Evidence-Based Practicesfor Children,Youth, andYoung Adults withAutismSpectrumDisorder 2014

ConnieWong,SamuelL.Odom,

KaraHume,AnnW.Cox,AngelFettig, SuzanneKucharczyk,MatthewE.Brock,

JoshuaB.Plavnick,VeronicaP.Fleury,and TiaR.Schultz

AutismEvidence-BasedPracticeReviewGroup

FrankPorterGrahamChildDevelopmentInstitute UniversityofNorthCarolinaatChapelHill

Evidence-BasedPractice / Definition
Antecedent-based intervention(ABI) / Arrangementofeventsorcircumstancesthatprecedetheoccurrenceofaninterferingbehavioranddesignedtoleadtothereductionofthebehavior .
Cognitivebehavioral intervention(CBI) / Instructiononmanagementorcontrolofcognitiveprocessesthatleadtochangesinovert behavior .
Differentialreinforcement ofAlternative, Incompatible,orOtherBehavior(DRA/I/O) / Provisionofpositive/desirableconsequencesforbehaviorsortheirabsencethatreduce
theoccurrenceofanundesirablebehavior .Reinforcementprovided:a)whenthelearneris engaginginaspecificdesired behaviorotherthantheinappropriatebehavior (DRA),b)when thelearnerisengaginginabehaviorthatisphysicallyimpossibletodowhileexhibitingtheinappropriatebehavior(DRI),orc)whenthelearnerisnotengagingintheinterfering behavior(DRO) .
Discretetrialteaching
(DTT) / Instructionalprocessusuallyinvolvingoneteacher/serviceproviderandonestudent/client
anddesignedtoteachappropriatebehaviororskills .Instructionusuallyinvolvesmassedtrials .Eachtrialconsistsoftheteacher’sinstruction/presentation,thechild’sresponse,acarefully plannedconsequence,andapausepriortopresentingthenextinstruction .
Exercise(ECE) / Increaseinphysicalexertionasameansofreducingproblembehaviorsorincreasingappropri- atebehavior .
Extinction(EXT) / Withdrawalorremovalofreinforcersofinterferingbehaviorinordertoreducetheoccurrence ofthatbehavior .Althoughsometimesusedasasingleinterventionpractice, extinctionoften occurs incombinationwithfunctionalbehaviorassessment,functionalcommunicationtraining,anddifferentialreinforcement .
Functionalbehavior assessment(FBA) / Systematiccollectionofinformationaboutaninterferingbehaviordesignedtoidentify functionalcontingenciesthatsupportthebehavior .FBAconsistsofdescribingtheinterfering orproblembehavior,identifyingantecedentorconsequenteventsthatcontrolthebehavior, developingahypothesisofthefunctionofthebehavior,and/ortestingthehypothesis .
Functionalcommunication training(FCT) / Replacementofinterferingbehaviorthathasacommunicationfunctionwithmoreappropriatecommunicationthataccomplishesthesamefunction FCTusuallyincludesFBA,DRA,and/ orEX .
Modeling(MD) / Demonstrationofadesired targetbehaviorthatresultsinimitationofthebehaviorbythe learnerandthatleadstotheacquisition oftheimitatedbehavior .ThisEBPisoftencombined withotherstrategiessuchaspromptingandreinforcement .
Naturalisticintervention
(NI) / Interventionstrategiesthatoccurwithinthetypicalsetting/activities/routinesinwhichthe learnerparticipates .Teachers/serviceproviders establishthelearner’sinterestinalearning eventthrougharrangementofthesetting/activity/routine,providenecessarysupportforthe learnertoengageinthetargetedbehavior,elaborateonthebehaviorwhenitoccurs,and/or arrangenatural consequencesforthetargetedbehaviororskills .
Parent-implemented intervention(PII) / Parentsprovideindividualizedinterventiontotheirchildtoimprove/increaseawidevariety ofskillsand/ortoreduceinterferingbehaviors .Parentslearntodeliverinterventionsintheir homeand/orcommunitythroughastructuredparenttrainingprogram .
Peer-mediatedinstruction andintervention(PMII) / Typicallydevelopingpeersinteractwithand/orhelpchildrenandyouthwithASDtoacquire newbehavior,communication,andsocialskillsbyincreasingsocialandlearningopportunities withinnaturalenvironments .Teachers/serviceproviders systematicallyteachpeersstrategies forengagingchildrenandyouthwithASDinpositiveandextendedsocialinteractionsinboth teacher-directedandlearner-initiatedactivities .
Evidence-BasedPractice / Definition
PictureExchange CommunicationSystem (PECS) / Learnersareinitiallytaughttogiveapictureofadesired itemtoacommunicativepartnerin exchangeforthedesired item .PECSconsistsofsixphaseswhichare:(1)“how”tocommunicate,(2)distanceandpersistence,(3)picturediscrimination,(4)sentencestructure,(5) responsiverequesting,and(6)commenting .
Pivotalresponse training
(PRT) / Pivotallearningvariables(i .e .,motivation,respondingtomultiplecues,self-management, andself-initiations)guideinterventionpracticesthatareimplementedinsettingsthatbuild onlearnerinterestsandinitiative .
Prompting(PP) / Verbal, gestural,orphysicalassistancegiventolearnerstoassisttheminacquiringorengag- inginatargetedbehaviororskill .Promptsaregenerallygiven byanadultorpeerbeforeoras alearnerattemptstouseaskill .
Reinforcement(R+) / Anevent,activity,orothercircumstanceoccurringafteralearnerengagesinadesired behav- iorthatleadstotheincreasedoccurrenceofthebehaviorinthefuture .
Responseinterruption/
redirection (RIR) / Introductionofaprompt,comment,orotherdistracterswhenaninterferingbehaviorisoccur- ringthatisdesignedtodivertthelearner’sattentionawayfromtheinterferingbehaviorand resultsinitsreduction .
Scripting(SC) / Averbaland/orwrittendescriptionaboutaspecificskillorsituationthatservesasamodel forthelearner. .Scriptsareusuallypracticedrepeatedlybeforetheskillisusedintheactual situation .
Self-management(SM) / Instructionfocusingonlearnersdiscriminatingbetweenappropriateandinappropriatebehaviors,accuratelymonitoringandrecordingtheirownbehaviors,andrewardingthemselvesfor behavingappropriately.
Socialnarratives(SN) / Narrativesthatdescribesocialsituationsinsomedetailbyhighlighting relevantcues and offeringexamplesofappropriateresponding .Socialnarrativesareindividualizedaccordingto learnerneedsandtypicallyarequiteshort,perhapsincludingpicturesorothervisualaids .
Socialskillstraining(SST) / Grouporindividualinstructiondesignedtoteachlearnerswithautismspectrum disorders
(ASD)waystoappropriatelyinteractwithpeers,adults,andotherindividuals.Mostsocial
skillmeetingsincludeinstructiononbasicconcepts,role-playingorpractice,andfeedbackto helplearnerswithASDacquireandpractice communication,play, orsocialskillstopromote positiveinteractionswithpeers .
Structuredplaygroup
(SPG) / Smallgroupactivitiescharacterizedbytheiroccurrencesinadefinedareaandwithadefined activity,thespecificselectionoftypicallydevelopingpeerstobeinthegroup,acleardelineationofthemeandrolesbyadultleading,prompting,orscaffoldingasneededtosupport students’performancerelatedtothegoalsoftheactivity .
Taskanalysis(TA) / Aprocessinwhichanactivityorbehaviorisdividedintosmall,manageablestepsinorder
toassessandteachtheskill .Otherpractices,suchasreinforcement,videomodeling,ortime delay,areoftenusedtofacilitateacquisition ofthesmallersteps .
Technology-aided instructionand intervention(TAII) / Instructionorinterventionsinwhichtechnologyisthecentralfeaturesupportingtheacquisitionofagoalforthelearner .Technologyisdefinedas“anyelectronicitem/equipment/ application/orvirtualnetworkthatisusedintentionally toincrease/maintain,and/orimprove dailyliving,work/productivity,andrecreation/leisurecapabilitiesofadolescentswithautism spectrum disorders”(Odom,Thompson,etal .,2013) .
Timedelay(TD) / Inasettingoractivityinwhichalearnershouldengageinabehaviororskill,abriefdelay occurs betweentheopportunitytousetheskillandanyadditionalinstructions orprompts .Thepurposeofthetimedelayistoallowthelearnertorespondwithouthavingtoreceivea promptandthusfocusesonfadingtheuseofpromptsduringinstructionalactivities .
Videomodeling(VM) / Avisualmodelofthetargetedbehaviororskill(typicallyinthebehavior,communication,
play,orsocialdomains),providedviavideorecordinganddisplayequipmenttoassistlearning inorengaginginadesired behaviororskill .
Visualsupport(VS) / Anyvisualdisplaythatsupportsthelearnerengaginginadesired behaviororskillsindependentofprompts .Examplesofvisualsupportsincludepictures,writtenwords,objectswithin theenvironment,arrangementoftheenvironmentorvisualboundaries,schedules,maps, labels,organization systems,andtimelines .

Table8.MatrixofEvidence-BasedPracticesbyOutcomeandAge(years)

Social

Communi-

cationBehavior

Joint

AttentionPlayCognitive

School

ReadinessAcademicMotorAdaptiveVocational

Mental

Health

EBP

ABI CBI

DRA/I/O DTT ECE EXT FBA FCT MD NI PII

PMII PECS PRT PP R+ RIR SC SM SN SST SPG TA TAII TD VM VS

Ashadedboxrepresentsthatatleastonestudymeetingcriteriaincludedparticipantsinthegivenagegroupandreportedimprovementonagivenoutcome

Table11.FocusedInterventionPracticesfromPreviousandCurrentReview.
PreviousReview:
Evidence-BasedPracticesfrom1997–2007 / CurrentReview:
Evidence-BasedPracticesfrom1990–2011 / ReasonforChange
Antecedent-BasedInterventions / Antecedent-BasedInterventions
CognitiveBehaviorIntervention / Moreaccumulatedevidence
ComputerAidedInstruction / Expandedconceptualization(see Technology-AidedInstructionandIntervention)
DifferentialReinforcementofOtherBehaviors / DifferentialReinforcementofOtherBehaviors
DiscreteTrialTeaching / DiscreteTrialTeaching
Exercise / Moreaccumulatedevidence
Extinction / Extinction
FunctionalBehaviorAssessment / FunctionalBehaviorAssessment
FunctionalCommunicationTraining / FunctionalCommunicationTraining
Modeling / Moreaccumulatedevidence
NaturalisticIntervention / NaturalisticIntervention
Parent-ImplementedIntervention / Parent-ImplementedIntervention
PECS / PECS
Peer-MediatedInstructionandIntervention / Peer-MediatedInstructionandIntervention
PivotalResponseTraining / PivotalResponseTraining
Prompting / Prompting
Reinforcement / Reinforcement
ResponseInterruption/Redirection / ResponseInterruption/Redirection
Scripting / Moreaccumulatedevidence
Self-Management / Self-Management
SocialNarrative / SocialNarrative
SpeechGeneratingDevices/VOCA / Expandedconceptualization(see Technology-AidedInstructionandIntervention)
SocialSkillsTraining / SocialSkillsTraining
StructuredPlayGroup / Moreaccumulatedevidence
StructuredWorkSystems / Morestringentcriteriareduced previousevidence
TaskAnalysis / TaskAnalysis
Technology-AidedInstructionandIntervention / Expandedconceptualization(incorporat- edpreviousComputerAidedInstructionandSpeechGeneratingDevices)
TimeDelay / TimeDelay
VideoModeling / VideoModeling
VisualSupport / VisualSupport