Evidence-Based Practice Tool - · PDF fileThis Evidence-Based Practice Tool was developed to...
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Evidence-Based Practice Tool Excerpted from 2016 Recommendations to the Office of the Arizona Governor Policy Advisor for Health and Human Services Original: February 9, 2016 Update: May 31, 2017
Transcript of Evidence-Based Practice Tool - · PDF fileThis Evidence-Based Practice Tool was developed to...
Evidence-Based Practice Tool Excerptedfrom2016RecommendationstotheOfficeoftheArizonaGovernorPolicyAdvisorforHealthandHumanServices Original: February 9, 2016 Update: May 31, 2017
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How to Use the Evidence-Based Practice Tool ThisEvidence-BasedPracticeToolwasdevelopedtoallowtheusertoassessthelevelofevidenceavailableforawiderangeofAutismSpectrumDisorder(ASD)interventions.You’llfindthefollowinginformationinthistool:
• BackgroundontheAutismSpectrumDisorderAdvisoryCommittee(page1)• MembersoftheEvidence-BasedTreatmentWorkGroup(pages1-2)• Evidence-BasedPracticeDefinition(pages3-4)• DevelopmentoftheEvidence-BasedPracticeTool(page4)• DefinitionofExperimentalServices(page5)• InterventionDescriptions(pages6-12)• StudyDescriptionsandReferences(page13)• Matrix:LevelsofEvidence(pages14-19)
Background TheAutismSpectrumDisorder(ASD)AdvisoryCommitteewasappointedinSpring2015byChristineCorieri,PolicyAdvisorforHealthandHumanServices,OfficeoftheArizonaGovernor.Dr.SaraSalek,ArizonaHealthCareCostContainmentSystem(AHCCCS)ChiefMedicalOfficerandachildpsychiatrist,servedaspointofcontactbetweenMs.CorieriandtheCommittee.TheCommitteewaschargedwitharticulatingaseriesofrecommendationstotheStateforstrengtheningthehealthcaresystem’sabilitytorespondtotheneedsofAHCCCSmemberswithoratriskforASD,includingthosewithcomorbiddiagnoses.Thechargeincludedfocusingonindividualswithvaryinglevelsofneedsacrossthespectrum,includingthosewhoareabletoliveontheirownandthosewhomayrequireinstitutionallevelsofcare,andaddressingboththeearlyidentificationofASDandthedevelopmentofperson-centeredcareplans.
Evidence-Based Treatment Work Group MembersoftheEvidence-BasedPracticeWorkGrouparelistedbelow.WorkGroupmemberswhowerealsomembersoftheASDAdvisoryCommitteeareshownfirstandinbold,inalphabeticalorder.• BryanDavey,PhD,BCBA-D,ChiefExecutiveOfficer,TouchstoneHealthServices;
President,HighlandBehavioral• JoannaKowalik,MD,DES/DDDActingChiefMedicalOfficer• CynthiaMacluskie,VicePresident,BoardofDirectors,AutismSocietyofGreater
Phoenix• TerryMatteo,PhD,ClinicalChildPsychologist• DanielOpenden,PhD,BCBA-D,PresidentandCEO,SouthwestAutismResearch&
ResourceCenter(SARRC)• LesliePaulus,MD,PhD,FACP,MedicalDirector,UnitedHealthcareCommunityPlan• AaronBlocher-Rubin,PhD,BCBA/LBA,ChiefExecutiveOfficer,ArizonaAutismUnited
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• MaureenCasey,DES—AzEIPProfessionalDevelopmentCoordinator• DianaDavis-Wilson,MEd,BCBA,ClinicalDirector,HopeGroup,LLC• MaureenMills,CommunicationsCoordinator,RaisingSpecialKids• KarrieSteving,Children’sSystemofCareAdministrator,MercyMaricopaIntegrated
Care(MMIC),RBHA• JacobVenter,MD,CPE,FAPA,DivisionChiefofPsychiatry,BarrowNeurological
InstituteatPhoenixChildren’sHospital• MeganWoods,MEd,BCBA,LBA,DES/DDDBehaviorAnalystAnindependentconsultant,SharonFlanagan-Hyde,MA,SeniorPartner,Flanagan-HydeAssociates,facilitatedtheWorkGroupandASDAdvisoryCommitteemeetings.Allmeetingagendas,materials,notes,andupdateswerepostedonline.
Evidence-Based Practice Definition TheASDAdvisoryCommitteerecommendeduseofanevidence-basedpracticedefinitionthatfocusesonaperson-centeredplan(meaninganapproach,notaspecificmodel),startswiththebestavailablescientificallyrigorousresearch,andintegratesclinicalexpertise,theindividual’scharacteristics,andthegoalofbuildingfamily/caregivercapacity.Evidence-basedpracticeisanapproachtotreatmentratherthanaspecifictreatmentandincorporatesculturallysensitiveinterventionstrategies.Theinterventiondescriptionsandanalysisareintendedtoserveasaguideregardingcategorizationoftreatments(i.e.,establishedevidenceandemergingevidence)andarenotintendedendorseorexcludeanyspecifictreatment.TheCommitteerecognizesthatthereisnota“onesizefitsall”ASDtreatmentapproach.Aperson-centeredtreatmentplanshouldbedevelopedusinganevidence-basedapproach:theintersectionofresearch,clinicalexpertise,theindividual’scharacteristics,andafocusonbuildingfamily/caregivercapacity.Evaluationsandtreatmentsshouldbedevelopmentallyappropriate.Ongoingscreeningforcomorbiditiesisessentialtoensurethattheneedsofthewholepersonareaddressed.
BestAvailableResearch
ClinicalExpertise
Individual
Characteristics
BuildingFamilyCaregiverCapacity
PERSON-CENTEREDTREATMENT
PLAN
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TheASDAdvisoryCommitteerecommendedthatAHCCCSusethefollowingdefinition:Evidence-basedpracticemeansadecision-makingprocessthatstartswiththebestavailablescientificallyrigorousresearchandintegratesclinicalexpertise,theindividual’scharacteristics,andthegoalofbuildingfamily/caregivercapacity.Evidence-basedpracticeisanapproachtotreatmentratherthanaspecifictreatmentandincorporatesculturallysensitiveinterventionstrategies.ItfocusesondevelopinganindividualizedPerson-CenteredPlan.Evidence-basedpracticepromotesthecollection,interpretation,integration,andcontinuousevaluationofvalid,important,andapplicableindividual-orfamily-reported,clinically-observed,andresearch-supportedevidence.Thebestavailableevidence,matchedtotheindividual’scircumstancesandpreferencesandafocusonbuildingfamilyandcaregivercapacity,isappliedtoensurethequalityofclinicaljudgmentsandfacilitatethemostcost-effectivecare.(AdaptedfromCATrailerBill)
Development of the Evidence-Based Practice Tool Inresponsetotheneedforclarityaboutevidence-basedtreatmentmodalities,theEvidence-BasedTreatmentWorkGroupundertookaprojectthatresultedinamajorcontributiontothefield:ananalysisoffourlargesystematicreviewstudiesofASDtreatments.InNovember2015,ASDCommitteememberTerryMatteo,PhD,andhiscolleagueCindyHoard,EdD,developedananalysisofthefoursystematicreviewsthatcomprisethisEvidence-BasedPracticeTool.TheWorkGroupdidnotconsiderindividualstudies.Instead,itreliedonsystematicreviewsofthepublishedbodyofresearchonASDinterventionsconductedbythefollowing:
• NationalProfessionalDevelopmentCenter/AutismEvidence-BasedPracticeReviewGroupatUNCChapelHill(NPC)
• U.S.DepartmentofHealthandHumanServices,CentersforMedicare&MedicaidServices.(2010).AutismSpectrumDisordersServices(ASDs):Finalreportonenvironmentalscan.Baltimore,MD:Young,J.,Corea,C.,Kimani,J.,&Mandell,D.(CMS)
• NationalStandardsProject–Phase2:NationalAutismCenter,ACenterofMayInstitute:NationalAutismCenter.(2015)(NPS2)
• TheDepartmentofHealthandHumanServicesandtheAgencyforHealthcareResearchandQuality.TherapiesforChildrenWithAutismSpectrumDisorder:BehavioralInterventionsUpdate.ComparativeEffectivenessReviewNo.137.(DHHS/AHRQ)
Thesefourstudiesrepresentedallofthesystematicstudiesormeta-analyses(quantitativere-analysesofdatareportedinpublishedstudies)availableinlate2015.[Therearenonewsystematicstudiesormeta-analysesasofMay2017.]
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Definition of Experimental Services ThedefinitionofExperimentalServices,R9-22-203,usedbyAHCCCS,ispresentedbelow.A.Experimentalservicesarenotcovered.Aserviceisnotexperimentalif:
1. ItisgenerallyandwidelyacceptedasastandardofcareinthepracticeofmedicineintheUnitedStatesandisasafeandeffectivetreatmentfortheconditionforwhichitisintendedorused.
2. Theservicedoesnotmeetthestandardinsubsection(A)(1),buttheservicehasbeendemonstratedtobesafeandeffectivefortheconditionforwhichitisintendedorusedbasedontheweightoftheevidenceinpeer-reviewedarticlesinmedicaljournalspublishedintheUnitedStates.
3. Theservicedoesnotmeetthestandardinsubsection(A)(2)becausetheconditionforwhichtheserviceisintendedorusedisrare,buttheservicehasbeendemonstratedtobesafeandeffectivefortheconditionforwhichitisintendedorusedbasedontheweightofopinionsfromspecialistswhoprovidetheserviceorrelatedservices.
B.Thefollowingfactorsshallbeconsideredwhenevaluatingtheweightofpeer-reviewedarticlesortheopinionsofspecialists:
1. Themortalityrateandsurvivalrateoftheserviceascomparedtotheratesforalternativenon-experimentalservices.
2. Thetypes,severity,andfrequencyofcomplicationsassociatedwiththeservicesascomparedwiththecomplicationsassociatedwithalternativenon-experimentalservices.
3. Thefrequencywithwhichtheservicehasbeenperformedinthepast.4. Whetherthereissufficienthistoricalinformationregardingtheservicetoprovide
reliabledataregardingrisksandbenefits.5. Thereputationandexperienceoftheauthorsand/orspecialistsandtheirrecordin
relatedareas.6. Theextenttowhichmedicalscienceintheareadevelopsrapidlyandtheprobability
thatmoredefinitedatawillbeavailableintheforeseeablefuture.7. Whetherthepeerreviewedarticledescribesarandomcontrolledtrialoran
anecdotalclinicalcasestudy.
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INTERVENTION DESCRIPTIONS
COMPREHENSIVE INTERVENTIONS ComprehensiveInterventionsutilizemultiplefocusedinterventionsthatareorganizedaroundacentraltheoreticalorconceptualframework,targetmultipledomains,andaretypicallylongerinduration.ComprehensiveBehavioralInterventionProgramsforYoungChildren:InterventionsinvolvingacombinationofinstructionalandbehaviorchangestrategiesandacurriculumthataddressescoreandancillarysymptomsandbehaviorsofASD.(CMS)Examplesinclude:LifeSkillsandEducationforStudentswithAutismandOtherPervasiveBehavioralChallenges(LEAP),EarlyStartDenverModel,UCLAYoungAutismProject.StructuredTeaching:Thisinterventioninvolvesacombinationofproceduresthatrelyonthephysicalorganizationofasetting,predictableschedules,andindividualizeduseofteachingmethods.TheseteachingmethodsmaybeusedincomprehensiveinterventionssuchasTreatmentandEducationofAutisticandrelatedCommunication-handicappedChildren(TEACCH)andLEAP.FOCUSED INTERVENTIONS Focusedinterventionsrefertotreatmentsthataretypicallyshortertermindurationandtargetdiscreteskills.AcademicInterventions:Interventionsinvolvingtheuseoftraditionalteachingmethodstoimproveacademicperformance.(CMS)• DirectInstruction:Instructionalpackageinvolvingstudentchoralresponses,explicit
signaltocuestudentresponses,correctionproceduresforincorrectornon-responses,modelingcorrectresponses,independentstudentresponses.(NPDC)
• CollaborativeCoaching:SystematicconsultationacrossyearstopromoteachievementofIEPgoals.(NPDC)
• CollaborativeLearning:Academiclearningorganizedaroundjointactivitiesandgoals.(NPDC)
• HandwritingWithoutTears:Multisensoryactivitiespromotingfinemotorandwritingskills.(NPDC)
• SentenceCombiningTechnique:Instructionalpackageincludingteachermodeling,studentpractice,andworksheettoincreaseadjectiveuseinwriting.(NPDC)
• TestTakingStrategyInstruction:Instructionalpackageincludingmodeling,mnemonicdevices,verbalpracticesessions,controlledpracticesessions,advancedpracticesessions.(NPDC)
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INTERVENTION DESCRIPTIONS
AntecedentIntervention/Package:Interventionsinvolvingthemodificationsofeventsthattypicallyprecedetheoccurrenceofatargetbehavior.Thesealterationsaremadetoincreasethelikelihoodofsuccessorreducethelikelihoodofproblemsoccurring.(CMS).Prompting,TimeDelayandStimulusControl/EnvironmentalModificationareincludedwithinthiscategory.• Prompting:Verbal,gestural,orphysicalassistancegiventolearnerstoassistthemin
acquiringorengaginginatargetedbehaviororskill.Promptsaregenerallygivenbyanadultorpeerbeforeorasalearnerattemptstouseaskill.(NPDC)
StimulusControl/EnvironmentalModification:TermusedbyNPDCinterchangeablywithAntecedent-basedInterventions.Interventionsinwhichenvironmentalmodificationsareusedtochangetheconditionsinthesettingthatpromptsalearnertoengageinaninterferingbehavior.Thegoalistoidentifyfactorsthatarereinforcingtheinterferingbehaviorandthenmodifytheenvironmentoractivitysothatthefactornolongerelicitstheinterferingbehavior.(NPDC)AuditoryIntegrationTraining:Interventioninvolvingthepresentationofmodulatedsoundsthroughheadphonesinanattempttoretainanindividual’sauditorysystemwiththegoalofimprovingdistortionsinhearingorsensitivitiestosound.(CMS)BehavioralPackage:Interventionsdesignedtoreduceproblembehaviorandteachfunctionalalternativebehaviorsorskillsthroughtheapplicationofbasicprinciplesofbehaviorchange.(CMS)NPDClistsnineseparateinterventionsthatfitwithinthiscategoryaswellasBehaviorMomentumIntervention.NSP2&CMSincludeReductivePackagewithinthiscategory.• DifferentialReinforcement:Provisionofpositive/desirableconsequencesfor
behaviorsortheirabsencethatreducetheoccurrenceofanundesirablebehavior.Reinforcementprovided:a)whenthelearnerisengaginginaspecificdesiredbehaviorotherthantheinappropriatebehavior;b)whenthelearnerisengaginginabehaviorthatisphysicallyimpossibletodowhileexhibitingtheinappropriatebehavior;orc)whenthelearningisnotengagingintheinterferingbehavior.(NPDC)ThistermisusedbyNPDCandinoverallcategoryofPositiveBehaviorSupportStrategiesorinBehavioralPackage(NSP2&CMS)
• Exposure:Interventionsinvolvinggraduallyincreasingexposuretoanxiety-provokingsituationswhilepreventingtheuseofmaladaptivestrategiesusedinthepastundertheseconditions.(CMS)Alsodefinedastheincreasingordecreasingofthestimulusintensityorconditionstopromotetheoccurrenceofthedesiredresponse.(NPDC)
• Extinction:Withdrawalorremovalofreinforcersofinterferingbehaviorinordertoreducetheoccurrenceofthatbehavior.Althoughsometimesusedasasingleintervention,extinctionoftenoccursincombinationwithfunctionalbehaviorassessment,functionalcommunicationtraining,anddifferentialreinforcement.(NPDC)
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INTERVENTION DESCRIPTIONS
• FunctionalBehaviorAssessment(FBA):Systematiccollectionofinformationaboutaninterferingbehaviordesignedtoidentifyfunctionalcontingenciesthatsupportthebehavior.FBAconsistsofdescribingtheinterferingorproblembehavior,identifyingantecedentorconsequenteventsthatcontrolthebehavior,developingahypothesisofthefunctionofthebehavior,and/ortestingthehypothesis.(NPDC)ThetermisusedbyNPDCandinoverallcategoryofPositiveBehaviorSupportStrategiesandalsousedbyNSP2andCMSintheBehavioralPackage.
• FunctionalCommunicationTraining(FCT):Replacementofinterferingbehaviorthathasacommunicationfunctionwithmoreappropriatecommunicationthataccomplishesthesamefunction.(NPDC)ThistermisusedbyNPDCandinoverallcategoryofPositiveBehaviorSupportStrategiesandisalsousedbyNSP2andCMSintheBehavioralPackage.
• Reinforcement:Anevent,activity,orothercircumstanceoccurringafteralearnerengagesinadesiredbehaviorthatleadstotheincreasedoccurrenceofthebehaviorinthefuture.(NPDC)IncludedinBehavioralstrategiescategory&BehavioralPackage(NSP2&CMS)
• RemovalofRestraints:Gradualremovalofrestraintsinvolvingapplicationofpressuretoarm,shadowing.(NPDC)IncludedinBehavioralStrategiescategory
• ResponseInterruption/Redirecting:Introductionofaprompt,comment,orotherdistracterwhenaninterferingbehaviorisoccurringthatisdesignedtodivertthelearner’sattentionawayfromtheinterferingbehaviorandresultsinitsreduction.(NPDC)IncludedinoverallcategoryofPositiveBehaviorSupportStrategies;BehavioralPackage(NSP2&CMS)
• TaskAnalysis&Chaining:Aprocessinwhichanactivityorbehaviorisdividedinto
small,manageablestepsinordertoassessandteachtheskill.Otherpractices,suchasreinforcement,videomodeling,ortimedelay,areoftenusedtofacilitateacquisitionofthesmallersteps.(NPDC)IncludedinBehavioralStrategiescategory;BehavioralPackage(NSP2&CMS)
CognitiveBehavioralInterventions:Interventionsdesignedtochangenegativeorunrealisticthoughtpatternsandbehaviorswiththeaimofpositivelyinfluencingemotionsandlifefunctioning.(CMS)Alsodescribedasinstructiononthemanagementorcontrolofcognitiveprocessesthatleadtochangesinovertbehavior.(NPDC)ReferredtoasCognitiveBehavioralInterventionPackagebyNSP2&CMS;AHRQidentifiedthespecificuseofCBTwithanxietyasshowingEstablishedEvidence.NPDCidentified“Schema-basedStrategyInstruction”asshowingemergingevidence(i.e.,insufficientevidencetobeincludedintheEstablishedEvidencecategory).
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INTERVENTION DESCRIPTIONS
Computer-aidedTreatment/(Technology-aided)Instruction:Theseinterventionsrequirethepresentationofinstructionalmaterialsusingthemediumofcomputersorrelatedtechnologies.(CMS)NPDCusedacategorycalledTechnology-aidedInstructionandIntervention.CMS&NSP2usedacategorycalled“Technology-basedTreatment.NPDCincludedthedefinitionoftechnologyas“anyelectronicitem/equipment/application/orvirtualnetworkthatisusedintentionallytoincrease/maintain,and/orimprovedailyliving,work/productivity,andrecreation/leisurecapabilitiesofadolescentswithautismspectrumdisorder(Odom,Thompson,etal.,2013).(NPDC).DevelopmentalRelationship–basedTreatment:Interventionsinvolvingacombinationofproceduresthatarebasedondevelopmentaltheoryandemphasizetheimportanceofbuildingsocialrelationships.(CMS).ThiscategoryoverlapswithParentTraining(AHRQ)sincetheyincludedDIR/FloortimeResearchintheirParentTrainingcategory.Exercise:Interventionsinvolvinganincreaseinphysicalexertionasameansofreducingproblembehaviorsorincreasingappropriatebehavior.(CMS)NPDC–foundestablishedevidenceforuseofexercisetodecreaseproblembehaviorsandincreasepositivebehaviors.NSP2foundanemerginglevelofevidence. JointAttention(JA)Intervention(InterventionandOutcome):Interventionsinvolvingteachingachildtorespondtothenonverbalsocialbidsofothersortoinitiatejointattentioninteractions.(CMS)CMStreatedJAasanintervention.JAhasbeenlinkedtoincreasesincommunicationandsymbolicplay.NSP2includedJAintheBehavioralPackage.NPDC&AHRQtreatedJAasanoutcome.InterventionsinthiscategoryoverlapwithmultipleNPDCcategoriesincludingJA-SymbolicPlayInstruction;AHRQ-Play-basedinterventionforJAasoutcome.LanguageTraining:Interventionsthathaveastheirprimarygoaltoincreasespeechproduction.(CMS)CMSidentifiedLanguageProductionashavinganemerginglevelofevidence.NSP2identifiedmorestudiesthatshowedestablishedevidenceforLanguageTraining(production).NSP2includedLanguageTrainingforUnderstanding(comprehension)asanemergingevidencecategory.Modeling:InterventionsrelyingonanadultorpeerprovidingademonstrationofthetargetbehaviorthatshouldresultinanimitationofthetargetbehaviorbytheindividualwithASD.(CMS)NPDCnotedthatmodelingisoftencombinedwithpromptingandreinforcement.NPDCincludedbothModelingandVideoModeling(useofvideorecording)asseparateestablishedevidencecategories.CMSincludedmodelingintheemergingevidencecategory.NSP2alsoincludedanewcategorycalledImitation-basedIntervention–andshowedemergingevidenceforthisintervention.
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INTERVENTION DESCRIPTIONS
Multi-componentPackage:Theseinterventionsinvolveacombinationofmultipletreatmentproceduresthatarederivedfromdifferentfieldsofinterestordifferenttheoreticalorientations.Thesetreatmentsdonotbetterfitoneoftheothertreatment“packages”listedabovenoraretheyassociatedwithspecifictreatmentprograms.Examplesare:TheFamilySupportProgram,MulticomponentTeachingPackage.MusicTherapy:Interventionsthatteachindividualsskillsthroughmusic(NPDC,CMS,NSP2)NaturalisticInterventions:Interventionsinvolvingusingprimarilychild-directedinteractionstoteachfunctionalskillsinthenaturalenvironment.Theyoftenfocusonprovidingastimulatingenvironment,modelinghowtoplay,encouragingconversation,providingchoicesanddirect/naturalreinforcers,andrewardingreasonableattempts.(CMS);Interventionstrategiesusuallyoccurduringtypicalsetting/activities/routines;establishthelearner’sinterestthrougharrangementofthesetting/activity/routine,providenecessarysupportforthelearnertoengageinthetargetedbehaviorwhenitoccurs,andarrangenaturalconsequencesforthetargetedbehavior.(NPDC)NSP2&CMSusethetermNaturalisticTeachingStrategiesParentImplementedInterventions:Interventionsinvolvingparentsdeliveringtheinterventiontotheirchildtoimprove/increaseawidevarietyofskillsand/ortoreduceinterferingbehaviors.Parentslearntodeliverinterventionsintheirhomeand/orcommunitythroughastructuredparenttrainingprogram.ParentTrainingApproaches/overlapwithSymbolicPlayandPlay-basedInterventions.(AHRQ)AHRQincludedDIR/Floortimestudiesinthisgroup.Examplesinclude:SocialCommunicationIntervention,ESDM,DIR/Floortime;JointAttentionIntervention,JointAttentionSymbolicPlayEngagementandRegulation(JASPER).NPDC&NSP2groupedstudiesthatwereidentifiedasshowingestablishedevidence.AHRQidentifiedthecategoryattheemerginglevel.PeerMediatedInterventions:Typicallydevelopingpeersinteractwithand/orhelpchildrenandyouthwithASDtoacquirenewbehavior,communication,andsocialskillsbyincreasingsocialandlearningopportunitieswithinnaturalenvironments.Teachers/serviceproviderssystematicallyteachpeersstrategiesforengagingchildrenandyouthwithASDinpositiveandextendedsocialinteractionsinbothteacher-directedandlearner-initiatedactivities.(NPDC).NSP2andCMSusePeerTrainingPackage;NPDCalsousesStructuredPlayGroup(agroupincludingbothtypicallydevelopingpeersandchildrenwithASD);NSP2includedInitiationTraining(intheemergingevidencecategory).
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INTERVENTION DESCRIPTIONS
PictureExchangeCommunicationSystem(PECS):Thisinterventioninvolvestheapplicationofaspecificaugmentativeandalternativecommunicationsystembasedonbehavioralprinciplesthataredesignedtoteachfunctionalcommunicationtochildrenwithlimitedverbaland/orcommunicationskills.(CMS)Learnersareinitiallytaughttogiveapictureofadesireditemtoacommunicativepartnerinexchangeforadesireditem.(NPDC).NPDC,NSP2&CMSconsistentlyusethisterm.PivotalResponseTraining(PRT):ThistreatmentisalsoreferredtoasPRT,PivotalResponseTeaching,andPivotalResponseTreatment.PRTfocusesontargeting“pivotal”behaviorareas,suchasmotivationtoengageinsocialcommunication,self-initiation,self-management,andresponsivenesstomultiplecues,withdevelopmentoftheseareashavingthegoalofverywidespreadandfluentlyintegratedcollateralimprovements.(CMS)TermusedbyNPDC;PivotalResponseTreatment(NSP2&CMS);IncludedinParentTrainingApproaches(AHRQ)Schedules:Interventionsinvolvingthepresentationofataskthatcommunicatesaseriesofactivitiesorstepsrequiredtocompleteaspecificactivity.Schedulesareoftensupplementedbyotherinterventionssuchasreinforcement.(CMS)NSP2&CMSincludedschedules.ThisoverlapswithStructuredWorkSystemsandVisualSupports(NPDC)Sensory/Massage–SensoryRegulation:Thiscategoryutilizessensoryinput:tactile,vestibular,auditory,andproprioceptive-toimprovebehavior.• Massage(CMSincludedTouchw/Massage):Interventionsinvolvingtheprovisionof
deeptissuestimulation(CMS)• MusicIntensity:Differentlevelsofmusicvolume(auditoryinput)usedtoaffectvocal
stereotypy(NPDC)• SensoryDiet:Sensorybasedactivitiesintegratedintochildroutinestomeetsensory
needs.(NPDC)• SensoryIntegration&FineMotorIntervention:Therapeuticactivitiescharacterized
byenhancedsensation,especiallytactile,vestibular,andproprioceptive;withactiveparticipationandadaptiveinteractionpairedwithindividualfinemotorinstructionfromOT.(NPDC)
• Touch-PointInstruction:Tactileandnumberlinematerialsusedtointroducemathandnumeracyconcepts.(NPDC)
Self-Management:TheseinterventionsinvolveindependencebyteachingindividualswithASDtoregulatetheirbehaviorbyrecordingtheoccurrence/non-occurrenceofthetargetbehavior,andsecuringreinforcementfordoingso.Initialskillsdevelopmentmayinvolveotherstrategiesandmayincludethetaskofsettingone’sowngoals.(CMS)ThistermisusedconsistentlybyNPDC,NSP2&CMS;Self-RegulatoryStrategyDevelopmentWriting(NSP2)
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INTERVENTION DESCRIPTIONS
SocialCommunicationIntervention:Theseinterventionspsychosocialinterventionsinvolvetargetingsomecombinationofimpairmentssuchaspragmaticcommunicationskills,andtheabilitytosuccessfullyreadsocialsituations.(CMS)InterventionsincludedinthiscategorybyNSP2&CMSareincludedintheAHRQParentTrainingApproachesCategory
SocialNarratives:Thesetreatmentsinvolveawrittendescriptionofthesituationsunderwhichspecificbehaviorsareexpectedtooccur.Storiesmaybesupplementedwithadditionalcomponents(e.g.,prompting,reinforcement,discussion,etc.).(CMS)Thesenarrativesdescribeinsomedetailtherelevantcuesofsocialsituationsandofferexamplesofappropriateresponding.(NPDC)ThisinterventionoverlapswithStory-basedInterventionPackage(NSP2&CMS)overlapswithScripting(NSP2&CMS)
SocialSkillsIntervention:TheseinterventionsseektobuildsocialinteractionskillsinchildrenwithASDbytargetingbasicresponses(e.g.,eyecontact,nameresponse)tocomplexsocialskills(e.g.,howtoinitiateormaintainaconversation).(CMS)SocialSkillsTrainingGroup(NPDC)issimilartoSocialSkillsPackage(NSP2&CMS)andSocialSkillsTraining(AHRQ);InitiationTraining(CMS)SpeechGeneratingStrategies:Interventionsinvolvingtheuseofhighorlowdevicestofacilitatecommunication.Examplesincludebutarenotrestrictedto:pictures(PECS),photographs,symbols,communicationbooks,computers,orotherelectronicdevices.(NPDC)alsoreferredtoasVOCAoverlapswithAugmentativeandAlternativeCommunicationDevices(NSP2&CMS);NPDCAidedLanguageModeling;SignInstruction(NSP2)TheoryofMind:TheseinterventionsaredesignedtoteachindividualswithASDtorecognizeandidentifymentalstates(i.e.,aperson’sthoughts,beliefs,intentions,desires,andemotions)inoneselforinothersandtobeabletotaketheperspectiveofanotherpersoninordertopredicttheiractions.(CMS)CMS,NPDC&NSP2identifiedcategoryattheemerginglevel.ToiletTraining:ModificationsoftoilettrainingprogramdevelopedbyArin&Fox(1971).(NPDC)Anisolatedskill.
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Study Descriptions and References
1. (NPDC)NationalProfessionalDevelopmentCenter/AutismEvidence-BasedPracticeReviewGroupatUNCChapelHill:Wong,C.,Odom,S.L.,Hume,K.Cox,A.W.,Fettig,A.,Kucharczyk,S.,Schultz,T.R.(2014).Evidence-basedpracticesforchildren,youth,andyoungadultswithAutismSpectrumDisorder.ChapelHill:TheUniversityofNorthCarolina,FrankPorterGrahamChildDevelopmentInstitute,AutismEvidence-BasedPracticeReviewGroup.
2. (CMS)TheCentersforMedicaid&MedicareServicescommissionedareviewofexistingservicesforASD:U.S.DepartmentofHealthandHumanServices,CentersforMedicare&MedicaidServices.(2010).AutismSpectrumDisordersServices(ASDs):Finalreportonenvironmentalscan.Baltimore,MD:Young,J.,Corea,C.,Kimani,J.,&Mandell,D.
3. (NSP2)NationalStandardsProject–Phase2:NationalAutismCenter,ACenterofMayInstitute:NationalAutismCenter.(2015).Findingsandconclusions:Nationalstandardsproject,phase2.Randolph,MA.
4. (DHHS/AHRQ)TheDepartmentofHealthandHumanServicesandtheAgencyforHealthcareResearchandQualitycommissionedVanderbiltUniversitytocompleteasystematicreviewoftheASDresearch:WeitlaufA.S.,McPheetersM.L.,PetersB.,SatheN.,TravisR.,AielloR.,WilliamsonE.,Veenstra-VanderWeeleJ.,KrishnaswamiS.,JeromeR.,WarrenZ.TherapiesforChildrenWithAutismSpectrumDisorder:BehavioralInterventionsUpdate.ComparativeEffectivenessReviewNo.137.(PreparedbytheVanderbiltEvidence-basedPracticeCenterunderContractNo.290-2012-00009-I.)AHRQPublicationNo.14-EHC036-EF.Rockville,MD:AgencyforHealthcareResearchandQuality;August2014.www.effectivehealthcare.ahrq.gov/reports/final.cfm.
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Foreachofthefourreviewsinthetablebelow,symbolsrepresentthefollowingcategories:• Level1:EstablishedEvidence(solidbullet)* Level2:EmergingEvidence(asterisk)Theabsenceofasymbolindicatesthattheinterventionwasnotaddressedinthestudy.
INTERVENTION N
PDC2014
CMS-IMPAQ2010
NSP22014
DHHS-AHRQ2014
SOCIAL
COMMUNICATION
BEHAVIOR
ACAD
EMIC/
COGN
ITIVE
ADAPTIVE
SYSTEMATICREVIEWS
TARGET/OUTCOMES
COMPREHENSIVE INTERVENTIONS
ComprehensiveBehavioralInterventionProgramsforYoungChildren(NSP2&CMS)alsoreferredtoasEarlyIntensiveBehavioralandDevelopmentalInterventions(AHRQ);EarlyIntensiveBehaviorInterventions(EIB)orbehavioralinclusiveprograms(NSP2).AllutilizeABAprinciples.Ex.LEAP,ESDM,UCLAYoungAutismProject.
• • •
•*
√√
√ √√
√ √√
StructuredTeaching(NSP2&CMS)describesprogramssuchasTEACCH;(AHRQ)andoverlapswithStructuredWorkSystemswhichareonecomponentofStructuredTeachinginTEACCHandLEAP.
•
*
•*
√√
√ √√
√ √√
FOCUSED INTERVENTIONS Academic(CMS) * √ √ √ √• DirectInstruction(NPDC) * √ • CollaborativeCoaching(NPDC) * √ • CollaborativeLearning(NPDC) * √ √ • HandwritingWithoutTears(NPDC) * √ • SentenceCombiningTechnique(NPDC) * √ • TestTakingStrategyInstruction(NPDC) * √
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INTERVENTION N
PDC2014
CMS-IMPAQ2010
NSP22014
DHHS-AHRQ2014
SOCIAL
COMMUNICATION
BEHAVIOR
ACAD
EMIC/
COGN
ITIVE
ADAPTIVE
SYSTEMATICREVIEWS
TARGET/OUTCOMES
AntecedentIntervention/Package(NSP2&CMS)groupsavarietyofantecedent-basedInterventions;NPDCuses3categories:Prompting,TimeDelayandStimulusControl/EnvironmentalModification(alsoreferredtoasAntecedent-basedInterventions)
• •
√ √ √ √
• PromptingTermusedbyNPDCandincludedinBehavioralStrategiescategory;AntecedentPackage(NSP2&CMS)
•
•
√ √ √ √ √
• StimulusControl/EnvironmentalModificationTermusedbyNPDCinterchangeablywithAntecedent-basedInterventionsandincludedinoverallcategoryofPositiveBehavioralSupportStrategies:AntecedentPackage(NSP2&CMS)
•
AuditoryIntegrationTraining(NPDC) *
BehavioralPackage(NSP2&CMS)groupsavarietyofbehaviorallybasedinterventions:NPDClistsnineseparateinterventionsthatfitwithinthiscategoryaswellasBehaviorMomentumIntervention.NSP2&CMSuseReductivePackagewithinthiscategory
•
•
•
√ √ √ √ √
• DifferentialReinforcementTermusedbyNPDCandinoverallcategoryofPositiveBehaviorSupportStrategies;BehavioralPackage(NSP2&CMS)
•
√ √ √ √ √
• ExposureTermusedby(NSP2) * *
• ExtinctionTermusedbyNPDCandinoverallcategoryofPositiveBehaviorSupportStrategies;BehavioralPackage(NSP2&CMS)
•
√ √ √
• FunctionalBehaviorAssessmentTermusedbyNPDCandinoverallcategoryofPositiveBehaviorSupportStrategies;BehavioralPackage(NSP2&CMS)
•
*
√ √ √
16
INTERVENTION N
PDC2014
CMS-IMPAQ2010
NSP22014
DHHS-AHRQ2014
SOCIAL
COMMUNICATION
BEHAVIOR
ACAD
EMIC/
COGN
ITIVE
ADAPTIVE
SYSTEMATICREVIEWS
TARGET/OUTCOMES
• FunctionalCommunicationTrainingTermusedbyNPDCandinoverallcategoryofPositiveBehaviorSupportStrategies;BehavioralPackage(NSP2&CMS)
•
√ √ √ √
• ReinforcementTermusedbyNPDCandincludedinBehavioralstrategiescategory;BehavioralPackage(NSP2&CMS)
•
√ √ √ √ √
• RemovalofRestraintsNPDCincludedinBehavioralstrategiescategory
*
• ResponseInterruption/RedirectingTermusedbyNPDCandinoverallcategoryofPositiveBehaviorSupportStrategies;BehavioralPackage(NSP2&CMS)
•
√ √ √ √ √
• TaskAnalysis&ChainingTermsusedbyNPDCandincludedinBehavioralstrategiescategory;BehavioralPackage(NSP2&CMS)
•
√
CognitiveBehavioralInterventionsCognitiveBehavioralInterventionPackage(NSP2&CMS);CognitiveBehavioralTherapy–specificforanxiety(AHRQ)Schema-BasedStrategyInstruction(NPDC)
•*
•
•
•
√√
√ √
√ √
Computer-aidedTreatment/Technology-aidedInstructionUseofTechnology-basedTreatment(CMS,NSP2);Technology-aidedinstruction(NPDC)
•
•
*
√ √ √ √ √
DevelopmentalRelationship–based(CMS);Developmental-Relationship-basedTreatment(NSP2):OverlapswithParentTraining(AHRQ)
* * √ √ √ √
Exercise(NSP2&NPDC) • *
17
INTERVENTION N
PDC2014
CMS-IMPAQ2010
NSP22014
DHHS-AHRQ2014
SOCIAL
COMMUNICATION
BEHAVIOR
ACAD
EMIC/
COGN
ITIVE
ADAPTIVE
SYSTEMATICREVIEWS
TARGET/OUTCOMES
JointAttentionIntervention(InterventionandOutcome)(CMS)treatedJAasintervention;NSP2includedJAinBehavioralPackage:NPDC&AHRQtreatedjointattentionasanoutcome,interventionsinthiscategoryoverlapwithmultipleNPDCcategoriesincludingJA-SymbolicPlayInstruction;AHRQ-play-basedinterventionforJAasoutcome.
*
•
•
•
√
√
√
√
LanguageTraining(NSP2)alsoreferredtoasLanguageProduction(CMS);NSP2(alsoincludedLanguageTrainingforUnderstanding(emergingcategory)
* •*
√ √
Modeling(NSP2&CMS)overlapswithVideoModeling(NPDC);Imitation-basedIntervention(NSP2)
• * • √ √ √ √
Multi-componentPackageThistermisusedonlybyNSP2andCMStodescribeinterventionsthatdonotclearlyfitinanothercategory
•
*
√ √ √ √ √
MusicTherapy(NPDC,CMS,NSP2) * * * √ √ √ √ √
NaturalisticInterventions• TermusedbyNPDC;NSP2&CMSusesthe
termNaturalisticTeachingStrategies
•
•
•
√ √ √
18
INTERVENTION N
PDC2014
CMS-IMPAQ2010
NSP22014
DHHS-AHRQ2014
SOCIAL
COMMUNICATION
BEHAVIOR
ACAD
EMIC/
COGN
ITIVE
ADAPTIVE
SYSTEMATICREVIEWS
TARGET/OUTCOMES
ParentImplementedInterventionsParentTrainingApproaches/overlapwithSymbolicPlayandPlay-basedInterventions(AHRQ)(NewtoNSP2)AHRQincludedDIR/Floortimestudiesinthisgroup.
•
•
* √ √ √ √
PeerMediatedInterventionsTermusedbyNPDC;NSP2andCMSusePeerTrainingPackage;NPDCalsousesStructuredPlayGroup;NSP2usesInitiationTrainingaswell
•
•
•
√ √ √
PictureExchangeCommunicationSystem(PECS)NPDC,NSP2andCMSconsistentlyusethisterm.
•
•
*
√ √ √
PivotalResponseTraining(PRT)TermusedbyNPDC;PivotalResponseTreatment(NSP2&CMS);includedinParentTrainingApproaches(AHRQ)
•
*
•
* √ √ √
Schedules(NSP2&CMS)overlapswithStructuredWorkSystemsandVisualSupports(NPDC)
•
•
√ √ √ √ √
Sensory/Massage–SensoryRegulation• Massage(CMSincludedTouchw/Massage)• MusicIntensity(hastodowithsensory
input)• SensoryDiet• SensoryIntegration&FineMotor
Intervention• TouchPointInstruction/TouchTherapy
****
*
*
19
INTERVENTION N
PDC2014
CMS-IMPAQ2010
NSP22014
DHHS-AHRQ2014
SOCIAL
COMMUNICATION
BEHAVIOR
ACAD
EMIC/
COGN
ITIVE
ADAPTIVE
SYSTEMATICREVIEWS
TARGET/OUTCOMES
Self-ManagementThistermisusedconsistentlybyNPDC,NSP2&CMS;Self-RegulatoryStrategyDevelopmentWriting(NSP2)
•
*
•
√ √ √ √
SocialCommunicationInterventionInterventionsincludedinthiscategorybyNSP2&CMSareincludedintheAHRQParentTrainingApproachesCategory
•
*
√ √
SocialNarratives(NPDC)overlapswithStory-basedInterventionPackage(NSP2&CMS)overlapswithScripting(NSP2&CMS)
•
•
•
√ √ √ √ √
SocialSkillsInterventionSocialSkillsTrainingGroup(NPDC)issimilartoSocialSkillsPackage(NSP2&CMS)andSocialSkillsTraining(AHRQ);InitiationTraining(CMS)
•
•
•
√ √ √
SpeechGeneratingStrategies(NPDC)alsoreferredtoasVOCAoverlapswithAugmentativeandAlternativeCommunicationDevices(NSP2&CMS);NPDCAidedLanguageModeling;SignInstruction(NSP2)
*
*
*
√ √
TheoryofMind *
*
*
√ √ √
ToiletTraining(NPDC,isolatedskill) * √
