Autism Spectrum Disorders
Service Delivery

Provider 

External Scientific Evidence

Evidence-Based Practice Guidelines

National Collaborating Centre for Women's and Children's Health; National Institute for Health and Clinical Excellence   Autism: Recognition, Referral and Diagnosis of Children and Young People on the Autism Spectrum National Institute for Health and Clinical Excellence. (2011). London (UK): National Institute for Health and Clinical Excellence (NICE), 296 pages. Added: April 2012

 

Description

This guideline provides recommendations for assessment of autism spectrum disorders in children and young people. The target audience is professionals who work in or use the National Health Service in England and Wales.

 

Recommendations

"In each area a multidisciplinary group (the autism team) should be set up.  The core membership should include a paediatrician and/or child and adolescent psychiatrist, speech and language therapist, and clinical and/or educational psychologist" (p. 13).

 

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American Speech-Language-Hearing Association    Guidelines for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders across the Life Span Wetherby, A., Diehl, S., et al. (2006). Rockville (MD): American Speech-Language-Hearing Association, 46 pages.    Added: July 2011

 

Description

This guideline provides recommendations for screening, diagnosis, assessment and treatment of children and adults with autism spectrum disorder (ASD). The target audience of this guideline is speech-language pathologists. 

 

Recommendations

SLPs with sufficient knowledge and skills can diagnose ASD independently; however, typically work as members of multidisciplinary diagnostic teams. 

 

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Royal College of Speech & Language Therapists; Department of Health; National Institute for Clinical Excellence (United Kingdom)    Royal College of Speech and Language Therapists Clinical Guidelines: 5.4 Autistic Spectrum Disorders Taylor-Goh, S., ed. (2005). RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd.  Added: July 2011

 

Description

This guideline provides recommendations for assessment and treatment of preschool and school-age children with autism spectrum disorder (ASD). The target audience of this guideline is speech-language pathologists. Recommendations are based on randomized controlled trials (Level A Evidence), well-conducted clinical studies (Level B Evidence), or expert opinion (Level C Evidence). 

 

Recommendations

Diagnosis and management of ASD should be multidisciplinary (Level C Evidence) and professionals should work collaboratively with parents, teachers and others involved in day-to-day care of the individual to ensure consistency and increase generalization and maintenance of communication skills (Level B Evidence) (p. 35). 

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Evidence-Based Systematic Reviews

Therapies for Children With Autism Spectrum Disorders. Comparative Effectiveness Review No. 26 Warren, Z., Veenstra-VanderWeele, J., et al. (2011). Agency for Healthcare Research and Quality (AHRQ) Publication No. 11-EHC029-EF. Added: April 2012

 

Description

This is a systematic review of studies investigating the impact of various interventions for children with autism spectrum disorder (ASD) in comparison to no treatment, placebo, or other treatment. 

 

Conclusions

“One study explicitly sought to examine the impact of provider (parent vs. professional) using similar interventions in an RCT. The study did not show a difference in outcomes for children receiving the UCLA/Lovaas protocol-based intervention in a clinical setting vs. at home from highly trained parents” (p. 7). 

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Training Parents to Implement Communication Interventions for Children with Autism Spectrum Disorders (ASD): A Systematic Review Lang, R., Machalicek, W., et al. (2009). Evidence-Based Communication Assessment & Intervention, 3(3), 174 - 190.   Added: April 2012

 

Description

This is a systematic review of peer-reviewed studies investigating parent-implemented communication interventions for children with autism spectrum disorders (ASD). Interventions taught to parents included expectant waiting with imitating/animating, enhanced milieu teaching, pivotal response training, Natural Language Paradigm, and Early Start Denver Model. 

 

Conclusions

• Parental instruction procedures included verbal instruction/instruction manuals, in vivo practice, role playing, trainer modeling, and video review of treatment sessions with a variety of treatment approaches (e.g., PRT, milieu teaching).
• "Each of the studies reported parents' ability to implement communication interventions with fidelity following training, and the resultant interventions improved communication for children with ASD" (p. 187).
• The overall literature base for this topic is considered limited and additional research is warranted.

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Social Story Interventions for Students with Autism Spectrum Disorders: A Meta-Analysis Kokina, A., & Kern, L. (2010). Journal of Autism and Developmental Disorders, 40(7), 812-826.  Added: April 2012

 

Description

This is a meta-analysis of single-subject research that investigated the use of Social Stories (TM) and the impact of a set of moderator variables on intervention outcomes, including social  and communication skills, in participants with autism spectrum disorder (ASD). 

 

Conclusions

• "Studies that used target children as their own [Social Stories] intervention agents were substantially more effective than those that were run by adults (i.e., teachers, reasearchers, or parents)" (p. 823).
• Implementation of Social Stories by natural intervention agents (i.e., teachers or students) resulted in more pronounced intervention effects than implementation by researchers" (p. 823). 

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Training Paraprofessionals to Implement Interventions for People Autism Spectrum Disorders: A Systematic Review Rispoli, M., Neely, L., et al. (2011). Developmental Rehabilitation, 14(6), 378-388. Added: April 2012

 

Description

This is a review of experimental studies that investigated training of paraprofessionals to implement interventions with individuals with autism spectrum disorder (ASD) in school or rehabilitation settings. 

 

Conclusions

• "Future research should seek to determine if and how paraprofessionals' background knowledge and buy-in to the intervention influences accuracy of implementation" (p. 387).
• "Variables such as training components, training duration, paraprofessional buy-in and paraprofessional characteristics may influence the accuracy of intervention implementation" (p. 387).
• "Given the increase in the number of individuals with ASD requiring behavioural and educational interventions, the reliance on paraprofessionals in schools and rehabilitation settings is not likely to decrease" (p. 387). 

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A Meta-Analysis of Peer-Mediated Interventions for Young Children with Autism Spectrum Disorders Zhang, J., & Wheeler, J. J. (2011). Education and Training in Autism and Developmental Disabilities, 46(1), 62-77. Added: April 2012

 

Description

This is a meta-analysis of single-subject design studies that investigated peer-mediated interventions for promoting social interactions in young children with autism spectrum disorder (ASD). 

 

Conclusions

"Further categorical comparisons suggest that these interventions were more effective in enhancing social responses in younger boys, when older male siblings served as interventionists, when the interventions took place in the home, when peer modeling was used, and when consideration was given to maintenance and generalization across participants, behaviors and activities, and in involving collaboration among all researchers, peers/siblings, school staff, and parents/families" (p. 71). 

 

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Social Skills Interventions for Children with High-Functioning Autism Spectrum Disorders Schreiber, C. (2011). Journal of Positive Behavior Interventions, 13(1), 49-62. Added: April 2012

 

Description

This is a review of studies that investigated social skills interventions used with children with high-functioning autism spectrum disorders (HFASD). 

 

Conclusions

"It would seem, according to the reviewed research, that an adult-facilitated, semistructured environment at the beginning, with fading scaffolding, might prove to be effective" (p. 59). 

 

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Functional Communication Training: A Review of the Literature Related to Children with Autism Mancil, G. R. (2006). Education and Training in Developmental Disabilities, 41(3), 213-224.   Added: April 2012

 

Description

This is a review of studies that examined "the effectiveness of functional communication training [FCT], particularly, the environments and individuals involved in the training, and the effectiveness of FCT with children who have a diagnosis of autism spectrum disorder (ASD)" (p. 214). 

 

Conclusions

• "Two ways teachers may enhance communicative behavior include: (a) taking advantage of naturally occurring opportunities and (b) arranging the environment to be conducive to communication" (p. 222).
• Parents can enhance their children's communication in the home: "(a) by taking advantage of the natural environment, and (b) by arranging the environment to be conducive to communication" (p. 223).  

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Parent Implemented Early Intervention for Young Children with Autism Spectrum Disorder: A Systematic Review McConachie, H., & Diggle, T. (2007). Journal of Evaluation in Clinical Practice, 13(1), 120-129. Added: July 2011

 

Description

This is a review of comparative studies pertaining to parent-mediated or parent-implemented interventions for young children with autism spectrum disorders (ASD). 

 

Conclusions

Findings suggest that parent-implemented training can improve social communication skills in children with autism. However, the authors state that results should be reviewed with caution due to methodological concerns with included studies and limited amount of evidence found (p. 120). 

 

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Early Intervention for Children with Autism Burrows, K. (2004). Paediatrics and Child Health, 9(4), 267-270.  Added: July 2011

 

Description

This is a review of studies investigating the effectiveness of educational interventions or programs that are intended to result in global improvement in young children with autism. These interventions are not specific to the field of speech-language pathology and include Lovaas, normalized teaching, LEAP, Floortime, and TEACCH. 

 

Conclusions

“Although evidence of efficacy of educational treatment programs for autism is weak, the studies to date do suggest some guiding principles that may be of use in planning treatment. Given the available information, it would appear reasonable to set a target of a minimum of 15 h a week of structured, individualized teaching. The family should be involved in service provision, and there should be ongoing program evaluation and adjustment to meet the child’s needs” (p. 269). It is important to note that these educational programs are often comprehensive and not specific to, but involve, speech and language treatment. 

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Parent-Mediated Early Intervention for Young Children with Autism Spectrum Disorder Diggle, T., McConachie, H. R., et al. (2002). Cochrane Database of Systematic Reviews (2).  Added: July 2011

 

Description

This is a review of randomized controlled trials, quasi-randomized controlled trials or comparative studies which investigate parent-mediated interventions for children with autism spectrum disorder aged 1 to 6 years. 

 

Conclusions

Only two studies with a small number of participants and results that could not be compared to one another were included.  “The research currently available does not allow conclusions to be drawn about best practice” (p. 10). 

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Communication Intervention for Children with Autism: A Review of Treatment Efficacy Goldstein, H. (2002). Journal of Autism and Developmental Disorders, 32(5), 373-396.  Added: July 2011

 

Description

This is a review and summary of empirical studies evaluating speech-language interventions involving children with autism. 

 

Recommendations

Poor methodological quality of parent training studies limits the ability to meaningfully interpret the findings.

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Using Telepractice in Parent Training in Early Autism Baharav, E., & Reiser, C. (2010). Telemedicine and e-Health, 16(6), 727-31.  Added: April 2012

 

Description

This study compares traditional speech therapy administered twice a week to an alternative service delivery model in which speech therapy is delivered once a week in a traditional clinical setting and once a week by parents at home and remotely supervised by a speech-language pathologist for children with autism spectrum disorder. 

 

Conclusions

Parents of the two subjects reported that they were comfortable using the technology required for telepractice, felt that they were an essential part of their child’s therapy, and were willing to continue to use the telepractice strategy. They also indicated that the telepractice sessions were as valuable as sessions delivered by the clinician directly, and that they would recommend the telepractice model to other parents. Points of dissatisfaction included using the wireless headset and the need to stay within the range of the web camera. Neither parent reported an overall preference for one setting over the other; however, they indicated that they felt the clinic room was a more controlled environment. 

 

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Parent-Directed, Intensive Early Intervention for Children with Pervasive Developmental Disorder Smith, T., Buch, G. A., et al. (2000). Research in Developmental Disabilities, 21(4), 297-309.  Added: April 2012

 

Description

This study investigates a parent-directed implementation of the UCLA treatment model for children with Pervasive Developmental Disorder. Parents were trained to implement this treatment by professional therapists over the course of several workshops. 

 

Conclusions

“[P]arents reported normal levels of stress during and after treatment, and parents whose children remained in treatment rated the treatment very positively at follow-up” (p. 307). 

 

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Pilot Study of a Parent Training Program for Young Children with Autism: The PLAY Project Home Consultation Program Solomon, R., Necheles, J., et al. (2007). Autism: The International Journal of Research & Practice, 11(3), 205-224.    Added: April 2012

 

Description

This study investigates a training program for parents of children with autism spectrum disorder that follows a DIR/Floortime model. This program is called The PLAY Project. 

 

Conclusions

Of the families that completed the satisfaction survey, most were very satisfied with The PLAY Project. Parents who responded that they were “somewhat satisfied” with the program commonly suggested that The PLAY Project did not provide enough services. 

 

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