Evidence Based Treatments for Autism Spectrum Disorder (ASD)
Summary
TLDRThis webinar, led by Dr. Taryn Goldberg and her team, delves into evidence-based treatments for Autism Spectrum Disorder (ASD). They highlight the importance of employing scientifically supported interventions, such as Applied Behavior Analysis (ABA), and discuss the National Standards Project's role in guiding treatment choices. The discussion also touches on the necessity of parental involvement and the need for ongoing training and competence among providers. The webinar provides a valuable resource for understanding effective ASD interventions and emphasizes the evolving nature of treatment approaches.
Takeaways
- 🌟 Evidence-based treatments are crucial for individuals with Autism Spectrum Disorder (ASD), and they should be the foundation of any intervention plan.
- 📈 The National Standards Project is a valuable resource for parents, caregivers, and professionals to understand and select effective treatments for ASD.
- 🧠 Applied Behavior Analysis (ABA) is recognized as a gold standard for treating individuals with ASD and other significant behavioral disorders, focusing on functional communication and adaptive skills.
- 🔍 Parents play a critical role in their child's treatment and should be active participants, advocating for their child and collaborating with treatment providers.
- 🤝 Collaboration between parents and providers is essential for successful outcomes, with open communication and shared decision-making being key components.
- 📚 Providers must have the appropriate training, competence, and stay up-to-date with current research to ensure they are offering the best possible interventions.
- 🎯 Setting clear, measurable goals is important for tracking progress and making necessary adjustments to the treatment plan.
- 🌐 Cultural, family structure, and financial factors should be considered when developing a treatment plan to ensure it fits the individual's and family's needs.
- 💡 Emerging interventions show promise but may not have enough research to confirm their effectiveness fully; thus, they should be approached with caution.
- 📝 It's important to use data-driven decision-making to assess the effectiveness of interventions and make necessary changes to the treatment plan.
Q & A
What is the primary goal of the webinar?
-The primary goal of the webinar is to provide an update on the state of evidence for treatments for Autism Spectrum Disorder (ASD) and to describe the importance of using empirically supported treatments with clients.
What is the role of the National Standards Project in treating individuals with ASD?
-The National Standards Project aims to answer the question of how to effectively treat individuals with ASD by reviewing and categorizing various interventions based on their level of evidence into established, emerging, and unestablished treatments.
What are the three categories of interventions that the National Autism Center groups ASD interventions into?
-The three categories are established interventions (repeatedly effective), emerging interventions (show some evidence of effectiveness), and unestablished interventions (lack sound evidence of effectiveness).
Why is Applied Behavior Analysis (ABA) considered a gold standard in treating individuals with ASD?
-ABA is considered a gold standard because it is based on learning theory and has been proven to be effective in teaching skills and reducing interfering behaviors in individuals with ASD through the use of behavioral techniques like positive reinforcement and functional analysis.
What are some of the established treatments for ASD mentioned in the 2015 phase 2 report?
-Some of the established treatments include behavioral interventions, cognitive behavioral therapy, comprehensive behavioral treatment for young children, and medically based treatments to address challenging behaviors associated with ASD.
What are the main factors that parents should consider when seeking treatment for their child with ASD?
-Parents should consider factors such as the evidence-based nature of the treatment, the competence and training of the treatment provider, the cultural and family context, financial considerations, and the fit of the treatment with their child's specific needs and their family situation.
How can parents ensure they are actively participating in their child's treatment?
-Parents can actively participate by asking questions, being involved in treatment sessions, learning to implement interventions at home, advocating for their child's needs, and collaborating with treatment providers to set appropriate goals and adjust the treatment plan as necessary.
What are some resources available for families seeking information on evidence-based treatments for ASD?
-Resources include the National Standards Project, Autism Speaks, the Center for Autism and Related Disorders (CARD), and Early Steps, which provide guidance, information, and referrals for evidence-based intervention options.
What is the significance of parent training in the treatment of children with ASD?
-Parent training is significant because it helps in the generalization of skills from the clinical setting to the natural environment. It empowers parents to support their child's learning and development outside of therapy sessions, leading to more effective and sustainable treatment outcomes.
How does the webinar address the issue of comorbid mood disorders in individuals with ASD?
-The webinar discusses the growing interest in treating emotion regulation difficulties in individuals with ASD, especially those with comorbid mood disorders like depression and anxiety. It highlights the potential efficacy of interventions like cognitive behavioral therapy (CBT), mindfulness-based interventions, and intensive outpatient programs (IOP) that focus on emotion regulation.
Outlines
🌟 Introduction to Evidence-Based Treatments for Autism Spectrum Disorder
The webinar begins with a welcoming introduction by Dr. Taryn Goldberg, a licensed psychologist, along with her colleagues Dr. Catherine Stubblefield, Dr. Danielle Silver, and Dylan Braun, a clinical psychology trainee. They are based at the Mailman Segal Center Building at Nova Southeastern University, specifically at the Children's Clinic Foundation, where they provide psychodevelopmental evaluations and community outreach presentations. The main topic of discussion is evidence-based treatments for individuals with Autism Spectrum Disorder (ASD), emphasizing the importance of reliable and well-researched interventions.
📚 Understanding Evidence-Based Treatments and the National Standards Project
The discussion shifts to the importance of evidence-based treatments, highlighting the National Standards Project conducted by the National Autism Center at May Institute. The project aims to determine effective treatments for individuals with ASD, with the first report released in 2009 and the second phase in 2015, currently being updated. The benefits of evidence-based treatments are emphasized, including their impact on families and the potential for children to lead more adaptive and independent lives. The talk includes a video case study of a 16-year-old with ASD, showcasing the profound impact of early intervention.
🎯 Established, Emerging, and Unestablished Interventions for ASD
The presentation outlines the categorization of interventions for ASD into three groups: established, emerging, and unestablished. Established interventions, which have been repeatedly shown to be effective, are primarily based on Applied Behavior Analysis (ABA) principles. Emerging interventions show promise but lack sufficient evidence for full endorsement. Unestablished interventions lack solid evidence of effectiveness. The importance of focusing on established and emerging practices is stressed, as these have demonstrated effectiveness in wide groups of children with ASD.
🤔 Parental Decision-Making and the Role of Professional Advice in ASD Treatment
The conversation addresses the challenges parents face when selecting treatments for their children with ASD, often overwhelmed by the vast amount of information available. Research indicates that parents heavily rely on professional advice when deciding on treatments. However, many parents are not fully aware of the gold standards or best treatments for their child with ASD. The discussion emphasizes the need for parents to understand and choose reliable treatments based on empirical support and professional guidance.
🧠 The Science Behind ABA and Its Application in Treating ASD
A detailed explanation of Applied Behavior Analysis (ABA) is provided, highlighting its basis on learning theory and its focus on teaching skills and reducing interfering behaviors. ABA is provided by trained, certified therapists in various settings and requires intensive hours of therapy. The treatment goals of ABA include improving functional communication skills, language acquisition, social skills, and reducing maladaptive behaviors. The discussion also includes a video that further explains ABA and its techniques for teaching complex skills through breaking them down into smaller, manageable parts.
🌱 Emerging Interventions and the Future of ASD Treatment
The conversation turns to emerging interventions for ASD, particularly those for individuals under 22. While these interventions show promise, they have not been studied extensively enough to be fully endorsed. The importance of considering these interventions, even if they are not categorized as well-established, is discussed. The group also speculates on the potential advancements in treatment options, such as technology-assisted interventions and sensory processing treatments, that may emerge in the next update of the National Standards Project.
💡 Insights on the Evolution of ASD Treatments and Parental Involvement
The discussion emphasizes the evolving nature of ASD treatments and the critical role of parents in their child's treatment journey. The importance of parent training and involvement in therapy sessions is highlighted for the generalization of skills from a controlled environment to real-life situations. The webinar also addresses the need for parents to be active participants, advocating for their children and collaborating closely with treatment providers to ensure the effectiveness of interventions.
📈 Evaluating and Adapting Treatment Strategies Based on Data
The importance of data-based decision-making in treating individuals with ASD is discussed. Clinicians are encouraged to collect and analyze data to determine the effectiveness of treatment and make necessary adjustments. The role of parents in this process is also emphasized, as they should be informed about their child's progress and have the right to advocate for changes in the treatment plan if needed. The discussion underscores the collaborative nature of treatment and the importance of adapting strategies based on empirical evidence and the unique needs of each child.
🌐 Resources and Support for Families and Providers in ASD Treatment
The webinar concludes with a focus on available resources and support for families and providers in the journey of ASD treatment. Several organizations are mentioned, including the National Standards Project, Autism Speaks, and the Center for Autism and Related Disorders (CARD), each offering guidance, referrals, and a wealth of resources. The importance of staying up-to-date with current research and maintaining open communication between providers and families is stressed, as well as the right of parents to ask questions and be actively involved in their child's treatment process.
Mindmap
Keywords
💡Autism Spectrum Disorder (ASD)
💡Evidence-Based Treatments
💡Applied Behavior Analysis (ABA)
💡Cognitive Behavioral Therapy (CBT)
💡Parent Training
💡National Standards Project
💡Early Intervention
💡Functional Communication Training (FCT)
💡Comorbid Conditions
💡Treatment Providers
Highlights
The webinar focuses on evidence-based treatments for Autism Spectrum Disorder (ASD).
Dr. Taryn Goldberg is a licensed psychologist and nationally certified school psychologist.
The presenters include two postdoctoral residents, Dr. Catherine Stubblefield and Dr. Danielle Silver, and a clinical psychology trainee, Dylan Braun.
The clinic, called The Chil at Nova Southeastern University, provides psychodevelopmental evaluations for autism and other developmental delays.
Evidence-based treatments are crucial for effective intervention and support for individuals with ASD.
Parents often rely on professional advice when deciding on treatments for their children with ASD.
The National Standards Project by the National Autism Center aims to identify effective treatments for individuals with ASD.
Early intervention is emphasized as profoundly impactful for children with autism and their families.
Applied Behavior Analysis (ABA) is recognized as a gold standard for treating individuals with autism and other significant behavioral disorders.
Cognitive Behavioral Therapy (CBT) and mindfulness-based interventions are noted for their potential efficacy in treating comorbid mood disorders in individuals with ASD.
The importance of parent training and involvement in the treatment process is highlighted for better generalization of skills.
The need for culturally sensitive and family-inclusive treatment approaches is discussed.
The role of clinicians in staying up-to-date with research and employing data-based decision-making is emphasized.
The webinar provides resources such as the National Standards Project and Autism Speaks for further guidance and support.
The importance of assessing and tailoring treatment based on individual needs, including considering factors like cultural background and family structure, is underscored.
The webinar concludes with an encouragement for ongoing learning and collaboration between providers and families to ensure the best outcomes for individuals with ASD.
Transcripts
hello everyone welcome to our webinar
entitled evidence-based treatments for
autism spectrum disorder or asd
as you're starting to sign on please
trickle in in the chat where you're
logging in from so we kind of have a
good sense of where everyone's located
if you also want to put down
where you work or if you're a student
what field you're in anything like that
could be helpful to help generate our
conversations
so welcome everyone my name is dr taryn
goldberg i am a licensed psychologist in
the state of florida as well as a
nationally certified school psychologist
i am joined here with two postdoctoral
residents in the field of psychology we
have dr catherine stubblefield
and we have dr danielle silver
we're also joined here by mr dylan braun
who is a clinical psychology trainee at
our clinic
so we are located at nova southeastern
university in davey fort lauderdale
florida specifically we are in the
mailman segal center building
at a clinic called the chil the unicorn
children's clinic foundation
developmental assessment clinic so what
we do is we provide psychodevelopmental
evaluations to test children for autism
as well as other developmental delays
and as you can see we also deliver
community outreach presentations
today we're presenting on evidence-based
treatments for this population who have
autism
so with that said i will let the team
take it away
all right thank you for that
introduction dr goldberg
we're honored that you all chose to
spend some of your thursday afternoon
with us thank you
so today we're going to be providing an
update on the state of the evidence for
treatments for autism spectrum disorder
we're going to describe the importance
of using empirically supported
treatments with our clients and
of course we'll describe some of the
main evidence-based interventions that
are used in practice today
we'll also discuss some important
considerations for both treatment
providers as well as for families
and i will leave you with some treatment
resources and referrals so you have
something to take away with you so
we have a lot of ground to cover so i'll
pass it along to dr silver
okay thank you dylan
so to start off and you can all just
type this in the chat but i'm curious to
know what you know about treatments for
autism spectrum disorder
so let some of those responses trickle
in one thing to make note of is
oftentimes what we do know about these
treatments
are
coming from google word of mouth
the news
they're not always necessarily
reliable
right so we want to make sure that when
we talk about treatments for autism
spectrum disorder that we are
considering reliable treatments that
have a lot of support and a lot of
research
i see aba um in the comments we'll talk
a little bit more about that
awesome behavior modification as well
so why don't we
get started and talking a little bit
more about some of those treatments
so when a parent first gets an autism
spectrum disorder diagnosis for their
child one of the first things they might
do is they might go to google and start
searching for available treatments and
this can be very overwhelming because if
you do that you realize that you come
with over 300 million results
so again that's a lot of information to
kind of try and sit through and can be
very overwhelming
more empirically um we're going to be
looking at this study that was conducted
in 2016.
what the researchers found was that
parents rated getting professional
advice as the most influential source
for deciding which treatment to use
meaning that parents are relying pretty
heavily on the advice given to them by
practitioners as to what treatments are
going to be best for their child
they also found that more than 35
percent of parents listed interventions
that were not part of the national
standards report and the majority of
parents only agreed with nine out of the
26 identified treatments
so really what this is telling us is
that parents don't really have a strong
understanding of what the gold standards
or the best treatments are for their
child with autism
so what are evidence-based treatments
and why are they important before we get
started um talking about that what i do
want to point out is a project um it's
the national standards project which is
conducted by the national autism center
at may institute and the aim of this
project was really to answer this big
question how do we effectively treat
individuals with autism spectrum
disorder so this project started i
believe in the early 2000s um in the
first report or the first phase was
released in 2009 the second phase is
what is supplying the information that
we're going to be reviewing here today
and that was released in 2015
and they are currently in the process of
updating this information for phase
three
so we might see a few different changes
and that's going to be coming out
sometime in the near future
so really i mean if we think about about
this project it's great because it's a
resource that can be used by parents by
caregivers providers
educators to really determine what's the
best course of action for their child
one major benefit to know about these
evidence-based treatments is that they
really help to impact families and they
help children live more adaptive and
independent lives we're going to go
ahead and watch this video it really
helps show the importance of early
intervention
sixteen-year-old paul whitsy cruder
takes autism one step at a time paul is
spunky
he's funny
he has a lot of energy
just in general good natured
paul was diagnosed with a moderate form
of autism when he was two soon after his
parents enrolled him in an autism school
at cleveland clinic he started as a
little boy who couldn't communicate was
easily frustrated and having tantrums
didn't know how to play with any toys
didn't know how to use objects
functionally it was non-verbal so they
taught him
first they told him to eat
then his name
you know he called his name and he'd
actually look at you
research shows young children with
autism benefit from early intervention
over the years paul has developed
adaptive skills and learned how to
communicate and socialize
we still think he has a lot of room for
growth but the things we're working on
now are so different you know
independent living and
um you know maybe he can have a job
where he attends for two hours at a time
that's where the family business comes
in a granola company inspired by paul's
dietary challenges he does a variety of
things he um
uses the best buy date gun
recently he's been filling some of the
bags which is a big deal because he has
to have gloves on he has to use a scale
when you step back and realize how much
effort it takes for him to learn
something
it's just
it's unbelievable paul has also overcome
two organ transplants a kidney and a
liver but you'd never know the adversity
he's faced by his happy helpful demeanor
he's really is kind of sweet and simple
and pure he has come a long way and it's
still like
he's smiling all the time he's totally
in the present i mean we should all live
this way at cleveland clinic i'm erica
foreman
thank you so as you can see from the
video
really the impact of of appropriate and
early intervention is profound not just
for the child but for their family as
well
so what is an evidence-based treatment
i'm going to be referring to
evidence-based treatments a lot so
the type of services
that we're going to be speaking about
they fall under this category of
evidence-based treatments and what that
essentially means is that this these
types of treatments have shown
scientifically that one group who got
the intervention showed improvement
while another group who did not get that
specific intervention did not improve in
the same way
so if a child is going to be exposed to
a treatment there should be some
evidence that it works right at least
for a significant group of p of children
so for example
if you have a group of children with
autism who have no words and you want to
know if a specific teaching intervention
will help there needs to be some sort of
control so it's important that what
happens is the group is split into two
one group gets an intervention one group
does not and then in the end you'll be
able to compare what happened between
the two groups so you'll see that
over here even in the group that didn't
get the intervention there were two
individuals who gained some words and we
would expect that because with normal
passing time they're going to be kids
that learn on their own and that are
able to gain these skills
but if we look at the intervention group
above 50 more kids so a total of four
were
progressing to using two words right so
we can say that there was a better
chance of children learning words if
they got this specific teaching
intervention
so knowing that there is an overwhelming
amount of information and research out
there the national autism center went
through all of the research um on these
types of interventions for children with
autism and they group these
interventions into three categories
established interventions which have
been shown to be repeatedly effective
emerging interventions
which show some evidence of
effectiveness but not enough to make
sure that they're truly effective and
then finally unestablished interventions
which do not have sound evidence of
effectiveness and although it's
important to treat every child as an
individual these evidence-based
treatments have shown to be effective so
those established treatments they're
they're shown to be effective in wide
groups of children with autism spectrum
disorder meaning that the more
established and
the more emerging practices are likely
going to be more effective
okay so let's jump into some of these
established treatments so according to
again the 2015 phase 2 reports there are
14 established treatments most of these
treatments are based on the principles
of applied behavior analysis
there are some that come out of the
special education and developmental
psychology field as well as medically
based treatments to address challenging
behaviors that are associated with
autism so if we kind of look through
this list we have some behavioral
interventions this primarily
encompasses interventions that look at
the antecedents of behaviors so
modifying those situational events that
precede a behavior as well as the
consequences of those behaviors
then we also have cognitive behavioral
therapy
comprehensive behavioral treatment for
young children so this
is kind of what encompasses aba so it
looks at um kind of early behavioral
interventions that target a range of
essential skills whether that's
communication skills social skills
uh and so forth then we have some other
interventions we're going to primarily
focus on aba but just to touch on a few
um scheduling right so this kind of
refers to the use of
visual schedules um
that can essentially help these children
increase their independence
as well as parent training i'd like to
point out so that involves teaching
parents effective ways to respond to
their child's behaviors
so aba is an evidence-based approach to
treating individuals with
autism and other significant behavioral
disorders one of the key ideas of aba is
to understand how the environment
triggers and maintains behaviors in
order to then change difficult behaviors
so that they're more functional and more
adaptive
and aba is provided by trained certified
therapists and it can be conducted in a
lot of different settings like clinical
settings the home school even the
natural environment
and aba requires very intensive hours of
therapy based on the severity and needs
it can range anywhere between 25 to 40
hours a week if provided in the home
setting so treatment goals include
functional communication skills general
language acquisition
social skills
reduction of maladaptive behaviors
increasing appropriate plan leisure
skills enhancing motor skills and so
forth
and the instruction and the skill
acquisition is really based on proven
behavioral principles so for example
positive reinforcement and functional
analysis
that are used to really shape the
child's behavior
in terms of the aba therapists they must
undergo pretty rigorous training
and collect data all while providing
um instructions and incorp incorporating
behavioral techniques to really help the
child to improve
so here's a nice video explaining aba in
a little bit more detail
so aba is
short for applied behavior analysis and
this is a technique that's based on
learning theory
and
it has two aims one is to teach skills
and the other is to try to work on
problem behaviors or interfering
behaviors so the interfering behaviors
might include avoidance of eye contact
sort of obsessive interests about
strange things um
sensory self-stimulation
like this kind of thing
and that can really interfere with
developing social relationships and with
learning from the environment
so there are and then there are other
problem behaviors of course like
aggression
or property destruction or refusing to
do what an adult is asking
and those things can be targeted with
things like planned ignoring reinforcing
alternative ways of expressing it
so there are a whole variety of
behavioral techniques to try to really
reduce these interfering behaviors and
then the other big main thrust of aba is
to teach skills that the children are
not learning the way typically
developing children are learning just
naturally from the environment
so if you have a three-year-old child
with autism who is not yet speaking just
giving them normal language input has
not been sufficient to trigger their
language learning so instead you break
down these complex skills into very
small
pieces and you teach them one at a time
with prompting and then you fade out
your prompting and a lot of liberal use
of all kinds of different rewards or
reinforcers and it's really amazing
how fast some children can learn given
these conditions
okay
so we're going to go ahead and talk
about a few of the other
types of interventions um so emerging
interventions for
for individuals under the age of 22 and
just as a reminder
emerging interventions are those ones
that they show promising outcomes in
some studies but they haven't been
studied enough to be fully confident
that those interventions are truly
effective and it's also important to
know when we're looking at this list
that
you know something like exercise or
music therapy for example
they may not be effective at treating
autism or categorized as a
well-established
intervention but that doesn't mean that
exercise or music may not be something
that your child will enjoy or will
benefit from so something to keep in
mind when we we think of these emerging
interventions
and then we have the unestablished
interventions so
these interventions typically
don't have enough quality research
research hasn't necessarily been
replicated
or
you know not a lot of research has been
published on the topic
or the topic has been studied and has
been shown to be
ineffective so again there's this long
list of approaches that have been shown
to be effective right and and even um
even emerging interventions so really
it's a better option to not choose an
intervention that is unestablished but
to focus on those emerging and
well-established treatment interventions
okay so thank you dr silver now we have
some questions for all of you please
type your responses in the chat and
we'll try to address them and also as a
reminder we'll have a chance to answer
questions towards the end of this
presentation
so first question given the 2015 phase
two update report that dr silver
discussed you know as well as your own
experience and your knowledge that you
bring to the table
please tell us what stood out to you
you know i think for me if some of the
stuff that stood out um you know while
we kind of wait for people to add their
responses
um definitely i saw that functional
communication training was still an
emerging um whereas i feel like that's
something that we focus on a lot in uh
you know aba
um so you know i guess just keeping in
mind that this was done in 2015 so just
be interesting to see
you know
that aspect um
and then i think also the fact of
animal assisted interventions would be
in unestablished although we see
oftentimes people trying to advocate for
you know therapy dogs for children with
autism and things like that so those
were kind of the things that
stood out for me
absolutely we've gotten some responses
so someone pointed out that a lot of the
treatment interventions that are
available are directed towards younger
children but there is a you know deficit
when it comes to teenagers adolescents
adults
and some people are surprised by the
location of various interventions like
music therapy or animal assisted
therapies so
um again this is from 2015. so
where uh sort of a thinking you know six
years down the line where do you think
some of these emerging or unestablished
treatments will be in the next update
so as we're waiting for responses i
think that technology-assisted
interventions were probably still in
their infancy in 2015 so i'm interested
to find out where those are going and as
we get more and more
support for those kind of approaches
absolutely especially now with
telehealth and all the use of augmented
devices such as like the ipads for
communication and things like that
um
you know and the sensory processing uh
treatments
since where there's more you know out
there about like the importance of
sensory
things for children with autism so i
agree with you dylan for sure
okay lots of responses
a big push for more support and more
additional resources outside of
behavioral modification
um
maybe more targeted approaches for
example the sensory aspect of asd
so very interesting ideas
um
and then finally what uh
what do you think will be added to the
list where do you see sort of the next
steps going and i think some of these
blend together but
as uh providers uh
we value your input
[Music]
i think just personally having done my
own little research out there i think uh
it'd be interesting to see if
mindfulness-based therapies or
acceptance and commitment treatments for
like the higher functioning individuals
um would be added to the list because
there's more i think there's more
recent information out there about how
that can help with emotion regulation
and for individuals with comorbid mood
disorders so for me i think that would
be something that could be added
absolutely packages of interventions
trans diagnostic interventions i think
this is where we're headed as a field
because
comorbidity is the rule even
in the case of asd especially in the
case of asd
communication support sibling training
very interesting yeah
the family system
plays an important role in in treatment
as we'll discuss a little bit later in
this presentation
so we will have time at the end to
discuss more and answer some questions
um but let's dive in a little bit more
into the evidence
thanks so much dylan for
leading the discussion so now that we've
kind of taken a look at uh the project
even though it was published in 2015 uh
what we kind of decided to do was let's
take a look at some of the more recent
literature
and what we did is we looked at between
2016 to 2021
and although there was a lot of
information to sift through we kind of
chose some of the ones that maybe are a
little bit more
relevant to the topic so this article
was an annual research review and it
looked at the state of intervention
science so basically looking at the
targeted psychological as well as
biological mechanisms for treatment
and also talked about future prospects
so you know looking forward to what can
be done in research
and basically um there's still a big
need for higher quality research in the
field of autism treatment
although we know that aba is the gold
standard and behavioral interventions
are the gold standard
there is still difficulty with having
high quality research and meaning
research that looks at uses randomized
controlled trials
and some of the difficulties with this
has been that although you know there's
a lot of information out there about the
interventions
to use with children with autism a lot
of the research methods vary
greatly and not just in the us but
internationally and when the methods
research methods vary that much it makes
it difficult to replicate which could
make it difficult to then have you know
these treatments be emerging or
evidence-based because again it's not
replicable
um also this article discussed that of
the evidence-based treatments available
emphasizing that aba remains the gold
standard
but again recognizing that most of the
research is based on small or single
case designs
there needs to be a push for again
randomized control trials looking at aba
and also looking at the long-term
effects of this intervention
they also found that early intensive
behavioral interventions that include
parent training remains most effective
so really targeting individuals on the
spectrum at a young age and including
the parents to help with that
generalization
and then there's also just the need for
study on the biological mechanisms i saw
someone in the chat mention that about
the you know the metabolic aspects
but also uh treatments in terms of
pharmaceutical um you know obviously
there's nothing that is
shown to be
um approved right now um but maybe
research in the field of looking at like
what medications can be paired with
non-non-pharmaceutical interventions and
if that is even useful or effective for
children with autism or individuals in
general
this next article reviewed the
current available behavioral and
developmental educational approaches to
treatment that are usually used with
individuals and children with autism
this is really it was more of a review
so it wasn't really a study and it also
emphasized the efficacy of each
so looking at this um all the
interventions that were included look
were looked at across various domains so
this included behavioral developmental
school-based language communication
skills social skills and sensory
integration
um and of course just kind of looking at
the list here we have aba discrete trial
training early intensive behavioral
interventions with those being the most
effective um and again this was
published in 2019
and then you have the parent mediated
and then in school based you have early
denver or teach autism program
picture exchange systems all of these
showing to be effective
including you know social skills groups
and video modeling
what was interesting that they did bring
up social sensory integration therapies
however they did note that although
they're being used they're still very
sparse research in this field in this
area of interventions and so they really
couldn't say if it was effective or not
and this was again just in 2019 so
there's a need for more research
in some of these aspects even though
they are being used
prominently in the fields
and then this last article looked at the
clinical update um implementing
evidence-based emotion regulation
treatments for clients with autism which
i kind of foreshadowed in my discussion
this was looking at trying to help
individuals with autism who may also be
struggling with
comorbid mood disorders such as
depression and anxiety
okay so they provided a synthesis of
treatment on emotion regulation for
treatment with autism and they also
provided suggestions for clinicians who
do not specialize in asd treatment
so this may be the provider who has you
know private practice or who's working
in clinic in a general type of setting
but then has a patient who comes in and
indicates that they're on the on the
autism spectrum
but is endorsing depression or anxiety
so um you know as someone who may not be
familiar with working with people with
autism um this article provides some
suggestions and we'll get into that list
in the follow in the next slide
um
moving on they found that there's little
research that has been conducted that
looks specifically at the treatment of
emotion regulation in children with our
individuals with autism but there's some
there has been some literature so it's
not that there hasn't been any
research
but the interest is starting to grow and
i feel that having worked many years
with individuals with autism
unfortunately this is an area that has
been ignored because even like dylan
said you know people with autism aren't
you know immune from struggling with
anxiety or depression so it is important
for us as clinicians and providers to
start you know looking at what are some
of the non-aba
treatments that could be helpful
so in this article they looked at a few
of the treatments so far that are
starting to show some efficacy and they
found cbt cognitive behavioral therapy
specifically for anxiety although not
much evidence for depression
they also looked at mindfulness-based
interventions
specifically for children and teens with
anxiety it was also helpful with
depression and just overall emotion
regulation
um so even individuals who don't have
depression or anxiety are just feeling
you know very overwhelmed
mindfulness-based interventions were
also useful
and then they also found uh intensive
outpatient programs that focus on
emotion regulation treatment or what
they call io pert and that they combine
that with uh either cbt or
mindfulness-based interventions and apa
so that's what these this io pert
combines these three aspects
and they've found that that has also
been very effective and helpful for
individuals
you know so far
um with autism and comorbid emotion
regulation difficulties
so some of the recommendations or
suggestions that the article presented
for the providers and this
you know who might not be familiar
working with individuals with autism
but might have someone who's
experiencing depression or anxiety um
here are some of the suggestions and
some examples so just to kind of touch
up on a few um you know maybe add a
training and emotion psycho-education
so this could be help the client
understand that emotions are natural um
you know even why they even when they
feel bad
um some other
examples include using visuals to make
other you know
you know concrete make even though
emotions can be very abstract
which is something that we know
individuals with autism may struggle
with using something as visuals or to
make it more concrete and more relatable
so this includes using maybe an
emotional thermometer
using specific examples to help them
anchor and understand better like you
know for their own means maybe using
work worksheets or props
and maintaining structure in in session
okay
and then the other thing could be maybe
adjusting the session duration frequency
or location
so just really tailoring treatment to
the individual that's in front of you
while understanding their cognitive
needs
so here's a little video about you know
how do you understand you know what
treatments are safe and effective for
autism we're not going to play the whole
video just the the first part to kind of
summarize what we've discussed so far
[Music]
[Applause]
[Music]
hi i'm donna murray i'm vice president
of clinical programs for autism speaks
and today we're going to be talking
about how do i know which autism
treatments are safe and
effective
at autism speaks we encourage families
to seek out evidence-based practice
although we know that's a challenge one
evidence-based intervention that we know
about is behavior therapy and it's
proven to be effective across the
lifespan in learning new skills
addressing communication skills as well
as social skills in addition to behavior
therapies there are a number of supports
that have also been proven to be
effective things like using visual
supports or schedules as well as using
modeling and you can use real person
modeling in real time as well as video
modeling challenging behaviors can be
very concerning for families one thing
that we really recommend is that before
you start an intervention for
challenging behaviors you have a
functional behavior assessment that
helps your provider understand what
might be triggering those behaviors and
then you can employ some of the behavior
therapies that we talked about or if
you're still or the child is still
experiencing behavior challenges may
also be combined with medication but
it's really important to work closely
with your provider when coming up with a
plan for challenging behaviors
some of the work that we've been doing
in the autism treatment network is doing
a better job of understanding some of
the medical and mental health conditions
that co-occur with autism and sometimes
when we can treat these medical and
mental health conditions we see improved
functioning the common co-occurring
conditions that we've been looking at in
the autism
so this video can go on for a minute we
kind of just wanted to play that first
part uh just to really emphasize what
we've been discussing so far um and you
know this latter part of the video is
you know
best suited for a different topic but
just again emphasizing currently what's
being used is you know the behavioral
interventions and then understanding
that we need to
and mental understand issues that
individuals with autism also experience
so now that we've kind of discussed a
lot about the evidence-based treatments
we're going to go into the factors oh
sorry some of the factors and roles that
parents and providers take
so understanding that parent role is
finding the right treatment for their
child it is up to the parent to really
figure out if the treatment that they're
trying to take their child into is
really effective and fits right for them
it's also part of their role to be
active a active participant in their
child's treatment um you know it's not
very effective for a parent to just kind
of drop off the child to therapy and
then you know come and pick them up
after
um it's really shows that parent
training is very very helpful and
important for the generalization of the
skills not just in the treatment setting
but outside in the natural environment
and it's also part of the parent's role
to ask as many questions as possible to
their providers and to individuals to
ensure that their child is getting the
services that they need in order to
succeed
so parents need to ask a lot of
questions and be active and as involved
as possible to advocate for their
children
as providers or clinicians our roles are
including to be as empathetic as
possible
to build rapport with the child and the
family so understanding that yes even
though you're treating the child again
to encourage parent training and parent
involvement you need to build that
establish that rapport with family
um going back to being empathetic it's
important for us as clinicians to
understand that even though we have the
training and the understanding of
working with children with autism we
don't live with them so we might be
present for the child in the family one
hour a week or depending if you're doing
aba
several hours a week but ultimately the
parents and the families are with the
child 24 7. so we need to be
understanding and empathetic of the
parents and the families when they come
to us with stress or difficulties okay
um it's also part of our role to have
the proper training and competence to
understand current literature which is
why we're here today
to encourage and again encourage and
promote parent involvement
have that collaborative approach with
the family and to have strong clinical
judgment that is based not just on the
research but also clinical experience
and the research
so a few factors to consider when
seeking or providing treatment include
various aspects one of the first
components is for the parent is for them
to
be able to know like the the fact that
their child cannot talk or for
themselves or for others this may be
increasing some aggressive behaviors
okay so kind of the parent understanding
what are the factors that are affecting
my child and that are influencing my
child's behaviors
um so when a parent is speaking to the
therapist it's important that they
express the concerns that the parent has
so my child has these difficulties these
are my concerns i need to communicate
this with
the therapist or therapist to be
okay and then the therapist's role is to
understand that some concerns may be
more urgent than others and so helping
the family have a collaboration that
open communication with them um to help
tease out which
concerns need to be addressed more uh
more like apprehending more frequently
or more earlier on than others okay
um and then the clinician also
it may be able to see some areas of
concerns that maybe parents overlook so
some parents might not see a certain
delays or developmental delays because
maybe they don't know so as a clinician
it's also important for us to be able to
bring up those concerns with the family
and discuss that with them
another important thing to consider are
factors to consider is goal setting so i
think we all here understand that goals
need to be concise observable measurable
right
we need to be able to make sure that the
goals identify the conditions under
which the behavior is demonstrated so
the setting events and to also
understand what conditions or factors
maintain the behaviors so the
reinforcement
what happens directly after that's going
to have keep the behavior happening
and then also knowing that behavior and
goals need to be continually reviewed
you know this needs to be a working
document a working process collaborating
with the family
in order to make sure that treatment is
being effective and progressing as it
should
so thinking of goals as targets okay so
what are the main targets we need to
talk about um you know understanding
that every clinician needs to identify
clear targets for behaviors meaning they
should not be vague okay they need to be
as concrete as possible meaning
increased so for example increasing
social engagement is not as good as a
target behavior versus increased child's
responding when greeted by another okay
so you want to be able to have goals
that you can actually measure
another example could be
increase how quickly child responds with
parental requests within under five
minutes i mean sorry five seconds um you
know so you're able to see okay is the
child complying within five seconds etc
other factors to consider for both the
parent and the clinician is that
ensuring that the clinician has the
training and the background and the
experience to work with the child on the
spectrum um specifically okay um this i
mean and this goes for any fields right
so working within our competence okay um
if and now it's important to understand
if a clinician is within a training
setting an institution such as nova
university um you know it's important
for the clinician or the therapist to
to divulge that information to the
family to disclose you know i'm the
therapist in training but however i am
receiving appropriate and adequate
supervision to work and provide
treatment to your child
um and then even though
and then this goes for even you know
clinicians in training or established
clinicians we still need to be able to
gather really good background
information so when you're first meeting
with the family understand what's going
on
and then you also need to be familiar
with current research and up-to-date
information so as an established
therapist who may have been doing
treatment for the last 15 years but
hasn't really been kept up to date with
the research
might not really be doing what's most
effective um especially if you know as
you can all see with the project things
change over time as more research comes
out so it's really important for our us
as clinicians to stay up to date
and then also using data based decision
making meaning as clinicians especially
in aba a lot of data is collected but
even as providers you know just
collecting on how information how the
child is progressing over time and then
using that information to
decide how treatment is going to
progress is it even progressing are
there difficulties are there you know
setbacks and using that data to make
decisions to move forward
and then when it comes to licensure and
certifications knowing that first of all
it's our roles as providers to be
properly certified and trained right i
think i've already mentioned that but
it's also the parents right and their
role um to really ask a lot of questions
so they should parents should not be
afraid to ask a therapist or their
supervisor about their credentials
you know their past experiences working
with the population um that's similar to
their child
any kind of training that they've had
how many years they've been practicing
etc
because at the end of the day the parent
should be again advocating as much as
possible for the child and they need to
make sure that the provider is giving
training or therapy within the scope
so when i say within the scope meaning
an occupational therapist should not be
given nutritional information or us as
clinical psychologists should not be
giving information or advice on
pharmaceuticals or medical interventions
right and parents need to know that
right so if a parent is asking questions
to a clinician and the clinicians may be
giving out questions or suggestions
outside of their scope that should maybe
be a little bit of a red flag
and parents should be aware of that
and then as clinicians again practicing
within your competence
and then going back to data and make
using data to drive your decision so
understanding that
especially in aba a lot of data is taken
you know data points data points data
points and then even as a you know
clinical psychologist we also take data
over time to make sure treatment is
progressing and seeing how things are
going
um and that is our responsibility
because otherwise how do we determine if
what we're doing is working okay
it's our
responsibility to be able to provide
this information or this data to the
parents and to have con you know ongoing
review and discussion with the family
and the caregiver and maybe even the
individual if you're treating someone
who's older maybe not just a child in
order to demonstrate to them how you
know hey look what we're doing is
working or it's not working or you know
how do you feel about this let's let's
kind of see where we need to go from
here okay
and it's also important to know when you
do present data presented in a way
that's easy to digest and understand for
the family
you know maybe don't present this very
complex elaborate graph
but do it in a way that the families can
understand as well
and i know i've kind of discussed this
already but understanding that you know
parents participation is very very
important like i said they
live with the child they are with a
child all the time unless they're
outside you know outside of school um so
it's very important that parents
participate in order to help the skills
that we're working on in treatment
generalized into the natural environment
meaning a person who goes into treatment
they may know how to do things in a
controlled clinical environment but when
you then take them out of that
environment put them into the real world
then they might get stumbled they might
stumble and get stuck so really having
that parent involvement can help these
individuals um including children maybe
older adolescents
put those skills into practice if the
parent is involved and knows how to help
them through the challenges
[Music]
and then some other factors to consider
include some of these cultural work
consideration family structure and
financial factors so as a clinician when
you're putting together a treatment plan
it's very important to look at all of
these different aspects and see
is this going to fit the family so for
example for cultural variables is there
something specific about the family that
would impact treatment
this could be religion this could be you
know cultural background so for example
it's known that in some cultures
it is actually considered very rude to
look at someone in the eye
however many or if not most of aba
interventions for children with autism
focuses on eye contact so it's important
to understand in the context of the
family's culture is this appropriate
in terms of family structure so it's
important to know who lives in the home
who will be involved in treatment so
is this a multi-generational family is
it just mom and dad or just mom or just
dad um does grandma and grandpa live
there um because when you're trying to
get involved that parent training then
maybe it's not just parent training it's
also family and grandparent training
right
i can just say from personal experience
i've worked with families where their
grandma lived in the home and although
if i did parent training if grandma
wasn't on board then kind of everything
we worked on would get washed away right
um so it was it's really important to
involve all the caregivers in the home
so considering family structure okay
um work and career considerations
especially with people with multi-income
homes are people working all the time
um you know does that is that going to
our schedule is going to impede the
family's ability to do
multiple sessions a week so considering
you know the dose you know the treatment
dose and how many times a week you'll do
that and does that fit with the family's
schedule
and then financial factors obviously
treatment without
insurance even with insurance can be
very costly so if you're suggesting
you know doing multiple sessions a week
is that going to fit in the family's
financial you know bracket or is that
going to fit you know their budget
so as clinicians we need to take into
consideration all of these factors when
coming up with a treatment program
and then
as the parent when they're looking at
this treatment plan it's important for
them to consider their family so your
family as a parent so they need to
decide and have a conversation does does
this fit with me and my family and the
factors all here and is it really right
for me okay and also for parents to
understand that they're not stuck
with whatever intervention they start
with okay
um if the parent decides or notices that
maybe the treatment plan isn't really
working or is as effective as they would
have hoped for it to be and they have
the right to have a discussion with the
provider
and to collaborate and to see what they
can do to change um you know maybe it's
too much for them because of work
considerations or financial factors
so you know having that open discussion
with the provider and the parent and
knowing that the parent has every right
to advocate and to change things as
needed and also the provider has a
responsibility to help the parent
understand
why some of the suggestions are being
made so again a very collaborative
conversation between the two
all right so now we have some resources
for all of you
um feel free to take a picture of this
uh next slide for for reference uh
there's some some great uh referrals
there so first we have the national
standards project which provides a
source of guidance for parents
for educators i see we have a lot of
educators present today
and and treatment providers on
evidence-based
uh intervention options for asd
so a good resource there we also have
autism speaks we saw a video
from that group it's another great
resource they have a number of other
videos that sort of provide
families with information about how to
pursue the process basically not just
the options but all of the ins and outs
that they need to know
over this
treatment endeavor
the center for autism and related
disorders or card
centers are a fantastic referral source
for the state of florida they have a
wealth of resources that are free of
charge and although they are not a
uh they don't provide much in the way of
direct services you can think of them
sort of as a repository where they can
where families can go and find what they
need um
we also have early steps uh which is
within
um
children's medical services and it helps
families with infants and toddlers from
birth to 36 months
who have developmental delays or a
condition that is likely to result in
developmental delays
so these are direct services for
supporting children
through the state of florida
so some great resources there
and in conclusion
uh we have treatments for asd they are
evolving and it's important for
providers to stay up to date so being
part of this training is part of that
process
thankfully there are numerous other
resources that are also available to
help you and your clients and the kids
that you work with to sort through all
of the information
as it comes in
so here are a few key reminders from
this presentation
this shark chat while a very good
refresher and an update is no substitute
for a proper training so please ensure
that those working with individuals on
the spectrum have the requisite
experience and competence and up-to-date
knowledge
um because otherwise it you'd be doing a
disservice to
clients and their families
as a reminder parents have a right to
ask questions
and they should expect to be shown how
their child is responding to the
intervention approach selected
and in addition parents should also know
that they have an active role to play in
their child's treatment and should be
equipped to do so
so
uh we are just about done on behalf of
our patients and their families i just
want to thank you all for taking the
time to learn more about evidence-based
treatments
for asd i hope that you'll think of the
the team here at the nova unicorn clinic
as a resource to you and your
clients and their families in the future
and now we have some time to answer
questions so please write them in the
chat and we'll attempt to address as
many as we can
so i know there are a few questions
already asked let me see if i can get
one started so
someone asked how do you find
appropriate treatments for kids who are
higher functioning
this might include children who are
diagnosed a little bit later on children
of color
girls who are under diagnosed etc so uh
team where do we start
yeah so
uh definitely the card uh that we talked
about card organization they definitely
have a lot of referrals and lists there
um you know and obviously seeing uh what
then there if the family has insurance
and what their providers um approved for
um but really starting off at you know
you want to get an evaluation so even
though they're a little bit older it's
important for an individual if they're
suspected of autism to have an
assessment like a comprehensive
evaluation not just by a neurologist but
by a you know trained team um such as
that we do here at dic so that we can
understand really where their level is
um and then to go from there
you would get recommendations for
resources um you know within their
community but you could definitely look
at card um and go to that website and
there's a plethora of resources and
referrals there
awesome thank you dr silberfield
we have another question um
what do you view as appropriate training
for an lm lmhc
to work with asd and adults
it was a good question one thing that
i'd bring up is the
idea that dr silver i believe discussed
which is when possible try to use
interventions that are up evidence-based
the the more evidence behind it perhaps
the most more appropriate would be for
clients
other thoughts
yeah i would second what dylan had said
so just kind of thinking back to that
list of well-established interventions
um some of the ones that were listed
were cognitive behavioral therapy which
may be more appropriate with
an adult who's diagnosed with autism
spectrum disorder
depending on
you know their
adaptive living skills and and
functional communication and such you
might want to integrate
some sort of language training
production
so really it will
tie into the presenting problem but
definitely as dylan had mentioned
referring back to those well-established
interventions
fantastic do we have other questions
i don't think we have questions i'm
looking through the chat and i see
individuals talking about like for
educators and things like that um
and if you go back in the recording that
will be uh posted looking at the slides
that i listed for uh specifically um the
review
uh you know the the page with the
article with the review that one had if
you look at that article there was a
section on school-based interventions
and that could be a good place to start
seeing like what are some of the
programs i know that the teach autism
program that's more of a school-based um
so maybe looking into that one or some
other um school-based interventions that
they list within that article i don't
have those off the top of my head um but
again maybe for school for in for
educators that we see there's a lot here
that could be a good starting point
and i would second that um just kind of
going back again to that slide with the
well-established treatments maybe
focusing on some of the naturalistic
teaching strategies so those are the
ones that are um
looking at helping children you know in
the home in school in their school in
the community kind of using their
naturally naturally occurring activities
as opportunities to increase certain
skills
i'm going to go back to the slide now
just so that because we're not going to
give out the slides but and just for the
recording
i'm going to kind of
do this okay sorry it's this one so this
article here if you'd like to take a
screenshot of the article title and you
could look it up um and again they had
different approaches they have
behavioral developmental school-based um
so looking at the different types of
intervention programs for educators
this would be a good start to look at
and then
in the resources okay so i'll give
people a second to take a picture of
this if they need it
[Music]
okay
and then going back to
the more
well-established and established so
these were the emerging
so maybe looking at some of these
but danielle was talking about
and as well as
these
so
we hope that helps
so i think there's no more questions i
think we are all done we thank you all
for participating and we hope this was
very useful
um and that you all learned something
new
thank you all very much
thank you all
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