Compare and Contrast

Evidence Based Practice for Children, Youth and Young Adults wit ASD

S ince the discovery of autism as a human condition by Kanner (1943) and Asperger (1944) in the 1940s, individuals responsible for education and care of children and youth with autism spectrum disorder (ASD) have striven to provide effective practices and programs. Such efforts continue today. The increased prevalence of ASD has intensified the demand for effective educational and therapeutic services, and intervention science is now providing evidence about which practices are effective. The purpose of this report is to describe a process for the identification of evidence-based practices (EBPs) and also to delineate practices that have sufficient empirical support to be termed “evidence-based.” In this introduction, we will briefly review the current conceptualization of ASD, explain the difference between focused intervention practices and comprehensive treatment models, provide a rationale for narrowing our review to the former, describe other reports that have identified evidence-based practices, briefly describe our first review of the literature (Odom, Collet-Klingenberg, Rogers, & Hatton, 2010), and lastly provide the rationale for conducting an updated review of the literature and revision of the former set of practices identified. In Chapter 2, we describe in detail the methodology followed in searching the literature, evaluating research studies, and identifying practices. In Chapter 3, the practices are described along with the type of outcomes individual practices generate and the age of children for whom the outcomes were found. In Chapter 4, we summarize the findings, discuss their relationship to other reviews, compare the current review process to the previous process, identify limitations of this review, and propose implications of study results for practice and future research. In the Appendix, each practice is described and specific studies that provide empirical support for the practice are listed. The increased prevalence of ASD has intensified the demand for effective educational and therapeutic services, and intervention science is now providing evidence about which practices are effective. 2 Wong, Odom, Hume, Cox, Fettig, Kucharczyk, Brock, Plavnick, Fleury & Schultz Autism Spectrum Disorder: Diagnostic Criteria The definition of autism has evolved over the years. Early on, Kanner (1943) noted that autism was characterized by failure to develop social relationships and a need for sameness. The characteristics, stated slightly differently, continue to define the condition today. In the United States, the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA, 1994, 2013) has provided the most well accepted diagnostic criteria, and as this report goes into print, the criteria have changed. In the fourth edition of the manual (DSM IV), Autistic Disorder was an established condition defined by social, language, and behavioral characteristics, but there were several other conditions that shared similar characteristics [i.e., Asperger syndrome, Rett’s syndrome, and Pervasive Developmental Disorders, Not Otherwise Specified (PDD-NOS)]. These diagnostic classifications were grouped under a broader classification called Pervasive Developmental Disorders (American Psychiatric Association, 1994). With the advent of DSM 5, there is only one diagnostic classification, termed Autism Spectrum Disorder. Similar to the earlier diagnostic classification, ASD is identified by two primary diagnostic markers: difficulties in social communication and restricted or repetitive behaviors and interests. Examples of difficulties in social communication include challenges in social reciprocity, nonverbal social behaviors, and establishment of social relationships. Restrictive and repetitive behaviors include stereotypic behavior or speech, excessive adherence to routines, and highly fixated interests. Rather than specify severity of ASD, the DSM 5 has the option of describing the level of support an individual would need. In addition, in the DSM 5, co-occurring conditions, such as intellectual disability or attention deficit hyperactive disorder, may also be diagnosed when a diagnosis of ASD is made. In the DSM IV, this overlap was not allowed. Because our literature review spans several decades and several editions of the DSM, we have included studies whose participants are identified as having autism, autistic disorder, ASD, Asperger syndrome, or PDD-NOS. In addition, we have included studies in which participants may also have had co-occurring conditions such as intellectual disability, speech/language impairment, seizure disorder, sensory impairment, and attention deficit hyperactivity disorder. Demographic Information The prevalence of ASD, as noted, has increased markedly over the past two decades, rising from 2 per 10,000 in 1990 to between 1 in 50 and 1 in 88 children (Blumberg, et al., 2013; Centers for Disease Control and Prevention, 2012) according to the latest report from the U.S. Centers for Disease Control and Prevention. ASD is diagnosed about three times more frequently in boys than in girls. Intellectual disability was once thought to be a condition that typically accompanied ASD; Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder 3 however, current estimates are that 35% of individuals with ASD score above the IQ cutoff (i.e., around 70 depending on the test) for intellectual disability (Dykens & Lense, 2011). Intervention Approaches Two broad classes of interventions appear in the research literature (Smith, 2013), and we have identified them as comprehensive treatment models and focused intervention practices. Although the current review concentrated on the latter class of interventions, it is important to describe both in order to distinguish the two. Comprehensive Treatment Models Comprehensive treatment models (CTMs) consist of a set of practices designed to achieve a broad learning or developmental impact on the core deficits of ASD. In their reivew of education programs for children with autism, the National Academy of Science Committee on Educational Interventions for Children with Autism (National Research Council, 2001) identified 10 CTMs. Examples included the UCLA Young Autism Program by Lovaas and colleagues (Smith, Groen, & Winn, 2000), the TEACCH program developed by Schopler and colleagues (Marcus, Schopler, & Lord, 2000), the LEAP model (Strain & Hoyson, 2000), and the Denver model designed by Rogers and colleagues (Rogers, Hall, Osaki, Reaven, & Herbison, 2000). In a follow-up to the National Academy review, Odom, Boyd, Hall, and Hume (2010) identified 30 CTM programs operating within the U.S. These programs were characterized by organization (i.e., around a conceptual framework), operationalization (i.e., procedures manualized), intensity (i.e., substantial number of hours per week), longevity (i.e., occur across one or more years), and breadth of outcome focus (i.e., multiple outcomes such as communication, behavior, social competence targeted) (Odom, Boyd, Hall, & Hume, in press). Focused Intervention Practices In contrast, focused intervention practices are designed to address a single skill or goal of a student with ASD (Odom et al., 2010). These practices are operationally defined, address specific learner outcomes, and tend to occur over a shorter time period than CTMs (i.e., until the individual goal is achieved). Examples include discrete trial teaching, pivotal response training, prompting, and video modeling. Focused intervention practices could be considered the building blocks of educational programs for children and youth with ASD, and they are highly salient features of the CTMs just described. For example, peer-mediated instruction and intervention (Sperry, Neitzel, & EngelhardtWells, 2010), is a key feature of the LEAP model (Strain & Bovey, 2011). The purpose of the current review is to identify focused intervention practices that have evidence of effectiveness in promoting positive outcomes for learners with ASD. Focused 4 Wong, Odom, Hume, Cox, Fettig, Kucharczyk, Brock, Plavnick, Fleury & Schultz intervention practices that meet the evidence criteria specified in the next chapter are designated as evidence-based practices (EBP). Teachers and other service providers may select these practices when designing an individualized education or intervention program because of the evidence that they produce outcomes similar to the goals established for children and youth with ASD. Odom, Hume, Boyd, and Stabel (2012) described this as a technical eclectic approach and the National Professional Development Center on ASD has designed a process through which these practices could be systematically employed in early intervention and school-based programs (Cox et al., 2013). Previous Literature Reviews of EBPs for Children and Youth with ASD The historical roots of EBP for students with ASD are within the evidence-based medicine movement that emerged from England in the 1960s and the formation of the Cochrane Collaboration to host reviews of the literature about scientifically supported practices in medicine (http://www. cochrane.org/). The subsequent adoption of the evidence-based conceptual approach in the social sciences is exemplified in the work of the Campbell Collaboration (http://www.campbellcollaboration.org/) and currently the What Works Clearinghouse (http://ies.ed.gov/ncee/wwc/). In the 1990s, the American Psychological Association Division 12 established criteria for classifying an intervention practice as efficacious or “probably efficacious,” which provided a precedent for quantifying the amount and type of evidence needed for establishing practices as evidencebased (Chambless & Hollon, 1998; Chambless et al., 1996). Previous to the mid-2000s, the identification of EBPs for children and youth with ASD was accomplished through narrative reviews by sets of authors or organizations (e.g., Simpson, 2005). Although these reviews were systematic and useful, they did not follow a stringent review process that incorporated clear criteria for including or excluding studies for the reviews or organizing the information into sets of practices. In addition, many traditional systematic review processes, such as the Cochrane Collaborative, have only included studies that employed a randomized experimental group design (also called randomized control trial or RCT) and have excluded single case design (SCD) studies. By excluding SCD studies, such reviews a) omit a vital experimental research methodology now being recognized as a valid scientific approach (Kratochwill et al., 2013) and b) eliminate the major body of research literature on interventions for children and youth with ASD. Two reviews have specifically focused their work on interventions (also called treatments) for children and youth with ASD, included both group and SCD studies, followed a systematic process for evaluating evidence before including (or excluding) it in their review, and identified a specific set of interventions that have evidence of efficacy. These reviews were conducted by the National Standards Project (NSP) at the National Autism Center (2009) and the National Professional Development Center on ASD (NPDC). Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder 5 National Standards Project (NSP) The NSP conducted a comprehensive review of the literature that included early experimenta