Full Length Article
Evidenced-Based Interventions for Children With Autism Spectrum Disorder

https://doi.org/10.1016/j.cppeds.2018.08.014Get rights and content

This paper reviews evidenced-based interventions for children with autism spectrum disorders (ASD) across the disciplines of psychology, speech-language pathology, occupational therapy, and developmental pediatrics. Background: rates of ASD diagnoses have been steadily rising over the past 2 decades. There are a wide range of therapies and interventions, of varying levels of evidence, across disciplines that are now available to treat children with ASD. The field has moved toward a greater emphasis on the identification and utilization of evidenced-based treatments. Methods: a review and summary of recent literature was conducted by professionals in an interdisciplinary autism center. An emphasis was placed on results of the National Autism Center's National Standards Project. Results and Conclusions: within each discipline, interventions exist that vary in level of evidenced-based support. Although disciplines may differ in their definitions of evidence-based treatments, it is important for each discipline to strive to offer and promote practices with the best evidenced-based support according to each field's standards.

Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by pervasive deficits in social interaction and communication, as well as the presence of rigid and/or repetitive behaviors or sensory concerns that impact the individual's functioning and development. Individuals with this disorder may experience symptoms with or without intellectual or language impairment. The term “spectrum” is used to capture the wide array of symptomology seen across age and developmental levels.1 According to the Center for Disease Control and Prevention's 2018 published data, approximately 1 in 59 children in the United States are diagnosed with ASD, with reported prevalence in all racial, ethnic, and socioeconomic groups. ASD is about 4 times more common among males (26.6 per 1000) than among females (6.6 per 1000).2 The documented rise in the prevalence of ASD is a much-debated topic, and may be linked to improvement in diagnostic tools, increasing awareness of the disorder, and/or an increase in incidence over time.

The manifestation and severity of symptoms of ASD vary widely, with treatment typically focusing on the core features of ASD such as: deficits in social communication or social interactions, restricted behaviors, sensory concerns, or on co-occurring challenging behaviors that impact the development of functional skills and independence. Symptom presentation and treatment may be further complicated by medical concerns such as: epilepsy, sleep problems, and gastrointestinal problems, as well as intellectual/cognitive impairment, and, in some children, the presence of challenging maladaptive behaviors such as hyperactivity, anxiety, irritability, self-injury, and aggression.3 Effective treatment for children with ASD involves an interdisciplinary approach. It includes a combination of educational interventions, psychological/behavioral therapies, speech-language therapy, occupational/physical therapy, and medical treatments (e.g., psychopharmacology). The focus of this paper is on the non-pharmacologic treatments and therapies that support optimal outcomes for children and adolescents with ASD.

Section snippets

What is meant by evidence-based practice?

There is a wide range of possible interventions available to treat core symptoms of ASD and co-occurring conditions. The cause of ASD is unknown and believed to be multi-factorial, including a combination of predisposing genetic factors and environmental exposures.4 There is no single cause for ASD, and there is no single best treatment option. Given the heterogeneity of ASD symptoms and severity across the spectrum, ASD is generally not a condition that can be “cured.” The primary goal of

Developmental screening and monitoring

Following guidelines of the American Academy of Pediatrics (AAP), primary care clinicians who provide well child care for children are expected to conduct routine developmental surveillance at all well child visits and structured developmental screening at 9, 18, and 30-months, including the use of ASD-specific screening tools at ages 18 and 24-months.11 Despite the AAP's 2006 recommendations for developmental screening, a 2014 report from the Centers for Disease Control and Prevention (CDC)

Treatment interventions

The goal of this paper is to provide an overview of evidence-based therapeutic interventions that clinicians in the fields of primary care and developmental pediatrics should consider for treatment of children and adolescents with ASD. This includes a review of the evidence-based therapies (non-pharmacologic treatments) across disciplines including the fields of: psychology, speech-language pathology, and occupational therapy. It is important to note that the scope of many treatments overlaps

Conclusion

There is a wide range of interventions available, with varying levels of evidence to treat the core features of ASD, which include communication and social deficits, challenging behaviors, and sensory processing and motor coordination difficulties. Since ASD is a pervasive disorder that affects multiple areas of functioning, it is important for clinicians to be knowledgeable about the most effective and evidenced-informed interventions across disciplines in order to provide clinical care that

References (116)

  • S.N. Compton et al.

    Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence-based medicine review

    Journal of the American Academy of Child & Adolescent Psychiatry

    (2004)
  • J.J. Wood et al.

    Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: A randomized, controlled trial

    Behavior Therapy

    (2015)
  • H.K. Jennett et al.

    Identifying empirically supported treatments for phobic avoidance in individuals with intellectual disabilities

    Behavior Therapy

    (2008)
  • J.B. Klein et al.

    Cognitive-behavioral therapy for adolescent depression: a meta-analytic investigation of changes in effect-size estimates

    Journal of the American Academy of Child & Adolescent Psychiatry

    (2007)
  • A.A. Spek et al.

    Mindfulness-based therapy in adults with an autism spectrum disorder: a randomized controlled trial

    Research in developmental disabilities

    (2013)
  • A. Palmen et al.

    A systematic review of behavioral intervention research on adaptive skill building in high-functioning young adults with autism spectrum disorder

    Research in Autism Spectrum Disorders

    (2012)
  • Association A.P. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Arlington, VA, American...
  • J. Baio et al.

    Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014

    MMWR Surveillance Summaries

    (2018)
  • SMJC. Myers

    Management of children with autism spectrum disorders

    Pediatrics

    (2007)
  • K. Lyall et al.

    The changing epidemiology of autism spectrum disorders

    Annual review of public health

    (2017)
  • M.A.G. Initiative

    Autism spectrum disorders: Guide to evidence-based interventions

    (2012)
  • H. Howard et al.

    The National Autism Center's National Standards Project “Findings and Conclusions”

    (2009)
  • Findings and conclusions: National standards project, phase 2

  • S.L. Odom et al.

    Evidence-based practices in interventions for children and youth with autism spectrum disorders

    Preventing school failure: Alternative education for children and youth

    (2010)
  • J. Young et al.

    Autism spectrum disorders (ASDs) services. IMPAQ final report on environmental scan Baltimore

    (2010)
  • Warren Z., Veenstra-VanderWeele J., Stone W., et al. Therapies for children with autism spectrum disorders....
  • B.F.S. Committee

    Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening

    Pediatrics

    (2006)
  • C.E. Rice et al.

    Screening for developmental delays among young children—National Survey of Children's Health, United States, 2007

    MMWR Surveill Summ

    (2014)
  • L. Radecki et al.

    Trends in the use of standardized tools for developmental screening in early childhood: 2002–2009

    Pediatrics

    (2011)
  • C. Bethell et al.

    Rates of parent-centered developmental screening: disparities and links to services access

    Pediatrics

    (2011)
  • Learn the Signs. Act Early

  • L. Zwaigenbaum et al.

    Early intervention for children with autism spectrum disorder under 3 years of age: recommendations for practice and research

    Pediatrics

    (2015)
  • L.K. Koegel et al.

    The importance of early identification and intervention for children with or at risk for autism spectrum disorders

    International journal of speech-language pathology

    (2014)
  • J.W. Jacobson et al.

    Cost–benefit estimates for early intensive behavioral intervention for young children with autism—general model and single state case

    Behavioral interventions

    (1998)
  • T. Smith et al.

    Intensive behavioral treatment for preschoolers with severe mental retardation and pervasive developmental disorder

    American Journal on Mental Retardation

    (1997)
  • S. Eldevik et al.

    Using participant data to extend the evidence base for intensive behavioral intervention for children with autism

    American journal on intellectual and developmental disabilities

    (2010)
  • O.I. Lovaas

    Behavioral treatment and normal educational and intellectual functioning in young autistic children

    Journal of consulting and clinical psychology

    (1987)
  • J.J. McEachin et al.

    Long-term outcome for children with autism who received early intensive behavioral treatment

    American Journal of Mental Retardation

    (1993)
  • G.O. Sallows et al.

    Intensive behavioral treatmentfor children with autism: Four-year outcome and predictors

    American Journal on Mental Retardation

    (2005)
  • S. Hartley et al.

    Prevalence and risk factors of maladaptive behaviour in young children with autistic disorder

    Journal of Intellectual Disability Research

    (2008)
  • D.M. Baer et al.

    Some current dimensions of applied behavior analysis

    Journal of applied behavior analysis

    (1968)
  • Cooper J.O., Heron T.E., Heward W.L. Applied behavior analysis....
  • Maurice C.E., Green G.E., Luce S.C. Behavioral intervention for young children with autism: A manual for parents and...
  • D.D. Reed et al.

    Teaching and behavior support for children and adults with autism spectrum disorder: A practitioner's guide

    Functional behavior assessment (FBA)

    (2011)
  • B.A. Glasberg

    Functional behavior assessment for people with autism: Making sense of seemingly senseless behavior

    (2006)
  • C.A. Gray et al.

    Social stories: Improving responses of students with autism with accurate social information

    Focus on autistic behavior

    (1993)
  • S.W. White et al.

    Social Skills Development in Children with Autism Spectrum Disorders: A Review of the Intervention Research

    Journal of Autism & Developmental Disorders

    (2007)
  • B. Reichow et al.

    Social skills interventions for individuals with autism: Evaluation for evidence-based practices within a best evidence synthesis framework

    Journal of autism and developmental disorders

    (2010)
  • Wang P., Spillane A. Evidence-based social skills interventions for children with autism: A meta-analysis. Education...
  • C. Wong et al.

    Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review

    Journal of Autism and Developmental Disorders

    (2015)
  • Cited by (28)

    • Evidence-Based Interventions in Autism

      2024, Pediatric Clinics of North America
    • Characteristics and treatment patterns of autism spectrum disorder in China, 2020

      2022, Psychiatry Research
      Citation Excerpt :

      Although the exact cause of ASD remains unknown and while ASD is a condition that generally cannot be cured, appropriate treatments may help relieve symptoms and improve social interactions and verbal communication (Sharma et al., 2018). One previous study suggested that evidence-based treatments, especially if initiated early, could reduce the core symptoms of ASD and co-existing conditions (Will et al., 2018). In our current study, we found that children who were male, had lower parental education level and were diagnosed with ASD later on had a higher likelihood of non-treatment than their counterparts.

    • Feasibility of a school-based mindfulness program for improving inhibitory skills in children with autism spectrum disorder

      2020, Research in Developmental Disabilities
      Citation Excerpt :

      With nearly one third (31 %) of individuals who have ASD utilizing some form of therapy (Lavelle et al., 2014), establishing effective treatment methods that are both efficient and cost-effective are crucial. There are well-established, evidence-based interventions for children who are diagnosed with ASD, with several other promising interventions gaining support (Will et al., 2018). In order to improve functional independence, these treatments frequently focus on reducing the symptom severity of the core features of ASD, including deficits in social communication, as well as restrictive and repetitive behaviors (RRBs; American Psychiatric Association, 2013).

    • Autism spectrum disorder and complex healthcare needs: The role of healthcare experiences

      2020, Research in Autism Spectrum Disorders
      Citation Excerpt :

      Autism severity is clinically determined during the evaluation process by widely accepted and reputable instruments such as the Autism Diagnostic Observation Scale, Second Edition (ADOS – 2; Lord, Rutter, DiLavore, & Risi, 2012). Yet the varying definitions of ASD severity that are represented in the available research may be conceptualized by ratings from standardized measures (e.g., ADOS), the frequency of externalizing/challenging behaviors, or the presence of co-occurring conditions (Will et al., 2018). There is a high prevalence of co-occurring conditions associated with ASD, including emotional and behavioral disorders, chronic medical conditions, and related developmental impairments, which further complicates the presentation of autism – related symptoms (Fava & Strauss, 2014; Levy et al., 2010).

    View all citing articles on Scopus
    View full text