Review of the Research to Identify the Most Effective Models of Practice in Early Intervention for Children with Autism Spectrum Disorders

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List of tables

List of shortened forms

AAB Australian Advisory Board-on-Autism Spectrum Disorders

AAC Alternative and Augmentative Communication

AARC Australian Autism Research Collaboration

ABA Applied Behavioural Analysis

ABI Autism Behavioural Intervention

ACT Australian Capital Territory

AD Autistic Disorder

ADI-R Autism Diagnostic Interview – Revised

ADOS Autism Diagnostic Observation Schedule

ADOS-G Autism Diagnostic Observation Schedule – Generic

AIT Auditory Integration Training

APA American Psychiatric Association

ASD Autism Spectrum Disorders

CAMs Complementary and Alternative Medicines

CBT Cognitive Behaviour Therapy

CCT Clinical Controlled Trial

CTM Comprehensive Treatment Model

DIR Developmental Individual-Difference, Relationship Intervention

DoHA Department of Health and Ageing

DSM Diagnostic and Statistical Manual (III: Third; IV: Fourth; V: Fifth Edition)

DSP Developmental Social-Pragmatic model

DV Dependent variable

EBSCO Elton B Stephens COmpany

ED Eclectic developmental

EI Early Intervention

EIBI Early Intensive Behavioural Interventions

ERIC Education Resources Information Center

ES Effect Size

ESDM Early Start Denver Model

FaHCSIA Australian Government Department of Families, Housing, Community Services and Indigenous Affairs

FC Facilitated Communication

FCT Functional Communication Training

FFW Fast ForWord Program

HAPP Hodson Assessment of Phonological Patterns

HCWA Helping Children with Autism Package

IBI Intensive Behavioural Intervention

ICD-10 WHO International Classification of Diseases

IEP Individual Education Program

IFSP Individual Family Service Plan

IOA Inter Observer Agreement

IP Individual Plan

IQ Intelligence Quotient

IR Inter-rater

IS Interpersonal Synchrony

ISP Individual Service Plans

IV Independent Variable

Ix Intervention

LEAP Learning Experiences: an Alternative Program for Preschoolers and their Parents

MT Magnitude of Treatment

NAC National Autism Council

NAS National Autistic Society

NLP Natural Language Paradigm

Non-IS Non-interpersonal synchrony

NSW New South Wales

OT Occupational Therapy

PACT Preschool Autism Communication Trial

PALS Playing and Learning to socialise

PBS Positive Behaviour Support

PDD Pervasive Developmental Disorders

PDD-NOS Pervasive Developmental Disorder - Not Otherwise Specified

PECS Picture Exchange Communication System

PEP-R Psycho-educational Profile-Revised

PLAY Play and Language for Autistic Youngsters

PLS Preschool Language Scale

PP Personal Plan

PRC Parenting Research Council

PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PROMPT PROMPTs for Restructuring Oral Muscular Phonetic Targets

PRT Pivotal Response Training

R&P Roberts and Prior

RCN Raising Children Network

RCT Randomised Control Trial

RDI Relationship Development Intervention

RPMT Responsive Education and Prelinguistic Milieu Teaching

SARRAH Services for Australian Rural and Remote Allied Health

SCERTS Social-Communication, Emotional Regulation, and Transactional Support

SERVAM Sensory considerations, Environmental management, Routines and planned change, Visual supports, Autism friendly communication, Motivation

SGD Speech Generating Device

SI Sensory Integration

SIT Sensory Integration Therapy

SM Scientific Merit

SMRS Scientific Merit Rating Scale

SP Speech Pathology

SP Symbolic Play (Intervention)

SPA Speech Pathology Australia

TEACCH Treatment and Education of Autistic and related Communications Handicapped Children

UCLA University of California, Los Angeles

Tx Treatment

VM Video Modelling

WHO World Health Organization

Context of the Review

This review is a follow up and extension of Roberts J.M.A., and Prior, M. (2006) A review of the research to identify the most effective models of practice in early intervention services for children with Autism Spectrum Disorders (ASD), Australian Government Department of Health and Ageing (DoHA). Since then, the Helping Children with Autism (HCWA) Package has been set up by the Australian Federal Government. The package is multifaceted and includes funding provided through the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) for early intervention for children with autism.

Controversy exists internationally about the most effective early intervention for children with ASD. There has been a rapid increase in the types of programs and interventions available over the past 6–7 years, along with a substantial increase in the amount of research into the outcomes of interventions. The reviews of evidence are of varying quality. This report reviews the latest research evidence, and includes a discussion of what is currently understood about principles of good practice in autism early intervention, and the application of those principles in practice. In addition, the report summarises the results of a survey of key stakeholders involved in the implementation of this component of the HCWA package. Sections of this report address matters that have arisen since the implementation of the FaHCSIA Early Intervention Services component of the HCWA Package.

FaHCSIA commissioned this report to provide up-to-date information about the evidence for the efficacy of interventions for young children with ASD up to the age of 7 years, including ratings of the scientific merit of the intervention research. In addition, FaHCSIA requested an update of current understanding of what constitutes good practice in autism intervention. Recommendations from this report are designed to inform processes used to assess the eligibility of interventions, and the suitability and capacity of potential providers to deliver effective autism early interventions under the HCWA Package.

Evidence-based treatment guidelines are particularly important in the field of autism where there has been considerable controversy surrounding the effectiveness of various treatments, including those which are well promoted but lack scientific evidence for their perceived effectiveness. Parents, professionals and government need information to help them evaluate claims of the success of treatments, particularly those treatments that claim or promise to cure children with ASD. Although some of these interventions might be helpful to children, others might be ineffective or even harmful. Research evidence is needed to address these claims and also to prevent limited resources from being invested in non-productive programs.

Previous syntheses of evidence have found that only a small number of autism treatment programs have direct research evidence that supports their effectiveness, and that this research is limited. In other words, previous reviews have found that very few outcomes of particular autism interventions are sufficiently robust to allow confident recommendations about their efficacy or otherwise. Most treatments have not been evaluated adequately and many have not been evaluated at all. In the absence of direct evidence, parents and professionals must also consider how well an intervention meets guidelines for good practice in autism intervention and the extent to which the rationale for the intervention is based on research evidence about autism.

The information described in this report is based on reputable peer-reviewed reviews that have rated the scientific merit of research evaluating a large number of interventions. In the case of study reports that had not previously been rated, the research was rated by the review team using a Scientific Merit Rating Scale (SMRS) developed by the United States’ National Autism Center, for the National Standards Report (National Autism Center, 2009). In addition, overall findings from several international reviews of the research evidence for treatments for children with ASD have been summarised and included. A list of these reviews is provided in Appendix A, and our current evidence reviews are summarised in Tables 1–4.

This review includes:

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