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).
Key References
ASAT - Association for Science in Autism Treatment
National Autism Center (2015). Findings and conclusions: National standards project, phase 2.Randolph, MA: Author.
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).
Key References
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.
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.
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).
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