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:

  • Have demonstrated support in the research literature
  • Are generally behaviorally based
  • Are provided early and at the right level and intensity for the child’s needs
  • Specifically target your child’s areas of strength and need
  • Match the context of your family system
  • Are administered within the context of an integrated intervention team, under the direction and supervision of a qualified, 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 a parent to do? Since an Internet search will yield a vast array of options, many of them ineffective, if not harmful, parents must turn to more solid sources of information as a guide when selecting the best treatment for their child. Parents should build their child’s intervention plan around treatments that have a solid basis in science (i.e., are “evidence-based”).  However, 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. In the end, it rests upon your family to choose what treatments best fit your needs and the needs of your child. The following are some of those most frequently used in integrated intervention approaches.

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

ABA is an intensive intervention for autism. It is a science based on the principles of learning, with a focus on improving lives. The central theory behind ABA is that behavior can be learned and modified by changing environmental conditions, such as through motivation, shaping, and prompting procedures. Goals target both increasing and decreasing specific behaviors. Behavior that is reinforced (rewarded) is more likely to be repeated than behavior that is not reinforced. Behavioral intervention may help children “learn to learn,” so they eventually begin to learn and develop skills on their own and become less dependent on therapists and intensive teaching. ABA can be implemented as a focused treatment to address a narrow range of targets (e.g., toileting, self-help skills, problem behavior) or a comprehensive treatment, where the behavior analyst designs and oversees a range of behaviors targeted for change. The most extensive research support for ABA services is in the area of autism.

In ABA, a wide variety of treatment methods are used, from highly structured programs using discrete trial training (DTT) to parent-driven naturalistic behavioral programs such as pivotal response training (PRT). Treatment intensity typically ranges from a few (5 or less) to 40 hours per week, and should be administered by a Board Certified Behavior Analyst (BCBA), a professional who is credentialed by the Behavior Analysis Certification Board (BACB) (see www.bacb.com).

Be advised that waiting lists for BCBAs can be long because the demand for them is great. When looking for ABA services, it is important to make sure that the training and experience of the potential provider fit your child’s area of need. Your child’s developmental specialist can help you identify the right fit for your child. The Association for Behavior Analysis International provides guidelines to help consumers select professionals qualified to design and oversee ABA interventions: bit.ly/ASATonline.

Although many in the research community agree that ABA services are evidence-based, you may find that some representatives from the Defense Health Agency disagree. One reason is that two recent large reviews (Cochrane, 2017, Hayes, 2018) found limited evidence for the effectiveness of early intensive behavioral interventions, including some ABA interventions. The American Psychological Association (APA), National Institutes of Health (NIH), and National Professional Development Center (NPDC) on Autism Spectrum Disorder maintain that ABA is evidence-based, as studies have shown positive gains in areas of academic, readiness-to-learn, social, communicative, motor, behavioral, and adaptive skills.

One of the main areas affected by autism is the ability to communicate. PECS helps get basic language underway, and provides a way of communicating for children who have limited or no verbal communication. Briefly, PECS uses ABA-based methods to teach children to exchange a picture (or set of pictures in a sentence) for something they want, such as an item or an activity. This approach enables a child with autism to communicate more easily. As a result, the child may experience less frustration and demonstrate fewer problem behaviors.

The developmental approach to intervention for children with autism is based on theories that link development of cognition and communication with emotion. As such, developmental interventions look at the whole child (e.g., sensory, motor skills) and the family (e.g., deployment, moving), 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.

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 child adapting to the environment). The goal of the TEACCH approach is to provide the child with the necessary skills to understand their world and other people’s behavior. Because TEACCH tends to build upon skills most children with autism already have, some families see it as a more congenial approach than the more structured interventions associated with ABA.

Communication challenges are at the heart of an autism spectrum diagnosis and, in many cases, contribute to behavior problems. As a result, a quality intervention program should include methods to improve communication. Including a Speech Language Pathologist (SLP) on your child’s team is often necessary. Some speech-language therapists who work with children with autism incorporate the principles of ABA into their practice to encourage positive behavior and help the children develop increasingly greater communication skills; however, SLP can also be used with benefit without ABA.

See: Scope of Practice for SLTs, according to the American Speech-Language Association

Many children with autism benefit from working with a registered/licensed occupational therapist (OTR/L). An OT is a trained and licensed healthcare professional who collaborates with the family, the individual (when appropriate), and the intervention team to set intervention goals related to activities of daily living (e.g., dressing, self-care), functional and academic tasks (e.g., use of a computer, writing, cutting with scissors, care of personal belongings), education, work, play, leisure, and social participation. The OTR/L evaluates performance to determine what interferes with desired performance of a given skill and subsequently builds an individually tailored treatment plan.

Learn more about how OT can help your child with autism: American Occupational Therapy Association

Children with autism may have challenges with physical coordination and gross- motor skills and, therefore, may not be as physically active as their typically developing peers. In addition, their limited ability may lead to limited interest in physical activities, which can reduce opportunities to engage in fun interactions with other children, which can otherwise serve as valuable opportunities to learn and develop age-appropriate skills. Further, if a child’s coordination is very impaired, safety may be a concern. To address such issues, a physical therapist can design a regimen that will help a child develop muscle strength and physical fitness while at the same time addressing issues related to gross-motor coordination and skills.

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