Evidence-Based Treatments

Evidence-Based Treatments

Evidence-based treatments are most recommended by research and medical professionals, however there is no one, single approach. Treatment for autism is highly individualized. So, the best treatments are those that are:

  • Provided at the right level and intensity
  • Specifically target your child’s areas of strength and need
  • Match the context of your family system; and are
  • Administered within the context of an integrated intervention team, under the direction and supervision of an interested and competent team leader.

From a simple google search, you will quickly discover that there are many treatments options of varying quality and effectiveness available. They run the gamut from resources well-founded in science to the other extreme, information lacking in scientific support and bordering on quackery. In between are more than a few interventions that seem to have helped some children and that some parents swear by, even if the support is anecdotal. What’s are you to do?

Most informed sources will advise you to build your child’s intervention plan around treatments that have a solid basis in science (i.e. are “evidence-based”). In medicine, evidence-based is defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” In autism intervention, that same standard of care applies, wherein those responsible (the intervention team) think about the individual, the existing science that suggests what treatments might be helpful for that individual, and work with families to implement and track progress for the child.

In the end, it rests upon your family to choose what treatments best fit your needs and the needs of your child. A “complementary” or “alternative” therapy may offer some benefit to your child’s health, disposition, or quality of life, regardless of whether or not it addresses autism directly. With investigation and subsequent consultation with your child’s PCP or intervention team leader, you might decide to include one or more of these therapies in your child’s treatment plan.

The following are some of those most frequently used in integrated intervention approaches.

ABA is an intensive, evidence-based approach to early intervention. ABA-Based interventions have been shown to be effective in improving a variety of challenging behaviors. There is, however, widespread misunderstanding about what ABA is, and what it is not. ABA is not a single, regimented treatment for autism. ABA is a science that includes a collection of principles and procedures for improving behaviors, both within and outside of the autism field. There is a wide variety of treatment programs that are based on the science of ABA, from highly structured intensive programs such as Discrete Trial Training (DTT) to parent-driven naturalistic behavioral programs such as Pivotal Response Training (PRT). It is important to keep in mind, that while they share a common scientific foundation, the practical application can vary.

Treatment intensity typically ranges from 25 to 40 hours per week and should be administered by a trained, ideally certified, professional with a Board Certified Behavior Analyst (BCBA) certificate. Interventions based upon the principles of ABA have been documented as highly effective in teaching a range of academic, social, communicative, motor, and adaptive skills. The central theory behind ABA is that behavior can be measured and, when necessary, changed through motivation. Behavior that is reinforced (rewarded) is more likely to be repeated than behavior that is not reinforced. Ideally, behavioral intervention helps children “learn to learn,” so they eventually begin to learn and develop skills on their own and are less dependent on therapists. Research has shown that ABA-based interventions consistently teach new skills and behaviors to children with autism. Be advised that waiting lists for BCBAs can be long because the demand is so great.

Whereas ABA is derived from earlier research into the nature of learning, the Developmental Approach to intervention for children with autism is based on theories that link development of cognition and communication with emotion, e.g., from Piaget, Vygotsky, and Bolby. So, ABA and developmental approaches come from different theoretical backgrounds. Developmental interventions look at the whole child (e.g., sensory, motor skills) and the family (e.g., deployment, moving, etc.), and guide other treatments, such as speech and language, educational, occupational therapy, and behavioral services, so that the entire team is working toward developmental progress. An example of a developmental intervention is DIR/Floortime (Developmental, Individual-Difference, Relationship-based approach). DIR/Floortime is a popular intervention commonly used with other therapies, though further research is needed to evaluate its efficacy.

TEACCH is a structured teaching approach based on the idea that the environment should be adapted to the child with autism, and not the other way around. The goal of the TEACCH approach is to provide the child with the necessary skills to understand his or her world and other people’s behavior. Because TEACCH tends to build upon skills children with autism already have, some families may see it as a more congenial approach than the more structured interventions associated with ABA.

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