Impact Feature Issue on Supporting Success in School and Beyond for Students with Autism Spectrum Disorders

In recent months, both television and print media have given exceptional attention to the increasingly prevalent and enigmatic conditions of Autism Spectrum Disorders (ASD). This is clear testament to the extraordinary interest this topic holds for both professionals and the general public. For instance, Town and Country,a popular magazine best recognized for profiling fashion trends and society events and goings-on, recently published an article on Autism (Guernsey, 2006) that included information on prevalence rates, diagnostic signs, causes, treatment alternatives, and support resources. The notable and widespread interest in ASD was similarly revealed in a recent feature article in Time(Wallis, 2006).Both the Timecover story and Town and Countryarticle (along with myriad similar reports) are particularly noteworthy because they address interests that are shared by professionals and the general public. Indeed, it is clear that many of us are struggling to understand many of the same fundamental issues connected to ASD.

Issues in Effective Interventions

One topic of considerable interest relates to identifying and correctly using intervention and treatment methods that have the best chance of producing positive outcomes in the lives of children and youth diagnosed with ASD. Interestingly, Wallis (2006), the author of theTimearticle, strongly implied that facilitated communication (Biklen, 1993), arguably a highly controversial intervention, was an effective practice. Many professionals, of course, will recognize facilitated communication as a method that behavioral scientists have unmistakably proven to lack efficacy based on numerous studies (Wheeler, Jacobson, Paglieri & Schwartz, 1993). Conceding that facilitated communication is indeed a controversial method, Wallis nevertheless offered that “it (facilitated communication) clearly turned Hannah’s life around. Since her breakthrough, she no longer spends much of her day watching Sesame Street and Blue’s Clues.Instead, she is working her way through high school biology, algebra and ancient history” (p. 44). In highlighting and tacitly recommending a highly controversial intervention for individuals with ASD, this journalist identifies several underlying, fundamental issues that confront parents and professionals connected to children and youth with ASD:

• There is significant lack of agreement within the field of ASD regarding methods that are most effective.
• The meaning and nature of what comprises and constitutes an effective and scientifically-based practice is imprecise and undecided.
• There are few practical and well-designed guidelines that professionals and families can use to make methodology-related decisions.

Accordingly, a fundamental issue confronting the field of ASD relates to identifying and correctly using the most efficacious methodologies, treatments, and strategies.

The fundamental elements that comprise an effective practice for students with ASD are open to debate. Nevertheless, federal policy, research implications, and logical and commonsense thinking lead to the undeniable conclusion that it is essential that children and youth with ASD have access to the most effective methods. Children and youth with ASD are in particular need of effective practices because they have been especially prone to encounter and suffer unproven and controversial treatments and interventions. A number of these purported ASD intervention methods lack theoretical, clinical and/or empirical foundation, yet often promise dramatic and all-encompassing improvements and even restoration to normalcy. They promise hope for positively responding to a lifelong disability that not only lacks a clear etiology, but also a clearly effective plan of treatment. That’s why professionals and parents who are given opportunities to use methods and treatments that promise dramatic improvements, even if the approach being considered lacks scientific validation, may be willing to “take a chance” and consider using techniques and strategies that all too frequently have little to offer.

Identifying Effective Practices

There appear to be two principal actions associated with identifying effective practices. The first involves identifying fundamental features associated with effective interventions, and evaluating the effectiveness of existing methods that are purported to be suitable for use with children and youth with ASD. This includes evaluating the effectiveness with particular types of students who have specific needs and problems. The second involves creating mechanisms for evaluating future ASD intervention methods and strategies. That is, since new methods are constantly being introduced, rating and evaluating existing methods is only a partial answer to the effective practice issue. Evaluation strategies that can be used by practitioners and others are needed to facilitate assessments of new methods and their suitability with individual students.

A tremendous amount of work needs to be done on both these fronts, yet progress is being made. For instance, the Committee on Educational Interventions for Children with Autism, Division of Behavioral and Social Sciences and Education, National Research Council (2001) identified several basic characteristics that should be in place in educational programs designed for young children with ASD:

…early [age] entry into an intervention program; active engagement in intensive instructional programming for the equivalent of a full school day, including services that may be offered in different sites, for a minimum of five days a week with full-year programming; use of planned teaching opportunities, organized around relatively brief periods of time for the youngest children (e.g., 15–20 minute intervals); and sufficient amounts of adult attention in one-to-one or very small group instruction to meet individualized goals. (p. 6)

In addition, Simpson and colleagues (2005) have evaluated commonly used interventions and treatments for children and youth with ASD. Grouped within 5 categories (interpersonal relationship; skill based; cognitive; physiological/biological/neurological; and other), 33 ASD methods were evaluated using the following considerations:

• Reported outcomes and effects.
• Qualifications of persons implementing the intervention or treatment.
• How, where, and when the intervention or treatment is best administered.
• Potential risks associated with the intervention or treatment.
• Costs associated with using the intervention or treatment.
• Methods for evaluating the effectiveness of the method.

Based on these factors, methods were assessed as being one of the following:

• Scientifically-based. Practices that have “significant and convincing empirical efficacy and support” (p. 9).
• Promising practice. Strategies that have “efficacy and utility with individuals with ASD” (p. 9), even though the method requires additional objective verification.
• Practice having limited supporting information. Those that lack objective and convincing supporting evidence, with unsure or potential utility and usefulness.
• Not recommended. Interventions and treatments that were judged to lack effectiveness and that have the potential to be harmful.

The following practices were found to meet the highest standard, that of the scientifically-based category:

• Applied behavior analysis (Alberto & Troutman, 2003).
• Discrete trial training (Maurice, Green & Luce, 1996).
• Pivotal response training (Koegel, Koegel, Harrower & Carter, 1999).
• Learning Experiences: An Alternative Program for Preschoolers and Parents (LEAP; Strain & Hoyson, 2000).

Basic progress is also being made in creating mechanisms for evaluating future ASD methods. Heflin and Simpson (1998) and Simpson (2005) recommended that basic questions be used by professionals and parents to determine the appropriateness of various interventions with students with ASD, including:

• What are the proven efficacy credentials of purported interventions and treatments, and do anticipated outcomes of particular practices line-up with the needs of individual students?
• What are the potential risks associated with a method?
• What is the most effective means of evaluating a particular method or approach?

Summary Thoughts

There is little chance that there is a single best-suited and universally effective method for all learners with ASD. However, it is clear that there are effective methods that should form the foundation of programs for students with ASD. And without question there are some methods and strategies that are associated with better outcomes for these children and youth. The best programs for students with ASD appear to be those that integrate a variety of objectively verified practices and that are designed to address and support the needs of individual students. It is essential that the field continue to make progress in identifying and using those methods that have the greatest potential for achieving desired outcomes, and evaluating future methods that purport to be suitable for use with students with ASD.