Evidence based practices for asd a review (2015)

ORIGINAL PAPER
Evidence-Based Practices for Children, Youth, and Young Adults
with Autism Spectrum Disorder: A Comprehensive Review
Connie Wong • Samuel L. Odom • Kara A. Hume • Ann W. Cox •
Angel Fettig • Suzanne Kucharczyk • Matthew E. Brock • Joshua B. Plavnick •
Veronica P. Fleury • Tia R. Schultz
Ó Springer Science+Business Media New York 2015
Abstract The purpose of this study was to identify evi-
denced-based, focused intervention practices for children
and youth with autism spectrum disorder. This study was
an extension and elaboration of a previous evidence-based
practice review reported by Odom et al. (Prev Sch Fail
54:275–282, 2010b, doi:10.1080/10459881003785506). In
the current study, a computer search initially yielded
29,105 articles, and the subsequent screening and evalua-
tion process found 456 studies to meet inclusion and
methodological criteria. From this set of research studies,
the authors found 27 focused intervention practices that
met the criteria for evidence-based practice (EBP). Six new
EBPs were identified in this review, and one EBP from the
previous review was removed. The authors discuss impli-
cations for current practices and future research.
Keywords Evidence-based practice Á Focused
intervention Á Autism spectrum disorder Á Children and
youth
Introduction
With acceleration of the prevalence of autism spectrum
disorder (ASD) has come the imperative to provide effec-
tive intervention and treatment. A commonly held profes-
sional value is that practitioners and professionals base
their selection of intervention practices on scientific evi-
dence of efficacy (Suhrheinrich et al. 2014). An active
intervention research literature provides the source for
identifying interventions and treatments that generate
positive outcomes for children and youth with ASD and
their families. However, it is impractical for professionals
and practitioners to conduct a search of the literature
whenever they are designing an intervention program for a
child or youth with ASD. Although there are many claims
for intervention practices that are evidence-based, and
researchers have reviewed research studies that support
individual practices (e.g., Reichow and Volkmar 2010),
few systematic, comprehensive reviews of the intervention
research literature have been conducted. The purpose of
this paper is to report a comprehensive review of the
intervention literature that identifies evidence-based,
focused intervention practices for children and youth with
ASD.
To specify the focus of this paper, it is important to
delineate two types of practices that appear in the literature.
Comprehensive treatment models (CTMs) consist of a set
of practices organized around a conceptual framework and
designed to achieve a broad learning or developmental
impact on the core deficits of ASD. In their summary of
C. Wong Á S. L. Odom (&) Á K. A. Hume Á
A. W. Cox Á S. Kucharczyk
Frank Porter Graham Child Development Institute, University of
North Carolina at Chapel Hill, CB 8180, 105 Smith Level Road,
Chapel Hill, NC 27599-8180, USA
e-mail: slodom@unc.edu
A. Fettig
University of Massachusetts at Boston, Boston, MA, USA
M. E. Brock
Ohio State University, Columbus, OH, USA
J. B. Plavnick
Michigan State University, East Lansing, MI, USA
V. P. Fleury
University of Minnesota, Minneapolis, MN, USA
T. R. Schultz
University of Wisconsin at Whitewater, Whitewater, WI, USA
123
J Autism Dev Disord
DOI 10.1007/s10803-014-2351-z

education programs for children with autism, the National
Academy of Science Committee on Educational Interven-
tions for Children with Autism (National Research Council
2001) identified 10 CTMs. Examples included the UCLA
Young Autism Program by Lovaas and colleagues (Smith
et al. 2000) and the TEACCH program developed by
Schopler and colleagues (Marcus et al. 2000). In a follow-
up to the National Academy review, Odom et al. (2010a)
identified 30 CTM programs operating within the U.S.
These programs were characterized by organization (i.e.,
around a conceptual framework), operationalization (i.e.,
procedures manualized), intensity (i.e., substantial number
of hours per week), longevity (i.e., occur across one or
more years), and breadth of outcome focus (i.e., multiple
outcomes such as communication, behavior, social com-
petence targeted) (Odom et al. 2014a). The Lovaas model,
and its variation known as Early Intensive Behavioral
Intervention, has the strongest evidence of efficacy (Rei-
chow and Barton 2014). At this writing, developers of three
other CTMs have published RCT-level efficacy studies,
with two showing positive effects [Early Start Denver
Model (Dawson et al. 2010) and LEAP (Strain and Bovey
2011)] and one showing mixed effects [More than Words
(Carter et al. 2011)]. Other CTMs have not been studied
with sufficient rigor to draw conclusions about efficacy
(Wilczynski et al. 2011) although some have substantial
and positive accumulated evidence [e.g., Pivotal Response
Treatment (Koegel and Koegel 2012; Stahmer et al. 2011)],
and there are many active efficacy studies of CTMs cur-
rently in progress. This literature will not be part of the
current review.
Focused interventions are a second type of practice that
appears in the literature. Focused intervention practices are
designed to address a single skill or goal of a student with
ASD (Odom et al. 2010b). These practices are operation-
ally defined, address specific learner outcomes, and tend to
occur over a shorter time period than CTMs (i.e., until the
individual goal is achieved). Examples include discrete
trial teaching, pivotal response training, prompting, and
video modeling. Focused intervention practices are the
building blocks of educational programs for children and
youth with ASD, and they are highly salient features of the
CTMs just described. For example, peer-mediated
instruction and intervention (Sperry et al. 2010), is a key
feature of the LEAP model (Strain and Bovey 2011).
The historical basis for employing focused intervention
practices that are supported by empirical evidence of their
efficacy began with the evidence-based medicine move-
ment that emerged from England in the 1960s (Cochrane
1972; Sackett et al. 1996) and the formation of the Coch-
rane Collaboration to host reviews of the literature about
scientifically supported practices in medicine (http://www.
cochrane.org/). In the 1990s, the American Psychological
Association Division 12 established criteria for classifying
an intervention practice as efficacious or ‘‘probably effi-
cacious,’’ which provided a precedent for quantifying the
amount and type of evidence needed for establishing psy-
chosocial intervention practices as evidence-based
(Chambless and Hollon 1998; Chambless et al. 1996).
Similarly, other professional organizations such as the
National Association for School Psychology (Kratochwill
and Shernoff 2004), American Speech and Hearing Asso-
ciation (2005), and Council for Exceptional Children
(Odom et al. 2004) have developed standards for the level
of evidence needed for a practice to be called evidence-
based.
Previous to the mid-2000s, the identification of evi-
dence-based practices (EBPs) for children and youth with
ASD was accomplished through narrative reviews by sets
of authors or organizations. Although these reviews, for the
most part, were thorough and useful, they often did not
follow a standard process for searching the literature, a
stringent review process that incorporated clear criteria for
including or excluding studies for the reviews, or a sys-
tematic process for organizing the information into sets of
practices. In addition, even when systematic reviews were
conducted, many traditional systematic review processes
such as the Cochrane Collaborative only included studies
that employed a randomized experimental group design
(also called randomized control trial or RCT) and excluded
single case design (SCD) studies (Kazdin 2011). By
excluding SCD studies, such reviews omitted a vital
experimental research methodology now being recognized
as a valid scientific approach (Kratochwill et al. 2013) and
eliminated the major body of research literature on inter-
ventions for children and youth with ASD.
In recent years, there have been reviews of empirical
support for individual focused intervention practices that
have included SCD as well as group design studies.
Researchers have published reviews of behavioral inter-
ventions to increase social interaction (Hughes et al. 2012),
social skills training (Camargo et al. 2014; Walton and
Ingersoll 2013), peer-mediated interventions (Carter et al.
2010), exercise (Kasner et al. 2012), naturalistic interven-
tions (Pindiprolu 2012), adaptive behavior (Palmer et al.
2012), augmentative and alternative communication (Sch-
losser and Wendt 2008), and computer- and technology-
based interventions (Knight et al. 2013). The reviews are
directed in their focus and provide support for individual
practices, but they do not always include an evaluation of
the quality of the studies included in their reviews.
Two reviews have specifically focused their work on
interventions (also called treatments) for children and
youth with ASD, included both group and SCD studies,
followed a systematic process for evaluating published,
peer-reviewed journal articles before including (or
J Autism Dev Disord
123

excluding) it in their review, and identified a specific set of
interventions that have evidence of efficacy. These reviews
were conducted by the National Standards Project (NSP)
and the National Professional Development Center on
Autism Spectrum Disorders (NPDC). The NSP conducted a
comprehensive review of the literature that included early
experimental studies on interventions for children and
youth with ASD and extended through September 2007
(National Autism Center 2009). At this writing, a report of
the updated version of the NSP review is forthcoming.
The NPDC also conducted a review of the literature,
including articles published over the 10-year period from
1997 to 2007 (Odom et al. 2010b). The NPDC was funded
to promote teachers’ and practitioner’s use of EBPs with
infant, and toddlers, children, youth, and youth adults with
ASD. The purpose of the review was to identify such
practices, although the NPDC mission narrowed the age
range of participants in the reviewed studies to the first
22 years. It should be acknowledged that identifying EBPs
for adults with ASD is also an important endeavor but out
of the purview of the NPDC’s mission.
NPDC investigators began with a computer search of the
literature, first using autism and related terms for the search
and specifying outcomes. They then used the research design
quality indicator criteria established by theCEC-Division for
Research (Gersten et al. 2005; Horner et al. 2005) to evaluate
articles for inclusion or exclusion from the review. Articles
included in the review were evaluated by a second set of
reviewers. This review yielded 175 articles. Investigators
conducted a content analysis of the intervention methodol-
ogies, created intervention categories, and sorted articles
into those categories. Adapting criteria from the Chambless
et al. (1996) group, they found that 24 focused intervention
practices met the criteria for being evidence-based.
Evidence-based practice is a dynamic, rather than static,
concept. That is, the intervention literature moves quickly.
The NPDC staff undertook the current review to broaden
and update the previous review. Many researchers have
made contributions to the ASD intervention literature since
the original review was conducted, so one purpose of the
current review was to incorporate the intervention literature
from the years subsequent to the initial review (i.e., 2007 to
the beginning of 2012). As in the previous review, the
emphasis is on practices appropriate for infants/toddlers,
preschool-age, and school-age children. A second purpose
was to expand the timeframe previous to the initial review,
extending the coverage to 1990 to be consistent with other
research synthesis organizations that have examined liter-
ature over a 20-year period (e.g., What Works Clearing-
house, WWC). The third purpose was to create and utilize a
broader and more rigorous review process than occurred in
the previous review. In the current review, investigators
recruited and trained a national set of reviewers to evaluate
articles from the literature rather than relying exclusively
on NPDC staff. Also, NPDC investigators developed a
standard article evaluation process that incorporated crite-
ria from several parallel reviews that have occurred (NSP;
WWC). The research questions driving this review are:
What focused intervention practices are supported as evi-
dence-based by empirical intervention literature? What
outcomes are associated with evidence-based focused
intervention practices? What are the emerging practices in
the field? What are recommendations for the future?
Method
Inclusion/Exclusion Criteria for Studies in the Review
Articles included in this review were published in peer-
reviewed, English language journals between 1990 and
2011 and tested the efficacy of focused intervention prac-
tices. Using a conceptual framework followed by the
Cochrane Collaborative [Participants, Interventions, Com-
parison, Outcomes, Study Design (PICOS)], the study
inclusion criteria are described in the subsequent sections.
Population/Participants
To qualify for the review, a study had to have participants
whose ages were between birth and 22 years of age and
were identified as having autism spectrum disorder (ASD),
autism, Asperger syndrome, pervasive developmental dis-
order, pervasive developmental disorder-not otherwise
specified, or high-functioning autism. Participants with
ASD who also had co-occurring conditions (e.g., intellec-
tual disability, genetic syndrome such as Retts, Fragile X or
Down Syndrome) were included in this review.
Interventions
To be included in this review, the focused intervention
practices examined in a study had to be behavioral,
developmental, and/or educational in nature. Studies in
which the independent variables were only medications,
alternative/complementary medicine (e.g., chelation, neu-
rofeedback, hyperbaric oxygen therapy, acupuncture), or
nutritional supplements/special diets (e.g., melatonin, glu-
ten-casein free, vitamins) were excluded from the review.
In addition, only interventions that could be practically
implemented in typical educational, clinical, home, or
community settings were included. As such, intervention
practices requiring highly specialized materials, equip-
ment, or locations unlikely to be available in most educa-
tional, clinic, community, or home settings were excluded
(e.g., dolphin therapy, hyperbaric chambers).
J Autism Dev Disord
123

Outcomes
Studies had to generate behavioral, developmental, or
academic outcomes (i.e., these were dependent variables in
the studies). Outcome data could be discrete behaviors
(e.g., social initiations, stereotypies) assessed observation-
ally, ratings of behavior or student performance (e.g., the
Social Responsiveness Scale), standardized assessments
(e.g., nonverbal IQ tests, developmental assessments), and/
or informal assessment of student academic performances
(e.g., percentage of correct answers on an instructional
task). Studies only reporting physical health outcomes were
excluded.
Study Designs
Studies included in the review had to employ an experi-
mental group design, quasi-experimental design, or SCD to
test the efficacy of focused intervention practices. Ade-
quate group designs included randomized controlled trials
(RCT), quasi-experimental designs (QED), or regression
discontinuity designs (RDD) that compared an experi-
mental/treatment group receiving the intervention to at
least one other control or comparison group that did not
receive the intervention or received another intervention
(Shadish et al. 2002). SCD studies had to employ within
subjects (cases) designs that compared responding of an
individual in one condition to the same individual during
another condition (Kazdin 2011). Acceptable SCDs for this
review were withdrawal of treatment (e.g., ABAB), mul-
tiple baseline, multiple probe, alternating treatment, and
changing criterion designs (Kratochwill et al. 2013).
Search Process
Research articles were obtained through an electronic
library search of published studies. Before beginning the
search, the research team and two university librarians
from the University of North Carolina at Chapel Hill
developed and refined the literature search plan. One
librarian had special expertise in the health sciences liter-
ature and the second had expertise in the behavioral and
social sciences literature. The research team employed the
following databases in the search: Academic Search
Complete, Cumulative Index to Nursing and Allied Health
Literature (CINAHL), Excerpta Medica Database (EM-
BASE), Educational Resource Information Center (ERIC),
PsycINFO, Social Work Abstracts, MEDLINE, Thomson
Reuters (ISI) Web of Knowledge, and Sociological
Abstracts. Broad diagnostic (autism OR aspergers OR
pervasive developmental disorder) AND practice (inter-
vention OR treatment OR practice OR strategy OR therapy
OR program OR procedure OR approach) search terms
were used to be as inclusive as possible. The only filters
used were language (English) and publication date
(1990–2011).
After eliminating duplicate articles retrieved from the
different databases, the initial broad search yielded 29,105
articles. The research team then conducted two rounds of
screening to select articles that fit the study parameters.
The first round of screening focused on titles, which
eliminated commentaries, letters to the editor, reviews, and
biological or medical studies. The second round of
screening investigators examined abstracts to determine if
the article included participants with ASD under 22 years
of age and used an experimental group design, quasi-
experimental group design, or SCD. In both rounds of
screening, articles were retained if the titles and/or
abstracts did not have enough information to make a
decision about inclusion. This screening procedure resulted
in 1,090 articles (i.e., 213 group design and 877 SCD)
remaining in the pool. All of these articles were retrieved,
archived in PDF form, and served as the database for the
subsequent review.
Review Process
The review process consisted of establishing review crite-
ria, recruiting reviewers, training reviewers, and conduct-
ing the review (See Fig. 1).
Criteria and Protocols
Protocols for reviewing group design and SCD studies
were designed to determine methodological acceptability,
describe the key features of the study (e.g., participants,
type of design), and describe the intervention procedures.
The initial protocols drew from the methodological quality
indicators developed by Gersten et al. (2005) for group
design and Horner et al. (2005) for SCD. In addition,
selected review criteria for group and SCD from the WWC
were incorporated into the review protocol. Central project
staff had participated in WWC training and been certified
by WWC as reviewers for group design and SCD studies.
Protocols went through two iterations of pilot testing
within the research group. Two national leaders with
expertise in SCD and group design, respectively, and who
were not members of the research team reviewed the pro-
tocols and provided feedback. From this process the pro-
tocols were finalized and formatted for online use.
National Board of Reviewers
To assist in reviewing the identified articles, external
reviewers were recruited through professional organiza-
tions (e.g., Association for Behavior Analysis International,
J Autism Dev Disord
123

Council for Exceptional Children) and departments of
education, psychology, health sciences, and related fields in
higher-education institutions. To be accepted as a reviewer,
individuals must have had experience with or knowledge
about ASD and have taken a course or training related to
group design and/or SCD research methodology. The
reviewers self-identified their methodological expertise and
interests as group, SCD, or both. Reviewers completed an
online training process described fully in the project report
(http://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/
files/2014-EBP-Report.pdf). After completing the reviewer
training, external reviewers were required to demonstrate
that they could accurately apply reviewer criteria by
evaluating one article of their assigned design type. The
reviewer’s evaluation was then compared to a master code
file established for the article and their accuracy was
calculated. Accuracy was defined as the rater coding the
same answer on an item as occurred in the master code file.
The criterion for acceptable accuracy was set at 80 %.
Reviewers had two opportunities to meet accuracy criteria.
One hundred fifty-nine reviewers completed the training
and met inter-rater agreement criteria with the master code
files; 63 % completed requirements for single case design
articles (n = 100), 24 % completed requirements for group
design articles (n = 39), and 13 % completed requirements
for both design types (n = 20). All reviewers had a doc-
toral degree, master’s degree, and/or were enrolled in a
graduate education program at the time of the review. Most
reviewers received their degrees in the area of special
education or psychology and were faculty (current or
retired), researchers, or graduate students. The majority of
reviewers had professional experience in a classroom,
clinic, or home setting and conducted research related to
individuals with ASD. In addition, approximately one-third
of the reviewers (n = 53) had Board Certified Behavior
Analyst (BCBA) or Board Certified Assistant Behavior
Analyst (BCaBA) certification. All reviewers received a
certificate of participation in the EBP training and article
review. BCBA/BCaBA reviewers received continuing
education credit if requested.
Each reviewer received between 5 and 12 articles.
Articles were randomly assigned to coders, with the
exception that a check was conducted after assignment
to make sure that the coder had not been assigned an
article for which they were an author. In total, they
evaluated 1,090 articles. Articles that did not meet all
the criteria in the group or SCD protocols were excluded
from the database of articles providing evidence of a
practice.
Inter-Rater Agreement
Research staff collected inter-rater agreement for 41 % of
the articles across all reviewers. The formula for inter-rater
agreement was total agreements divided by agreements
plus disagreements multiplied by 100 %. Two levels of
agreement were calculated: (1) agreement on individual
items of the review protocol and (2) agreement on the
summative evaluation of whether a study met or did not
meet criteria for inclusion in the review. Mean inter-rater
agreement on the individual study design evaluation cri-
teria was 84 % for group design articles and 92 % for SCD
articles, generating a total mean agreement of 91 %. Mean
inter-rater agreement for summary decisions about article
inclusion was 74 % for group design articles and 77 % for
SCD articles, generating a total agreement of 76 %.
Final Check
As a final check, members of the EBP evaluation team
reviewed each article that had been identified as meeting
criteria by reviewers as well as articles that were flagged by
reviewers for further review by the evaluation team.
Studies that did not meet criteria were then eliminated from
the database.
29,105
Published articles
1,090 Potentially
eligible intervention
articles
3,449 Potentially
eligible articles
25,656 Excluded
based on title review
2,359 Excluded based
on abstract review
90 Excluded based on
full-text review (after
final check by NPDC
review team)
456 Intervention
articles included in
evidence base
544 Excluded based
on full-text review
(by external
reviewers)
546 Potentially
eligible intervention
articles
Fig. 1 Review process of articles
J Autism Dev Disord
123

Analysis and Grouping Literature
The review process resulted in 456 articles meeting inclu-
sion criteria for study parameters. A process of content
analysis (Krippendorff 1980) was then followed using pro-
cedures established in the first NPDC review (Odom et al.
2010b). Because categories for practices were already cre-
ated by the NPDC (e.g., reinforcement, discrete trial
teaching, pivotal response training), these categories and
established definitions were initially used to sort the articles.
If a practice was not sorted into an existing category, it was
placed in a general ‘‘outlier’’ pool. A second round of con-
tent analysis was then conducted to create new categories.
Following a constant comparative method, a category and
definition was created for a practice in the first outlier study;
the intervention practice in the second study was compared
to the first study and if it was not similar, a second practice
category and definition was created. This process continued
until studies were either sorted into the new categories or the
study remained as an idiosyncratic practice. Seven articles
were used to support two different practice categories
because it either demonstrated efficacy of two different
practices as compared to a control group or baseline phase or
the article presented several studies showing efficacy for
different practices. Finally, research staff reviewed all arti-
cles sorted into categories. For individual studies, they
compared the practices reported in the method section with
the definition of the practice into which the study had been
sorted. If research staff disagreed with the assignment of an
article to a focused intervention category, the staff member
and original coder discussed their differences and reached
consensus on the appropriate categorical assignment.
When all articles were assembled into categories, a final
determination was made about whether a practice met the
level of evidence necessary to be classified as an EBP using
criteria for evidence established by the NPDC. The
NPDC’s criteria were drawn from the work of Nathan and
Gorman (2007), Rogers and Vismara (2008), Horner et al.
(2005), and Gersten et al. (2005), as well as the earlier
work by the APA Division 12 (Chambless and Hollon
1998). It specifies that a practice is considered evidence-
based if it was supported by: (a) two high quality experi-
mental or quasi-experimental design studies conducted by
two different research groups, or (b) five high quality single
case design studies conducted by three different research
groups and involving a total of 20 participants across
studies, or (c) a combination of research designs that must
include at least one high quality experimental/quasi-
experimental design, three high quality single case designs,
and be conducted by more than one researcher or research
group. These criteria are aligned with criteria proposed by
other agencies and organizations (Chambless and Hollon
1998; Kratochwill and Shernoff 2004; Odom et al. 2004).
Results
The summary of these findings includes information about
the types of experimental designs employed in the studies,
participants, the identified evidence-based practices, out-
comes addressed by the EBPs, and practices that had some
empirical support but did not meet the criteria for this
review.
Design Types
Of the 456 studies accepted for this review, 48 (11 %)
utilized a group design. The majority (n = 38) of group
design studies were randomized controlled trials (i.e.,
experimental group designs), although authors also
employed quasi-experimental designs in 10 studies.
Researchers employed SCD in 408 articles (89 %). Mul-
tiple baseline designs were used most frequently
(n = 183), although withdrawal of treatment (n = 79; i.e.,
ABAB) and multiple probe design (n = 52) also were
utilized in a substantial number of articles. In addition,
research sometimes employed a combination of designs,
such as a withdrawal of treatment embedded in a multiple
baseline design, which was classified as a mixed design
(n = 57).
Participants
In the majority of studies, authors described participants as
having autism, which was usually confirmed by a formal
diagnosis. Other terms, which under DSM 5 would be
classified as ASD, were also used to describe participants
(i.e., PDD/PDD-NOS, Asperger/High Functioning Autism,
and actually ASD). Co-occurring conditions were identi-
fied for participants in a substantial minority (37.9 %) of
studies. The co-occurring condition descriptor identified
most frequently was intellectual disability (25.4 % of all
studies).
The majority of the participants in studies were children
between the ages of 6 and 11 years, with preschool-age
children (3–5 years) also participating in a large proportion
of studies (see Fig. 2). Relatively fewer studies included
children below 3 years of age (i.e., in early intervention).
While a substantial minority of studies included partici-
pants above 12 years of age, this number declined as the
ages increased.
Outcomes
Although studies in the literature incorporated a wide range
of outcomes, research focused primarily on outcomes asso-
ciated with the core symptoms of ASD: social, communi-
cation and challenging behaviors (Table 1). Researchers
J Autism Dev Disord
123

focused on communication and social outcomes most fre-
quently, followed closely by challenging behaviors. Play and
joint attention were also reported in a considerable number
of studies, perhaps reflecting the large representation in the
literature of studies with preschool children. However,
school readiness and pre-academic/academic outcomes also
appeared in a substantial number of studies, perhaps
reflecting the elementary school age range of participants in
many studies. Outcomes of concern in the adolescent years,
such as vocational skills and mental health, appeared infre-
quently in studies.
Evidence-Based Practices
Twenty-seven practices met the criteria for being evidence-
based. These practices with their definitions appear in
Table 2. The evidence-based practices consist of inter-
ventions that are fundamental applied behavior analysis
techniques (e.g., reinforcement, extinction, prompting),
assessment and analytic techniques that are the basis for
intervention (e.g., functional behavior assessment, task
analysis), and combinations of primarily behavioral prac-
tices used in a routine and systematic way that fit together
as a replicable procedure (e.g., functional communication
training, pivotal response training). Also, the process
through which an intervention is delivered defines some
practices (e.g., parent-implemented interventions, peer-
mediated intervention and instruction, technology-aided
interventions).
The number of studies identified in support of each
practice also appears in Table 2; the specific studies sup-
porting the practice are listed in the original report (Wong
et al. 2014). As noted, SCD was the predominant design
methodology employed, and some practices had very strong
support in terms of the number of studies that docu-
mented their efficacy (e.g., antecedent-based intervention,
differential reinforcement, prompting, reinforcement, video
modeling). Other practices had strong support from studies
using either SCD or group design methodologies (e.g.,
parent-implemented interventions, social narratives, social
skills training, technology-aided instruction and interven-
tion, visual supports). No practices were exclusively sup-
ported through group design methodologies.
The current set of EPBs includes six new focused inter-
vention practices. Five of these categories—cognitive
behavioral intervention, exercise, modeling, scripting, and
structured play groups—are entirely new since the last
review. The new technology-aided instruction and inter-
vention practice reflects an expansion of the definition of
technology interventions for students with ASD, which
resulted in the previous categories of computer-aided
instruction and speech generating devices/VOCA being
subsumed under this classification. It is important to note that
video modeling involves technology, but is included as its
own category (i.e., rather than being merged within tech-
nology-assisted intervention and instruction) because it has a
large and active literature with well-articulated methods. The
new methodological criteria also resulted in one former
practice, structured work systems, being eliminated from the
list, although subsequent research may well provide the
necessary level of empirical support for future inclusion.
A matrix that identifies the type of outcomes produced
by an EBP appears in Fig. 3. These outcomes are refer-
enced by age; a ‘‘filled-in’’ cell indicates that at least one
study documented the efficacy of that practice for the age
identified in the column. Most EBPs produced outcomes
across multiple developmental and skill areas (called out-
come types here). EBPs with the most dispersed outcome
types were prompting, reinforcement, technology, time
delay, and video modeling (i.e., all with outcomes in at
least 10 areas). EBPs with the fewest outcome types were
Picture Exchange Communication System (3), pivotal
response training (3), exercise (4), functional behavior
assessment (5), and social skills training (5). Importantly,
the least number of practices were associated vocational
and mental health outcomes.
Outcomes are also analyzed by age of the participants.
Figure 3 reflects the point made previously that much of
the research has been conducted with children (age
15 years) rather than adolescents and young adults. Some
EBPs and outcomes were logically associated with the
young age range and were represented in that way in the
data. For example, naturalistic intervention and parent-
implemented intervention are EBPs that are often used with
young children with ASD and produced effects for young
children across outcome areas. However, many EBPs
extended across age ranges and outcomes. For example,
technology-aided instruction and intervention produced
outcomes across a variety of areas and ages.Fig. 2 Ages of participants in included studies
J Autism Dev Disord
123

Other Practices with Some Support
Some practices had empirical support from the research
literature, but they were not identified as EBPs. In some
studies researchers combined practices into behavioral
packages to address special intervention goals, but the
combination of practices was idiosyncratic. In other cases,
an intervention practice did not have the required number
of studies to meet the EBP criteria or there were charac-
teristics about the studies (i.e., all conducted by one
research group) that excluded them.
Idiosyncratic Behavioral Intervention Packages
In the studies categorized as idiosyncratic behavioral
intervention packages, researchers selected combinations
of EBPs and other practices to create interventions to
address participants’ individual and unique goals. The
study by Strain et al. (2011) is an example of an idiosyn-
cratic behavioral intervention package. The authors used
functional behavior assessment, antecedent intervention,
and differential reinforcement of alternative behavior to
address the problem behaviors of three children with ASD.
The entire list of idiosyncratic intervention packages and
studies may be found in the original EBP report.
Other Practices with Empirical Support
Some focused intervention practices with well-defined
procedures were detected by this literature review but were
not included as EBPs because they did not meet one or
more of the specific criteria. A common reason for not
meeting criteria was insufficient numbers of studies docu-
menting efficacy. For example, the efficacy of the struc-
tured work system practice is documented by multiple
studies (Bennett et al. 2011; Hume and Odom 2007;
Mavropoulou et al. 2011) and was included as an EBP in
the previous EBP review. However, with the methodo-
logical evaluation employed in this review, only three SCD
studies met the criteria, which was less than the five SCD
studies needed to be classified as an EBP. One practice,
behavioral momentum interventions, did have support from
nine SCD studies; however, the total number of partici-
pants across the studies (16) did not meet the EBP quali-
fication criteria (i.e., total of at least 20 participants across
the SCD studies).
Other practices were also supported by multiple dem-
onstrations of efficacy, but all the studies were conducted
by one research group (i.e., the practice efficacy needs to
be replicated by at least two research groups). For example,
the reciprocal imitation training (RIT) approach developed
by Ingersoll and colleagues had a substantial and impres-
sive set of studies documenting efficacy (Ingersoll, 2010,
2012; Ingersoll and Lalonde 2010; Ingersoll et al. 2007),
but the same research group conducted all of the research.
Similarly, the joint attention and symbolic play instruction
practice has been studied extensive by Kasari and col-
leagues (Gulsrud et al. 2007; Kasari et al. 2006, 2008), but
at the time of this review had not been replicated in an
acceptable study by another research group.
A number of researchers designed interventions to pro-
mote academic outcomes, but because their procedures
differed, the studies could not be grouped into a single EBP
category. To promote reading and literacy skills, Ganz and
Flores (2009) and Flores and Ganz (2007) used Corrective
Reading Thinking Basics. To teach different writing skills,
Rousseau et al. (1994) used a sentence combining tech-
nique; Delano (2007) used an instruction and self-man-
agement strategy; and Carlson et al. (2009) used a
Table 1 Outcomes identified in studies
Outcomes related to Studies
(n)
Communication 182
Ability to express wants, needs, choices, feelings, or ideas
Social 165
Skills needed to interact with others
Challenging/interfering behaviors 158
Decreasing or eliminating behaviors that interfere with
the individual’s ability to learn
Play 77
Use of toys or leisure materials
School readiness skills 67
Performance during a task that is not directly related to
task content
Pre-academic/academic 58
Performance on tasks typically taught and used in school
settings
Adaptive/self-help 55
Independent living skills and personal care skills
Joint attention 39
Behaviors needed for sharing interests and/or experiences
Motor 18
Movement or motion, including both fine and gross motor
skills, or related to sensory system/sensory functioning
Cognitive 15
Performance on measures of intelligence, executive
function, problem solving, information processing,
reasoning, theory of mind, memory, creativity, or
attention
Vocational 12
Employment or employment preparation or relate to
technical skills required for a specific job
Mental health 1
Emotional well-being
J Autism Dev Disord
123

Table2WorkingdefinitionsforEBPs
Evidence-basedpracticeDefinitionEmpiricalsupport
Group
(n)
Single
case(n)
Antecedent-basedintervention(ABI)Arrangementofeventsorcircumstancesthatprecedetheoccurrenceofaninterferingbehavioranddesignedtolead
tothereductionofthebehavior
032
Cognitivebehavioralintervention(CBI)Instructiononmanagementorcontrolofcognitiveprocessesthatleadtochangesinovertbehavior31
Differentialreinforcementofalternative,
incompatible,orotherbehavior(DRA/I/O)
Provisionofpositive/desirableconsequencesforbehaviorsortheirabsencethatreducetheoccurrenceofan
undesirablebehavior.Reinforcementprovided:(a)whenthelearnerisengaginginaspecificdesiredbehavior
otherthantheinappropriatebehavior(DRA),(b)whenthelearnerisengaginginabehaviorthatisphysically
impossibletodowhileexhibitingtheinappropriatebehavior(DRI),or(c)whenthelearnerisnotengaginginthe
interferingbehavior(DRO)
026
Discretetrialteaching(DTT)Instructionalprocessusuallyinvolvingoneteacher/serviceproviderandonestudent/clientanddesignedtoteach
appropriatebehaviororskills.Instructionusuallyinvolvesmassedtrials;eachtrialconsistsoftheteacher’s
instruction/presentation,thechild’sresponse,acarefullyplannedconsequence,andapausepriortopresentingthe
nextinstruction
013
Exercise(ECE)Increaseinphysicalexertionasameansofreducingproblembehaviorsorincreasingappropriatebehavior33
Extinction(EXT)Withdrawalorremovalofreinforcersofinterferingbehaviorinordertoreducetheoccurrenceofthatbehavior.
Althoughsometimesusedasasingleinterventionpractice,extinctionoftenoccursincombinationwithfunctional
behaviorassessment,functionalcommunicationtraining,anddifferentialreinforcement
011
Functionalbehaviorassessment(FBA)Systematiccollectionofinformationaboutaninterferingbehaviordesignedtoidentifyfunctionalcontingenciesthat
supportthebehavior.FBAconsistsofdescribingtheinterferingorproblembehavior,identifyingantecedentor
consequenteventsthatcontrolthebehavior,developingahypothesisofthefunctionofthebehavior,and/ortesting
thehypothesis
010
Functionalcommunicationtraining(FCT)Replacementofinterferingbehaviorthathasacommunicationfunctionwithmoreappropriatecommunicationthat
accomplishesthesamefunction.FCTusuallyincludesFBA,DRA,and/orEX
012
Modeling(MD)Demonstrationofadesiredtargetbehaviorthatresultsinimitationofthebehaviorbythelearnerandthatleadsto
theacquisitionoftheimitatedbehavior.ThisEBPisoftencombinedwithotherstrategiessuchaspromptingand
reinforcement
14
Naturalisticintervention(NI)Interventionstrategiesthatoccurwithinthetypicalsetting/activities/routinesinwhichthelearnerparticipates.
Teachers/serviceprovidersestablishthelearner’sinterestinalearningeventthrougharrangementofthesetting/
activity/routine,providenecessarysupportforthelearnertoengageinthetargetedbehavior,elaborateonthe
behaviorwhenitoccurs,and/orarrangenaturalconsequencesforthetargetedbehaviororskills
010
Parent-implementedintervention(PII)Parentsprovideindividualizedinterventiontotheirchildtoimprove/increaseawidevarietyofskillsand/orto
reduceinterferingbehaviors.Parentslearntodeliverinterventionsintheirhomeand/orcommunitythrougha
structuredparenttrainingprogram
812
Peer-mediatedinstructionandintervention(PMII)Typicallydevelopingpeersinteractwithand/orhelpchildrenandyouthwithASDtoacquirenewbehavior,
communication,andsocialskillsbyincreasingsocialandlearningopportunitieswithinnaturalenvironments.
Teachers/serviceproviderssystematicallyteachpeersstrategiesforengagingchildrenandyouthwithASDin
positiveandextendedsocialinteractionsinbothteacher-directedandlearner-initiatedactivities
015
PictureExchangeCommunicationSystem(PECS)Learnersareinitiallytaughttogiveapictureofadesireditemtoacommunicativepartnerinexchangeforthe
desireditem.PECSconsistsofsixphaseswhichare:(1)‘‘how’’tocommunicate,(2)distanceandpersistence,(3)
picturediscrimination,(4)sentencestructure,(5)responsiverequesting,and(6)commenting
24
J Autism Dev Disord
123

Table2continued
Evidence-basedpracticeDefinitionEmpiricalsupport
Group
(n)
Single
case(n)
Pivotalresponsetraining(PRT)Pivotallearningvariables(i.e.,motivation,respondingtomultiplecues,self-management,andself-initiations)guide
interventionpracticesthatareimplementedinsettingsthatbuildonlearnerinterestsandinitiative
17
Prompting(PP)Verbal,gestural,orphysicalassistancegiventolearnerstoassisttheminacquiringorengaginginatargeted
behaviororskill.Promptsaregenerallygivenbyanadultorpeerbeforeorasalearnerattemptstouseaskill
132
Reinforcement(R?)Anevent,activity,orothercircumstanceoccurringafteralearnerengagesinadesiredbehaviorthatleadstothe
increasedoccurrenceofthebehaviorinthefuture
043
Responseinterruption/redirection(RIR)Introductionofaprompt,comment,orotherdistracterswhenaninterferingbehaviorisoccurringthatisdesignedto
divertthelearner’sattentionawayfromtheinterferingbehaviorandresultsinitsreduction
010
Scripting(SC)Averbaland/orwrittendescriptionaboutaspecificskillorsituationthatservesasamodelforthelearner.Scripts
areusuallypracticedrepeatedlybeforetheskillisusedintheactualsituation
18
Self-management(SM)Instructionfocusingonlearnersdiscriminatingbetweenappropriateandinappropriatebehaviors,accurately
monitoringandrecordingtheirownbehaviors,andrewardingthemselvesforbehavingappropriately
010
Socialnarratives(SN)Narrativesthatdescribesocialsituationsinsomedetailbyhighlightingrelevantcuesandofferingexamplesof
appropriateresponding.Socialnarrativesareindividualizedaccordingtolearnerneedsandtypicallyarequite
short,perhapsincludingpicturesorothervisualaids
017
Socialskillstraining(SST)Grouporindividualinstructiondesignedtoteachlearnerswithautismspectrumdisorders(ASD)waysto
appropriatelyinteractwithpeers,adults,andotherindividuals.Mostsocialskillmeetingsincludeinstructionon
basicconcepts,role-playingorpractice,andfeedbacktohelplearnerswithASDacquireandpractice
communication,play,orsocialskillstopromotepositiveinteractionswithpeers
78
Structuredplaygroups(SPG)Smallgroupactivitiescharacterizedbytheiroccurrencesinadefinedareaandwithadefinedactivity,thespecific
selectionoftypicallydevelopingpeerstobeinthegroup,acleardelineationofthemeandrolesbyadultleading
and/orpromptingorscaffoldingasneededtosupportthestudents’performancerelatedtothegoalsoftheactivity
22
Taskanalysis(TA)Aprocessinwhichanactivityorbehaviorisdividedintosmall,manageablestepsinordertoassessandteachthe
skill.Otherpractices,suchasreinforcement,videomodeling,ortimedelay,areoftenusedtofacilitateacquisition
ofthesmallersteps
08
Technology-aidedinstructionandintervention
(TAII)
Instructionorinterventionsinwhichtechnologyisthecentralfeaturesupportingtheacquisitionofagoalforthe
learner.Technologyisdefinedas‘‘anyelectronicitem/equipment/application/orvirtualnetworkthatisused
intentionallytoincrease/maintain,and/orimprovedailyliving,work/productivity,andrecreation/leisure
capabilitiesofadolescentswithautismspectrumdisorders’’(Odometal.2014a)
911
Timedelay(TD)Inasettingoractivityinwhichalearnershouldengageinabehaviororskill,abriefdelayoccursbetweenthe
opportunitytousetheskillandanyadditionalinstructionsorprompts.Thepurposeofthetimedelayistoallowthe
learnertorespondwithouthavingtoreceiveapromptandthusfocusesonfadingtheuseofpromptsduring
instructionalactivities
012
Videomodeling(VM)Avisualmodelofthetargetedbehaviororskill(typicallyinthebehavior,communication,play,orsocialdomains),
providedviavideorecordinganddisplayequipmenttoassistlearninginorengaginginadesiredbehaviororskill
131
Visualsupports(VS)Anyvisualdisplaythatsupportsthelearnerengaginginadesiredbehaviororskillsindependentofprompts.
Examplesofvisualsupportsincludepictures,writtenwords,objectswithintheenvironment,arrangementofthe
environmentorvisualboundaries,schedules,maps,labels,organizationsystems,andtimelines
018
J Autism Dev Disord
123

multisensory approach. For teaching different math skills,
Cihak and colleagues (Cihak and Foust 2008; Fletcher
et al. 2010) employed touch point instruction, and Rock-
well et al. (2011) designed a schema-based instructional
strategy. Test taking behavior, a particular problem for
some children and youth with autism, was promoted
through the use of modeling, mnemonic strategies, and
different forms of practice to improve test taking perfor-
mance by Songlee et al. (2008). Also, Dugan et al. (1995)
employed a cooperative learning approach to promote
engagement in a number of academic activities for children
with ASD. This focus on academic outcomes has emerged
primarily in post-2007 studies and appears to represent a
trend in current and possibly future research.
Discussion
The current review extends and improves on the previous
review of the literature conducted 5 years ago (Odom et al.
2010b) in several ways. First, the authors expanded cov-
erage of the literature from 10 years (1997–2007) in the
previous review to 21 years in the current review
(1990–2011), bringing in more current research and
aligning the length of the review coverage with the pro-
cedures followed by other research review organizations
such as the What Works Clearinghouse. Also, the review
procedures were enhanced by employing a national panel
of reviewers, using a standardized article evaluation format
based on quality indicators derived from multiple sources
(Gersten et al. 2005; Horner et al. 2005; NSP; WWC) and
multiple screening and evaluation processes before articles
were included in the review. All of these added features
improved the rigorous quality of the review process. In
addition, the review was conducted in a highly transparent
way so that readers could see exactly how practices were
identified and which specific studies provided empirical
support (i.e., studies are found in the original report
accessible online).
Confidence that a practice is efficacious is built on
replication, especially by different groups of researchers. In
systematic, evaluative reviews of the literature such as this,
the number of studies that support a given practice does not
necessarily reflect the relative effect or impact of the
practice (i.e., how powerful the intervention is in changing
behavior), but does reflect the degree to which a
Fig. 3 Matrix of evidence-based practices by outcome and age in years. A filled in cell indicates that at least one study documented the efficacy
of that practice for the age identified in the column on a given outcome
J Autism Dev Disord
123

practitioner may expect that the practice, when imple-
mented with fidelity, will produce positive outcomes. Fif-
teen of the EBPs had over 10 studies providing empirical
support for the practice, and among those, the foundational
applied behavior analysis techniques (e.g., prompting,
reinforcement) have the most support. Antecedent-based
intervention, differential reinforcement, and video model-
ing also have substantial support with over 25 studies
supporting their efficacy. The number and variety of these
replications speak to the relative strength of these EBPs.
A clear trend in the set of studies found in this review
was the authors’ use of combinations of EBPs to address a
specific behavior problem or goal for the participant. These
idiosyncratic packages differ from the multicomponent
EBPs (e.g., pivotal response training, functional commu-
nication training, peer-mediated intervention and instruc-
tion). Multicomponent EBPs consist of the same methods
used in the same way in multiple studies. In the idiosyn-
cratic packages, combinations of methods were unique and
not used in subsequent studies. They do demonstrate,
however, that practitioners and researchers may employ
multiple EBPs to address unique goals or circumstances.
Some focused intervention practices with well-defined
procedures (e.g., independent works systems) were detec-
ted by this literature review, and despite strong evidence,
were not included as EBPs because they did not meet one
or more of the specific criteria (e.g., insufficient numbers of
studies documenting efficacy, insufficient number of par-
ticipants across studies). Other practices (e.g., reciprocal
imitation training, joint attention interventions) were also
supported by multiple demonstrations of efficacy, but all
the studies were conducted by one research group (i.e., the
practice efficacy needs to be replicated by at least one other
research group). These focused intervention practices have
national visibility and are likely to be replicated by other
researchers in the future, which will meet the inclusionary
criteria. It is important, however, to issue a cautionary note.
There is a continuum of empirical support for practices
falling below the EBP criteria, such as these just described
that have multiple studies documenting efficacy and others
for which only one or two methodologically acceptable
studies exist. The further a practice is from the evidentiary
criteria just noted, the greater scrutiny and caution practi-
tioners should exercise in their choice of the practice for
use with children and youth with ASD.
Limitations
As with nearly any review, some limitations exist for this
review. As noted, the review was only of studies published
from 1990 to 2011. Two limitations exist regarding this
timeframe. First, we acknowledge that we are missing
studies that occurred before 1990, although one might
expect early (i.e., pre-1990) studies of important and
effective practices to have been replicated in publications
over subsequent years. Second, because of the time
required to conduct a review of a very large database and
involve a national set of reviewers, there is a lag between
the end date for a literature search (i.e., 2011) and the
publication of the completed review. Studies have been
published in the interim that could have moved some
practices into the EBP classification. The implication is
that beginning an update of this review should start
immediately.
The age range of participants in the studies reviewed
was from birth to 22, or the typical school years (i.e., if one
counts early intervention). This is important information
for early intervention and service providers for school-age
children and youth. The practices also have implications
for older individuals with ASD, but the review falls short of
specifically identifying EBPs for adults with ASD. Also, a
major oversight was not collecting demographic informa-
tion on the gender, race, and ethnicity of the participants of
studies. Such information could have been a useful and
important feature of this review. Last, in this review,
authors placed the emphasis on identifying the practices
that are efficacious. It provides no information about
practices that researchers documented as not having an
effect or for practices that have deleterious effects. Cer-
tainly, studies showing no effects are difficult to publish,
and a well-acknowledged publication bias exists in the
field, but such a limitation is difficult to avoid if one
chooses to include only peer-reviewed articles.
Since this is a critical review and summary of the lit-
erature rather than a meta-analysis, there was no plan to
calculate effect size, which could be seen as a limitation.
The advantage of having effect size estimates is that one
can compare the relative strength of interventions. For
other disabilities, investigators have used meta-analysis
effectively to document relative effect size of practices in
special education (see Kavale and Spaulding 2011), but
those analyses have been based on group experimental
design studies. Currently there is not agreement on the best
methodology for statistically analyzing SCD data and cal-
culating effect size (Kratochwill et al. 2013), nor on whe-
ther effect sizes for group designs and SCD studies can or
should be combined. Progress in developing and validating
such techniques is occurring (Kratochwill and Levin 2014),
and meta-analysis of comprehensive reviews, such as this
one, may be a direction for the future.
Implications for Practice
An identified set of EBPs, such as described in this review,
is a tool or resource for creating an individualized inter-
vention program for children and youth with ASD.
J Autism Dev Disord
123

Practitioners’ expertise plays a major role in that process.
From the evidence-based medicine movement, Sackett
et al. (1996) noted that ‘‘the practice of evidence-based
medicine means integrating individual clinical experience
with the best available external clinical evidence from
systematic research. By clinical expertise we mean the
proficiency and judgment that individual clinicians acquire
through clinical experience and clinical practice’’ (p. 71).
Drawing from the clinical psychology and educational lit-
eratures, Odom et al. (2012) proposed a ‘‘technical eclectic
model’’ in which practitioners initially establish goals for
the learner and then use their professional expertise to
select the EBP(s) that has or are likely to produce the
desired outcome. Practitioners base their selection of
practices on characteristics of the learner, their or other’s
(e.g., family members’) previous history with the learner,
their experience using a practice, access to professional
development to learn the practice, as well as other features
embedded in ‘‘professional judgment.’’ Adopting such a
model requires professional development (Odom et al.
2013) and an intentional decision about supporting imple-
mentation (Fixsen et al. 2013) that extends beyond just
having access to information about the practices. A major
implication for practice in the future would be to employ
both the knowledge generated by this and other systematic
reviews of EBPs and preparation of practitioners to use
their judgment in ways that will lead to effective programs
for learners with ASD.
Implications for Future Research
This review has several implications for future research.
Progress in developing and validating methods for calcu-
lating effects sizes for SCD could allow a comparison of
the relative strength of EBPs, which could be seen as a
direction for future research. Such intervention compari-
sons could also be conducted directly by employing group
experimental designs or SCDs. For example, Boyd et al.
(2014) directly compared the relative effects of the TEA-
ACH and LEAP comprehensive treatment programs. In an
older study, Odom and Strain (1986) used SCD to compare
relative effects of peer-mediated and teacher antecedent
interventions for preschool children with ASD. Certainly,
the examination of the relative effects of different EBPs
that focus on the same outcomes would be a productive
direction for future research.
Scholars have distinguished between evidence-based
programs and evidence-supported programs (Cook and
Cook 2013). As noted, developers of some CTMs, such as
the Lovaas Model (McEachin et al. 1993) and the Early
Start Denver Model (Dawson et al. 2010), have conducted
RCT efficacy studies that provide empirical support for
their program models, which would qualify them as evi-
dence-based programs. The technical eclectic program
described previously would be characterized as an evi-
dence-supported program in that EBPs are integral features
of the program model, but the efficacy of the entire pro-
gram model has not been validated through a randomized
controlled trial. Given that the evidence-based term has
been used loosely in the past, it is important to be specific
about how the EBPs generated by this report fit with the
entire movement toward basing instruction and interven-
tion for children and youth with ASD on intervention sci-
ence. Certainly, conducting efficacy trials for this technical
eclectic program would be an important direction for future
research.
This review reveals gaps that exist in current knowledge
about focused intervention practices for children and youth
with ASD. The majority of the intervention studies over the
last 20 years have been conducted with preschool-age and
elementary school-age children. A clear need for the field
is to expand the intervention literature up the age range to
adolescents and young adults with ASD (Rue and Knox
2013; Volkmar et al. 2014). The small number of studies
that addressed vocational and mental health outcomes
reflects this need. Similarly, fewer studies were identified
for infants and toddlers with ASD and their families. While
the evidence for comprehensive treatment programs for
toddlers with ASD is expanding (Odom et al. 2014a), there
is a need for moving forward the research agenda that
addresses focused intervention practices for this age group.
Early intervention providers and service providers for
adolescents with ASD who build technical eclectic pro-
grams for children and youth with ASD now have to
extrapolate from studies conducted with preschool and
elementary-age children with ASD. This practice is similar
to the psychopharmacological concept of off-label use of
medications (e.g., those tested with adults and used with
children and youth). The need for expanding the age range
of intervention research has been identified by major policy
initiative groups such as the Interagency Autism Coordi-
nating Committee (2012), and the prospect for future
research in this area is bright.
Because of the demographics of ASD, much of the
research has been conducted with boys and young men
with ASD, and less is known about the effects of inter-
ventions and outcomes for girls and young women. In
addition, while acknowledging the oversight in not coding
information about race/ethnic/cultural diversity and
underrepresented groups in this review, it will be important
for future studies to include an ethnically diverse sample in
the studies (Pierce et al. 2014). Similarly, information
about children’s or their families’ socioeconomic status is
rarely provided in studies.
J Autism Dev Disord
123

Conclusion
The current review identifies focused intervention prac-
tices for children and youth with ASD supported by
efficacy research as well as the gaps in the science. As the
volume and theoretical range of the literature has expan-
ded, the number of EBPs has increased. This bodes well
for a field that is in need of an empirical base for its
practice and also for children and youth with ASD and
their families, who may expect that advances in inter-
vention science will lead to better outcomes. The prospect
of better outcomes, however, is couched on the need for
translating scientific results into intervention practices that
service providers may access and providing professional
development and support for implementing the practices
with fidelity. Fortunately, the emerging field of imple-
mentation science may provide the needed guidance for
such a translational process (Fixsen et al. 2013) and
professional development models for teachers and service
providers working with children and youth with ASD
have begun to adopt an implementation science approach
(Odom et al. 2014b). Such movement from science to
practice is a clear challenge and also an important next
step for the field.
Acknowledgments Funding for this study was provided by Grant
No. H325G07004 from the Office of Special Education Programs and
R324B090005 from the Institute of Education Science, both in the
Department of Education. Opinions expressed do not reflect those of
the funding agency.
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