ASAT Responds to Cape Cod Institute Summer 2012 Program

Dear Dr. Levin,

We recently received your brochure for the 33^rd annual Cape Cod Institute. We are familiar with the Institute and its longstanding reputation of providing training for new and established psychologists every year. As professionals in the field of autism treatment, we always look with great interest at your training offerings. This year, we saw that you have billed Dr. Karen Levine to speak on the “State-of-the-Art Humanistic Diagnosis and Treatment” of autism spectrum disorders.

Upon closer inspection of the topics covered in the week-long training, we took exception to the use of “evidence based comprehensive treatments” to describe all of the following treatment approaches for individuals with autism: Applied Behavior Analysis (ABA), DIR/Floortime, Early Start Denver Model (ESDM), RDI, and SCERTS. Of these approaches, only ABA has extensive scientific evidence to qualify it as “evidence-based” (Beaulieu, Tweed, & Connolly, 2009). The National Standards Project, a comprehensive report and analysis published by the National Autism Center, found some evidence of effectiveness for developmental relationship-based treatment (which includes DIR/Floortime, ESDM, and RDI), but not enough for the National Autism Center to be confident that they are truly effective treatments. The findings of the report are further tempered by the fact that seemingly disparate treatments, such as RDI and Floortime, were lumped together with a combined literature base of only seven empirical articles (Wilczynski et al., 2009).

Separately, DIR/Floortime, RDI, and SCERTS have negligible research support as stand-alone treatments. Only a handful of studies have examined the effects of treatment (e.g., Gutstein, Burgess, & Montfort, 2007; Solomon, Necheles, Ferch, & Bruckman, 2007), and these studies are fraught with research design problems, such as a lack of a control group that both confound the studies and weaken the results. ESDM is supported by one well-designed study (Dawson et al., 2010) demonstrating its effectiveness for children with autism, but requires additional research to be considered evidence-based. We look forward to seeing more research investigating these interventions.

We appreciate your efforts to train psychologists and other professionals in the most up-to-date treatment approaches available. However, your organization presents trainings on a large scale, and care should be taken to not misrepresent the approaches in which professionals are trained. The Association for Science in Autism Treatment works tirelessly to teach families and professionals how to carefully evaluate the myriad treatments for individuals with autism to identify those that are evidence-based. Though non-evidence-based treatments may not harm an individual with autism, they should be implemented with caution as they may be ineffective and could potentially replace other evidence-based, effective treatments. By misrepresenting untested and under-researched treatments as “evidence-based” you may unintentionally contribute to the problematic overuse of un-established treatment approaches. In the future, we hope that you appreciate the influence you have on the acceptance of treatments for individuals with autism, and label evidence-based and non-evidence-based treatments with greater care.

Sincerely,

Kate Fiske Massey, Ph.D., BCBA-D
Consumer Corner Coordinator, Association for Science in Autism Treatment

David Celiberti, Ph.D., BCBA-D
President, Association for Science in Autism Treatment

References Cited in this Letter:
Beaulieu, A., Tweed, L.,& Connolly, N. (2009, October). Interventions for Autism Spectrum Disorders: State of the evidence. (A collaboration of the Maine Department of Health and Human Services & the Maine Department of Education.). Augusta, ME: Muskie School of Public Service and the Maine Department of Health and Humans Services.
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., & Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, e17-e23.
Gutstein, S.E., Burgess, A.F., & Montfort, K. (2007). Evaluation of the Relationship Development Intervention program. Autism, 11(5), 397-411.
Solomon, R., Necheles, J., Ferch, C., & Bruckman, D. (2007). Pilot study of a parent training program for young children with autism: The PLAY project home consultation program. Autism, 11(3), 205-224.
Wilczynski, S., Green, G., Ricciardi, J., Boyd, B., Hume, A., Ladd, M., Ladd, M., Odom, S., & Rue, H. (2009). The National Standards Project: Addressing the need for evidence-based practice guidelines for Autism Spectrum Disorders. Randolph, MA: National Autism Center.