Addressing the Need for Evidence-Based Practice Guidelines for Autism Spectrum Disorder
With comments by Jeffrey C Holden, Ph.D., LP, HSP-P, Director of Specialized Services, Murdoch Developmental Center
In 2009, the National Autism Center published the National Standards Report, which provided information on effective interventions so that parents, educators, and providers could make informed choices as to which practices or programs to use. A panel of experts reviewed and summarized the research on the effectiveness of educational and behavioral interventions for individuals with autism spectrum disorder (ASD) under age 22. This report was updated and released in April 2015. The Phase 2 report not only addressed research conducted in the field from 2007 to 2012, but it also added studies evaluating interventions for adults (ages 22 and older), marking the first time that research on adults with ASD has been systematically evaluated. Studies in this latter category dated as early as 1987.
For both reports, interventions were rated as either being established, emerging, or unestablished on the basis of the strength of evidence that investigators provided. Reviewers looked at ten developmental skills to be increased and at four behavioral areas of challenge to be decreased. In Phase 2, for interventions targeting individuals under the age of 22, reviewers rated 14 interventions as being established, 18 as being emerging, and 13 as being unestablished interventions. For interventions targeting individuals ages 22 and older, reviewers identified one established behavioral intervention, one emerging vocational training package, and four unestablished interventions (i.e., cognitive behavioral intervention package, modeling, music therapy, and sensory integration package).
From Dr. Holden
This recently published report was thought provoking and forced me to reconsider my thoughts on evidence-based practice for autism and other developmental disabilities. The National Standards Project did an excellent job of providing a thorough review of research and identifying evidence-based interventions for individuals with autism. More importantly, the report highlighted the differences between evidence-based interventions and evidence-based practice. Evidence-based practice is more complex than simply identifying interventions that are supported by research. In order to provide effective evidence-based practice, the practitioner must use sound professional judgment to apply the research, consider the values and preferences of the individual, and ensure the capacity to correctly implement an intervention for an individual with autism.
It is this last point that resonated most deeply with me. The report stated, “There is substantial evidence to support the use of Established Interventions with individuals with ASD. However, not all individuals with ASD have access to Established Interventions. In the age of budget cuts, limited resources, and some regions with few ASD professionals, it is the capacity to implement interventions that becomes the barrier to evidence-based practice.” Including Established Interventions (e.g., schedules, cognitive behavior therapy, parent training, etc.) in an individualized service plan (ISP), an individualized education plan (IEP), or a behavior support plan (BSP) is important, but does not ensure the provision of evidence-based practice. We must continue to raise the bar and do a better job of holding ourselves accountable by insisting that interventions are implemented in a clinically sound manner.
About Dr. Holden
Dr. Holden completed his bachelor’s degree in psychology at Catawba College in Salisbury in 1974. He graduated with a master’s degree in 1976 and a doctorate in 1981 from the University of Alabama in psychology, with a specialization in developmental disabilities. After graduation, he worked at the Partlow State School and Hospital in Tuscaloosa before joining the staff at the Murdoch Developmental Center in 1982. While Dr. Holden has held multiple roles at the Murdoch Center, his work has focused on working with individuals, both children and adults with developmental disabilities, including those with autism. He is specifically interested in supporting individuals who exhibit challenging behaviors and require intensive behavioral programming.