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


Part 2 – Research Evidence for Treatment Efficacy



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Part 2 – Research Evidence for Treatment Efficacy

2.1 Introduction

Decisions about implementation of interventions should be informed by research evidence about the intervention. Evidence varies in quality and quantity so it is important to establish how much evidence there is and how reliable the findings are. In order to do this we search research data bases and then review and rate the articles that are found relating to a particular intervention. This is direct evidence and is referred to as Type 1 research evidence.

It is also important to consider whether the intervention makes sense in relation to what we know about autism. In order to do this we consider research about the condition and whether or not the intervention makes sense in relation to our research-based knowledge of autism. This is referred to as Type 2 research evidence.

The final consideration we make when evaluating the evidence for an intervention, is the extent to which the intervention addresses criteria for good practice in autism intervention. These are referred to as principles of good practice. (Appendix F provides a detailed description and operationalisation of principles of good practice in autism intervention as used in this report.)

Ideally an intervention will have both types of evidence and will also address principles of good practice in autism intervention; however this is often not the case. Many interventions have not been directly evaluated (Type 1), in which case we need to make decisions based on research-based information about autism (Type 2 evidence) and evaluate how well the intervention adheres to the principles of good practice in autism intervention.



This section includes:

Summary of research searches and rating methodology. Detailed description of findings can be found in Appendix E

A review of recent (April 2005–May 2011) research literature evaluating outcomes of early intervention for autism. Where studies have been assessed and findings documented in reliable recent comprehensive reviews the findings of these reviews have been summarised. Relevant research published from April 2005–May 2011 which had not been included in existing comprehensive reviews, was reviewed for the purposes of this report using the Scientific Merit Rating Scale (SMRS) described in the United States 2009 National Autism Center (NAC) review (see www.nationalautismcenter.org/nsp/ for details).

A table summarising available information about interventions that have one or fewer published trials available, including existing direct (Type 1) and indirect (Type 2) evidence and best practice assessment where information is available.

Summary table showing recommended eligibility rating based on results for nominated interventions incorporating Type 1 and Type 2 direct research evidence and principles of good practice in autism intervention.

2.2 Summary of Research Search and Rating Methodology

2.2.1 Research search

General literature


Literature searches of Medline, PsychInfo, Cochrane Central and ERIC were conducted using combinations of the following search terms: (intervention, treatment outcome or therapy) AND (autism, pervasive developmental disorders or Asperger’s syndrome) AND (randomised controlled trial, controlled clinical trial or between group comparisons). Searches were limited to publication dates ranging from 2005 to 2011 and to young children up to the age of 12 years (See Appendix D for full search strategy). Bibliographies of key reviews were hand searched to identify additional publications. Finally, publications known to authors of this review were also taken into account.

Abstracts of articles identified were examined to determine whether studies met key criteria (described below).

Study quality was assessed by one of three reviewers using the Scientific Merit Rating Scale (SMRS) as described in the National Standards Report (National Autism Center 2009). Studies that had already been reviewed and described in the National Standards Report were not reviewed as the findings of this report were considered to be reliable.

Specific interventions

Specific interventions were also searched in order to determine any research that may not have been elicited via the comprehensive search. This included a list of interventions provided by FaHCSIA. In these cases, the databases Medline and PsychInfo were searched using the following terms: (Specific intervention) AND (autism OR autism key word).

Websites of specific interventions were also searched for key research.

Abstracts of articles identified were examined by reviewers to determine whether studies met key criteria. The amount of information available for these interventions varied and in some cases there was insufficient information on which to base recommendations.

Inclusion criteria


Abstracts of articles identified through the electronic database searches and website searches were examined to determine whether studies met the following key criteria:


published original research

children aged from 0–7 years with ASD (Autism, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), Asperger’s syndrome)

studies with 10 participants or more

any study design except single subject designs having less than 10 participants

children experiencing educational and behavioural interventions, not biomedical or psychodynamic interventions.
2.2.2 Assessing methodological quality of individual studies


Study quality was assessed by one of three reviewers using the Scientific Merit Rating Scale (SMRS) as described in the National Standards Report (National Autism Center 2009). Studies that had already been reviewed and described in the National Standards Report were not reviewed as the findings of this report were considered to be reliable.

The National Standards Report (National Autism Center 2009) examines five critical dimensions of experimental rigour:




research design

measurement of the dependent variable

measurement of the independent variable or procedural fidelity

participant ascertainment

generalisation of results.

For each of the five dimensions of scientific merit, a score between zero and five (0–5) was assigned, with 0 representing a poor score and 5 representing a strong score. The dimension scores were combined to yield a composite score that was rounded to the nearest whole number; this was called the SMRS score. The formula for combining these dimensions is as follows:

Research Design (0.30) + Dependent Variable (0.25) + Participant Ascertainment (0.20) + Procedural Integrity (0.15) + Generalisation (0.10) = 1


SMRS scores of 3, 4, or 5 indicate that sufficient scientific rigor has been applied.

SMRS scores of 2 provide initial evidence about treatment effects. However, more rigorous research must be conducted to confirm these same effects would be more likely to occur when more rigorous procedures are applied to other individuals with an ASD.

SMRS scores of 0 or 1 indicate that insufficient scientific rigor has been applied to allow for generalization to the population of individuals with ASD.

Findings from the search, quality assessment and data extraction were summarised according to the type, quality and quantity of evidence found. (See Appendix E for tabulated data from each article).




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