here - National Council for Special Education

Educating Persons with Autistic
Spectrum Disorder - A Systematic
Literature Review
NCSE Research Conference, 2014
Caroline Bond, University of
Manchester and Wendy Symes, Edge
Hill University
19th November 2014
Overview of the review
• Systematic Literature Review of educational
interventions for children and young people
with ASD 2008-2013
• 5 country case studies
• Supplementary review of guidance documents
• All 3 strands to identify implications for
provision in Ireland
Methodology for SLR
• A six stage process was followed and informed
by established frameworks for undertaking
systematic reviews
1. Development of search terms related to autism,
educational provision, children and young
people and outcome. 15 research data bases
were searched 25.7.13-26.8.13
2. Reference harvesting and database searching
resulted in 6232 hits and 1021 studies retained
for screening once duplicates removed
Methodology for SLR
3. The 1021 full text papers were screened in relation to
the inclusion criteria. 845 were excluded and 176 were
retained for inclusion and full coding
4. Development and trialling of coding framework specific
to the review. The framework enabled description and
assessment of each paper. Each was assessed for
• quality of evidence
• methodological appropriateness to review aims
• effectiveness of intervention
This enabled studies to be categorised as high/medium
and low in each of the 3 assessment areas.
Methodology for SLR
5. Coding of studies – each full text article was
added to a central database and coded using the
framework. The research team undertook regular
inter-rated reliability checking and reviews of
6. Description and presentation of the 85 studies
retained for inclusion in the final report. Included
studies had to be assessed as medium or above in
the 3 assessment areas (quality, methodological
appropriateness and effectiveness)
Key findings from the SLR
• 85 best evidence studies of at least medium
methodological quality
• Majority focused on pre-school children and
children aged 5-8 years
• Most research studies from US
• Time frame limited assessment of strength of
evidence over time
Intervention rating scheme
(all studies 2008-2013)
• 4. Most evidence - At least 4 studies providing positive
evidence which either includes a positive RCT or quasi
experimental study or 6 or more single case
experimental studies.
• 3. Moderate evidence– 3 or more studies providing
positive evidence which either includes a positive RCT
or QES or 4 or more SCE studies.
• 2. some evidence - 2 or more studies providing
positive evidence which either includes a positive RCT
or QES or 3 or more SCE studies.
• 1. Little evidence – 1 RCT/ QES or 1 or 2 SCE studies
providing positive evidence.
Interventions rated 4 (most evidence)
1. interventions to increase joint attention skills
- Mostly 1:1 play based/turn taking interventions
with an adult (teacher or parent).
2. comprehensive early interventions (N=10)
- Interventions part of holistic learning experience
and targeted a range of areas e.g. social skills,
behaviour, communication, attention and
learning, often in a school setting. Measures
sampled a range of areas of development.
Interventions rated 4 (most evidence)
School age
1. peer mediated interventions in mainstream schools
- Naturalistic interventions to enable peers to interact more
effectively with ASD child (e.g. lunchtime clubs or peers,
researcher and child with ASD meeting to collaboratively
plan strategies, may include some peer instruction).
2. Multi-component social skills interventions (N=6)
- Interventions (e.g. UCLA PEERS, Children’s Friendship
Training) included several elements such as a parent group
to support social skills/networks and a social skills group
and/or social skills training for the young people with ASD.
Interventions rated 4 (most evidence)
School age
Flexibility interventions
3. Behavioural interventions based upon
behavioural principles (N=7)
- behavioural interventions enabled the
development of flexibility and tolerance for
change (e.g. multi-element behaviour plans,
environmental modification and prompting).
Often based on functional analysis of
Interventions rated 3 (moderate
1. Play based interventions (N=3)
- 1:1 and small group. Interventions focused on
teaching play skills or peer mediated play
2. Video modelling to develop communication
skills (N=4)
- Use of video of desired behaviour (or video as
prompt) to encourage behaviour such as use of
PECS or sharing information about the school day.
Interventions rated 3 (moderate
School age
1. Social initiation training (N=4)
- Pivotal Response Training or use of scripts to teach child
with ASD to initiate social interaction.
2. Computer assisted emotion recognition interventions
- using computer programmes and video modelling to
improve emotion recognition.
3. Picture Exchange Communication System in special
school (N=3)
- behaviourally based communication system beginning
with exchange of symbols for desired objects.
Interventions rated 3 (moderate
School age
4. Discrete skills training using behavioural
approaches (N=4)*
- Usually 1:1 skills training (e.g. model-lead-test and
direct instruction) to support acquisition of discrete
skills such as letter/number recognition.
5. Narrative interventions (N=5)
- 1:1, interventions such as social stories and power
cards used to prompt particular behaviours.
(* and pre-school)
Interventions rated 2 (some evidence)
• No specific pre-school interventions identified in this
School age
• Lego therapy® - small group intervention with clear roles to
enable group construction of lego models.
• Behavioural interventions to develop communication skills
(special school) – 1:1 structured interventions using
behavioural strategies to encourage or shape
• School age comprehensive intervention programmes coaching teachers to plan individualised strategies for
children in special schools and classes and measurement of
whether goals set for children were achieved.
Comparison with 4 previous
systematic reviews
• Ministries of Health and Education, New
Zealand (2008), National Standards Project
(National Autism Centre, 2009), National
Professional Development Centre (Odom,
Collet-Klingenberg, et al., 2010 ) and Wong et
al. (2013).
• Differences in evaluation of interventions
between reviews due to timescale; review
process; and categorisation of interventions.
Differences between reviews
• Range of behavioural interventions smaller in current
review so fewer categories.
• Multi-component social interventions not always included
in previous reviews as relatively new.
• Comprehensive pre-school interventions a category in the
current review but not always included as a category in
some previous comprehensive reviews.
• Parent implemented interventions a distinct category in
some reviews but not current review.
• Attention treated as an outcome rather than an
intervention types in some reviews.
• Technology assisted category has grown in recent years.
• Scale of current review - less evidence for some
interventions in small categories such as exercise or
cognitive or with a smaller evidence base e.g. visual
supports, self-management.
Similarities between reviews
• Most evidence 3-11 years
Evidence based interventions
• Social - peer mediated; social initiation training,
technology assisted.
• Play
• Communication – PECS, video modelling.
• Flexibility - behavioural interventions to promote
flexibility, narrative interventions e.g. social stories.
• Learning – discrete skills training using behavioural
Key findings from the guidance
• 15 documents, from Northern Ireland, USA, Australia,
Canada, New Zealand and UK.
• Policy context influenced availability of guidance.
• Policy orientation influenced research/good practice
• In most a strong commitment to inclusion.
• More documents focused on pre-school children.
• Promising examples e.g. N. Ireland using data to track
outcomes and inform planning; professional
development in relation to competencies (NZ, South
Australia, N. Carolina) funded EY interventions outlined
Guidance and SLR comparison
• Recommended interventions similar to those
endorsed by reviews as drew on the same
• Differences few but related to interventions
where the evidence base was smaller e.g.
music therapy or where good practice was
recommended alongside research evidence
e.g. transition support, professional
Considerations for education in Ireland
1. Use of comprehensive pre-school ASD specific
interventions - informed by behavioural
principles, tailored to child/family need (through
additions such as joint attention; play; video
modelling interventions or parent
support/workshops), delivered in an education
2. School age interventions which address key
features of ASD (social skills and flexibility);
involve peers as appropriate with use of
supplementary interventions as needed (e.g.
learning, communication).
Considerations for education in Ireland
3. Guidance which provides a clear framework
for families and practitioners and draws upon
good practice in addition to research literature
as required.
4. A professional development framework.
5. Further development of collaborative
research partnerships between researchers and
6. Further development of ASD evidence base.
• Ministries of Health and Education (2008) New Zealand Autism Spectrum
Disorder Guidelines. Ministry of Health: Wellington.
• National Autism Center (2009). National Standards Report. National
Autism Center: Massachusetts.
• Odom, S. L., Collet-Klingenberg, L., Rogers, S., & Hatton, D. (2010).
Evidence-based practices for children and youth with autism spectrum
disorders. Preventing School Failure, 54, 275-282.
• Parsons, S., Guldberg, K., Macleod, A., Jones, G., Prunty, A., & Balfe, T.
(2009). International review of the literature of evidence of best practice
provision in the education of persons with autistic spectrum disorders.
Research Report 2. National Council for Special Education.
• Wong, C., Odom, S.L., Hume, K., Cox, A.W., Fettig, A., Kucharczyk, S…
Schultz, T.R. (2013) Evidence-Based Practices for Children, Youth and
Young Adults with Autism Spectrum Disorder. Chapel Hill: The University
of North Carolina, Frank Porter Graham Child Development Institute,
Autism Evidence Base Practice Review Group.

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