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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 DESIGN
Group 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 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
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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 RESEARCH
Empirically-supported practicesResearch-based interventions
Science-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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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
