The National Center for Evidence-Based Practice
in Communication Disorders
Home      ASD-Treatment-Cognition-Language-Behavioral-Interventions

Autism Spectrum Disorders
Cognition/Language Treatment

Behavioral Interventions

(e.g., Applied Behavioral Analysis, Discrete Trial Training, Lovaas and Early Intensive Behavioral Intervention)

 


 

External Scientific Evidence

Evidence-Based Practice Guidelines
New York State Department of Health, Early Intervention Program

Clinical Practice Guideline: Report of the Recommendations. Autism/Pervasive Developmental Disorders: Assessment and Intervention for Young Children (Age 0-3 Years)
New York State Department of Health, Early Intervention Program. (1999).
Albany, NY: NYS Department of Health, 322 pages.
Added: February 2013

Description
This guideline provides recommendations for assessment and treatment of autism/pervasive developmental disorders.  The target audience of this guideline is families, service providers, and public officials. Levels of evidence are provided and defined as follows:

  • "[A] = Strong evidence is defined as evidence from two or more studies that met criteria for adequate evidence about efficacy and had at least moderate applicability to the topic, and where the evidence consistently and strongly supports the recommendation.

  • [B] = Moderate evidence is defined as evidence from at least one study that met criteria for adequate evidence about efficacy and had at least moderate applicability to the topic, and where the evidence supports the recommendation.

  • [C] = Limited evidence is defined as evidence from at least one study that met criteria for adequate evidence about efficacy and had at least minimally acceptable applicability to the topic, and where the evidence supports the recommendation.

  • [D] = Panel consensus opinion (either [D1] or [D2] below):

    • [D1] = Panel consensus opinion based on information not meeting criteria for adequate evidence about efficacy, on topics where  systematic review of the literature was done

    • [D2] = Panel consensus opinion on topics where a systematic literature review was not done" (p. I-21)

Recommendations

  • General Findings

    • “It is recommended that principles of applied behavior analysis (ABA) and behavior intervention strategies be included as an important element of any intervention program for young children with autism” (Level A Evidence) (p. IV-15).

    • “Specific behavioral strategies that are useful for children with autism include techniques such as prompting, modeling, fading, and reinforcement” (Level A Evidence) (p. IV-26).

    • “It is recommended that behavioral interventions for reducing maladaptive behaviors be used when such behaviors interfere with the child’s learning or socialization, or present a hazard to the child or others” (Level A Evidence) (p. IV-34).

  • Behavioral Interventions for Improving Communication

    • “It is recommended that interventions focused on development of communication be included as part of the total intervention program for young children with autism” (Level D1 Evidence) (p. IV-39).

    • “In developing a behavioral or educational strategy for improving communication, it is important to consider:

      • the skills and abilities of the child

      • the child’s age, developmental level, skills, and abilities

      • the child’s environment

      • the child’s need for functional communication within his/her current environment” (Level D1 Evidence) (p. IV-39).

    • “A variety of behavioral techniques may be useful for increasing and improving communication in young children with autism” (Level A Evidence) (p. IV-40).

    • “Prompting the child for a response or modeling correct responses, followed by reinforcement, may be especially useful techniques for improving language skills” (Level C Evidence) (p. IV-40).

  • Behavioral Interventions for Improving Social Interactions

    • “It is recommended that interventions focused on improving social interactions be included as part of the total intervention program for young children with autism” (Level D1 Evidence) (p. IV-45).

    • “In developing a behavioral or educational strategy for improving social interaction, it is important to consider:

      • the skills and abilities of the child

      • interventions that are developmentally appropriate for the child

      • the child’s environment

      • the child’s need for social interaction in his/her current environment” (Level D1 Evidence) (p. IV-45).

    • “A variety of behavioral techniques may be useful for increasing and improving social interactions of children with autism” (Level A Evidence) (p. IV-45).

    • “Prompting the child for a response or modeling correct responses, followed by reinforcement, may be especially useful techniques for improving social skills” (Level C Evidence) (p. IV-45).

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Scottish Intercollegiate Guidelines Network; NHS Quality Improvement Scotland (United Kingdom)

Assessment, Diagnosis and Clinical Interventions for Children and Young People with Autism Spectrum Disorders: A National Clinical Guideline
Scottish Intercollegiate Guidelines Network. (2007).
Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN), SIGN publication No. 98, 65 pages.
Added: July 2011

Description
This guideline provides recommendations for assessment and intervention for children with autism spectrum disorders (ASD). The target audience includes a wide range of professionals involved in the management and care of children with ASD. Recommendations are graded A, B, C, D, or "Good Practice Point" based on the strength of supporting evidence. Grade A recommendations are based on evidence from systematic reviews and meta-analyses of randomized controlled trials that are directly relevant to the population. Grade B recommendations include high quality case control or cohort studies or high quality systematic reviews of those studies that are directly applicable to the population, or recommendations extrapolated from Grade A evidence. Grade C recommendations include well conducted case control or cohort studies or recommendations extrapolated from Grade B evidence. Grade D recommendations are based on evidence from non-analytic studies or expert opinion or recommendations extrapolated from Grade C evidence. Good Practice Points are recommendations based on the clinical experience of the guideline development group.

Recommendations
“The Lovaas programme should not be presented as an intervention that will lead to normal functioning” (Grade A Evidence) (p. 18). However, behavioral interventions should be considered to address specific behaviours in children and young people with ASD, “both to reduce symptom frequency and severity and to increase the development of adaptive skills” (Grade B Evidence) (p. 18).

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National Autism Center

National Standards Report
(2009).
National Autism Center, 1-161.
Added: July 2011

Description
This guideline provides recommendations for treatment of children and adolescents with autism spectrum disorders. The audience for this guideline includes parents, caregivers, educators, and service providers. Treatments have been evaluated and determined to be established, emerging, or unestablished. No treatments were determined to be ineffective or harmful.

Recommendations
The guideline authors stress that treatment selection should be made by a team of individuals and that this document should not dictate which treatments can or cannot be used for individuals with autism. However, the following suggestions are made to assist in decision making.
  • “We recommend the decision-making team give serious consideration to [Established Treatments] because these treatments have produced beneficial effects for individuals involved in the research studies published in the scientific literature, b) access to treatments that work can be expected to produce more positive long-term outcomes, and c) there is no evidence of harmful effects” (p. 76).

  • Established interventions that have been shown to increase communication skills include:

    • Antecedent Package

    • Behavioral Package

    • Comprehensive Behavioral Treatment for Young Children

    • Joint Attention

    • Modeling

    • Naturalistic

    • Teaching Strategies

    • Peer Training

    • Pivotal Response Treatment

  • Established interventions that have been shown to increase interpersonal skills include:

    • Antecedent Package

    • Behavioral Package

    • Comprehensive Behavioral Treatment for Young Children

    • Joint Attention

    • Modeling

    • Naturalistic

    • Teaching Strategies

    • Peer Training

    • Pivotal Response Treatment

    • Self-management

    • Story-based

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Evidence-Based Systematic Reviews
Improving Social Skills in Adolescents and Adults with Autism and Severe to Profound Intellectual Disability: A Review of the Literature
Walton, K., & Ingersoll, B. (2013).
Journal of Autism & Developmental Disorders, 43(3), 594-615.
Added: May 2013

Description
This is a review of studies that investigated the impact of social skills interventions on adolescents and adults with autism spectrum disorder (ASD) and severe to profound intellectual disability (S/PID).

Conclusions

  • "Together, these studies [of behavioral interventions] suggest that adolescents and adults with autism and [intellectual disability] can increase appropriate social initiations and responses following structured behavioral training procedures. In addition, several of these studies demonstrated generalization of social initiations to untrained peers following teaching with a number of peer exemplars" (p. 606).

  • Methodological limitations were reported, such as small sample size.

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A Systematic Review of Training Programs for Parents of Children with Autism Spectrum Disorders: Single Subject Contributions
Patterson, S. Y., Smith, V., et al. (2012).
Autism: The International Journal of Research & Practice, 16(5), 498-522.
Added: February 2013

Description
This is a review of single study research designs (SSRD) that investigated "the effectiveness of interventions designed to increase parents' ability to support communication and social [skills] development in children with autism spectrum disorders (ASDs)" (p. 498).

Conclusions

  • "Assorted degrees of positive effects on both parents and child outcomes were demonstrated for a variety of interventions including [augmentative and alternative communication] AAC, [Early Start Denver Model] ESDM, [discrete trial training] DTT, joint attention training, [pivotal response training] PRT, [natural language paradigm] NLP, milieu teaching, and general case teaching" (p. 515).

  • "Overall, the studies were of moderate quality...and achieved [improvement rate difference] IRD scores that ranged between 'large' to 'no effect' with a median IRD score reflecting 'moderate' effectiveness" (p. 515).

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Outcome of Comprehensive Psycho-Educational Interventions for Young Children with Autism
Eikeseth, S. (2009).
Research in Developmental Disabilities, 30(1), 158-178.
Added: February 2013

Description
This is a review of peer-reviewed studies that investigated psycho-educational intervention outcomes in young children with autism.

Conclusions
"Four [applied behavioral analysis] ABA studies received Level 1 rating demonstrating that children receiving ABA made significantly more gains than control group children on standardized measures of IQ, language and adaptive functioning" (p. 173).

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Evidence-Based Practices in Interventions for Children and Youth with Autism Spectrum Disorders
Odom, S. L., Collet-Klingenberg, L., et al. (2010).
Preventing School Failure, 54(4), 275-282.
Added: February 2013

Description
This is a systematic review of studies of evidence-based practice interventions for children and youth with autism spectrum disorders (ASD). 

Conclusions

  • The following evidence-based practices have shown efficacy for teaching communication: Behavioral intervention strategies (i.e., reinforcement, task analysis and chaining, time delay), discrete trial training, naturalistic interventions, pivotal response training, positive behavioral support strategies (i.e., functional behavior assessment, response interruption/redirection, extinction, differential reinforcement) (p. 280).

  • The following evidence-based practices have shown efficacy for teaching social skills: Behavioral intervention strategies (i.e., task analysis and chaining, time delay) and pivotal response training (p. 280).

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Moving Beyond the Intensive Behavior Treatment Versus Eclectic Dichotomy: Evidence-Based and Individualized Programs for Learners with ASD
Odom, S., Hume, K., et al. (2012).
Behavior Modification, 36(3), 270-297.
Added: February 2013

Description
This is a review of peer-reviewed studies that investigated comparisons of intensive behavioral treatment (IBT) and eclectic treatments in children and youth with autism spectrum disorder (ASD).

Conclusions
"Seven of the studies found that the children enrolled in the IBT group demonstrated significantly more change on measures of cognition, development, adaptive behavior, language, and/or autism severity" (p. 281).

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A Meta-Analytic Review of the Effectiveness of Behavioural Early Intervention Programs for Children with Autistic Spectrum Disorders
Makrygianni, M. K., & Reed, P. (2010).
Research in Autism Spectrum Disorders, 4(4), 577-593.
Added: February 2013

Description
This is a review of pre-test, post-test single or multiple group studies that investigated behavioural early intervention programs (EIPs) in young children with autism spectrum disorder (ASD).

Conclusions

  • "The meta-analysis showed that the behavioural EIPs are very effective in improving the intellectual, language, communication and social abilities of children with ASD, while they had a moderate to high effect on the adaptive behavioural improvement of the children" (p. 588).

  • Limitations of the meta-analysis were reported, such as the uncertainty of the impact of included studies with a variety of methodological limitations on the meta-analysis results (p. 589).

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Early Intensive Behavioral Intervention (EIBI) for Young Children with Autism Spectrum Disorders (ASD)
Reichow, B., Barton Erin, E., et al. (2012).
Cochrane Database of Systematic Reviews(10).
Added: February 2013

Description
This is a review of randomized controlled trials, quasi-randomized control trials, and controlled trials that investigated the effectiveness of [early intensive behavioral intervention] EIBI in increasing functional behaviors and skills for young children with [autism spectrum disorder] ASD" (p. 6).

Conclusions

  • "The results show evidence that EIBI improves...expressive and receptive language ([standardized mean difference effect size] SMD ES 0.50, SMD ES 0.57, respectively), everyday communication skills (SMD ES 0.74), [and] everyday social competence (SMD ES 0.34)" (p. 28).

  • "The quality of the evidence, as rated by the GRADE software, is low" (p. 28).

  • Potential sources of bias in the review process, such as the decision to exclude studies using geographically-based comparisons, were reported (p. 28).

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New Directions in Behavioral Treatment of Autism Spectrum Disorders
Kasari, C., & Lawton, K. (2010).
Current Opinion In Neurology, 23(2), 137-143.
Added: February 2013

Description
This is a review of studies that investigated behavioral interventions for use with children with autism spectrum disorder (ASD).

Conclusions
Studies regarding spoken communication "almost always utilized applied behavior analysis and reported improvements in spoken communication" (p. 138).

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Lovaas Model of Applied Behavior Analysis
(2010).
IES What Works Clearinghouse (WWC) Intervention Report.
Added: April 2012

Description
This is a systematic review of studies, meeting (or meeting with reservations) the What Works Clearinghouse (WWC) evidence standards, that address the effects of the Lovaas Model of Applied Behavior Analysis on outcomes for children with disabilities. The two studies included in this review include only children with autism or pervasive developmental disorder.

Conclusions
“Based on the two studies, the WWC found potentially positive effects on cognitive development for children with disabilities and no discernible effects on communication/language competencies, social-emotional development/behavior, and functional abilities” (p. 5).

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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.

This review meets the criteria for a high-quality evidence-based systematic review.
 
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
  • “Early intensive behavioral and developmental intervention may improve core areas of deficit for individuals with ASDs; however, few randomized controlled trials (RCTs) of sufficient quality have been conducted, no studies directly compare effects of different treatment approaches, and little evidence of practical effectiveness or feasibility exists” (p. 5).

  • While the strength of the evidence is low, studies of UCLA/Lovaas-based intervention have demonstrated improvements in cognitive, language, and adaptive behavior outcomes as compared to eclectic community treatments. Also, some children receiving intensive intervention failed to make rapid progress and many children continued to show impairment.

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A Systematic Review of Early Intensive Intervention for Autism Spectrum Disorders
Warren, Z., McPheeters, M. L., et al. (2011).
Pediatrics, 127(5), e1303-11.
Added: April 2012

Description
This is a review of research studies (excluding case reports) examining the evidence for the use of early intensive intervention for children with autism spectrum disorder (ASD).

Conclusions
“With a relatively larger (albeit still inadequate) body of literature, UCLA/Lovaas-based intervention and [Early Intensive Behavioral Intervention] EIBI variant studies have revealed positive shifts in language, adaptive, cognitive, and educational outcomes, but our confidence (strength of evidence) in that effect is low because of the need for additional, confirmatory research, a lack of high-quality RCTs, and no studies that have directly compared effects of promising manualized treatment approaches” (p. e1309).

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A Meta-Analytic Study on the Effectiveness of Comprehensive ABA-Based Early Intervention Programs for Children with Autism Spectrum Disorders
Peters-Scheffer, N., Didden, R., et al. (2011).
Research in Autism Spectrum Disorders, 5(1), 60-69.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: April 2012

Description
This is a meta-analysis of pre-test post-test control group studies of the effectiveness of comprehensive applied behavioral analysis (ABA)-based early intervention programs for children with autism spectrum disorders (ASD). Outcomes included receptive and expressive language as well as social behavior.

Conclusions
"Children with ASD participating with [Early Intensive Behavioral Intervention] EIBI generally outperformed children receiving treatments or treatment as usual on both IQ and adaptive behavior measures [which included measures of socialization]" (p. 65). Limitations, such as publication bias, were discussed.

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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
"At this time, applied behavior analysis (ABA) is the only social skill intervention method that has solid empirical research demonstrating an increase in positive behaviors" (p. 55).

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Special Report: Early Intensive Behavioral Intervention Based on Applied Behavior Analysis among Children with Autism Spectrum Disorders
Mauger Rothenberg, B., Samson, D. J., et al. (2009).
Blue Cross and Blue Shield Association, Technology Evaluation Center, 62 pages.
Added: April 2012

Description
This is a review of randomized controlled trial and nonrandomized comparative studies that investigated the use of early intensive behavioral intervention (EIBI) among young children with autism.

Conclusions
  • "Overall, the quality and consistency of results of this body of evidence are weak. Consequently, no conclusions can be drawn from this literature on how well EIBI works. Weaknesses in research design and analysis, as well as inconsistent results across studies, undermine confidence in the reported results. It is important to distinguish between certainty about ineffectiveness and uncertainty about effectiveness. Based on the weakness of the available evidence, we are uncertain about the effectiveness of EIBI for ASDs" (p. 2).

  • To better address the questions posed in this review, future studies should be randomized controlled trials with larger sample sizes, greater consistency in treatments, and longer follow-up in the context of an incremental research strategy (e.g., comparison of various aspects of treatment, such as duration or type of provider) (p. 3).

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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.

Conclusions
  • Findings for discrete-trial training suggested that treatment provides a foundation for the development of procedures needed to teach discriminative performances. Comparison studies between discrete-trial training and natural language paradigm have found mixed results in skill acquisition and generalization.

  • “…[T]here is no compelling evidence that milieu teaching procedures are clearly more effective than the procedures that have developed out of discrete-trial procedures” (p. 388).

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What Is the Evidence for the Effectiveness of Behavioural and Skill-Based Early Intervention in Young Children with Autism Spectrum Disorder (ASD)?
Doughty, C. (2004).
NZHTA Tech Brief Series, 3(1).
Added: July 2011

Description
This is a review of primary and secondary research pertaining to behavioral and skill-based intervention in children with autism spectrum disorders (ASD).

Conclusions
The results of this review support the effectiveness of behavioral intervention. However, the authors do not conclude that one particular behavioral intervention is more effective than another.

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Behavioural Interventions for Preschool Children with Autism
McGahan, L. (2001).
Ottawa: Canadian Coordinating Office for Health Technology Assessment, Technology Report No. 18.
Added: July 2011

Description
This is a review of the literature investigating previous reviews and expert opinion in regard to behavioral interventions for children with autism. Program options for behavioral interventions include the Lovaas Program, Douglass Developmental Disabilities Centre Program, LEAP, May Institute, Autism Preschool Program, Princeton Child Development Institute Program (PCDI), TEACCH, and the Denver Model.

Conclusions
  • Based on expert opinion and experience, professionals and parents recommend that ABA principles and strategies be included in any intervention program for young children with autism for a minimum of approximately 20 hours per week. The number of hours per week would be expected to vary depending on characteristics of the child and family (p. 52).

  • Results of previous reviews indicate that primary studies of the efficacy of behavioral interventions suffer from methodological flaws that limit interpretation of the findings. The limited findings suggest that children with autism who receive behavioral intervention demonstrate cognitive and functional improvement; however, the effect on specific subgroups of children, components of intervention, maintenance of effects, and impact on quality of life are unclear (p. 53).

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Do Behavioural Approaches Teach Children with Autism to Play or Are They Pretending?
Luckett, T., Bundy, A., et al. (2007).
Autism, 11(4), 365-388.
Added: July 2011

Description
This is a review of research relating to behavioral approaches to promote play in children with autism.

Conclusions
The results of this review suggest that behavioral approaches are sometimes effective in changing children's play behaviors. The authors note that while the interventions were highly structured and emphasized reinforcement and shaping, the actual instruction strategies used with children were often not typical behavioral strategies.

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Evidence-Based Comprehensive Treatments for Early Autism
Rogers, S. J., & Vismara, L. A. (2008).
Journal of Clinical Child & Adolescent Psychology, 37(1), 8-38.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2011

Description
This is a review of comparative studies assessing the efficacy of early comprehensive interventions (those that addressed the core deficits of autism including language, social, cognition, and play) for children with autism.

Conclusions
Lovaas’s intervention approach meets the “criteria for probably efficacious” (p. 30).

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Behavioural and Developmental Interventions for Autism Spectrum Disorder: A Clinical Systematic Review
Ospina, M. B., Krebs Seida, J., et al. (2008).
PLoS ONE, 3(11), e3755.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2011

Description
This is a review of experimental and observational studies investigating the effects of behavioral and developmental interventions for children with autism spectrum disorders (ASD).

Conclusions
  • This review demonstrates a lack of agreement across studies on the effects these interventions may have on various outcomes. “Despite evidence, there is no clear answer regarding the most effective therapy to improve symptoms associated with ASD” (p. 26).

  • The effects of discrete trial training were inconsistent across studies. Lovaas therapy, compared to standard care or regular instruction, yielded better outcomes in intellectual functioning, language comprehension, and communication skills. High–intensity Lovaas showed greater effects than low-intensity Lovaas in intellectual functioning and communication skills (p. 4).

  • A meta-analysis combining findings from a “few, methodologically weak studies with few participant and relatively short-term follow-up” (p. 28) found that Lovaas (compared to special education) produced better outcomes in overall intellectual functioning, adaptive behavior, communication and interaction, comprehensive language, expressive language, and socialization but not in non-verbal intellectual functioning. Pooled results of 2 randomized controlled trials showed no significant differences in communication skills between Lovaas treatment and Developmental Individual-difference Relationship-based interventions (DIR).

  • “There is limited and inconclusive evidence for various combinations of discrete trial training, incidental teaching, pivotal response training, and milieu teaching” (p. 24).

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Evidence-Based Review of Interventions for Autism Used in or of Relevance to Occupational Therapy
Case-Smith, J., & Arbesman, M. (2008).
American Journal of Occupational Therapy, 62(4), 416-429.
Added: July 2011

Description
This is a review of Level I (i.e., randomized controlled trials, systematic reviews, meta-analyses), Level II (nonrandomized clinical trials, cohort studies), and Level III evidence (before-after studies and one group designs) that pertain to interventions conducted by occupational therapists for children and adolescents with autism. Although the intended audience is occupational therapists, the interventions target cognitive communication outcomes.

Conclusions
Discrete trial training “has evidence of moderate to strong effects” (p. 423).

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Evidence-Based Practices for Young Children With Autism: Contributions for Single-Subject Design Research
Odom, S. L., Brown, W. H., et al. (2003).
Focus on Autism and Other Developmental Disabilities 18(3), 166-175.
Added: July 2011

Description
This is a review of single-subject design research investigating various interventions for young children with autism.

Conclusions
Two fundamental elements of discrete-trial training, adult directed interventions and differential reinforcement of desired behaviors, “met the criteria for a well-established level of effectiveness” (p. 172).

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Comprehensive Synthesis of Early Intensive Behavioral Interventions for Young Children with Autism Based on the UCLA Young Autism Project Model
Reichow, B., & Wolery, M. (2009).
Journal of Autism and Developmental Disorders, 39(1), 23-41.
Added: July 2011

Description
This is a meta-analysis of experimental and quasi-experimental studies investigating early intensive behavioral interventions (EIBI) for young children with the diagnosis of autism.

Conclusions
Although limited by methodological quality and number of studies, the authors report that EIBI shows positive effects for some children with autism.

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Efficacy of Applied Behavioral Intervention in Preschool Children with Autism for Improving Cognitive, Language, and Adaptive Behavior: A Systematic Review and Meta-Analysis
Spreckley, M., & Boyd, R. (2009).
Journal of Pediatrics, 154(3), 338-344.
Added: July 2011

Description
This is a review and meta-analysis of systematic reviews and randomized or quasi-randomized controlled trials (RCTs) that look at the effectiveness of applied behavior intervention (ABI) programs for preschool children with autism spectrum disorder (ASD).

Conclusions
“Four randomized or quasirandomized clinical trials met inclusion criteria and had primary outcomes analyzed. The meta-analyses of these studies showed that ABI did not result in significant improvement in cognitive, language, or adaptive behavioral outcomes compared with standard care” (p. 342).

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The Effectiveness of Intervention on the Behavior of Individuals With Autism: A Meta-Analysis Using Percentage of Data Points Exceeding the Median of Baseline Phase (PEM)
Ma, H. H. (2009)
Behavior Modification, 33(3), 339-359.
Added: July 2011

Description
This is a review of studies investigating the effectiveness of several components of behavior modification interventions for individuals with autism.

Conclusions
“The five highly effective (mean effect size >.9) intervention strategies were priming, self-control, training, positive reinforcement for desirable behavior plus punishment for undesirable behavior, and presenting preferential activities or reinforcers. Dependent variables, of which the mean effect sizes were >.9, were social interactions, language abilities, and attention” (p. 357).

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Systematic Review of Early Intensive Behavioral Interventions for Children with Autism
Howlin, P., Magiati, I., et al. (2009).
American Journal on Intellectual and Developmental Disabilities, 114(1), 23-41.
Added: July 2011

Description
This is a review of controlled studies investigating the effectiveness of early intensive behavioral interventions (EIBI) for young children with autism.

Conclusions
The authors conclude that strong evidence exists for the effectiveness of EIBI “for some, but not all, children with autism spectrum disorders, and there is wide variability in response to treatment” (p. 37). Results also suggest that “if gains are made, they are likely to be greatest in the first 12 months of intervention” (p. 37).

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Evaluation of the Efficacy of Communication-Based Treatments for Autism Spectrum Disorders
Brunner, D. L., & Seung, H. (2009).
Communication Disorders Quarterly, 31(1), 15-41.
Added: July 2011

Description
This is a review of the best available evidence investigating communication-based treatments for children with autism spectrum disorders (ASD).

Conclusions
“The best available evidence indicates that the efficacy of ABA methods as an intervention for adaptive behavior and broadly defined language is well established” (p. 17).

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Meta-Analysis of Early Intensive Behavioral Intervention for Children with Autism
Eldevik, S., Hastings, R. P., et al. (2009).
Journal of Clinical Child & Adolescent Psychology, 38(3), 439-450.
Added: July 2011

Description
This is a review of comparison or controlled studies investigating Early Intensive Behavioral Intervention (EIBI) for children with autism spectrum disorder (ASD).

Conclusions
“EIBI produces large to moderate effects sizes for changes in IQ and [Adaptive Behavior Composite] scores for children with ASD when compared with no intervention controls and eclectic provision [i.e., range of treatments]. These results support the clinical implication that EIBI at present should be an intervention of choice for children with ASD” (p. 449).

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Behavioural Intervention Practices for Stereotypic and Repetitive Behaviour in Individuals with Autism Spectrum Disorder: a Systematic Review
Patterson, S. Y., Smith, V., et al. (2010).
Developmental Medicine and Child Neurology, 52(4), 318-327.
Added: July 2011

Description
This is a review of experimental and quasi-experimental studies investigating behavioral interventions for stereotypic and repetitive behaviors (SRBs) in children with autism spectrum disorders (ASD).

Conclusions
“Overall, positive effects were reported for behavioural interventions to reduce SRBs maintained by a variety of identified functions displayed by individuals with ASDs” (p. 326). However, the efficacy of behavioral interventions to decrease stereotypic and repetitive behavior and improve function is preliminary. Due to the limited number of studies, no conclusions can be drawn regarding best practice.

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Social Skills Interventions for Individuals with Autism: Evaluation for Evidence-based Practices within a Best Evidence Synthesis Framework
Reichow, B., & Volkmar, F. R. (2010).
Journal of Autism and Developmental Disorders, 40, 149-166.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2011

Description
This is a review of experimental and quasi-experimental studies investigating social skills interventions for individuals with autism spectrum disorder.

Conclusions
For social skills outcomes “…there is much support for the use of interventions based on ABA, and the use of these techniques should continue to be used in practice” (p. 159).

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Applied Behavior Analytic Intervention for Autism in Early Childhood: Meta-Analysis, Meta-Regression and Dose-Response Meta-Analysis of Multiple Outcomes
Virues-Ortega, J. (2010).
Clinical Psychology Review, 30(4), 387-399.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2011

Description
This is a meta-analysis of published, peer-reviewed, quantitative studies investigating applied behavior analytic intervention for young children with autism spectrum disorders.

Conclusions
“Results suggest that long-term, comprehensive ABA intervention leads to (positive) medium to large effects in terms of intellectual functioning, language development, and adaptive behavior of individuals with autism” (p. 397).

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Autism Spectrum Disorders (ASDs) Services: Final Report on Environmental Scan
Young, J., Corea, C., et al. (2010).
Baltimore, MD: IMPAQ International, 112 pages.
Added: July 2011

Description
This is an “environmental scan” of the empirical evidence regarding the efficacy, effectiveness, safety, and availability of behavioral and psychosocial interventions for individuals with autism spectrum disorders (ASD). The evidence, separated by children, transitioning youth, and adults and interventions, is rated as evidence-based, emerging evidence-based, or unestablished within each population. Interventions were considered evidence-based if they were supported with multiple high quality randomized, quasi-experimental or single-subject design studies with no critical design flaws to create confounders to the studies. Emerging evidence-based interventions were those supported with evidence of mixed quality and mixed effects. An intervention was considered unestablished based on the poor quality of the studies or the lack of studies showing a positive result.

Conclusions
  • Evidence-based interventions for children include behavioral, cognitive behavioral, comprehensive behavioral early intervention, joint attention, multi-component, naturalistic teaching, peer training, picture exchange communication system, schedules, social communication, social skills, story-based, structured teaching, and technology-based.

  • “Overall, the studies reviewed for the interventions included in this group had positive outcomes. The behaviors targeted by the interventions were improved in the majority, if not all of the subjects of the study. None of the studies showed negative or harmful results” (p. 24).

  • Emerging evidence-based interventions for transitioning youth include behavioral interventions, social skills, and technology-based interventions (p. 37).Evidence-based interventions for adults with ASD include behavioral interventions and structured teaching (p. 42).

  • Four studies addressed cost and funding issues for early intensive behavioral intervention (EIBI) for individuals with ASD. “Overall, these studies present findings in favor of implementing EIBI in place of the status quo for children with ASDs but it is important to take into account the factors that may facilitate or impede the success of an EIBI program” (p. 53).

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      Clinical Expertise/Expert Opinion

      Consensus Guidelines
      American Academy of Pediatrics; Council on Children with Disabilities

      Management of Children With Autism Spectrum Disorders
      Myers, S. M., & Johnson, C. P. (2007).
      Pediatrics, 120(5), 1162-1182.
      Added: July 2011

      Description
      This guideline provides recommendations for the management of children with autism spectrum disorder (ASD). The target audience of this guideline is pediatricians. In place of formal recommendations, conclusive statements regarding the level of evidence supporting a specific treatment are included.

      Recommendations
      Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups” (p. 1164).

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      State of New Hampshire, Department of Health and Human Services

      The New Hampshire Task Force on Autism: Part I Assessment and Interventions
      New Hampshire Task Force on Autism. (2001).
      (NH): Department of Health and Human Services, 69 pages.
      Added: July 2011

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

      Recommendations
      • “In reviewing the literature and research on ASD, it is clear that there is no one treatment or intervention that works well for all people. However, there are many approaches that are effective and work well for specific individuals” (p. 23).

      • If an applied behavioral analysis intervention is decided upon, the authors provide several implementation considerations including but not limited to ensuring that there is adequate training, time, oversight, and rigor for the program, avoiding punishment that caused pain or shame, ensuring generalization of skills, and focusing on the child’s quality of life (p. 28).

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      Client/Patient/Caregiver Perspectives

      Early Intensive Behavioral Intervention: Outcomes for Children with Autism and Their Parents after Two Years
      Remington, B., Hastings, R. P., et al. (2007).
      American Journal of Mental Retardation, 112(6), 418-438.
      Added: February 2013

      Description
      This is a comparative study of 23 preschool children with autism. This study examined "whether early intensive behavioral intervention (EIBI) for children with autism can be beneficial in routine use, incorporating a wide range of outcome measures for both children with autism and their parents" (p. 421).

      Conclusions
      "Exceptionally, children in the intervention group differentially showed robust improvements in parental ratings of positive social behaviors, but there was no evidence of a similar change in parents' reports of children's behavior problems or ratings of their autistic behaviors" (p. 432).

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      Social Skills Training for Adolescents with Asperger's Syndrome Using a Consultation Model
      Minihan, A., Kinsella, W., et al. (2011).
      Journal of Research in Special Educational Needs, 11(1), 55-69.
      Added: February 2013

      Description
      Findings from two controlled case studies of adolescents with Asperger’s syndrome are reported. These case studies examined “the effectiveness of behavioural consultation as a method for improving [the adolescents’] social skills” (p. 55).  Parents and teachers provided feedback on the students’ social skills progress following training.

      Conclusions

      • Four out of five parents’ score on the social communication questionnaire of the Social Responsiveness Scale (SRS) indicated a statistically reliable change in their children’s total score (p. 62).

      • Two out of five parents reported a clinically significant change in their children’s total score on the social communication questionnaire of the Social Responsiveness Scale (SRS) (p. 62).

      • Parents reported statistically reliable changes across the following social communication aspects on the Social Responsiveness Scale (SRS): social awareness (2/5 parents), social cognition (1/5), social communication (3/5), social motivation (1/5), and autistic mannerisms (2/5) (p. 63).

      • Parents reported clinically significant changes across the following social communication aspects on the Social Responsiveness Scale (SRS): social awareness (2/5 parents), social cognition (2/5), social communication (2/5), social motivation (2/5), and autistic mannerisms (3/5) (p. 63).

      • Five out of five teachers’ score on the social communication questionnaire of the Social Responsiveness Scale (SRS) indicated a statistically reliable change in their student’s total score (p. 62).

      • Four out of five teachers reported a clinically significant change in their student’s total score on the social communication questionnaire of the Social Responsiveness Scale (SRS) (p. 62).

      • Teachers reported statistically significant changes across the following social communication aspects on the Social Responsiveness Scale (SRS): social awareness (3/5 teachers), social cognition (4/5), social communication (5/5), social motivation (4/5), and autistic mannerisms (3/5) (p. 63).

      • Teachers reported clinically significant changes across the following social communication aspects on the Social Responsiveness Scale (SRS): social awareness (4/5 teachers), social cognition (4/5), social communication (3/5), social motivation (3/5), and autistic mannerisms (3/5) (p. 63).

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      Parent Education and Home-Based Behaviour Analytic Intervention: An Examination of Parents' Perceptions of Outcome
      Dillenburger, K., Keenan, M., et al. (2004).
      Journal of Intellectual & Developmental Disability, 29(2), 119-130.
      Added: February 2013

      Description
      This is a qualitative study of 22 families who implemented home-based applied behavioral analysis (ABA) therapy with their child with autism spectrum disorder (ASD).  Findings were separated by the length of time families had been involved in ABA training: an average of 35.5 months for the long-term group (LTG) and an average of 6.1 months for the short-term group (STG).

      Conclusions

      • In regard to interaction, a “great difference” was noted by 6 LTG families and 7 STG families. “Some difference” was reported by 5 LTG families and 3 STG families (p. 124).

      • The following parent ratings pertain to the impact of ABA on social skills: very effective (9 LTG; 4 STG), effective (5 STG), not effective (1 LTG), and don’t know (1 STG) (p. 124).

      • Parent ratings of the effectiveness of ABA in enhancing communication are as follows: very effective (9 LTG; 7 STG) and effective (3 LTG; 3 STG) (p. 124).

      • Examples of parent statements about the impact on their child’s communication/speech include, “It has improved his communication hugely” and “Her language and awareness have exceeded all expectations” (p. 127).

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      Services for Children with Autism Spectrum Disorders
      Dymond, S. K., Gilson, C. L., et al. (2007).
      Journal of Disability Policy Studies, 18(3), 133-147.
      Added: February 2013

      Description
      This is a qualitative study of 783 parents of children with autism.  Parents’ recommendations for improving school and community-based services for their children with autism spectrum disorder (ASD) were reported.

      Conclusions
      The 371 parent recommendations indicated that more/better services were needed in the following categories:

      • Applied behavior analysis (14.56%)

      • Speech therapy/communication training (11.32%)

      • Social skills training/social opportunities (8.09%)

      • Assistive technology (2.16%)

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      Parental Experience with Treatments for Autism
      Green, V. (2007).
      Journal of Developmental and Physical Disabilities, 19(2), 91-101.
      Added: February 2013

      Description
      This is a qualitative study of 19 parents of children with autism. This study examined parents’ experiences with treatments for autism (e.g., applied behavior analysis [ABA], sensory integration [SI]).

      Conclusions

      • “Parents reported that ABA was more difficult to implement” (p. 99).

      • Many parents had high expectations for outcomes associated with ABA and SI; the study results indicate that most parents “tended to report positive outcomes as a result of using these treatments” (pp. 99-100).

      • Limitations of this study include a small sample size and that the sample may not have been representative (p. 100).

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      Facilitating Factors and Barriers to the Implementation of Intensive Home-Based Behavioural Intervention for Young Children with Autism
      Johnson, E., & Hastings, R. P. (2002).
      Child: Care, Health and Development, 28(2), 123-129.
      Added: February 2013

      Description
      This is a qualitative study of 141 parents of a young child with autism. This study examined parents’ perceptions of “factors that acted as facilitative factors and barriers to the implementation of [Lovaas-style interventions]” (p. 123).

      Conclusions

      • Barriers included lack of appropriate training for staff, family constraints, problems with negative attitudes of education authorities, lack of support for Lovaas methods in schools, lack of concentration on the child’s part, and inflexibility of school routines (p. 126).

      • Facilitative factors included committed team members, visible progress of the child in the program, and support from extended family and school staff (p. 127).

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      The Impacts of Home-Based Early Behavioural Intervention Programmes on Families of Children with Autism
      Trudgeon, C., & Carr, D. (2007).
      Journal of Applied Research in Intellectual Disabilities, 20(4), 285-296.
      Added: February 2013

      Description
      This is a qualitative study of 16 parents of children with autism. This study examined the impact of a home-based early behavioral intervention on the families and child with autism.

      Conclusions

      • Some parents reported positive changes in their child early in the program such as “…it was only a couple of months in and his talking really started to come on” (p. 293).

      • Limitations, such as a small sample size, were discussed (p. 294).

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      Interventions for Adolescents and Young Adults with Autism Spectrum Disorders. Comparative Effectiveness Review No. 65
      Lounds Taylor, J., Dove, D., et al. (2012).
      (Prepared by the Vanderbilt Evidence-Based Practice Center under Contract No. 290-2007-10065-I.). Rockville, MD: Agency for Healthcare Research and Quality.
      Added: February 2013

      Description
      This is a review of all study designs except single case that investigate behavioral, educational, vocational, adaptive/life skills, medical and related, and allied health interventions in adolescents and adults with autism spectrum disorder (ASD).

      Conclusions
      “Research involving individual or group-based interventions reported improvements across a variety of social skills as rated by parents” (p. 54).

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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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      Outcome Survey of Early Intensive Behavioral Intervention for Young Children with Autism in a Community Setting
      Boyd, R. D., & Corley, M. J. (2001).
      Autism, 5(4), 430-441.
      Added: July 2011

      Description:
      This article reports on findings from a survey of parents with children in an early intensive behavioral intervention (EIBI) program for children with autism.

      Conclusions
      Results were obtained from 73% of parents. The majority indicated that they were satisfied or very satisfied with the program implementation and child’s outcome and that the level of intervention was sufficient to meet their child’s needs. The areas of development that parents saw the most improvement in were language, compliance, and pre-academic skills. Developmental areas of pragmatic language and socialization were reported to have shown the least improvement (p. 37).

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      Parents' Experiences of Home-Based Applied Behavior Analysis Programs for Young Children with Autism
      Grindle, C. F., Kovshoff, H., et al. (2009).
      Journal of Autism & Developmental Disorders, 39(1), 42-56.
      Added: July 2011

      Description:
      This is a report of a semi-structured interview of parents whose children are involved in an early intensive behavioral intervention (EIBI).

      Conclusions
      While the interviews highlighted some emotional and practical challenges of running an EIBI program, most parents felt that the intervention was positive overall. Over 75% of parents reported that EIBI was the right choice for the child and family and over 66% of parents would recommend EIBI to others (pp. 51-52).

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      Effectiveness of Training Parents to Teach Joint Attention in Children with Autism
      Rocha, M. L., Schreibman, L., et al. (2007).
      Journal of Early Intervention, 29(2), 154-172.
      Added: July 2011

      Description:
      This study investigates the effectiveness of parent-implemented interventions to target joint attention in children with autism. Parents were taught to use naturalistic behavior analytic techniques.

      Conclusions
      “Parents indicated on the Consumer Satisfaction Questionnaire that they were satisfied with the training program. Parents also felt that their children improved during the course of the intervention” (p. 167).

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      Intensive Intervention for Children and Adolescents with Autism in a Community Setting in Italy: A Single-Group Longitudinal Study
      Valenti, M., Cerbo, R., et al. (2010).
      Child & Adolescent Psychiatry & Mental Health, 4, 23.
      Added: July 2011

      Description:
      This study was conducted in order to determine functional outcomes of children and adolescents with autism after two years of intensive treatment in a special autism center. The treatment in the center was based upon behavior modification; however, it cannot be considered a pure applied behavioral analysis approach.

      Conclusions
      “Results from parent satisfaction questionnaires showed a high degree of parental satisfaction with the treatment” (p. 3 of 9).

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      Use the images below to navigate to other sections of the Autism Spectrum Disorders evidence map.

       
       

       
       

      e.g. frequency, intensity, duration