Evidence-Based Practices

What are Evidence-Based Practices?

Evidence-based practices (EBP) for individuals with autism are therapies and treatments that have undergone a thorough research and review process by professionals in the field, and have been found to be effective for treating various symptoms of autism.  Choosing treatments that are evidence-based provides the best chance for improving outcomes for an individual with autism. Knowing the difference between treatments that are established as evidence-based compared to emerging treatments or those that are unestablished, can help parents, family, caregivers, teachers and other professionals choose the best possible treatment options.

Who Determines What is Evidence-Based?

There are two main organizations who have independently reviewed the scientific literature and research on treatments for autism, and provided reports on treatments that are considered evidence based.

The National Standards Project published their first report in 2009 based on research and data from 1957-2007. They updated this report in 2015 to include research and data from 2007-2012. They are currently in the process of reviewing research and data from 2012-2018, with a plan to release that report in 2021. In their second report, they also included research on treatments for individuals age 22+.

The National Professional Development Center on Autism Spectrum Disorder, also reviewed scientific literature and research, publishing a report based on data from 1997-2007 in their initial report. This was updated in their second review to include research from 1990-2011, with plans for a third report including data through 2017 to be released in the coming year. These reports only provide information on evidence-based treatment for individuals age 0-21.

The National Standards Project, conducted by the National Autism Center at May Institute, is a comprehensive review of the scientific evidence for autism treatments. The goal of this project is to reduce uncertainty around autism treatment, and provide guidelines for how to make choices about interventions.

Phase 1

The first phase of the National Standards Project looked at educational and behavioral intervention literature for the treatment of autism between 1957 and the fall of 2007. All of this literature was put through a standardized review process, and a list of established, emerging and unestablished treatments for individuals with autism was created.  The Phase 1 report was released in 2009.

Phase 2

In 2015 the National Standards Project released Phase 2, which included research that was conducted between 2007 and 2012, essentially providing an update on treatments from when Phase 1 was completed. Findings from the Phase 1 report were updated, and the “emerging” treatments were reviewed to determine if they now met criteria for “established” treatments, or should fall into the “unestablished” treatments. Additionally, interventions for individuals age 22 and older were also reviewed and categorized as established, emerging, or unestablished, which was never done previously.

Types of Treatments

Established Intervetions

Interventions that are described as “established” have been shown through numerous research studies over many years to be an effective treatment for individuals with autism. These treatments have been thoroughly studied, tested and reviewed and clearly demonstrate positive effects when used in the treatment of individuals with autism.

Emerging Interventions

Interventions that are described as “emerging” have one or more studies that suggest they may produce favorable outcomes. However, before they can be described as “established”, there needs to be additional high quality studies to show that consistently show these interventions are effective for individuals with autism.

Unestablished Interventions

Interventions that are described as “unestablished” have little or no evidence in the scientific literature to determine if they are effective treatments for individuals with autism. Individuals should not assume that these interventions are effective in any way, and because there is little to no scientific evidence about these treatments there is no way to rule out the possibility that they are ineffective or even harmful.

Treatments for Ages 0-22

Established Interventions

There are 14 Established Interventions that have been thoroughly researched and have sufficient evidence to confidently state they are effective:

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

Emerging Interventions

There are 18 treatments that have been reviewed and classified as Emerging Interventions, meaning there is need for further research before being considered established interventions:

  • Augmentative and Alternative Communication Devices
  • Developmental Relationship-based Treatment
  • Exercise
  • Exposure Package
  • Functional Communication Training
  • Imitation-based Intervention
  • Initiation Training
  • Language Training (Production & Understanding)
  • Massage Therapy
  • Multi-component Package
  • Music Therapy
  • Picture Exchange Communication System
  • Reductive Package
  • Sign Instruction
  • Social Communication Intervention
  • Structured Teaching
  • Technology-based Intervention
  • Theory of Mind Training

Unestablished Interventions

There are 13 treatments that have been reviewed and classified as Unestablished Interventions. These treatments have little to no evidence to allow conclusions to be drawn about their effectiveness, and there is no way to rule out the possibility that these interventions are harmful or ineffective:

  • Animal-assisted Therapy
  • Auditory Integration Training
  • Concept Mapping
  • DIR/Floor Time
  • Facilitated Communication
  • Gluten-free/Casein-free diet
  • Movement-based Intervention
  • SENSE Theatre Intervention
  • Sensory Intervention Package
  • Shock Therapy
  • Social Behavioral Learning Strategy
  • Social Cognition Intervention
  • Social Thinking Intervention

Treatments for Ages 22+

Established Interventions

The only intervention to be identified as Established for individuals ages 22 years and older is Behavioral Interventions. The Behavioral Intervention category consists of applied behavior analytic interventions to increase adaptive behaviors and decrease challenging behaviors.

Emerging Interventions

There is one treatment that has been reviewed and classified as an Emerging Intervention, meaning there is need for further research before being considered established interventions: Vocational Training Package

Unestablished Intervention

There are 4 treatments that have been reviewed and classified as Unestablished Interventions. These treatments have little to no evidence to allow conclusions to be drawn about their effectiveness, and there is no way to rule out the possibility that these interventions are harmful or ineffective:

  • Cognitive Behavioral Intervention Package
  • Modeling
  • Music Therapy
  • Sensory Integration Package

The National Professional Development Center for Autism Spectrum Disorder, is a comprehensive review of literature and scientific research on treatments for autism. The initial report focused on research dating from 1997-2007, a ten-year time span. In this initial report, they found 24 focused intervention practices that met criteria for being evidence-based. They only classified treatments as evidence-based, and did not list those that were “emerging” or “unestablished”.

In the second review of the literature, research articles dating back to 1990, and up through 2011, were included in the review. Additionally, a broader and more rigorous review process was put in place, included a standard evaluation process for the research. This report was released in 2014 and includes 27 interventions considered evidence-based, with plans for an updated report to be released in the coming year.

These reports also only reviewed treatments for individuals with autism age 0-21, there is no review of literature on treatments for adults.

Treatments for Ages 0-21

Evidence Based Treaments

The following treatments are considered evidence-based:

  • Antecedent-based intervention
  • Cognitive behavioral intervention
  • Differential reinforcement of Alternative, Incompatible, or other Behavior
  • Discrete trial teaching
  • Exercise
  • Extinction
  • Functional behavior assessment
  • Functional communication training
  • Modeling
  • Naturalistic intervention
  • Parent-implemented intervention
  • Peer-mediated instruction and intervention
  • Picture Exchange Communication System
  • Pivotal response training
  • Prompting
  • Reinforcement
  • Response/interruption/redirection
  • Scripting
  • Self-management
  • Social narratives
  • Social skills training
  • Structured play group
  • Task analysis
  • Technology-aided instruction and intervention
  • Time delay
  • Video modeling
  • Visual support

 

Practices with Some Support

These interventions either did not have enough studies to meet criteria to be considered evidence-based, were all conducted by the same research group, did not include enough participants across studies, or included idiosyncratic behavior intervention packages for participants:

  •  Aided language modeling
  • Auditory integration training
  • Behavioral momentum intervention
  • Collaborative coaching
  • Cooperative learning groups
  • Direct instruction
  • Exposure
  • Handwriting Without Tears
  • Independent work systems
  • Joint attention-symbolic play instruction
  • Music intensity
  • Music therapy
  • Reciprocal imitation training
  • Removal of restraints
  • Schema-based strategy instruction
  • Self-regulated strategy development writing intervention
  • Sensory diet
  • Sensory integration and find motor intervention
  • Sentence-combining technique
  • Test taking strategy instruction
  • Theory of mind training
  • Toilet training
  • Touch-point instruction
  • Touch therapy