by Darcy Schiller
This is truly exciting news! The Evidence-Based Practices for Children, Youth, and Young Adults with Autism (Steinbrenner et. al., 2020) was recently published in April 2020! What?! You haven’t read the 140-page report yet? Consider this the Cliff’s Notes of the most recent research on EBPs! The TSLAT team is already in the process of updating all our resources to reflect the new research.
"The purpose of this report is to identify approaches that support autistic children and youth in being more independent and realizing outcomes that support their success." This is the third iteration of this review of the literature on EBPs. The first report completed by the National Professional Development Center on Autism Spectrum Disorder (NPDC) identified 24 evidence-based practices (EBPs). The second report, published in 2014, also by the NPDC, identified 27 EBPs. The National Clearinghouse for Autism Evidence and Practice (NCAEP, pronounced en-CAPE) is continuing the work of the NPDC in conducting these systematic reviews of the literature. This current report compares the new evidence with what was reported in the 2014 review.
The first thing of note is that the evidence base has more than doubled! To be exact, the previous review covered articles published from 1990-2011. 427 articles, published over 21 years, met the criteria for inclusion in the previous review. The current review expanded the evidence base to 2017, covering articles published from 2012 to 2017. In just these 5 years, 545 articles met their strict criteria for inclusion in this literature review. That is a 56% increase in the evidence base! This helps give validity to our practices!
What Didn’t Change?
20 of the 27 EBPs from the 2014 report had no changes. They had a strong evidence base in 2014 and now they have an even stronger evidence base. As expected, all of the EBPs that the TSLAT team considers belonging on your Tool Belt (see blog on the Tool Belt), remained EBPs with no changes!
| EBPs on Your Tool Belt | Other EBPs with No Changes |
|---|---|
| Reinforcement | Discrete Trial Training |
| Differential Reinforcement | Extinction |
| Prompting | Functional Behavior Assessment |
| Visual Supports | Functional Communication Training |
| Antecedent-Based Interventions | Naturalistic Interventions |
| Modeling | Parent-Implemented Intervention |
| Video Modeling | Response Interruption/Redirection |
| Task Analysis | Self-Management |
| Social Narratives | |
| Social Skills Training | |
| Technology-Aided Instruction and Intervention | |
| Time-Delay |
There are 5 NEW EBPs!
Appendix 3 in the new report has an intervention fact sheet for each of the 28 identified EBPs that includes a definition of the practice, information about participant ages and positive outcomes from the studies, and a full reference list.
| Augmentative and Alternative Communication | Augmentative and Alternative Communication (AAC) interventions use and/or teach the use of a system of communication that is not verbal/vocal included aided and unaided communication systems. Unaided communication systems do not use any materials or technology (e.g., sign language and gestures). Aided communication systems include low tech systems (e.g., exchanging objects/pictures or pointing to letters) and extend to high tech speech generating devices (SGDs) and applications that allow other devices (i.e., phones, tablets) to service as SGDs. Methods of teaching AAC use are also included in this category (e.g., Aided Language Modeling) which may include other EBPs such as prompting, reinforcement, visual supports, and peer-mediated interventions. Manualized Interventions Meeting Criteria: Picture Exchange Communication System (PECS; Bondy and Frost, 1985). |
|---|---|
| Behavioral Momentum Intervention | Behavioral Momentum Intervention (BMI) is a strategy in which the task presentation is modified so that those requiring less effortful responses (i.e., high probability response sequences) occur before those requiring more difficult responses (i.e., low probability response sequences). This is done so that learners will receive reinforcement earlier and will be more likely to remain engaged and persist with more challenging tasks or requests that follow. BMI can be used in academic, social, communication, and behavioral domains. In addition to reinforcement, BMI strategies are often used in conjunction with other evidence-based practices such as antecedent-based interventions and prompting. |
| Direct Instruction | Direct Instruction (DI) is a systematic approach to teaching and a sequenced instructional package that utilizes scripted protocols or lessons, emphasizes teacher and student dialogue through choral and independent student responses, and employs systematic and explicit error corrections to promote mastery and generalization. Direct instruction is usually provided to small groups of learners and includes brisk pacing, student responses, explicit signals to cue student responses, correction procedures for incorrect or non-responses, and modeling correct responses. Instruction is sequenced so that students are required to master levels in a pre-specified order before moving to the next level. DI interventions can be used to support learners in acquiring literacy and mathematics skills and are often used in conjunction with other evidence-based practices including prompting, reinforcement, modeling, and visual supports. |
| Music-Mediated Intervention | Music-mediated Intervention (MMI) uses music as a key feature of the intervention delivery. This includes music therapy, which occurs in a therapeutic relationship with a trained music therapist, in addition to the planned use of songs, melodic intonation, and/or rhythm to support the learning or performance of target behaviors and skills in varied contexts. |
| Sensory Integration | Sensory Integration (SI, Ayres, 1989) is a theory and practice that targets a person's ability to process and internally integrate sensory information from their body and environment, including visual, auditory, tactile, proprioceptive, and vestibular input. SI uses individually tailored activities that challenge sensory processing and motor planning, encourage movement and organization of self in time and space, utilize "just right" challenges, and incorporate clinical equipment in purposeful and playful activities in order to improve adaptive behavior. SI is implemented by trained occupational therapists (OTs) and primarily takes place in clinical settings. |
What Happened to SC, SPG, PRT, and PECS?
"With this review, four focused intervention practices previously identified as EBPs have been merged into other categories. Scripting is now within Visual Supports. Structured Play Groups is included in Peer-Based Instruction and Intervention, a reconceptualized category that now includes adult-mediated interventions with peers in addition to peer-mediated interventions. While Pivotal Response Training (PRT; Koegel & Koegel, 2006; Stahmer et al., 2011) has quite an expansive literature base, it is often described as a Naturalistic Intervention, and to provide more conceptual consistency it has been merged into the latter grouping. Similarly, Picture Exchange Communication System® (PECSTM; Bondy & Frost, 2011), with its own expansive literature base, now fits conceptually within the Augmentative and Alternative Communication EBP. Importantly, these reclassifications do not indicate that these practices are any less effective or evidence-based. Rather, the reclassifications are designed to provide more conceptual clarity, consistency, and conciseness."
Three EXPANDED EBP Categories:
CBI (Cognitive Behavior Intervention) has expanded to include academic-focused cognitive interventions, and is now called CBIS (Cognitive Behavioral/Instructional Strategies). Exercise (EXE) has also expanded to include mind-body interventions such as yoga, and is now named Exercise and Movement (EXM). A third expanded EBP category is Peer-Mediated Instruction/Intervention (PMII) and is now Peer-Based Instruction and Intervention (PBII).
MIMCs:
Here is a new term used in the report, Manualized Interventions Meeting Criteria (MIMCs). "A set of interventions grouped within established EBP categories now themselves have sufficient evidence to be classified as evidence-based. We have labeled these as Manualized Interventions Meeting Criteria (MIMC) and they are operationally defined as interventions that a) are manualized, b) have unique features that create an intervention identity, and c) share common features with other practices grouped within the superordinate EBP classification. Two of the most prominent… are PECS® (Frost & Bondy, 2002), merged into Augmentative and Alternative Communication and PRT merged into Naturalistic Intervention. Other MIMCs under Naturalistic Intervention are JASPER (Kasari et al., 2014), and Milieu Training (Kaiser & Roberts, 2013). Two MIMCs grouped within Parent-Mediated Intervention are Project ImPACT (Ingersoll & Dvortcsak, 2019) and Stepping Stones/Triple P (Turner et al., 2010). Social Stories ™ (Gray, 2000) is grouped within the broader Social Narrative EBP, and the PEERS® intervention (Laugeson & Frankel, 2010) is in the Social Skills Training EBP. Two programs that do not necessarily have a “manual” but rather have software documentation and sufficient evidence are Mindreading (Golan & Baron-Cohen, 2006) and FaceSay® (Hopkins et al., 2011). They are grouped within the Technology-Aided Instruction and Intervention EBP." There are a total of ten MIMCs in the new report.
What About Emerging Practices, Practices with Some Evidence?
To wrap up, here is what happened to the "emerging practices" from the previous review and show you the new list of "practices with some evidence". In Table 4.2 in the new report, the first column lists the 11 practices that were considered emerging in the previous report. The second column shows you how they were categorized, or where they went.
Table 3.2 from the new report shows the new list of emerging practices and the reason why they were excluded from being identified as an EBP in this report. The report was clear in cautioning the use of Punishment and that "there are some practices (i.e., auditory integration, sensory diet) that were supported by only one study, had no new studies published since the last review, and for which articles have been published that document their lack of effectiveness (i.e., American Academy of Pediatrics, 2010; Barton et al., 2015). Practitioners should not interpret their inclusion in this review as an endorsement of their evidence base."
Finally, there's a new matrix from the new report. The new outcome category, Self-Determination, contains outcomes in the 6-14 age range for cognitive behavioral/instructional strategies, self-management, and social skills training.
Download the full report here.
Steinbrenner, J. R., Hume, K., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2020). Evidence-based practices for children, youth, and young adults with Autism. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team.
Darcy Schiller, M.S., CTP-E, is an Autism Education Specialist at Education Service Center Region 13 in Austin, TX and is on the Texas Statewide Leadership for Autism Training (TSLAT) team. She develops and provides training and technical assistance to educators and families across Texas who are impacted by autism, other developmental disabilities, and those who have experienced trauma. She has over 20 years of experience in the fields of special education and psychology.