Ann W. Cox, Ph.D. The National Professional Development Center on Autism Spectrum Disorders Supported by OSEP #H325G070004 and IES #R324B090005 (PI: Odom)
Comprehensive models (30+)are multicomponent programs designed to positively and systematically affect the lives of children with ASD and their families (Howlin, et al, 2009; Reichow & Wolery, 2009; Odom, et al, 2010) Early Start Denver Model Lovaas Institute LEAP May Institute Focused interventions are procedures that promote individual skills or learning within a specific skill area.
We had our audience in mind teachers and early interventionists Wanted flexibility of use of EBP to address individual needs of students. Not all students benefit from a given comprehensive treatment model. Wanted to be able to build on the infrastructure that exists in programs and schools (IEPs) Wanted a way to assist teachers improve on their use of strategies that are widely used: prompting, reinforcement, visual supports, etc. (fidelity) Wanted to demonstrate that use of EBPs can be applied universally
Published between 1990-2011 in English Population/Participants: Have clear inclusion criteria for individuals with ASD between birth and 22 years of age Interventions: Focused interventions that must be behavioral, developmental, or educational in nature and could be implemented in typical educational intervention settings (school, home, community) Comparison: Interventions were compared to no intervention or alternate interventions Outcomes: Generate behavioral, developmental, or academic outcomes. Study Design: Employed an experimental or quasi-experimental group design or single-case design
9 Library Databases: 1990-2011 Diagnostic terms Intervention terms Autism OR Asperger OR pervasive developmental disorder AND Intervention OR treatment OR practice OR strategy OR therapy OR program OR procedure OR approach
NPDC EBP Workgroup NPDC EBP Workgroup NPDC EBP Reviewers NPDC EBP Workgroup Title Review 29,101 Abstract Review 3,439 Article Review 1,085 Final Check 540 446 acceptable studies
Application Experience with/ knowledge about ASD Previous training related to group design/ SCD methodology Training Online training module Review protocols for article inclusion Coding descriptive features of articles Inter-rater Agreement Evaluate one article- compared to master code file 80% accuracy; 2 tries Correctly determine if the article met inclusionary criteria
Reviewer Inter-Rater Agreement Criteria 80% on study design evaluation criteria AND 100% agreement on article inclusion as evidence Yes No Try again Congratulations, NPDC EBP Reviewer! Yes No Sorry, inter-rater agreement has not been established.
N=159 SCD & Group design 13% Group design 24% Single case design 63%
Reviewer Demographics # Degree level Masters Degree or Current Graduate Students 65 Doctorate 94 BCBA/BCaBA 53 Degree area Applied Behavior Analysis 9 Education 11 Occupational Sciences 3 Psychology 28 School Psychology 5 Special Education 97 Speech/Language 3 Other (music, neurology, social work) 3 Reviewer Demographics Position Faculty 68 Researcher 14 Graduate Student 46 Practitioner/ Administrator 31 Experience with ASD Teaching in classroom setting 109 Providing intervention in clinical setting 76 Providing intervention in home setting 103 Conducting ASD research 117 # Teaching college level course on ASD 84
Criteria for Qualification as an Evidence-Based Practice o At least two high quality experimental group or quasi-experimental design articles Conducted by at least two different researchers or research groups OR o At least five high quality single case design articles Conducted by at least three different researchers or research groups Having a total of at least 20 participants across studies OR o A combination of at least one high quality group experimental or quasi-experimental design article and at least three high quality single case design articles Conducted by at least two different research groups
# of Studies 300 250 200 150 SCD group 100 50 0 0 to 2 3 to 5 6 to 11 12 to 14 15 to 18 19 to 22
CC 2% MP 8% AT 9% Mixed SCD 8% RCT 10% QED 2% ABAB 15% MB 46%
Identifying and Grouping Practices: extent of research support, common interventions but with different names, etc. o Identified 28 focused interventions Outcomes : analyzing outcomes to determine 12 outcome categories o social, communication, behavior, joint attention, play, cognitive, school readiness, academic, motor, adaptive, vocational, mental health Ages: Determine useful age ranges to summarize results. Used 6 categories that parallel traditional developmental and school categories. o 0-2.9; 3-5.9; 6-11.9; 12-14.9; 15-18.9; and 19-22
28 Evidence-Based Practices Antecedent Based Interventions Functional Behavioral Assessment Pivotal Response Training Social Skills Training Behavioral Momentum Interventions Functional Communication Training Prompting Structured Play Groups Cognitive Behavior Intervention Differential Reinforcement Discrete Trial Teaching Modeling Reinforcement Task Analysis Naturalistic Interventions Parent-Implemented Interventions Response Interruption/ Redirection Scripting Technology-Aided Instruction/ Intervention Time Delay Exercise PECS Self-Management Video Modeling Extinction Peer-Mediated Instruction/ Intervention Social Narrative Visual Supports
ABI BMI CBI DRA/I/O DTT ECE EXT FBA FCT MD NI PII PMII PECS PRT PP R+ RIR SC SM SN SST SPG TA TAII TD VM VS Social Behavior Joint Attention Play Cognitive Communication School- Readiness Academic Motor Adaptive Vocational Mental Health
Antecedent-based interventions (ABI) Behavioral momentum intervention (BMI) Cognitive behavioral intervention (CBI) Differential reinforcement (DRA/I/O) Discrete trial teaching (DTT) Exercise (ECE) Extinction (EXT) Functional behavior assessment (FBA) Functional communication training (FCT) Modeling (MD) Naturalistic intervention (NI) Parent-implemented intervention (PII) Peer-mediated instruction and intervention (PMII) Picture Exchange Communication System (PECS) Pivotal Response Training (PRT) Prompting (PP) Reinforcement (R+) Response interruption/redirection (RIR) Scripting (SC) Self-management (SM) Social narratives (SN) Social skills training (SST) Structured play groups (SPG) Task analysis (TA) Technology-aided intervention and instruction (TAII) Time delay (TD) Video modeling (VM) Visual supports (VS) 0-2.9 years 3-5.9 years 6-11.9 years 12-14.9 years 15-18.9 years 19-22 years
0-5 6-14 15-22 0-5 6-14 15-22 0-5 6-14 15-22 0-5 6-14 15-22 0-5 6-14 15-22 0-5 6-14 15-22 0-5 6-14 15-22 0-5 6-14 15-22 0-5 6-14 15-22 0-5 6-14 15-22 0-5 6-14 15-22 0-5 6-14 15-22 Matrix of Evidence-Based Practices by Outcome and Age (years) EBP Social Behavior Joint Attention Play Cognitive Communication School- Readiness Academic Motor Adaptive Vocational Mental Health ABI BMI CBI DRA/I/O DTT ECE EXT FBA FCT MD NI PII PMII PECS PRT PP R+ RIR SC SM SN SST SPG TA TAII TD VM VS
446 Acceptable studies 192 Early Childhood studies 30 EI 187 ECSE
# of Studies 300 250 200 150 SCD group 100 50 0 0 to 2 3 to 5 6 to 11 12 to 14 15 to 18 19 to 22
Nature of Literature Base: Participants # Diagnosis* Autism 169 PDD/ PDD-NOS 29 Autism Spectrum Disorder 26 Asperger Syndrome/HFA 7 *Studies may have reported more than one diagnosis &/or co-occurring condition.
Nature of Literature Base: Participants # Co-occurring Conditions* No co-occurring conditions reported 140 Intellectual disability 23 Speech/language impairment 15 Sensory impairment 4 Developmental delay 3 Epilepsy/seizure disorder 2 Physical disability 2 Learning disability 2 Other (neurological disorder, hyperthyroidism, Tourette syndrome, otitis) 11 *Studies may have reported more than one diagnosis &/or co-occurring condition.
120 100 80 60 40 20 ECSE EI 0
EI (0-2 years) ECSE (3-5 years) Evidence-Based Practices Group SCD EBP Group SCD EBP Antecedent-based interventions (ABI) - 1-35 Y Behavioral momentum intervention (BMI) - - - 5 Y Cognitive behavioral intervention (CBI) - - - - Differential reinforcement (DRA/I/O) - - - 9 Y Discrete trial teaching (DTT) - - - 13 Y Exercise (ECE) - - 1 1 Extinction (EXT) - - - 1 Functional behavior assessment (FBA) 1 1 1 1 Functional communication training (FCT) - - - 7 Y Modeling (MD) 1 - - 5 Y Naturalistic intervention (NI) 1 1-8 Y Parent-implemented intervention (PII) 5 9 Y 5 14 Y Peer-mediated instruction and intervention (PMII) - - - 8 Y Picture Exchange Communication System (PECS) - - 1 3 Y Pivotal Response Training (PRT) 1-1 2 Prompting (PP) - 1-19 Y Reinforcement (R+) - 2-18 Y Response interruption/redirection (RIR) - - - 5 Y Scripting (SC) - 1 1 3 Y Self-management (SM) - - - 1 Social narratives (SN) - - - 4 Social skills training (SST) - - 1 3 Y Structured play groups (SPG) - - - - Task analysis (TA) - - - 1 Technology-aided intervention and instruction (TAII) - - 3 1 Y Time delay (TD) - - - 7 Y Video modeling (VM) - 2 1 11 Y Visual supports (VS) - - - 9 Y
EBP ABI BMI DRA/I/O DTT ECE EXT FBA FCT MD NI PII PMII PECS PRT PP R+ RIR SC SM SN SST TA TAII TD VM VS Social 0-2 3-5 Communi -cation Behavior JA Play Cognitive School- Readiness Academic Motor Adaptive 0-2 3-5 0-2 3-5 0-2 3-5 0-2 3-5 0-2 3-5 0-2 0-2 0-2 0-2
Identification of EBPs o o o o More practices identified for preschool- and elementary-age participants Fewer for 0-2 and 19-22 age groups Most frequently measured outcomes in social, communication, behavior, school readiness and academics Least frequently measured outcomes in cognition, motor, and mental health Strength of evidence o o o No attempt to calculate effect size; not meta analysis Empirical support derived from 2 different methodologies Adherence to methodologically sound criteria (Horner, et al; Gerstin, et al) Limitations o Only included articles published 1990-2011 o No information on ineffective/harmful practices o Missing data on gender, ethnicity/race
Practitioners can build eclectic /evidence-supported programs to address specific needs of individuals with ASD More research is needed to address focused intervention practices for infants and toddlers; and with older adolescents and young adults with ASD Positive outcomes in mental health, cognition, and motor development not reported Better child outcomes dependent on translation of EBPs o o Implementation science Professional development models