Fact sheet for information and discussion on the evidence-based interventions for Autism, an Autism Spectrum Disorder


by Barry K. Morris B.ScWk


A parent is faced by a bewildering array of interventions to use when their child has been diagnosed as being on the autism spectrum. Which ones are the best? Which will suit the child? Should I trust the judgment of other parents, psychologists or researchers? Let's picture some scenarios.


A parent tries a range of interventions for her child diagnosed with Asperger's syndrome. They have varying degrees of effect. Jumping around the Internet, she finds a vitamin supplement and figures it is worth trying. Over the next six months, there are dramatic improvements. In her joy, she passes this information on to every parent possible through internet forums. Unknown to her, the supplement had no effect. Her child experienced a natural 'growth spurt' in her development.


This vitamin supplement is tried by another parent when he reads this on a forum. Unknown to him, his daughter had a vitamin deficiency but unrelated to his daughter's Autism. There is a dramatic improvement and he is quick to pass on the good news that this could be the cure that researchers have missed.


A couple make huge sacrifices to put their child into a full-time one-on-one intervention program that is experimental but has had good reviews by some parents. There are some improvements, but not beyond what could be expected without the intervention. However, the parents have sold their home, downgraded their car and now live very simply to afford the therapy, and subconsciously don't want to accept that these sacrifices may have been in vain. They jump on the smallest improvement and believe the program is making a big difference.


A shady character aiming to exploit parents markets a new intervention for children on the autism spectrum. The website is glossy, it is packed with rave reviews by parents, although strangely there isn't anything in the forums or literature about it. It is expensive so it must be a good intervention.


Overly cynical?

Although we value our logical rational minds, we are easily swayed by our emotions, internal biases, the beliefs of others, and our own hopes and dreams - usually far more than we realize. History is littered with examples of medications, counseling styles and therapies that had rave reviews but were later proved to be unfounded.


This article is not intended to denigrate every early intervention that doesn't have proper credentials from rigorous testing. When research is lacking in so many areas, parents are often left to do this research themselves, and no doubt there are important interventions that could work well for their child, but their efficacy hasn't been established yet. However, parents should be aware of the best standards of proof that currently exist.


What is evidence-based medicine when it comes to autism?

Evidence-based medicine aims for the ideal that healthcare professionals should make "conscientious, explicit, and judicious use of current best evidence" in their everyday practice. It categorizes different types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research.


The strongest evidence for therapeutic interventions is provided by randomized, double-blind, placebo-controlled trials involving a homogeneous patient population and medical condition. Although still fallible if not conducted properly, it is the highest standard of proof that currently exists for the effectiveness of interventions.


For example, samples are randomized so the influence such as age, social class, cultural background and nationality are minimized. With Autism Spectrum Disorders, this is crucial because as many parents know, what may work brilliantly for one child may have no effect on another.


The actual intention of the research may be hidden from participants so their feedback isn't influenced by the researchers' expectations. In the case of medication, some participants will receive a 'placebo', a drug that looks like the real thing but is a fake, because our mind can actually make us feel better if we think the drug is going to work. The same principle can work with an expensive intervention, particularly if we have made many sacrifices to get our child into it!


In contrast, patient testimonials, case reports, and even expert opinion have less value as proof because of the placebo effect, the biases inherent in observation and reporting of cases, difficulties in ascertaining who is an expert, and more.

Evidence-based intervention implies not only clinical expertise, but expertise in retrieving, interpreting, and applying the results of scientific studies, and in communicating the risks and benefit of different courses of action to parents.

The evidence, particularly that behind drug treatments, has improved over the decades although there is still little research on drugs for children on the autism spectrum. Interventions such as Applied Behavior Analysis are evidence-based as there has been plenty of stringent research done over the years. But there are still many types of interventions, particularly the biomedical ones, that haven't been properly tested.


is a potential autism intervention evidence-based?

Even when there is evidence, you may not get it unless you ask for it. When talking to a specialist about an intervention you are considering for your child, ask for information on any rigorous testing done. Ideally there should be articles they can produce from peer-reviewed journals - this means that research findings are reviewed by other specialists in a given field before being allowed publication.


If the intervention has no evidence-based foundation, simply proceed with caution. It does not mean this intervention won't work - it is simply missing the best proof possible so you are forced to rely on anecdotal evidence from others, with all the inaccuracy that can entail.


WhY ARE THERE SO FEW EVIDENCE-BASED interventions for autism?

Unfortunately research moves slowly, particularly in the Autism field and it can take years for a new intervention to become 'evidence-based'. It may take up to a decade for an intervention to be confirmed or refuted, and even then the research findings may still conflict with each other due to different methods and samples. As a rough rule of thumb, be very wary of early interventions that still don't have solid well-researched evidence after ten years of entering the Autism arena.


Why isn't this evidence-based approach providing quicker answers on the most effective interventions?

• These scientific studies are usually expensive, time-consuming and difficult to set up
• What works for one child on the autism spectrum may not work for other children
• Parents may not want their children to take part in time-consuming research
• Researchers may have commercial backing which lead to bias in their results
• Human biases and errors from the researchers can easily invalidate their research
• It can be tricky separating intervention effects from a child's natural development over time.


Finally, a key principle of the evidence-based approach is that other researchers should be able to replicate the results and provide further evidence. In other words, one study may indicate a new intervention helps most children with Autism, but this will not be widely accepted until similar research by others adds to this evidence. An example of this is Applied Behavior Analysis which has a wide range of research projects over the decades indicating its effectiveness.


Criticism of evidence-based medicine

Critics of evidence-based medicine say lack of evidence and lack of benefit are not the same, and that the more data are pooled and aggregated, the more difficult it is to compare the patients in the studies with the patient in front of the doctor — that is, this approach applies to populations, not necessarily to individuals. Some critics suggest that evidence-based medicine discounts the value of clinical experience.


Many interventions for Autism Spectrum Disorders do not have a strong literature base supporting them. In some cases, this will be simply because the intervention simply does not benefit the majority of children. However, there may be cases where the expense or difficulty of conducting randomized double-blind placebo-controlled trials means that funding sources play a role in what gets investigated.

Large randomized controlled trials are useful for examining carefully defined medical conditions. The more complex the patient population (e.g. severity of condition, co-morbid conditions, etc) in the study, the more difficult it is to assess the treatment effect. This is can be the case with Autism Spectrum Disorders.


Button for closing Autism fact sheet on evidence-based interventions

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An evidence-based approach to early interventions for Autism Spectrum Disorders provides a solid foundation for establishing the efficacy of interventions