Making Informed Choices
The needs of individuals with autism are unique, complex, and can impact their lives 24/7. There is often much for them to learn, and time is of the essence. So it is crucial to provide treatment that is most likely to be effective. Although much about autism is not yet fully understood, there are strategies that have been proven effective for learners with ASD, and others that have been proven ineffective or harmful. The supports provided can greatly affect each person’s ability to learn and succeed. Many can make great gains with specialized strategies customized for their particular strengths and challenges.
Whether you are a parent or a professional, it is important to know what research says about the many treatment options you may come across. Weighing the conflicting information marketed as autism treatment can be a confusing and overwhelming process. Autism New Jersey is here to help you understand what research suggests about diverse methodologies and how to document that the intervention is beneficial for a particular individual once it has begun.
A Framework for Understanding What Is Evidence-Based
Much treatment information is presented as factual when it may not be. Looking through the filter of science helps us differentiate opinions/testimonials from substantiated data as well as faulty or poorly designed research from well-designed studies. Autism New Jersey uses a simple stoplight analogy to translate the body of empirical autism-specific research.
Treatments shown through research to be most effective for individuals with autism
Applied Behavior Analysis (ABA)
The science and practice of ABA includes a variety of evidence-based practices.1,2
- Teaching, maintaining, and generalizing skills
- Activity Schedules
- Backward and Forward Chaining
- Comprehensive Behavioral Treatment for Young Children3
- Differential Observing Response
- Direct Instruction
- Discrete Trial Instruction
- Errorless Learning/Teaching
- Imitation Training
- Incidental Teaching
- Joint Attention Intervention
- Picture Exchange Communication System
- Pivotal Response Treatment
- Precision Teaching/Fluency-Based Instruction
- Reinforcement Schedules and Systems
- Repeated Practice
- Scripting/Script Fading Procedures
- Social Skills Package
- Standard Echoic Training
- Story-based Intervention
- Verbal Behavior/Applied Verbal Behavior
- Video Modeling
- Treating challenging behavior
Positive Behavior Support (PBS) is an ABA-based service delivery package that incorporates the following components to understand and treat challenging behavior as well as many of the components listed above to teach functionally-equivalent replacement skills.
- Function-based Intervention
- Functional Behavior Assessment
- Functional Communication Training
- Antecedent-based interventions
- Differential Reinforcement
- Response Interruption and Redirection
1 – National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. Randolph, MA: Author.
2 – Association for Science in Autism Treatment
3 – Typical interventions include the use of discrete trial teaching, incidental teaching, errorless learning, behavioral momentum, shaping, modeling and other interventions derived from ABA.
Risperdal and Abilify (to treat ASD-related irritability)
Have not been studied enough (or at all) to put them in another category
PRELIMINARY EVIDENCE SUGGESTS EFFECTIVENESS
- Melatonin (neurohormone to treat sleep, not ASD)
MORE RESEARCH NEEDED
- Animal therapies (therapy dogs, therapeutic riding)
- Antifungal agents
- Art therapy
- Developmental therapies (DIR/Floortime, RDI, SCERTS, ESDM, RPMT)
- Herbs and homeopathics
- Immune therapy
- Massage therapy
- Medical marijuana
- Mindfulness-based practices
- Music therapy
- Omega-3 fatty acids
- Oral motor therapy/training (PROMPT, Kaufman)
- Project TEACCH
- Social stories (if done in isolation)
- Son-Rise Program
- Vision therapy
- Vitamin supplements
PRELIMINARY EVIDENCE SUGGESTS INEFFECTIVENESS
- Craniosacral therapy
- Dietary changes
- Sensory integration
- Vitamin B6 with magnesium
Shown through research to be harmful or ineffective for individuals with autism
- Auditory Integration Therapy/Training and any type of listening program
- Detoxifying clay baths
- Facilitated Communication
- Hyperbaric oxygen
- Rapid Prompting Method
About Applied Behavior Analysis (ABA)
Hundreds of autism-specific studies have demonstrated the effectiveness of ABA for teaching skills and reducing challenging behavior. While it is effective for other learners as well, it is considered the gold standard in autism intervention. Research also indicates that students in ABA programs make more progress than those in programs combining several different methods.
The goal of ABA is two-fold: to increase useful behaviors that improve quality of life and decrease those that are harmful or interfere with learning or relationships. It is a structured teaching approach that can be implemented in many settings to teach skills from many domains (communication, selfcare, academic, play/leisure, social skills, etc.). It involves understanding patterns of behavior and examining the influence of environmental factors including what happens before and after the behavior. Other key elements are motivation, reinforcement, and task analysis to break complex skills into small steps.
Considerations on the Yellow and Red Light Treatments
Many of the red and yellow light interventions fall into one of two categories:
- They were created to address an unproven theory about a cause of autism
- They may be beneficial for individuals with other special needs but don’t address the unique challenges faced by those with autism
Additionally, it is important to differentiate between treatment/therapy and recreation. Some of the activities which are not established as evidence-based practices for autism may be enjoyable to individuals and valuable as reinforcers (opportunities they would like to work for) or leisure activities (hobbies to enjoy). However, they do not qualify as therapeutic treatment unless they directly alleviate the challenges of autism, teach skills, or reduce challenging behavior.
Autism New Jersey understands that any one individual may respond well to an intervention that is not documented as effective for the majority of people with autism. As with any intervention, we recommend collecting and analyzing data regularly to assess progress with the treatment team. Being alert to possible side effects is also important.
For ANY strategy that is attempted, data should be regularly analyzed to determine if the intervention is bringing about improvement on a specific goal. Implementation can vary, so even established interventions need to be monitored and adjusted to maximize effectiveness. Progress may be slow, so it’s important to keep records that will guide the team’s decisions and keep everyone informed.
The Road Less Traveled (Celiberti et al., 2004) is a helpful resource for evaluating any intervention and its implementation for your child/learner.