Autism researchers from the UNC Frank Porter Graham Child Development Institute have published their latest review of literature related to interventions for individuals with autism spectrum disorder (ASD), identifying five new evidence-based practices (EBPs) and reclassifying interventions to better support those who serve children and youth with ASD.

"Evidence-Based Practices for Children, Youth, and Young Adults with Autism: Third Generation Review," was published online with open access on January 15, 2021, in the Journal of Autism and Developmental Disorders.

"Our publication filters the amount of literature that practitioners, families, and researchers have to sort through to help make decisions about what evidence-based practices they might use or study," says Kara Hume, PhD, a faculty fellow at FPG and associate professor in the UNC School of Education who is lead author of the paper. "Since our last review of the literature in 2014, we have identified five new evidence-based practices and identified new ways to classify interventions to help with decision making."

Investigators in the FPG Autism Evidence-Based Practice Review Group narrowed down the 60,000 articles on ASD published between 1990 and 2017 to nearly 1,000 that met set standards for methodological quality. Through this review, the team found five new EBP categories, bringing the total to 28. The new categories are:

• Behavior momentum intervention: the organization of behavior expectations in a sequence in which more difficult responses are embedded in a series of less effortful responses to increase persistence.
• Direct instruction: a systematic approach to teaching using a sequenced instructional package with scripted protocols or lessons, emphasizing teacher and student dialogue.
• Music-mediated intervention: an intervention that incorporates songs, melodic intonation, and/or rhythm to support learning or performance of skills/behaviors.
• Sensory integration: interventions (originated by A. Jean Ayres) that target the ability to integrate sensory information from the body and environment in order to respond using organized and adaptive behavior.
• Augmentative and alternative communication (including practices previously in other categories): interventions using a system of non-vocal communication, which can be aided (e.g., device, communication book) or unaided (e.g., sign language).

Also important to this review was the team's inclusion of single-case design studies, recognizing the method's rigor for conducting research with this population. Though randomized control trials are seen as the most scientifically rigorous, they can be difficult to conduct due to their cost, because the samples arent' large enough, or because it would be difficult to randomize participants already being served in the classroom setting.

"If we only review randomized controlled trials, we miss a lot of important research that has been conducted. That leaves the field grappling with what practices to use. Including high-quality, single-case design studies can give the field more ideas and more practices to choose from," says Sam Odom, PhD, a co-author of the study.

This latest review highlights FPG's commitment to moving research into real-world practice, beginning with high-quality intervention research that is then published in peer-reviewed journals, followed by a literature review from experts, translation of the findings into user-friendly practices (such as FPG's AFIRM (Autism Focused Intervention Resources and Modules), and culminating in the successful implementation and application of those practices with children and youth with ASD.

Part of identifying what practices will work, says Hume, is recognizing practices that aren't as effective for certain individuals or certain age groups. The research team is working on examining null findings, studies that show that an intervention didn't work for individuals. Including this information as a summary of these findings can help parents and practitioners make informed decisions and guide researchers to gaps in research where more studies are needed.

"There are far fewer practices that have been proven to be effective with young adults with autism. We also see certain outcome areas, especially mental health, where there are far fewer interventions. It really helps to know where the areas of need are related to age groups and outcomes we want to target," says Hume.

The review also found that most studies are not identifying the race and ethnicity of study participants, which Hume says are disproportionately white. A deeper analysis related to who is included and excluded in autism research is necessary.

"We need to do a better job of making sure that autism research is inclusive, and represents the diversity of the population, including ensuring the voice of those with autism is well represented."

Other members of the review group include Jessica Dykstra Steinbrenner, PhD, Kristi L. Morin, PhD, Sallie W. Nowell, PhD, Brianne Tomaszewski, PhD, Susan Szendrey, MOT, Nancy S. McIntyre, PhD, Şerife Yücesoy-Özkan, PhD, and Melissa N. Savage, PhD.