Evidence For Early Intervention Presentation For Autism ASD

The Evidence-Base for Early
Intervention for Autism

Supporting Newly Diagnosed Children and Their Families
This Photo by Unknown author is licensed under CC BY-SA.

• In the spirit of reconciliation, the Autism
Behavioural Intervention Association acknowledges
the Traditional Custodians of country throughout
Welcome Australia and their connections to land, sea and
community. We pay our respect to their elders past
and present and extend that respect to all
Aboriginal and Torres Strait Islander peoples today
Objectives
1 2 3 4
Describe models of Distinguish therapies Discuss the essential Describe important
therapy for children with an established practice considerations and
with autism evidence-based components of red flags when
from those without evidence-based selecting a therapy
evidence early interventions
for autism
Why is this topic important?
The number of children diagnosed with autism has increased
Autistic people face a higher likelihood of exclusion, social isolation, or

difficulties in school and employment later in life
Autistic people may experience fewer opportunities and more restrictions that
their non-autistic peers
Autistic people can gain skills and experience meaningful participation and
social inclusion!
• Parents need to be able to advocate for their child
with autism, to ensure that their child receives
safe, effective, and individualised educational and
Parents behavioural support

• Parents need to know that children with autism
need to be are capable of learning, and learning a lot!

• 'If children do not learn the way we teach, then we
informed change the way we teach to better suit they way

the child learns'
• It is up to us to change how we support the child
to meet the child's needs, rather than fitting the
child into a 'one size fits all' approach
NDIA Proposed Core Principles
The following core principles are important in any early autism intervention
Supports for children with autism should be evidence-based and delivered
using a family-centred approach that incorporates individual planning.
The specific early intervention program chosen will take into account family
preferences and capacity and each child’s strengths and difficulties, age and
stage of development.
Aims of support for the child with autism are to improve social
What does good communication and minimise behaviours that challenge to enhance
practice look like? learning and participation.
Early intervention or support should start as soon as a diagnosis is made

and the family are ready.
Having well-trained professionals working as teams to support children with

autism and their families is needed. Parent or peer training is promoted, as
long as it is incorporated to take into account a family-centred approach
What interventions have an
evidence-base?
Imitation and modelling
Visual supports
Structured teaching (discrete trial teaching)
Naturalistic teaching
Positive reinforcement
Functional communication training
Picture exchange communication training
Prompting and prompt fading
Task analysis
The above can be delivered as focused interventions, or as a combined intervention package

What
interventions
do not have an
evidence-base?
These interventions do not yet have
evidence to support them
What interventions may actually be harmful?
These interventions should not be used
Do child characteristics influence intervention outcomes?
There is some emerging evidence, but more research is needed
Does intensity of intervention matter?
• Yes! 15-25 hours per week of planned, systematic intervention is recommended

• What happens during these hours?
• Can be delivered in a range of settings – home, school, and community!
• Focus is on creating a positive and enriched learning environment, in which the child’s wants and needs are
understood and met
• Focus is on creating lots of teachable moments
• Some skills may be taught using more structured, therapist directed teaching strategies
• Some skills may be taught in the context of child-directed activities
• Skills taught in the context of play and daily activities (eating, toileting, dressing, etc.)
• A high rate of positive reinforcement is maintained
• These hours may include parent education and coaching
• Once new skills are learned, they are generalised
• The hours should be delivered across the week in ways that work for the child and family
• Ultimately, the intensity of intervention is individualised to the needs of the child – some may need more, some
may need less
• Intensive early intervention is NOT 15-25 hours per week of therapist directed tabletop
teaching. That is not best practice nor developmentally appropriate
The role of parents in early intervention
• Parents need to be involved!

• But it’s important to distinguish between parenting and therapy
Parenting Therapy
• All day every day! • Structured and planned
• Unstructured • Delivered by team members working within
• Play their scope of practice and competence
• Daily activities • Uses a range of evidence-based strategies
• Family activities • Strategies are implemented with strong
• ‘Teachable moments’ and practice fidelity
• Promote communication • A high number of learning opportunities
• Promote generalization of skills • Data collection
• Use practical strategies recommended by • Data analysis
therapy team, in daily life • Data based problem solving
• Parents can be therapists, but they shouldn’t have to be the therapist

Essential Practice Components of Early
Intervention
An assessment to identify the person’s strengths and needs
An understanding of why, when, and how behaviours happen, and the value of the behaviour to the
person
An emphasis on teaching important skills that increase the person’s independence, well-being, and
quality of life, using a variety of individualised and evidence-based teaching and behaviour support
strategies
The collection and analysis of data to guide decision-making
Training and support for family members, educators, therapists, and any other people who are
responsible for program implementation
Govt commissioned reviews of evidence
There was no to little evidence to support sensory-based, technology-based,
or animal assisted therapy, cognitive behavioural therapy, TEACH, or other
therapies, and little evidence to support developmental interventions
The best available evidence supports behavioural and natural developmental

behavioural interventions (both are ABA-based, and developmental!)
What to consider when selecting an therapy for your
child?
Is there any published

What is the therapeutic
What is the focus of the research demonstrate the
value? (in other words, Are the outcomes and gains
therapy? (note – if the positive effects of the
what are the positive as a result of participating
focus is not on teaching therapy? (beware of
outcomes that can be in this therapy enduring?
new skills, be skeptical!) testimonials as the sole
expected?)
evidence)
How is the therapy How will progress be

Who is qualified to provide
individualised to my child's monitored and shared with
this therapy?
strengths and needs? me?
What are some red flags
The therapy claims to The therapy involves

The therapy claims to
provide a miracle cure having the child ingest a
cure autism
or quick fix substance
The therapist 'does

The therapy forces the
something to the child' - There is no data
the child does not child to do things that
they don't like or can't collection or progress
actively learn monitoring
something do
References
• Raising Children Network Parent Guide: Therapies for Autism

• Interventions for children on the autism spectrum: A synthesis of research evidence (summary). Autism CRC, 2020.
• Hyman, S. L., Levy, S. E., & Myers, S. M. (2020). Identification, evaluation, and management of children with autism
spectrum disorder. Pediatrics, 145(1).
• Steinbrenner et al. (2020). Evidence-based practices for children, youth, and young adults with Autism. The University of
North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism
Evidence and Practice Review Team.
• Roberts, J. M., Williams, K., Smith, K., & Campbell, L. (2016). Autism spectrum disorder: Evidence-based/evidence-
informed good practice for supports provided to preschool children, their families and carers. Report prepared for the
National Disability Insurance Agency (NDIA).
• Prior, Margot, et al. (2011). A review of the research to identify the most effective models of practice in early
intervention for children with autism spectrum disorders. Australian Government Department of Families, housing,
Community Services and Indigenous Affairs (FaHCSIA). Australia.
• National Research Council. (2001). Educating children with autism. Committee on Educational Interventions for Children
with Autism. C. Lord and JP McGee (Eds.), Division of Behavioral and Social Sciences and Education. Washington, DC:
National Academy Press. Journal of Early Intervention, 28, 227-251.
Australian Court Rulings for Intensive Early
Intervention
• ESDM or ABA? Either may be a reasonable and necessary support: XXWC

v NDIA [2020] AATA 923
• Funding for Applied Behaviour Analysis - FRCT and WKZQ v NDIA [Part 1]
• Funding for Applied Behaviour Analysis - FRCT and WKZQ v NDIA [Part 2]
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The Evidence-Base for Early

Intervention for Autism

This Photo by Unknown author is licensed under CC BY-SA.

Autistic people face a higher likelihood of exclusion, social isolation, or

Parents behavioural support

need to be are capable of learning, and learning a lot!

informed change the way we teach to better suit they way

Early intervention or support should start as soon as a diagnosis is made

Having well-trained professionals working as teams to support children with

Structured teaching (discrete trial teaching)

Functional communication training

Picture exchange communication training

Prompting and prompt fading

The above can be delivered as focused interventions, or as a combined intervention package

• Yes! 15-25 hours per week of planned, systematic intervention is recommended

• Parents need to be involved!

• Parents can be therapists, but they shouldn’t have to be the therapist

An assessment to identify the person’s strengths and needs

The collection and analysis of data to guide decision-making

The best available evidence supports behavioural and natural developmental

Is there any published

How is the therapy How will progress be

The therapy claims to The therapy involves

The therapist 'does

• Raising Children Network Parent Guide: Therapies for Autism

• ESDM or ABA? Either may be a reasonable and necessary support: XXWC

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