Research and Overview of Evidence Based Practices for Autism

1. Research and Overview of Evidence Based Practices for Autism

3. Research should clearly describe The intervention How the intervention differed from the control How the intervention is supposed to affect outcome. What actually happened, whether it was anticipated or not What is good research?

4. The best research will be in professional journals When reading – who is funding the project Look for independent research studies Look for current studies Approach .com website information with caution Research Bias

5. Informed by research Established environmental variables Documentation of implementation fidelity Documentation of intended and unintended consequences Hierarchyfor Strength of Evidence

6. A ranking used to describe the strength of the results measured in a research study Level 1 (likely reliable) Evidence - representing the most valid reports addressing patient-oriented outcomes. Examples include rigorous randomized trial sand systematic reviews of level 1 evidence reports. Level 2 (mid-level) Evidence - representing reports addressing patient-oriented outcomes, and using some method of scientific investigation, yet not meeting the quality criteria to achieve level 1 evidence labeling. Examples include randomized trials with less than 80% follow-up and non-randomized comparison studies Level 2 evidence does not imply reliable evidence. Level 3 (lacking direct) Evidence - representing reports that are not based on scientific analysis of patient-oriented outcomes. Examples include case series, case reports, and expert opinion. Levels of Evidence

7. Rigorous research designs • Randomized experimental designs • Other acceptable designs • Quasi-experimental designs • Single subject studies There are others. Refer to the CEC website on www.cec.sped.org Informed by Research

8. Randomized experimental designs place subjects in control and experimental groups through a random selection process. The experimental group receives the treatment and the control group does not. Typically, pre and post tests are given to each group, and then statistically compared to determine the potential effect of the treatment. RANDOMIZED EXPERIMENTAL DESIGNS

9. Group 1 (experimental group) R Observation Treatment Observation Group 2 (control group) R Observation ------- Observation Simple Pre/post test randomized experimental design

10. A quasi-experimental design is a research study in which a group of subjects receives a treatment while another group does not. The key difference between this design, and an clear experimental design is the lack of random assignment. Quasi-Experimental Designs

11. These research designs compare a subject’s performance on a target behavior with repeated measures of that behavior over time. In these designs, the individual is his/her own control group. Single Subject Designs

13. Problem Intervention Comparison Outcome Problem: What is the situation, issue, or individual that requires attention? Intervention: What instructional approach, strategy, intervention is needed or suggested? Comparison: What is the main (or other) alternative to the suggested approach? Outcome: What do the data say about the suggested approach? Supporting literature for selected approach PICO worksheet

14. PDSA cycles The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method, used for action-oriented learning. Institute for Healthcare Improvement, 2010

15. Quality research should clearly describe The intervention, including who administered it, who received it, and what it cost, How the intervention differed from what the control group received, and The logic of how the intervention is supposed to affect outcomes. Established Environmental Variables

16. Implementation fidelity refers to the degree to which the intervention was delivered per the prescribed instructions or plan. In other words, did the “teacher” deliver the instruction as he/she was supposed to ?? Documentation of implementation fidelity

17. Good research will describe what actually happened, whether it was planned (intended) or not planned (unintended). Documentation of intended and unintended consequences

18. Empirically-supported practices Research-based interventions Science-based services Science-verified practices Refers to programs or techniques that are proven to work, and produce consistent, positive results… (Waters, 2005) Evidence Based Research

19. “Practices that are informed by research, in which the characteristics and consequences of environmental variables are empirically established and the relationship directly informs what a practitioner can do to produce a desired outcome.” (Dunst, Trivette, & Cutspec, 2002, p. 3) An Operational Definition of Evidence-Based Practice

20. A Closer Look….National Standards Project

21. National Standards Report (2009) - NAC

23. Established. Sufficient evidence is available to confidently determine that a treatment produces beneficial treatment effects for individuals on the autism spectrum. That is, these treatments are established as effective. Emerging. Although one or more studies suggest that a treatment produces beneficial treatment effects for individuals with ASD, additional high quality studies must consistently show this outcome before firm conclusions can be drawn about treatment effectiveness. Unestablished. There is little or no evidence to allow us to draw firm conclusions about treatment effectiveness with individuals with ASD. Additional research may show the treatment to be effective, ineffective, or harmful. Ineffective/Harmful. Sufficient evidence is available to determine that a treatment is ineffective or harmful for individuals on the autism spectrum. http://www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf The National Autism Center’s National Standards Report

25. Antecedent Package • Behavioral Package • Comprehensive Behavioral Treatment for Young Children • Joint Attention Intervention • Modeling • Naturalistic Teaching Strategies • Peer Training Package • Pivotal Response Treatment • Schedules • Self-management • Story-based Intervention Package Established Treatments

26. Emerging Treatments • Augmentative and Alternative Communication Devices (AAC) • Cognitive Behavioral Intervention Package • Developmental Relationship-based Treatment • Exercise • Exposure Package • Imitation-based Interaction • Initiation Training • Language Training (Production) • Language Training (Production & Understanding) • Massage/Touch Therapy • Multi-component Package • Music Therapy • Peer-mediated Instructional Arrangement • Picture Exchange Communication Systems (PECS) • Reductive Package • Scripting • Sign Instruction • Social Communication Intervention • Social Skills Package • Structured Teaching • Technology-based Treatment • Theory of Mind Training

27. Academic Interventions • Use traditional teaching methods to improve academic performance, including “special education” • Auditory Integration Training • Facilitated Communication • Using a keyboard of words or pictures, or a typing device to communicate with the help of a facilitator • Gluten- and Casein-Free Diet • Sensory Integrative Package • Using all the senses as a means of addressing overstimulation or understimulation from the environment Unestablished Treatments