Evidence Based Practices Within Single Subject Research

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The purpose of this article is to discuss issues that families and professionals deal with when selecting appropriate practices for students with Autism Spectrum Disorders. The article also provides the current best practices that are effective for children with Autism.

The purpose of this study is to review evidence based practices within single-subject research used with children with Autism Spectrum Disorders.

The purpose of this research is to identify practices that support educational and behavioral interventions for students under 22 years of age with Autism Spectrum Disorders.

Study

In this article 33 interventions and treatments used for children with Autism were evaluated and classified into the categories of interpersonal relationship, skill-based, cognitive, physiological/ biological/neurological, and other.

The 33 interventions and treatments were categorized into four sections depending on the results of the study. The four areas are: scientifically based, promising practice, limited supporting information, and not recommended.

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This study used seven journals that contained single-subject research for students with Autism. The selected journals were Education and Training in Developmental Disabilities (ETDD), Education and Treatment of Children (ETC), Focus on Autism and Other Developmental Disabilities (FOCUS), Journal of Applied Behavior Analysis (JABA), Journal of Autism and Developmental Disorders (JADD), Journal of Positive Behavior Interventions (JPBI), and Research in Developmental Disabilities (RDD).

The research had to include participants diagnosed within the Autism Spectrum, participants within the ages of 3-21 involved in a behavioral treatment, and the research had to be published within the years of 200-2009.

Twenty-three standards were used throughout the research.

Raters evaluated the 23 standards to determine if they were considered "acceptable" or "not acceptable." Acceptable studies had to meet each part of the operational definition, and not acceptable was considered if any part of the operational definition was not met.

This research analyzed and reviewed 775 evidence based practices.

The studies were conducted by trained professionals and conducted in universities, schools, hospitals, and clinics.

In order to ensure that the practices met proper standards a Scientific Merit Rating Scale and Strength of Evidence Classification System was created.

After the review of the articles, treatments were identified and categorized into established, emerging, unestablished, and ineffective/harmful.

Results

Scientifically Based Practices

These were the interventions and treatments found to meet the standards of scientifically based practices:

No scientifically based practices were found in the areas of interpersonal relationship, physiological/ biological/neurological, or "other".

The skill-based category showed applied behavior analysis, discrete trial teaching, and pivotal response.

In the category of cognitive the practice found was Learning Experiences: An Alternative Program for Preschoolers and Parents.

Promising Practices

In promising practices, play oriented strategies fell under the interpersonal relationship category.

Under the section of skill-based, the treatments found were Picture Exchange Communication System, incidental teaching, structured teaching, augmentative alternative communication, assistive technology, and joint action routines.

In the cognitive category, cognitive behavior modification, cognitive learning strategies, social stories, and social decision making strategies were considered promising practices.

In the physiological/ biological/neurological category the intervention found was the sensory integration.

Limited Support

The limited support practices lack valuable evidence information used to support the treatment or intervention.

In the category of interpersonal relationship, gentle teaching, option method, floor time, pet/animal therapy, and relationship development intervention were found.

The skill-based category showed the Van Dijk curricular approach and Fast ForWord to be limited practices.

In the cognitive category the limited practices were cognitive scripts, cartooning, and power cards.

In the physiological/ biological/neurological category the interventions found were scoptopic sensitivity syndrome, auditory integration training, megavitamin therapy, Feingold diet, and herbs, minerals and other supplements.

The "other" category found music therapy as a limited practice.

Not Recommended

Two interventions fell under the not recommended category because they showed no evidence of effectiveness and may have been harmful for children with Autism.

Holding therapy and facilitated communication are not recommended interventions for children with Autism.

Results concluded that articles found in the JABA, JPBI, JADD, and FOCUS journals included 160 studies, equaling 79% of the study.

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The interventions that were replicated and showed effectiveness in studies over a ten year period were:

Multicomponent (combined interventions)

Prompting/reinforcement

Social stories

Video modeling

It was noted in the review that the most commonly found independent variable was multicomponent. Through the review, it was also discovered that the number of studies within the independent variables was unevenly distributed among the geographic origins of the South and Atlantic States regions. Ratings show that the numbers of single subject studies for ASD have increased as well as the "acceptable" standards ratings. Finally, through the research few independent variables were identified to meet the National Professional Development Center's definition of evidence based practices for students within the Autism Spectrum.

Established Treatments

Established treatments are interventions that have scientific evidence to support effectiveness of the treatment as well as the results to demonstrate the positive effects.

The following treatments were identified as 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

Emerging Treatments

Emerging treatments show studies that suggest interventions but additional studies need to be created to show the consistency of the intervention.

The following treatments are considered emerging treatments:

Augmentative and Alternative Communication Device

Cognitive Behavioral Intervention Package

Developmental Relationship-based Treatment

Exercise

Exposure Package

Imitation-based Interaction

Initiation Training

Language Training

Massage/Touch Therapy

Multi-component Package

Music Therapy

Peer-mediated Instructional Arrangement

Picture Exchange Communication System

Reductive Package

Scripting

Sign Instruction

Social Communication Intervention

Social Skills Package

Structured Teaching

Technology-based Treatment

Theory of Mind Training

Unestablished Treatments

Unestablished treatments lack evidence to demonstrate the effectiveness of the intervention.

The following treatments have been identified as unestablished treatments:

Academic Interventions

Auditory Integration Training

Facilitated Communication

Gluten- and Casein-Free Diet

Sensory Integrative Package

Ineffective/Harmful Treatments

Ineffective or harmful treatments provide no support of the effectiveness of the intervention and may result in possible harmful effects for children with Autism.

There were no treatments found in this research that meet the ineffective and harmful category.

The purpose of Simpson, Horner, and the National Standards Project was to discuss scientific based practices used for children with Autism Spectrum Disorders. Simpson's article focused mainly on issues and factors parents and professionals are faced with when selecting effective practices for children with ASD. Simpson offered recommendations for professionals and parents for selecting an appropriate and effective program, method, or intervention for students with ASD. Simpson's article also evaluated 33 treatments and interventions commonly used for children diagnosed with ASD. The interventions were broken into five categories, and the results displayed which interventions and treatments have proven to be scientifically based practices, promising practices, limited practices, and not recommended. Like Simpson, the National Standards project also rated their results with comparable categories. The categories used in the National Standards Projects were established treatments, emerging treatments, unestablished treatments, and ineffective/harmful treatments. These categories are equivalent to Simpon's categories when rating the interventions, the only difference were the names used to describe the categories. Both Simpson and the National Standards gave similar intervention and treatment results in the promising practices/emerging treatments category. Simpson found two studies that were not recommended opposed to the National Standard Project that found no treatments that were ineffective or harmful. The National Standard Project differed from the Simpson article since the article did not focus on controversial issues but on research treatment findings. Unlike Simpson and the National Standard Project, Horner's reviewed journals, independent variables, study locations, and study researchers. Horner's article differed from the National Standard Project and Simpson's article since the results were not based on research practices categories, but on twenty-three standards. Horner categorized the findings by standards acceptability and not effective practices. Simpson and the National Standard Project were very similar and focused on the same concept of interventions and treatments. Horner's article differed in many ways to Simpson and the National Standard Project. In conclusion, Simpson's article provided recommendations and current best practices, the National Standard Project defined the Evidence Classification System and treatments, and Horner focused on acceptability and single-subject research.

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