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RESEARCH AND OVERVIEW OF EVIDENCE BASED PRACTICES FOR AUTISM

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WHAT IS GOOD RESEARCH?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

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RESEARCH BIAS 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

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HIERARCHY FOR STRENGTH OF EVIDENCE

Informed by research Established environmental variables Documentation of implementation

fidelity Documentation of intended and

unintended consequences

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LEVELS OF EVIDENCE 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.

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INFORMED BY RESEARCH 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

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RANDOMIZED EXPERIMENTAL DESIGNS 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.

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SIMPLE PRE/POST TEST RANDOMIZED EXPERIMENTAL DESIGNGroup 1 (experimental group)R Observation Treatment

Observation

Group 2 (control group)R Observation ------- Observation

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QUASI-EXPERIMENTAL DESIGNS

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.

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SINGLE SUBJECT DESIGNS 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.

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PICO WORKSHEET 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

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PDSA CYCLESThe 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

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ESTABLISHED ENVIRONMENTAL VARIABLES

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.

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DOCUMENTATION OF IMPLEMENTATION FIDELITY

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 ??

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DOCUMENTATION OF INTENDED AND UNINTENDED CONSEQUENCES

Good research will describe what actually happened, whether it was planned (intended) or not planned (unintended).

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EVIDENCE BASED RESEARCHEmpirically-supported practices

Research-based interventionsScience-based servicesScience-verified practices

Refers to programs or techniques that are proven to work, and produce consistent, positive results…

(Waters, 2005)

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AN OPERATIONAL DEFINITION OF EVIDENCE-BASED PRACTICE

“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)

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A CLOSER LOOK….NATIONAL STANDARDS PROJECT

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NATIONAL STANDARDS REPORT (2009) - NAC

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THE NATIONAL AUTISM CENTER’S NATIONAL STANDARDS REPORT 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

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ESTABLISHED TREATMENTS 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

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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

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UNESTABLISHED TREATMENTS 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