Tamara Marder, Ph.D.
Program Coordinator: Masters in Severe Disabilities, Graduate Certificate in Autism, Graduate Certificate in Severe Disabilities, Masters in General Special Education at Johns Hopkins University, School of Education
Dawn Fraser, M.S. Ed.
Doctoral student in the Special Education Teacher Preparation program at Johns Hopkins University
A diagnosis of autism is defined by deficits in three major areas, including social skills, communication skills, and restricted patterns of interests or behaviors (American Psychiatric Association, 2000). Autism is considered the fastest growing disability (CDC, 2010) with current rates in the United States accounting for well over 730,000 individuals between the ages of 0-21 years (CDC, 2010). Additionally, with the inclusion of autism as a disability category in the 2001 reauthorization of the Individuals with Disabilities Education Act (IDEA), the number of school age children (ages 6 to 21) receiving special education services under the category of autism has increased from 98,000 students in 2001 to just over 193,000 students in 2005 (USDOE, 2007). As these numbers of children identified with autism continuously grow, the number and variety of treatments and strategies also increases (Stansberry-Brusnahan & Collet-Klingenberg, 2010).
For educators attempting to meet the diverse range of learning needs for children with ASD, decisions regarding the types of interventions to implement in the classroom and the limited research on numerous strategies can be both misleading and confusing. Simpson (2005) warns that professionals’ and caregivers’ reliance on untested methods and dependence on strategies that have limited evidence have resulted in unrealistic and unreasonable expectations for students and have hindered the potential progress of students with ASD. It is important for teachers, administrators, and other school personnel to be knowledgeable about evidence-based approaches to adequately address the needs of students with autism. The purpose of this article is to provide educators with a definition and overview of evidence-based practice, outline guidelines for identifying effective teaching practices, and highlight specific resources that teachers can use.
Defining Evidence-Based Practice
An evidence-based practice can be defined as an instructional strategy, intervention, or teaching program that has resulted in consistent positive results when experimentally tested (Mesibov & Shea, 2011; Simpson, 2005). The implementation of high quality research is needed in order for intervention strategies to be considered an evidence-based practice (Odom, Collet-Klingenberg, Rogers, & Hatton, 2010). Boutot and Myles (2011) further define “quality” as research that incorporates experimental, quasi-experimental, or single-subject research designs; is replicated multiple times; and is published in peer-reviewed professional journals. It excludes evidence that is supported by anecdotal reports, case studies, and publication in non-refereed journals, magazines, internet, and other media news outlets (Boutot and Myles, 2011). Perry and Weiss (2007) provide terms for which to look when identifying a practice as evidence-based, including data-based approaches, empirically-validated treatment, and clinical practice guidelines.
The concept of evidence-based practice began in the medical field in the 1970s (Odom et al., 2005) and was adopted into the field of education with the No Child Left Behind (NCLB) Act (NCLB, 2002), in which the term “scientifically-based research” is mentioned more than 100 times (Simpson, 2005). Special educators are required by professional standards (Council for Exceptional Children, 2009) and United States federal regulation to implement effective educational strategies supported by evidence and research (NCLB, 2002). According to Mayton, Wheeler, Menendez, and Zhang (2010), the field of special education has been confronted with a significant gap between research and practice. Strategies that are supported by research are often not put into practice in the classroom.
The resources for determining best practices in autism are more complete and accessible than in previous years (see resources below), however, educators face the challenge of being able to accurately identify those evidence-based practices and then replicate the strategies in the classroom and other educational settings (Stansberry-Brusnahan & Collet-Klingenberg, 2010). It is imperative not only for the field of special education, but specifically those educators responsible for teaching children with autism to have firsthand knowledge of evidence-based practices to help minimize the gap between research and practice. According to the National Research Council (2001), the education of teachers and school personnel is the primary way of ensuring that evidence-based teaching strategies are applied when working with students with autism. Teachers have the advantage of directly being able to identify each student’s specific needs and goals; when they have the knowledge of evidence-based practice in the classroom they are better equipped to match the strategies to the individual needs of each student served (Simpson, 2005).
Determining the Evidence is Supported by Science
When implementing interventions and teaching strategies for students with autism in the classroom setting, it must be determined that the strategy is supported by science (Green, 1996). That means published research exists that implements direct observation and measurement; provides repeated demonstration of the results to support reliability of the strategy; the procedures outlined provide evidence that an alternative explanation for the results does not exist; and finally, the research outcomes have resulted in the clinical use of the treatment. Therefore, teaching and intervention strategies that are supported through speculation, subjective evidence, indirect measures, non-comparative data, and descriptive research should be avoided (Green, 1996).
Special education teachers and administrators need the tools for evaluating the evidence to support the strategies being implemented. When presented with a new teaching approach or evaluating existing strategies, educators should consider the support provided for instructional procedures instead of accepting policy or word-of-mouth that such a practice is effective. A variety of questions can be used to critically evaluate if specific treatment strategies are evidence-based (Celiberti, Bleecker, Kreiss, and Rosenfeld, 2000; Green, 1996; Perry and Weiss, 2007).
1. Has research been conducted to evaluate the specific treatment or strategy? Has that research been published in a peer reviewed journal? Has there been replication of positive outcomes from use of the strategy?
2. Does the specific strategy include an assessment of the individual student’s current performance followed by implementation of a strategy to improve that performance beyond the baseline rates?
3. Does the intervention include requirements for data collection and ongoing monitoring of student progress?
4. What are the measurable outcomes of implementing this strategy? What specific student skills will be addressed?
5. What are the specific benefits and limitations of using this strategy? Do the benefits outweigh the limitations?
Answers to the above questions should point to teaching procedures that have support through replication of results and publication in a peer-reviewed journal. There should be a clear description of the measureable outcomes, including assessment and baseline data which can be compared to progress on the identified skills following implementation of the instructional strategy. Data collection must be evident, as well as follow-up data that measures generalization and maintenance of skills over time. Finally, there should be a discussion of the benefits and limitations, including additional steps practitioners can take to decrease the potential limitations.
Accessing the Practices that are Evidence-Based
Since 2000, resources have emerged that provide systematic reviews of research outcomes to identify practices as evidence-based. In 2001, The National Research Council published a report outlining the requirements for evaluating the evidence regarding effective educational practices for young children with ASD. This report specifically focused on research findings for teaching strategies created for students up to the age of 8 years old. Six components were identified as important skill areas that should be the focus of instruction, including functional spontaneous communication, social skills, plays skills, cognitive development, and functional academic skills, along with proactive strategies to decrease challenging behaviors. In 2005, Simpson and his colleagues (as cited by Simpson, 2005) evaluated 33 frequently used treatments and strategies for students with ASD and placed them into specific categories, including: scientifically based, promising practice, practice having limited support, and not recommended.
More recently, two major resources became available to special educators that provide a list, along with systematic reviews of evidence-based practices for students with ASD. The National Autism Center (NAC; 2009) completed the National Standards Project (NSP) in which they reviewed 775 research studies to identify effective treatments for individuals with ASD. These treatments were divided into three categories: established, emerging, and unestablished. They identified 11 established treatments that resulted in beneficial outcomes; 22 emerging treatments that have some evidence of effectiveness; and five unestablished treatments that did not have any evidence to support effectiveness (NAC, 2009).
The National Professional Development Center on Autism Spectrum Disorders (NPDC on ASD; Odom et al., 2010) reviewed numerous research studies and identified 24 evidence-based practices for students with ASD to date. Whereas the NAC reviewed comprehensive treatment packages, the NPDC on ASD reviewed focused interventions which target a specific skill or concept through one instructional practice. Both the NAC and the NPDC on ASD reviewed research prior to 2008. The NPDC on ASD is currently reviewing articles that have been published since the last review to update their evidence-based practices list. Special educators should focus on these established and evidence-based practices when making decisions for students with ASD. This information can be accessed through the websites described in the resources section of this article.
Steps for Identifying and Implementing Evidence-Based Practice in the Classroom
Being able to define and identify evidence-based practice is the first step in bringing these practices into the classroom. Outlined below are steps that educators can follow to incorporate evidence-based practice that will specifically address goals and objectives for students with autism.
The first step prior to choosing a specific strategy is conducting an assessment of the student’s current skills to create measureable goals (Odom et al., 2010). These goals should be individualized and address the components of instruction outlined by the NRC (2001): functional spontaneous communication, social skills, plays skills, cognitive development, functional academic skills, and proactive interventions to address challenging behavior. It is equally important to collaborate with educational professionals, as well as the student’s family to identify additional pertinent goals and objectives along with the student’s individual preferences and motivators.
Next, use the resources outlined in this paper to identify evidence-based teaching strategies to address the written objectives. Information on accessing the available resources is outlined in the resources section below. It is important to consider that special educators could be aware of a promising practice that might have the potential to meet the student’s educational needs, but does not yet have adequate documentation to be labeled evidence-based. In this situation, Odom et al., (2010) recommends that the teacher should rely on clinical experience to determine if the procedure would produce positive outcomes for the student. Furthermore, in this type of situation, it is IMPERATIVE that the teacher collect data on the objective using the teaching strategy and measure progress to determine efficacy for the identified student. Identifying and choosing a strategy that is not supported by evidence should never take precedence over choosing an evidence-based strategy that has not yet been tried.
Once an effective strategy has been identified, ensure that all members of the educational team involved in teaching the skill are trained on the procedures outlined (Odom et al., 2010). The NPDC has assembled free online trainings (see resources section; http://www.autisminternetmodules.org) that include step-by-step guidelines. The organization also has created evidence-based practice briefs which describe in detail the 24 practices identified as evidence-based, including step-by-step directions for implementation, an implementation checklist, and supplemental materials.
Using Evidence to Influence Practice Everyday
Educators are responsible for ensuring that effective evidence-based strategies are implemented. Along with implementing these practices, measurement to ensure the intervention techniques are used effectively must be in place (Mesibov & Shea, 2011). Single-subject research is a well established methodology for evaluating best practices in special education and autism (Horner, Carr, Halle, McGee, Odom, & Wolery, 2005). It is also closely aligned with the emphasis of special education and should be used as a guideline for measuring effectiveness of teaching practices in the classroom every day. More specifically, single-subject methodology and special education are aligned in the following ways: focus on the individual student behavior (e.g., increasing verbal requests, increasing social initiations, decreasing frequency of aggression, increasing independence on five-step task analysis for hand washing); implementation of a specific teaching strategy/intervention (e.g., shaping, differential reinforcement, functional communication training, chaining); and measuring the outcomes of that strategy by determining if there is a change in behavior (e.g., verbal requesting increased from a baseline of one request per day to ten requests per day). Therefore, not only must the teaching strategies used each day be identified as evidence- or research-based, but there must also be actual evidence of daily instruction through measurement to determine if a relationship between the implementation of the teaching strategy and an increase in skills or decrease in behaviors exists. Equipped with that information, teachers are able to make data-based decisions regarding students’ progress and future programming. As summarized by Simpson (2005), effective practices must be systematically and objectively verified through data collected, implemented with accuracy, and tailored to meet the individual needs of students with ASD.
Taking the Next Steps
According to Rogers (1998), it is the responsibility of professionals who teach in the fields of special education and autism to have knowledge regarding effective intervention and strategies so they may provide families, caregivers, and other service providers with information to enable them to discriminate between effective and unsubstantiated strategies, as well as work toward ensuring that effective services and teaching methodologies are available to all students identified with autism spectrum disorders. In 2012, this is even more pertinent as the number of different intervention approaches increases. Appropriate training for all special educators, specifically in the field of autism, is imperative. Teacher preparation programs need to ensure that future teachers are provided with the tools to accurately evaluate research to identify evidence-based practice; how to implement that practice in their daily teaching strategies; and how to keep current on the emerging research studies that evaluate evidence-based strategies for teaching students with autism. Additionally, training should be provided to teachers to share information and strategies for evaluating evidence-based practice with parents and other caregivers. Along with teaching emerging special educators in college and graduate level coursework, school systems have the responsibility, as outlined in NCLB (2002), to ensure their teaching staff is trained on evidence-based practice through in-service instruction, as well as opportunities for attending professional conferences and other workshops on evidence based practice.
Armed with the knowledge of evidence backed by science to support teaching strategies, the ability to access ongoing research, systematic reviews, and the tools to implement effective interventions, special educators will be better able to meet the diverse and challenging learning needs of students with ASD.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Boutot, E. A., & Myles, B. S., (2011). Autism spectrum disorders: Foundations, characteristics, and effective strategies. Pearson Education, Inc.: Upper Saddle River, NJ.
Celiberti, D., Bleecker, F., Kreiss, D., & Rosenfeld, D. (2000). Alternative treatment approaches for ASD: Tools for identifying appropriate and effective interventions. COSAC OutReach, 14, 3- 14.
Centers for Disease Control and Prevention (2010). Autism: Frequently asked questions: Prevalence. Retrieved from http://www.cdc.gov/ncbddd/autism/faq-prevalence.html
Council for Exceptional Children (2009). What every special educator should know: Ethics, standards, and guidelines (6th Edition). Arlington, VA: Author. Retrieved from http://www.cec.sped.org/content/navigationmenu/professionaldevelopment/professionalstandards/
Green, G. (1996). Evaluating claims about treatments for ASD. In Maurice, C., Green, G., Luce, S. C., Behavioral intervention for young children with ASD: A manual for parents and professionals. Pro-ed: Austin, Texas.
Horner, R. H., Carr, E. G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single subject research to identify evidence-based practice in special education. Exceptional Children, 71, 165-180.
Mayton, M. R., Wheeler, J. J., Menendez, A. L., and Zhang, J. (2010). An analysis of evidence-based practices in the education and treatment of learners with autism spectrum disorders. Education and Training in Autism and Developmental Disabilities, 45, 539-551.
National Autism Center (NAC). (2009). National Standards Report. Retrieved from http://www.nationalautismcenter.org/nsp/reports.php
National Research Council. (2001). Educating children with autism. Washington DC: National Academy Press. Retrieved from http://www.nap.edu/openbook.php?isbn=0309072697
No Child Left Behind Act of 2001, 20 U.S.C. 70 § 6301 et seq. (2002). Retrieved from http://www2.ed.gov/policy/elsec/leg/esea02/107-110.pdf
Perry, A., & Weiss, J. A. (2007). Evidence-based practice in developmental disabilities: What is it and why does it matter? Journal on Developmental Disabilities, 12, 167-171.
Rogers, S. J. (1998). Empirically supported comprehensive treatments for young children with autism. Journal of Clinical Child Psychology, 27(2), 168-179.
Simpson, R. (2005). Evidence-based practices and students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 20(3), 140-149.
Stansberry-Brusnahan, L. L., & Collet-Klingenberg, L. L. (2010). Evidence-based practices for young children with autism spectrum disorders: Guidelines and recommendations from the National Resource Council and National Professional Development Center on Autism Spectrum Disorders. International Journal of Early Childhood Special Education, 2, 45-56.
Association of Science in Autism Treatment www.asatonline.org
This website contains descriptions and research summaries of autism treatments, video demonstrations of interventions, book reviews, and the Clinical Corner which showcases questions asked by educators and parents and answered by autism experts.
Autism Research Institute http://www.autism.com/
This website contains resources for educators, families, and individuals with ASD, including teaching tips, helpful videos, educational strategies, and academic accommodations for successful inclusion.
National Autism Center http://www.nationalautismcenter.org/
This website contains information regarding the National Standards Project, a free downloadable Educator’s manual, resource articles and guides, and answers to frequently asked questions.
The National Professional Development Center on Autism Spectrum Disorders http://autismpdc.fpg.unc.edu/
This website contains a comparison of their evidence-based practices to those identified in the National Standards Project in an easy-to-read PDF format. This site also contains evidence-based practice briefs, which describe in detail the 24 practices identified as evidence-based for students with ASD and include step-by-step directions for implementation, an implementation checklist, and supplemental materials.
Autism Internet Modules http://www.autisminternetmodules.org/
This website contains 14 of the evidence-based practices identified by the NPDC on ASD and includes the information in the evidence-based practice briefs in addition to free access to case studies, video examples, pre- and post-tests, and more.
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