Research overview evidence based practices in autism

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RESEARCH AND OVERVIEW OF EVIDENCE
BASED PRACTICES FOR AUTISM
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WHAT IS GOOD RESEARCH?
Research should clearly describe
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The intervention
How the intervention differed from the control
How the intervention is supposed to affect outcome.
What actually happened, whether it was anticipated or not
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RESEARCH BIAS
The best research will be in professional
journals
 When reading – who is funding the project
 Look for independent research studies
 Look for current studies
 Approach .com website information with
caution
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HIERARCHY FOR STRENGTH OF EVIDENCE
Informed by research
 Established environmental variables
 Documentation of implementation fidelity
 Documentation of intended and unintended
consequences
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LEVELS OF EVIDENCE
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A ranking used to describe the strength of the results measured in a
research study
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Level 1 (likely reliable) Evidence - representing the most valid reports addressing
patient-oriented outcomes. Examples include rigorous randomized trial sand
systematic reviews of level 1 evidence reports.
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Level 2 (mid-level) Evidence - representing reports addressing patient-oriented
outcomes, and using some method of scientific investigation, yet not meeting the
quality criteria to achieve level 1 evidence labeling. Examples include randomized
trials with less than 80% follow-up and non-randomized comparison studies Level 2
evidence does not imply reliable evidence.
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Level 3 (lacking direct) Evidence - representing reports that are not based on
scientific analysis of patient-oriented outcomes. Examples include case series, case
reports, and expert opinion.
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INFORMED BY RESEARCH
Rigorous research designs
 Randomized experimental designs
 Other acceptable designs
 Quasi-experimental designs
 Single subject studies
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There are others.
Refer to the CEC website on www.cec.sped.org
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RANDOMIZED EXPERIMENTAL DESIGNS
Randomized experimental designs place subjects in
control and experimental groups through a random
selection process. The experimental group receives
the treatment and the control group does not.
Typically, pre and post tests are given to each group,
and then statistically compared to determine the
potential effect of the treatment.
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SIMPLE PRE/POST TEST RANDOMIZED
EXPERIMENTAL DESIGN
Group 1 (experimental group)
R Observation
Treatment
Group 2 (control group)
R Observation
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Observation
Observation
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QUASI-EXPERIMENTAL DESIGNS
A quasi-experimental design is a research study in
which a group of subjects receives a treatment
while another group does not. The key difference
between this design, and an clear experimental
design is the lack of random assignment.
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SINGLE SUBJECT DESIGNS
These research designs compare a subject’s
performance on a target behavior with repeated
measures of that behavior over time. In these
designs, the individual is his/her own control
group.
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PICO WORKSHEET
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Problem
Intervention
Comparison
Outcome
Problem: What is the situation, issue, or individual that requires
attention?
Intervention: What instructional approach, strategy, intervention
is needed or suggested?
Comparison: What is the main (or other) alternative to the
suggested approach?
Outcome: What do the data say about the suggested
approach?
Supporting literature for selected approach
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PDSA CYCLES
The Plan-Do-Study-Act
(PDSA) cycle is
shorthand for testing a
change — by planning
it, trying it, observing
the results, and acting
on what is learned.
This is the scientific
method, used for
action-oriented
learning.
Institute for Healthcare Improvement,
2010
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ESTABLISHED ENVIRONMENTAL
VARIABLES
Quality research should clearly describe
 The intervention, including who administered it,
who received it, and what it cost,
 How the intervention differed from what the
control group received, and
 The logic of how the intervention is supposed to
affect outcomes.
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DOCUMENTATION OF
IMPLEMENTATION FIDELITY
Implementation fidelity refers to the degree
to which the intervention was delivered per
the prescribed instructions or plan. In other
words, did the “teacher” deliver the
instruction as he/she was supposed to ??
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DOCUMENTATION OF INTENDED AND
UNINTENDED CONSEQUENCES
Good research will describe what actually
happened, whether it was planned
(intended) or not planned (unintended).
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EVIDENCE BASED RESEARCH
Empirically-supported practices
Research-based interventions
Science-based services
Science-verified practices
Refers to programs or techniques that are proven to
work, and produce consistent, positive results…
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(Waters, 2005)
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AN OPERATIONAL DEFINITION OF
EVIDENCE-BASED PRACTICE
“Practices that are informed by research, in
which the characteristics and consequences
of environmental variables are empirically
established and the relationship directly
informs what a practitioner can do to
produce a desired outcome.”
(Dunst, Trivette, & Cutspec, 2002, p. 3)
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A CLOSER LOOK….NATIONAL STANDARDS
PROJECT
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NATIONAL STANDARDS REPORT (2009) - NAC
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THE NATIONAL AUTISM CENTER’S NATIONAL
STANDARDS REPORT
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Established. Sufficient evidence is available to confidently determine that a
treatment produces beneficial treatment effects for individuals on the autism
spectrum. That is, these treatments are established as effective.
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Emerging. Although one or more studies suggest that a treatment produces
beneficial treatment effects for individuals with ASD, additional high quality studies
must consistently show this outcome before firm conclusions can be drawn about
treatment effectiveness.
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Unestablished. There is little or no evidence to allow us to draw firm conclusions
about treatment effectiveness with individuals with ASD. Additional research may
show the treatment to be effective, ineffective, or harmful.
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Ineffective/Harmful. Sufficient evidence is available to determine that a treatment is
ineffective or harmful for individuals on the autism spectrum.
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http://www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf
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ESTABLISHED TREATMENTS
 Antecedent
Package
 Behavioral Package
 Comprehensive Behavioral Treatment for Young Children
 Joint Attention Intervention
 Modeling
 Naturalistic Teaching Strategies
 Peer Training Package
 Pivotal Response Treatment
 Schedules
 Self-management
 Story-based Intervention Package
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EMERGING TREATMENTS
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Augmentative and Alternative
Communication Devices (AAC)
Cognitive Behavioral Intervention
Package
Developmental Relationshipbased Treatment
Exercise
Exposure Package
Imitation-based Interaction
Initiation Training
Language Training (Production)
Language Training (Production &
Understanding)
Massage/Touch Therapy
Multi-component Package
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Music Therapy
Peer-mediated Instructional
Arrangement
Picture Exchange Communication
Systems (PECS)
Reductive Package
Scripting
Sign Instruction
Social Communication Intervention
Social Skills Package
Structured Teaching
Technology-based Treatment
Theory of Mind Training
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UNESTABLISHED TREATMENTS
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Academic Interventions
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Auditory Integration Training
Facilitated Communication
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Use traditional teaching methods to improve academic
performance, including “special education”
Using a keyboard of words or pictures, or a typing device to
communicate with the help of a facilitator
Gluten- and Casein-Free Diet
Sensory Integrative Package
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Using all the senses as a means of addressing
overstimulation or understimulation from the environment
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