The rise of wide-ranging treatment approaches for Autism Spectrum Disorder (ASD) has provided parents with the ability to construct an individualized approach to best suit each child’s unique needs. However, sorting through all of these options can become overwhelming for many of the families that we see at our center. Between all of the therapeutic interventions, dietary regiments, and alternative techniques that float in and out of popular regard, devising a formula to address ASD symptoms can be a frustrating process of trial-and-error for both parents and children.
Consistent with the medical field’s standards for best practices, mental health professionals have moved towards employing evidence-based practice (EBP) to ensure that clients receive the highest quality of care. However, deceiving terms such as “research-based,” “scientifically-based,” “proven,” and “effective” are used to describe a slew of traditional and modern therapies, often leaving caregivers at a loss when it comes to differentiating between them. To top it all off, insurance companies, school districts, and other sources of financial support have become increasingly stringent in determining and enforcing specific criteria for service coverage. Gaining a clear grasp and understanding of what constitutes EBP is essential for parents and other caregivers who are charged with navigating this complex system.
What is Evidence-Based Practice?
Evidence-based practice involves the implementation of practices that have demonstrated effectiveness through multiple trials of rigorous research design. Rather than anecdotal accounts from advocates of certain interventions, EBP’s must have measurable outcomes, a clear cause-and-effect reduction in symptoms, and show consistent effectiveness across studies conducted by multiple researchers who adhere to high standards of experimental design (Odom, Brantinger, Gersten, Horner, Thompson, & Harris, 2005).
To pave the way, the National Autism Center conducted the National Standards Project in 2009. This research endeavor constituted the largest-scale empirical review of treatment to date. Rather than deeming treatment approaches as simply effective or ineffective, descriptive categories were created to allow room for growth and change within various areas of clinical practice. The amount and quality of research to support each type treatment was carefully examined, based on which the treatment was labeled as established, emerging, unestablished, or ineffective/harmful. The results from this study are extensive in scope, and the full report can be viewed on the National Autism Center’s website (www.nationalautismcenter.org).
Outcomes from EBP classification have influenced the treatment process by lending strong support to some approaches, such as behavioral-based interventions, while highlighting a lack of substantiation for others. Furthermore, the potential for growth among emerging treatments has led to substantial efforts in devising techniques for measuring and dispersing promising empirical evidence of effectiveness (Reichow, Doehring, Cicchetti, & Volkmar, 2011). In other words, therapists, teachers, parents, and clients have been called to engage in a collective movement towards gathering data for facilitation of the much-needed advancements in ASD treatment.
Evidence-Based Care for Your Child
Parents often seek EBP to address their children’s symptoms, yet they may struggle to choose which EBP best applies to their own child’s profile of strengths and weaknesses. Additionally, it may be difficult to discern a provider’s commitment to the implementation of EBP to best treat an individual child. Referencing unbiased and reliable resources, including national and local ASD associations, peer-reviewed research journals, and the organizations cited in this article, is often a helpful starting point in assessing the efficacy of a given approach. Consulting with multiple professionals, seeking guidance from educational and medical providers, and networking with parents who face similar challenges may also be helpful tactics (Tetenbaum & Nichols, 2012). Most importantly, it is essential that caregivers remain active and apprised throughout the duration of any intervention. Research has identified parents’ involvement in the treatment process to be a key factor in children’s successful outcomes (Brookman-Frazee, Baker-Ericzen, Stadnick, & Taylor, 2011).
It is also important to note that the dynamic and ever-changing nature of the ASD treatment pool produces promising treatments that parents may be interested in pursuing before the evidence base has been fully established. For example, clinicians at our center have modified Cognitive Behavioral Therapy (CBT), an evidence-based treatment for numerous mental health concerns, to specifically fit treatment needs of children and adults on the autism spectrum. This treatment is considered emerging since supportive research is still in progress (National Autism Center, 2009), but we have consistently achieved strong positive responses among clients. On top of parents at our practice noting significant improvement in their children’s symptoms, many other clinicians have begun to implement CBT for mental health concerns in their work with ASD clients. As more research emerges, more clinicians have adapted this approach. A book summarizing current research in CBT for youth with ASDS has recently been published (Scarpa, White, & Atwood, 2013) and shows promising results from utilizing for this population.
Parents considering an emerging therapy approach are advised to make a number of preliminary considerations (Prizant, 2011). First, existing evidence that has been collected for treating similar concerns should be taken into account. For example, several years of research has substantiated CBT as a highly effective treatment for depression and anxiety in children (Friedburg & McClure, 2002). Work with providers and consultants to weigh the risks and benefits, and also consider practical information and experiences. Explore educational resources, clinical data, and other parents’ perceptions of their children’s progress. The Association for Science in Autism (www.asatonline.org) is an excellent resource for families who are considering specific therapies. Research summaries on many of the current approaches to ASD treatment, as well as information on the strength of the research, are easily accessible through ASAT’s website and quarterly newsletter. Finally, don’t be afraid to ask treatment providers directly about empirical support for the treatments that they offer and research efforts that they may be involved in. Well-trained professionals will be up-to-date on empirical developments, and they will whole-heartedly welcome your collaboration in structuring the optimal treatment for your child.
Alyson H. Sheehan, PhD, is a Post-Doctoral Fellow and Samara P. Tetenbaum, PhD, is a licensed clinical psychologist at ASPIRE Center for Learning and Development. For more information, please visit www.aspirecenterforlearning.com.