills Training
• Story-based Intervention

“The National Standards Project is an ongoing effort designed to give educators, families, practitioners, and organizations the information and resources they need to make informed choices about effective interventions that will offer individuals with ASD the greatest hope for their futures,” said Hanna C. Rue, Ph.D., BCBA-D, Executive Director of the National Autism Center.

Implications

It is important to note that the NSP2 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. The document cautions readers that “research findings” are only one component of evidence-based practice to consider when selecting interventions. NSP2 is not intended to dictate which interventions can or cannot be used for individuals with ASD. Moreover, it should not be assumed that these interventions will universally produce positive outcomes for all individuals with ASD. The researchers also note that intervention selection is complicated and should be made by a team of individuals who can consider the unique needs and history of the individual with ASD, along with his or her environment. Likewise, the judgment of the professionals with expertise in ASD must be taken into consideration in the decision-making process, together with stakeholder values and preferences. 
 

The report is available for free download at: http://www.nationalautismcenter.org/national-standards-project/phase-2/

About the National Autism Center

The National Autism Center is May Institute’s Center for the Promotion of Evidence-based Practice. It is a nonprofit organization dedicated to serving children and adolescents with autism spectrum disorder (ASD) by providing reliable information, promoting best practices, and offering comprehensive resources for families, practitioners, and communities. For more information about the National Autism Center, please visit http://www.nationalautismcenter.org/.

Lee A. Wilkinson, PhD, 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 the 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).

Schools Need Improved Definitions & Evaluation Procedures for Autism

The dramatic increase in the number of students qualifying for special education under autism in our schools may be due, in part, to vague definitions together with ambiguous, variable, and irrelevant evaluation procedures, according to a study published in the journal, Autism Research and Treatment. The study examined the definition of autism published by each state education agency (SEA) and the District of Columbia, as well as SEA evaluation procedures for determining student eligibility for autism. The researchers compared components of each SEA definition from two authoritative sources: DSM-IV-TR and IDEA-2004.

The results indicated that many more SEA definitions incorporate IDEA-2004 features than DSM-IV-TR features. However, despite similar foundations, SEA definitions of autism displayed considerable variability. Many of the definitions were too vague to be of much use. Evaluation procedures were found to vary even more across SEAs. There often was little concordance between the definition (what autism is) and evaluation procedures (how autism is identified). Definition components often were not addressed by evaluation features, even in a cursory way. One of the least recommended evaluation features was the requirement to administer an autism-specific evaluation as part of the eligibility process. Of the SEAs that included an autism assessment in the evaluation process, none specified the use of a recognized instrument such as the Autism Diagnostic Observation Schedule (ADOS) or the Childhood Autism Rating Scales (CARS). Although several of these SEAs did indicate the required use of a state-created autism checklist, none gave any reference to a source or psychometric characteristics of those checklists

Recommendations for state and federal policy changes are discussed. For example, the researchers suggest that the publication of DSM-5 provides SEAs with the opportunity to expand and update their current definition of autism. They note that the DSM-5 criteria for autism spectrum disorder (ASD) encompass all of the elements stated by the current IDEA definition. The DSM-5 also recognizes the salience of sensory processing problems and co-occurring (comorbid) disorders (e.g., ADHD). The study recommends that SEAs consider the DSM-5 criteria for ASD as they consider revisions to their state definition of autism and corresponding procedures by which assessors will provide data for eligibility determination. Likewise, IDEA-2004 is overdue for Congressional reconsideration and possible amendment, so there is an opportunity to also update and clarify the federal educational definition of autism. Improved, more specific definitions and evaluation procedures will enable SEAs and school districts to better serve students with autism and more efficently allocate resources.

Malinda L. Pennington, Douglas Cullinan, and Louise B. Southern, “Defining Autism: Variability in State Education Agency Definitions of and Evaluations for Autism Spectrum Disorders,” Autism Research and Treatment, vol. 2014, Article ID 327271, 8 pages, 2014. http://dx.doi.org/10.1155/2014/327271

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)