Recommendations of expert panels & government task forces

Many expert panels and task forces have convened to review research on treatments for individuals with autism spectrum disorders (ASD). The following are some key findings:

• Behavioral and educational interventions are currently the main treatments for individuals with ASD.
• Of these interventions, approaches based on applied behavior analytic (ABA) have received the most extensive research.
• Almost all reviewers conclude that early intensive behavioral intervention, based on ABA, has been shown to be effective in increasing IQ and adaptive behavior.
• Some reviewers also conclude that other ABA interventions have been shown to be effective in teaching specific skills. For example, the Picture Exchange Communication System and Pivotal Response Treatment often help children begin to communicate or expand their language skills. Peer-mediated social skills training and video modeling are useful for increasing interaction with other children. A variety of ABA teaching strategies can reduce problem behavior.
• Medications may be effective for some individuals with ASD if they also display challenging behaviors such as aggression or hyperactivity. (Many individuals with ASD do not display these challenging behaviors, however.)

In addition, the reviews have identified priorities for future research:

• Additional studies are needed to examine the effects of EIBI on outcomes other than IQ and adaptive behavior, such as social communication skills. Studies are also needed on the effects of varying components of EIBI, such as the number of teaching hours, the teaching methods that are used, and the curriculum content.
• There is a great need for research on outcomes of comprehensive intervention programs for older children, youth, and adults with ASD.
• Studies evaluating interventions based on paradigms other than ABA (e.g., DIR, TEACCH) are needed to evaluate their possible effectiveness for individuals with autism.

Some important reviews are listed here:

• • Agency for Healthcare Research and Quality
  • Medical Therapies for Children with Autism Spectrum Disorder – An Update
  • Behavioral Therapies for Children with Autism Spectrum Disorder Update
  • General Therapies for Children with Autism Spectrum Disorder
    • Main findings:
      • Evidence supports early intensive behavioral intervention. However, additional studies with improved research methodologies are needed, particularly to determine which children benefit most. Some evidence also supports play-based interventions to promote social communication skills.
      • A few medications are helpful in treating problem behaviors that some (but not all) individuals with ASD may exhibit.
      • The strength of evidence is insufficient to recommend any other interventions.
    • Reference:

      Weitlauf, A., McPheeters, M., Peters, B., Sathe, N., Travis, R., Aiello, R., . . . Warren, Z. (2014). Therapies for children with autism spectrum disorders – Behavioral interventions update. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publication No. EHC-2013-09-0038.R1. Rockville, MD: Agency for Healthcare Research and Quality.

• • Cochrane Collaboration
    • Main findings:
      • Evidence indicates that early intensive behavioral intervention is effective for some children with ASD. However, the evidence is limited by methodological shortcomings in studies on this intervention.
    • Reference:

      Reichow, B., Barton, E. E., Boyd, B. A., & Hume, K. (2012). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD).Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD009260. DOI: 10.1002/14651858.CD009260.pub2.

• • Report of the Maine Administrators of Services for Children with Disabilities (MADSEC)
    • Main findings:
      • Many applied behavior analytic interventions and some medications have “established evidence” of efficacy for individuals with ASD.
      • All other interventions have substantially lower levels of evidence.
      • An updated report from MADSEC and the Maine Department of Education is available from here
    • Reference:

      Children’s Services Evidence-Based Practice Advisory Committee (2009). Interventions for autism spectrum disorders: State of the evidence. Retrieved from http://www.maine.gov/dhhs/ocfs/cbhs/ebpac/asd-report2009.pdf

  • National Autism Center’s National Standards Project Findings and Conclusions 2009
    National Autism Center’s National Standards Project Phase 2 2015
    • Main findings:
      • Eleven interventions, based almost entirely on applied behavior analysis, are “established” treatments, with extensive scientific support.
      • All other interventions have substantially lower levels of evidence.
    • Reference:

      National Autism Center. (2015). National Standards Project, Phase 2: Findings and conclusions. Randolph, MA: Author.

• • Rand Corporation
    • Main findings:
      • Although no interventions for individuals with ASD have excellent scientific support, four have moderate support: early intensive behavioral intervention, integrated behavioral/developmental programs, the Picture Exchange Communication Systems, and behavioral interventions for social skills.
    • Reference:

      Maglione, M. A., Gans, D., Das, L., Timbie, J, & Kasari, C. (2012). Nonmedical interventions for children with ASD: Recommended Guidelines and further research needs. Pediatrics, 130, S169–S178.

Because ABA currently has substantially more scientific support than any other behavioral or educational intervention for children with ASD, ASAT recommends that families and professionals strongly consider implementing ABA and be cautious about other approaches. ASAT further recommends that professionals describe other behavioral and educational interventions as “untested” and encourage families who are considering these interventions to evaluate them carefully.

For additional information on interventions identified as evidence-based, see ASAT’s treatment summaries: