Evidence Based Treatments for Autism Spectrum Disorder (ASD)

Summary

This 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

00:00

🌟 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.

05:01

📚 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.

10:03

🎯 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.

15:05

🤔 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.

20:10

🧠 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.

25:13

🌱 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.

30:14

💡 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.

35:15

📈 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.

40:16

🌐 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.

Keywords

💡Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder (ASD) is a developmental disorder characterized by challenges with social interaction, communication, and repetitive behaviors. In the video, it is the central topic of discussion, with various evidence-based treatments being explored for managing symptoms and improving quality of life for individuals with ASD.

💡Evidence-Based Treatments

Evidence-based treatments refer to therapeutic interventions that are supported by extensive research and proven to be effective for a specific condition or disorder. In the context of the video, these treatments are crucial for providing effective care to individuals with ASD, ensuring that the methods used have a strong foundation in scientific research.

💡Applied Behavior Analysis (ABA)

Applied Behavior Analysis (ABA) is a scientific method for changing behavior through understanding and modifying the environmental factors that influence it. ABA is a well-established treatment for ASD that focuses on teaching new skills and reducing challenging behaviors through positive reinforcement and other behavioral techniques.

💡Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is a type of psychological treatment that helps individuals identify and change negative thought patterns and behaviors. In the context of ASD, CBT can be used to address specific challenges such as anxiety or depression that may co-occur with the disorder.

💡Parent Training

Parent training involves educating and supporting parents of children with ASD to help them effectively respond to their child's behaviors and implement therapeutic strategies at home. This approach is crucial for generalizing skills learned in therapy to the natural environment.

💡National Standards Project

The National Standards Project is an initiative conducted by the National Autism Center aimed at identifying and promoting effective treatments for individuals with ASD. It provides a resource for parents, caregivers, and professionals to determine the best course of action for treating autism based on empirical evidence.

💡Early Intervention

Early intervention refers to the provision of services and support to young children with developmental delays or disabilities, including ASD, to improve their developmental outcomes. It is a critical aspect of treatment because it can significantly enhance a child's ability to learn and adapt.

💡Functional Communication Training (FCT)

Functional Communication Training (FCT) is a behavioral intervention that teaches individuals with ASD to replace challenging behaviors with more appropriate communication strategies. The goal is to understand the function of a behavior and provide alternative, more effective ways to communicate the same need or desire.

💡Comorbid Conditions

Comorbid conditions refer to the presence of one or more additional disorders or conditions co-occurring with a primary condition, such as ASD. In the context of the video, it is important to address these comorbid conditions, like anxiety or depression, as they can impact the overall well-being and functioning of individuals with ASD.

💡Treatment Providers

Treatment providers are professionals, such as psychologists, therapists, and educators, who deliver interventions and support services to individuals with ASD. Their role is to assess, plan, and implement evidence-based treatments, ensuring that the care they provide is effective and tailored to the needs of each client.

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