Mesibov, G. B., & Shea, V. (2011). Evidence-based practices and autism. Autism, 15, This review paper traces the origins of evidence based

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1 Mesibov, G. B., & Shea, V. (2011). Evidence-based practices and autism. Autism, 15, This review paper traces the origins of evidence based practice (EBP) concepts in psychology and education in general. It also explores the issues related to the application of the concepts of evidence based practice to autism treatments. The authors emphasise the benefits of an evidence based approach to autism treatments such as enabling the field to go beyond the use of anecdotal evidence, counterbalancing various non-scientific pressures (political pressures and historical traditions for example) that can influence how services are organised and delivered. However, the authors also describe some of the limitations related to uncritical application of the concept of evidence based practice to field of ASD treatment research. For example, although a stringent evidence based approach to the evaluation of treatments brings necessary rigor, in particular to the choice and measurements of treatments outcomes, this can limit intervention research to outcomes that are easily measurable. As a consequence long-term outcomes that might be more meaningful to ASD individuals and their families such as life satisfaction, adaptation and improvements to personal relationships tend to be disregarded as these variables are not easily quantifiable and do not lend themselves easily to statistical analysis. Secondly, although various criteria for establishing treatments as evidence based require that treatment needs to have detailed written treatment protocols (this is referred to as manualization of treatment), the authors point out that due to the heterogeneity (variability) of the autistic spectrum, autism treatment programs are far too complex for an overall manual to be practical. Finally, authors provide a useful discussion on the reasons why the randomized control trials (RCTs) might be of limited use in research on autism treatments and why RCTs are not necessarily the best research methodology. In addition to providing a critique of the EBP concepts, Mesibov and Shea also provide a set of useful recommendations for future research and practice. They argue that strict definitions of EBP that include specific criteria that were not developed for the field autism are not useful. Instead, flexible definitions which include clinical expertise and the concept of individualising treatment based on various client factors are a more fruitful approach. It is emphasised that single case designs and qualitative studies should be used when considering the evidence base

2 of a certain treatment. The use of small studies in order to isolate specific strategies that are effective for specific problems/behaviours are advocated. Manuals in autism treatment research should be treated as summaries of theory and principles on which a particular treatment is based and summaries of possible treatment strategies and strategies for treatment individualization. Rather than opting for simple, easily measurable treatment outcomes, more attention should be on outcomes that are meaningful for ASD individuals and their families. Lastly, the authors argue for finding ways of measuring professional recognition and clinical expertise in autism treatments and interventions.

3 Odom, S., Collet-Klingenberg, L., Rogers, S., & Hatton, D. (2010). Evidence-Based Practices in Interventions for Children and Youth with Autism Spectrum Disorders. Preventing School Failure, 54(4), This paper concentrates on identifying evidence based, focused, interventions for children and young people with Autism Spectrum Disorders (ASD). As described in more details in our Overview of the Autism Interventions document, focused interventions are intervention strategies or practices used to either teach specific skills or reduce specific unwanted behaviours. The authors provide a brief yet informative overview of the history of evidence based practices (EBP) in general, and in ASD, before providing their definition of EBP. According to these authors, interventions can be considered to be EBP if they that have been found efficacious after being tested in high quality research designs. Simply being based on theory or research from other fields is not sufficient for an intervention to be considered as EBP. Odom et. al. propose that an intervention must have evidence from in order to meet thecriteria for EBP : a. at least two experimental/quasi-experimental group design studies carried out by independent investigators; OR b. at least five single case design studies from at least three independent investigators. OR c. a combination of at least one experimental/quasi-experimental study and three single case design studies from independent investigators. Using these criteria, the authors have identified the following 24 focused EBP intervention practices: prompting, reinforcement, task analysis and chaining, time delay, computer-aided instruction, discrete trial training, naturalistic interventions, parent-implemented interventions, peer-mediated instruction/interventions, picture exchange communication system, pivotal response training, functional behaviour assessment, stimulus control/environmental modification, response interruption/redirection, functional communication training, extinction, differential reinforcement, self-management, social narratives, social skills training groups,

4 structured work systems, video modelling, visual supports, and VOCA/Speech Generating Devices. The authors also provide descriptions of strategies that might be useful for translating identified EBP focused interventions into practice. Odom, S. L., Boyd, B. A., Hall, L. J., & Hume, K. (2010). Evaluation of comprehensive treatment models for individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 40(4), This paper evaluated comprehensive intervention models in order to provide information that would help service providers, families and researchers in the process of selection of appropriate intervention model. As described in more detail in our Overview of the Autism Interventions document, comprehensive interventions are systematically organised packages of practices that are intended to address the core deficits in individuals with autism spectrum disorders. The multidimensional evaluation process used by authors consisted of the following six dimensions: 1. Operationalisation the intervention has to be documented in a manual in a detailed enough manner that would allow individuals not involved in the design of intervention to use intervention themselves; 2. Implementation measures measures should ideally have established reliability and validity; 3. Replication any replication has to be conducted by individuals independent of the original intervention programme developers; 4. Type of empirical evidence efficacy evidence should ideally be published in peer-reviewed scientific journals. Evidence published in book chapters or developer reports is considered as less strong and less convincing; 5. Quality of the research methodology in order for quality of methodology to be established, evidence should be published in a peer-reviewed scientific journal; 6. Complementary Evidence from studies of focused interventions it is possible to provide evidence for efficacy of focused interventions that are part of a comprehensive intervention model. As described in feature 4, evidence published in peer-reviewed journals is preferable.

5 The authors developed a six point rating system for each of the above described dimensions. Models that had 4 or 5 ratings across at least 4 dimensions of the evaluation were considered to have stronger evidence of what authors called model development. These models include the Denver Model, Learning experiences: an alternative program for pre-schoolers and parents, the Lovaas model, May Institute, and Princeton Child Development Institute. Models that had 4 or 5 ratings on less than 4 domains, but had strengths were Autism Partnerships, Center for autism and related disorders, Children s Toddler Program; DIR/Floortime; Douglass; Pivotal Response Training; Responsive Teaching; SCERTS and TEACCH. Finally models such as Hanen, Higashi, Eden, Summit, Lancaster, and Son Rise received low ratings across all dimensions. Odom, S. L. (2009). The tie that binds: Evidence-based practice, implementation science, and early intervention. Topics in Early Childhood Special Education, 29, In this paper the author discusses approaches that might be important in helping practitioners to adopt evidence based practices in their work with individuals with ASD and their families. Approaches are classified as: 1. Expired approaches that although important in their time have less relevance and are of limited use today; 2. Tired ones to which professionals in the field have for years devoted time and energy, but even with these efforts, the gaps between research and practice have continued to exist ; and 3. Wired approaches that represent the next steps and have the promise of moving the field forward. Approaches identified as expired by the author are basing the selection of intervention only on professional opinion or on narrative reviews of the literature. Limitations of both of these approaches are discussed. It is important to emphasize that although narrative reviews are no longer consider as relevant in choosing the appropriate intervention, they are still considered useful for providing basic knowledge on interventions. Approaches identified as tired are: meta-analysis, What Works Clearinghouse, and quantitative reviews of studies and aggregation of results.

6 Although the merit of these approaches in identifying research evidence on whether certain intervention is efficacious or not, the author highlights that these approaches are limited in the sense that they do not provide detailed procedural information that would allow a successful move from science to application. Approaches identified as wired by author are: a. a practice-based review of evidence which provides an analysis of the procedural features of the practice and examines functional or statistical relationships between the practice and the outcome; b. implementation science the author defines implementation as program delivered to and experienced by participants and their families and illustrates strategies for implementation using the example of the program called the Children s School Success (CSS) Project (Odom et al., 2008); c. enlightened professional development that builds on the findings about social dynamics of professional teams and on the advances in technology. The author provides description and references for several useful approaches and models.