As the prevalence of autism spectrum disorders (ASDs) increases, more and more children and young adults are receiving services in public school settings. This has intensified the demand for effective educational and therapeutic services, and science is now providing evidence about which practices work best. Furthermore, current legislation (Individuals with Disabilities Education Improvement Act, 2004; No Child Left Behind, 2001) in general and special education mandates that all educators implement evidence-based educational programs.
Many interventions and treatments for students with ASD are often based on anecdotal reports, case studies, publication in non-referred journals, magazines, internet or other media outlets (Boutot & Myles, 2011). They are not based on empirical evidence to substantiate their effectiveness, thus precluding worthwhile interventions in the school setting (Hess, Morrier, Heflin & Ivey, 2008). Over the years, the field has made significant advances in research and practice, and today, a selection of strategies and interventions are available with best practice guidelines in place. Key words and phrases that educators should look for in the literature that indicate an evidenced-based practice (EBP) are: data-based approaches, empirically validated treatments, and clinical practice guidelines (Perry & Weiss, 2007).
How do teachers and practitioners bridge this gap and implement more EBPs in the classroom? An administrator would rarely hand a procedural manual to a teacher and expect him or her to incorporate a particular strategy accurately. The literature in general and special education identifies teacher training, administrative support, time for planning, and a clear definition of roles, as the biggest barriers. The emerging science around implementation of EBPs, documents the need for a systems perspective for moving evidence-based practice into daily education practice for students with ASD.
Before these practices can move into the classroom, we need to agree on a working definition of an evidence-based intervention. Professionals’ and caregivers’ reliance on untested methods and strategies with limited evidence has resulted in unrealistic and unreasonable expectations for students, while hindering the potential progress of students with ASDs. It is important for teachers, administrators and school personnel to be knowledgeable about evidence-based approaches to adequately address the needs of students with autism. To help accomplish this, the National Professional Development Center on Autism Spectrum Disorders (NPDC), collaboration among three universities — the University of North Carolina at Chapel Hill, the Waisman Center at the University of Wisconsin at Madison, and the MIND Institute, University of California-Davis — has established a set of standards for a practice or intervention to be considered evidence-based. The NPDC determines if an intervention is effective through a process of peer-reviewed research in scientific journals and must meet the following criteria:
- Either a randomized or quasi-experimental design where two high quality experimental or quasi-experimental group design studies are conducted by at least two different researchers OR
- A single-subject design where five high-quality single studies were conducted by three different investigators who have a total of at least 20 participants OR
- A combination of evidence, meaning one high-quality randomized or quasi-experimental group design and at least three high-quality single subject design studies conducted by three different investigators (http://autismpdc.fpg.unc.edu/what-criteria-determined-if-intervention-was-effective).
When considering interventions and strategies in the classroom setting, we are focusing on individual instructional practices used to teach specific education targets, skills, or concepts to children with ASDs. They are ideally based on explicit teacher behaviors that can be described and measured and typically involve multiple steps (Odom, Collet-Klingenberg, Rogers & Hatton, 2010). The NPDC has identified 27 evidence-based practices, reflected in Table 1. (http://autismpdc.fpg.unc.edu/evidence-based-practices).
While best practices in autism are more complete and accessible today, educators still face the challenge of accurately replicating the strategies in the classroom. It is imperative, not only for the field of special education, but also for those educators responsible to have firsthand knowledge of these practices to help minimize the gap between research and practice. Teachers have the advantage of directly being able to identify each student’s specific needs and goals; when they have knowledge of how to implement EBPs in the classroom they are better equipped to match the strategies to the individual needs of each student (Simpson, 2005). It is also equally important to collaborate with educational professionals, as well as the student’s family to identify additional pertinent goals and objectives along with the student’s individual preferences and motivators.
These identified EBPs are not final, the literature in ASD is active, with new research studies focused on interventions being published monthly (Odom, Collet-Klingenberg, Rogers & Hatton, 2010). Since the literature seldom describes the implementation in enough detail for a teacher to bring to the classroom, the NPDC has constructed step-by-step guidelines and corresponding checklists to guide teachers in their use of these methods in schools. These checklists are assembled in web-based modules, developed by the NPDC in collaboration with the staff at the Ohio Center for Autism and Low Incidence Disabilities and the Autism Intervention Modules website (http://www.autisminternetmodules.org). In addition to the implementation guidelines, the modules also contain information on the evidence-base for each practice, procedural details of the EBP, descriptions of how to collect data for the particular practice, case examples, picture examples, video examples and additional resources, such as data, sheets, materials (Odom, Collet-Klingenberg, Rogers & Hatton, 2010).
Teachers have little support when selecting strategies and are left to their own devices when determining which practice is best. This often leaves them to make decisions based on variables unrelated to the scientific basis for particular strategies (Hess, Morrier, Heflin & Ivey, 2008). A third of the interventions teachers reported using in the classroom had limited support from a research standpoint, suggesting a disconnection between the accepted best practice and what is going on in the classroom. A way teachers and practitioners can bridge the gap between research and practice is by effectively promoting EBP in their schools by utilizing the NPDC web-based modules. This helps practitioners grow knowledgeable about EBPs and how to implement them with fidelity. More guidance on best practices for teaching students with ASD is needed. Public and private school leaders should also receive training. Academic leaders, involved in curriculum selection, teacher recruitment, employment and evaluation, are in positions to ensure that teachers use the most effective strategies to teach students with autism and avoid strategies with limited scientific evidence. The work of the NPDC is one resource using research to develop step-by-step guidelines, implementation checklists and web-based modules for educators and other practitioners.
To move the research on effective interventions for students with autism into the classroom requires a systematic process for identifying and describing EBPs. The NPDC is supporting this effort. The broader range of literature featuring more EBPs bodes well for the scientific field, as well as for improving outcomes for children and youth with an ASD and their families. Teacher preparation programs need to ensure that future educators have the tools to accurately evaluate research to help them identify EBPs, know how to implement that practice and keep informed of the latest research. School systems must encourage professional development and support for implementing evidence-based strategies into daily practice. Through practical instruction, as well as opportunities for professional conferences, workshops, and systematic reviews of research, educators will be better able to meet the diverse and challenging needs of students with ASD. Moving from science to practice continues to be a clear challenge. However, it is a critical next step for the field.
Jill Krata, PhD, is Program Coordinator of Autism BrainNet at the Icahn School of Medicine at Mount Sinai. Dr. Krata has over 15 years of clinical and academic experience in working with individuals with autism spectrum disorders, intellectual disabilities, and various genetic disorders such as Williams and Fragile X syndromes. Dr. Krata holds a doctorate degree in intellectual disabilities and autism from Teachers College, Columbia University and master’s degrees in clinical psychology, counseling psychology and special education. Dr. Krata previously worked at the YAI Network in a variety of clinical and managerial positions in the residential and clinical and family services departments, including the Center for Specialty Therapy, Premier HealthCare and most recently, as the Manager of Clinical Services at the Autism Center. Currently, Dr. Krata is the Program Coordinator of the Autism BrainNet regional node at the Icahn School of Medicine at Mount Sinai. Dr. Krata is affiliated with various professional organizations, including the American Association on Intellectual and Developmental Disabilities (AAIDD), The National Association for the Dually Diagnosed (NADD), The Council for Exceptional Children (CEC) and the Division on Autism and Developmental Disabilities of the CEC, and The Williams Syndrome Association (WSA).
Dr. Hof graduated from the School of Medicine of the University of Geneva, Switzerland, and now is the Irving and Dorothy Regenstreif Research Professor of Neuroscience and the Vice-Chair of the Fishberg Department of Neuroscience at the Icahn School of Medicine at Mount Sinai in New York. He also leads the Kastor Neurobiology of Aging Laboratories in the Friedman Brain Institute. Dr. Hof became, as of 2012, Editor-in-Chief of the Journal of Comparative Neurology, which was founded by C.L. Herrick in 1891 and is the oldest journal of neuroscience in existence. His laboratory has extensive expertise in the pathology of neuropsychiatric disorders and has established an international reputation in quantitative approaches to neuroanatomy and studies of brain evolution. Dr. Hof’s research is directed towards the study of selective neuronal vulnerability in dementing illnesses and aging using classical neuropathologic as well as modern quantitative morphologic methods to determine the cellular features that render the human brain uniquely vulnerable to degenerative disorders, in particular Alzheimer’s disease and frontotemporal dementia. Dr. Hof recent research demonstrated using a combination of electrophysiology, mathematical modeling, and high-resolution cellular imaging, that pyramidal neurons are affected in a regional and layer-specific manner in the primate cerebral cortex with substantial alterations in dendritic spines and dendrite integrity, that are reflected by disturbances in the biophysical properties of these neurons. His research also extends to study patients suffering from psychiatric illnesses, such as autism spectrum disorders and schizophrenia. Dr. Hof also contributed considerably to our understanding of the structure of the mammalian brain and has identified, in select mammalian species, specific neuronal types in parts of the cerebral cortex known to be involved in social awareness, judgment, and attention, that can be considered as markers of adaptive mechanisms and functions in response to particular ecological pressures. He is an Associate Director of the Alzheimer’s Disease Research Center at Mount Sinai and he receives major funding from the NIA and NIMH. He has been recently funded by Autism Speaks, the Seaver Foundation, and the Simons Foundation for his work on the neuropathology of autism and from the James S. McDonnell Foundation for his studies of brain evolution. Since 2014 he is the Director of the Seaver Autism Center Tissue Program, the Mount Sinai regional node of Autism BrainNet (http://www.autismbrainnet.com).
For more information, please contact Dr. Krata at jill.krata@mssm.edu, or Dr. Hof at patrick.hof@mssm.edu or visit http://www.icahn.mssm.edu/research/centers/seaver-autism-center. For information about the Autism BrainNet, visit www.AutismBrainNet.org or www.TakesBrains.org.
References
Boutot, E.A., & Myles, B.S., (2011). Autism spectrum disorders: Foundations, characteristics and effective strategies. Pearson Education, Inc.: Upper Saddle River, NJ.
Hess, K.L., Morrier, M.J., Heflin, L.J., & Ivey, M.L. (2008). Autism treatment survey: Services received by children with autism spectrum disorders in public school classrooms. Journal of Autism and Developmental Disorders. 38, 961-971. doi: 10.1007/s10803-007-0470-5
Odom, S.L., Collet-Klingenberg, L., Rogers, S.J., & Hatton, D.D. (2010). Evidenced-based practices in interventions for children and youth with autism spectrum disorders. Preventing School Failure, 54(4), 275-282. doi: 10.1080/10459881003785506
Perry, A., & Weiss, J.A. (2007). Evidence-based practice in developmental disabilities: What is it and why does it matter? Journal on Developmental Disabilities, 12, 167-171.
Simpson, R. (2005). Evidence-based practices and students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 20(3), 140-149.
Wong, C., Odom, S.L., Hume, K.A., Cox, C.W., Fettig, A., Kurcharczyk, S., et al. (2015). Evidence-based practices for children, youth and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, in press, doi: 10.1007/s10803-014-2351-z.
