Evidence-Based Practices in the ASD Community

Evidence-Based Practices for ASD

Autism Spectrum Disorder (ASD) is currently estimated to occur in 1 in 36 children with prevalence rates steadily increasing as diagnostic practices and access to care improve (Maenner et al., 2023). Further, children with an ASD diagnosis may have co-occurring diagnoses of other neurodevelopmental disorders (e.g., ADHD) and mental health disorders (e.g., anxiety; Lai et al., 2014; Simonoff et al., 2008). Given both the core and these common co-occurring concerns for autistic children, there have been a considerable number of mental and behavioral health interventions developed to address functional impairment and interference (Wainer et al., 2017). Some of these interventions have also notably been classified as evidence-based practices (EBPs) after rigorous demonstration of improved outcomes through research (Wong et al., 2015). These EBPs, along with clinical expertise and consideration of client preferences, are therefore a gold standard for treatment. As such, Sunfield Center strives to deliver EBPs to our clients.

The Research-to-Practice Gap

Unfortunately, EBPs are not always implemented or may be mis-implemented in other community-based settings, which are also often the settings where autistic youth, particularly from racial and ethnic minoritized groups, rural communities, and/or experiencing socioeconomic disadvantage are likely to receive care (Drahota et al., 2021; Smith et al., 2020; Straiton et al., 2021). This difference between what research shows to be beneficial for clients and what typically happens in practice has been called the “research-to-practice gap”. The “research-to-practice gap” is defined by interventions adopted by providers and organizations not being the interventions shown to be effective and most likely to benefit a target population (Rabin & Brownson, 2012). 

While this phenomenon of a “research-to-practice gap” is certainly unfortunate, the good news is that there are a number of actions that researchers, providers, and clients can take (Stahmer et al., 2019). For example, researchers can increasingly involve community partners and 

 intended clients of interventions in their research on interventions to make sure the interventions they develop and test can be implemented in community-based settings that are different from university laboratories. They can also make efforts to include participants with the intersecting identities representing the individuals they hope will eventually receive their intervention. In addition, mental and behavioral health providers can advocate for and increase their own training in delivering EBPs, along with leadership support and provision of time and funding.

However, perhaps most important, are the actions that clients and families can take when they may find themselves in a service system affected by the “research-to-practice gap”. Such actions can include increasing knowledge of EBPs in order to advocate for their receipt and consulting free EBP resources if in a position where access to evidence-based services is not immediate. Of course, any resource is not meant to replace the advice of a qualified professional but can serve as a starting point to receiving an EBP.

Resources for Families

• EffectiveChildTherapy.Org 
  • This APA Society of Clinical Child & Adolescent Psychology website has been developed to provide parents and other caregivers with easy-to-access, comprehensive information on the symptoms and treatments of behavioral and mental health problems in children and adolescents, for a wide range of presenting concerns (Society of Clinical Child and Adolescent Psychology, Division 53, American Psychological Association, 2023).
• National Clearinghouse on Autism Evidence and Practice (NCAEP)
  • The NCAEP provides a list of 28 EBPs as well as 10 manualized interventions that meet criteria to be considered an EBP for autism (Hume et al., 2021).
• Autism Focused Intervention Resources and Modules (AFIRM)
  • “Timely Toolkits” are made available to support autistic individuals and their caregivers navigating through specific global and/or local events that may disrupt or impact routines (e.g., COVID-19 pandemic, gun violence; Sam et al., 2020)
• Vanderbilt Kennedy Center Tips and Resources For Caregivers
  • This website provides tips and resources for caregivers of younger children, and overviews EBPs like visual supports, choice boards, and first-then boards (Vanderbilt Kennedy Center, 2023)
• Unstuck and On Target Support Videos
  • The Unstuck and On Target intervention has been classified as an EBP for elementary school aged autistic children with co-occurring executive functioning challenges. Intervention developers have recently released free videos for caregivers for immediate support available in both English and Spanish (Alexander et al., 2019). 
• Vanderbilt IRIS Center High School and Beyond Strategies
  • The Vanderbilt IRIS Center has free resources for caregivers on strategies for youth in high school and beyond, such as information on self-management, technology-aided instruction and intervention, and other transitional services (The IRIS Center, Peabody College, Vanderbilt University, 2023)

Conclusion

In conclusion, EBPs have been developed to improve outcomes for autistic individuals and Sunfield Center delivers these gold standard treatments to clients (Wong et al., 2015). However, EBPs are unfortunately not always implemented or may be mis-implemented where autistic individuals receive care (Drahota et al., 2021). For example, these practices are often not implemented in the community-based settings where many marginalized populations are most likely to receive care (Smith et al., 2020; Straiton et al., 2021). This gap between what research shows to be beneficial and what actually happens is known as the “research-to-practice gap” (Rabin & Brownson, 2012). While researchers and providers should take steps to address this gap, there are also several resources for families to consult to increase their own knowledge as a first step in eventually receiving these services.

References

Alexander, K., Kenworthy, L., Anthony, L., Childress, D., Verbalis, A., Armour, A., … & Werner, M. (2019). Leveraging technology to develop a feasible, acceptable, and effective alternative to in-person parent education sessions. The American Journal of Occupational Therapy, 73(4_Supplement_1), 7311520397p1-7311520397p1.

Drahota, A., Meza, R. D., Bustos, T. E., Sridhar, A., Martinez, J. I., Brikho, B., … & Aarons, G. A. (2021). Implementation-as-usual in community-based organizations providing specialized services to individuals with autism spectrum disorder: a mixed methods study. Administration and Policy in Mental Health and Mental Health Services Research, 48, 482-498.

Hume, K., Steinbrenner, J. R., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., … & Savage, M. N. (2021). Evidence-based practices for children, youth, and young adults with autism: Third generation review. Journal of Autism and Developmental Disorders, 1-20.

Lai, M.-C., Lombardo, M. V., & Baron-Cohen, S. (2014). Autism. The Lancet, 383(9920), 896–910. https://doi.org/10.1016/S0140-6736(13)61539-1

Maenner, M. J., Warren, Z., Williams, A. R., Amoakohene, E., Bakian, A. V., Bilder, D. A., … & Shaw, K. A. (2023). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2020. MMWR Surveillance Summaries, 72(2), 1. 

Rabin, B. A., & Brownson, R. C. (2017). Terminology for dissemination and implementation research. Dissemination and implementation research in health: Translating science to practice, 2, 19-45.

Sam, A. M., Cox, A. W., Savage, M. N., Waters, V., & Odom, S. L. (2020). Disseminating information on evidence-based practices for children and youth with autism spectrum disorder: AFIRM. Journal of Autism and Developmental Disorders, 50, 1931-1940.

Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child & Adolescent Psychiatry, 47(8), 921–929. https://doi.org/10.1097/CHI.0b013e318179964f

Smith, K. A., Gehricke, J. G., Iadarola, S., Wolfe, A., & Kuhlthau, K. A. (2020). Disparities in service use among children with autism: A systematic review. Pediatrics, 145(Supplement_1), S35-S46.

Society of Clinical Child and Adolescent Psychology, Division 53, American Psychological Association. (2023). Evidence-Based Therapies.  https://sccap53.org/resources/education-resources/effective-child-therapy/ 

Stahmer, A. C., Dababnah, S., & Rieth, S. R. (2019). Considerations in implementing evidence-based early autism spectrum disorder interventions in community settings. Pediatric Medicine, 2.

Straiton, D., Groom, B., & Ingersoll, B. (2021). Parent training for youth with autism served in community settings: a mixed-methods investigation within a community mental health system. Journal of Autism and Developmental Disorders, 51, 1983-1994.

The IRIS Center Peabody College Vanderbilt University. (2023). What specific strategies can improve outcomes for these children? Page 7: High School and Beyond. https://iris.peabody.vanderbilt.edu/module/asd2/cresource/q2/p07/#content

Vanderbilt Kennedy Center (VKC). 2023. Evidence-Based Practices. https://vkc.vumc.org/vkc/triad/ebp-resources 

Wainer, A., Drahota, A., Cohn, E., Kerns, C., Lerner, M., Marro, B., … & Soorya, L. (2017). Understanding the landscape of psychosocial intervention practices for social, emotional, and behavioral challenges in youth with ASD: A study protocol. Journal of Mental Health Research in Intellectual Disabilities, 10(3), 178-197.

Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., Brock, M. E., Plavnick, J. B., Fleury, V. P., & Schultz, T. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951–1966. https://doi.org/10.1007/s10803-014-2351-z