SPECIAL ARTICLE: Korean Practice Guideline for Autism Spectrum Disorder eISSN 2233-9183

J Korean Acad Child Adolesc Psychiatry 2024;35(1):29-38

https://doi.org/10.5765/jkacap.230019

Behavioral Interventions for Autism Spectrum Disorder:

A Brief Review and Guidelines With a Specific Focus
on Applied Behavior Analysis
Kyong-Mee Chung, Eunsun Chung, and Hoomyung Lee
Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea

We conducted a comprehensive review of behavioral and educational interventions for individuals with autism spectrum disorder
(ASD). The most prominent type of intervention, Comprehensive Early Intervention, often referred to as Early Intensive Behavioral In-
tervention (EIBI), has been found to be particularly effective in improving intelligence and adaptive behaviors. The naturalistic develop-
mental behavioral intervention, designed to enhance social and communication abilities, showed effectiveness in improving language,
cognitive function, and social initiation. However, more studies are needed to examine its effectiveness. Intensive individualized inter-
vention, which provides a tailored intervention for a specific target behavior, was effective in improving social skills and communica-
tion, as well as reducing sleep, eating, and toileting problems. Cognitive behavioral therapy (CBT) is the most effective method for deal-
ing with emotional difficulties, but it has not been widely used because of the shortage of trained experts. Parent-mediated intervention
(PMI) involves parents acquiring knowledge and specific skills to improve their child’s functioning or reduce challenging behaviors.
Speech and language therapy, sensory integration, Treatment and Education of Autistic and related Communications Handicapped
Children, developmental approaches, and social stories are frequently used interventions. However, evidence of their effectiveness has yet
to be well established. Based on these findings, intervention recommendations for autism include EIBI, Early Start Denver Model, in-
tensive individualized intervention, CBT, and PMI. The choice of intervention should be tailored to the individual’s needs and delivered
by qualified professionals with expertise in the specific intervention.

Keywords: Autism spectrum disorder; Early Intensive Behavioral Intervention; Naturalistic developmental behavioral intervention;
Parent-mediated intervention; Comprehensive treatment model; Focused intervention.
Received: March 21, 2023 / Revised: July 21, 2023 / Accepted: December 3, 2023
Address for correspondence: Eunsun Chung, Department of Psychology, College of Arts and Science, Yonsei University, 50 Yonsei-ro, Seodaemun-gu,
Seoul 03722, Korea
Tel: +82-2-2123-4886, E-mail: [email protected]

INTRODUCTION intervention, behavior modification, behavior therapy, and

behavior treatment were introduced in the early 70s, when
Intervention approaches for individuals with autism spec- learning theory was applied as a treatment method for chang-
trum disorder (ASD) encompass educational practices, de- ing behaviors of other clinical populations, including chil-
velopmental perspectives, and behavioral strategies [1]. Among dren with diverse behavior problems and persons with phys-
these, applied behavior analysis (ABA) is recognized as the ical illness (e.g., diabetes, asthma, obesity, and so forth) [6].
most extensively utilized and proven effective method for ad- Although these terms differ slightly, they are often used in-
dressing the behavioral and educational needs of individuals terchangeably, which can lead to confusion.
with ASD. ABA is a scientific and systematic approach root- Numerous studies have established the efficacy of ABA in
ed in learning theory, best represented by operant condition- enhancing cognitive function, language skills, intelligence
ing [2] and classical conditioning [3] to induce behavioral quotient (IQ), and social abilities in individuals with ASD
changes in individuals diagnosed with ASD [4]. The term [7,8]. Federal, state, and national organizations in the US and
ABA came in the early 50s when learning theory was applied UK consistently recommend ABA-based interventions as
as a treatment strategy to change behaviors in persons with the first choice of assessment and treatment guidelines for
developmental disabilities [5]. New terms such as behavior ASD. These organizations include the US Center for Disease
This is an Open Access article distributed under the terms of the Creative Commons Control [9], Australian Center for Disease Control [10], divi-
Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) sion 53 of the American Psychological Association (Society
which permits unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited. of Child and Adolescent Clinical Psychology) [11], American

Copyright ⓒ 2024 Korean Academy of Child and Adolescent Psychiatry 29

Behavioral and Educational Intervention for Individuals With ASD

Academy of Child and Adolescent Psychiatry [1], as well as ter the age of 5, especially when parental and family involve-
the states of NY [12], WA [13], and Maine [14]. In this study, ment was high.
our primary focus was on treatments with a strong recom- However, two recent reviews reported no significant chang-
mendation, categorized according to the strictest evidence- es in symptom severity after intervention [24,25] and limited
based treatment criteria. Additionally, we introduce treat- long-term effects [25], questioning the effectiveness of EIBI.
ments that are widely used in clinical practice but need more Careful interpretation is needed because most studies in-
accumulated evidence. cluded in the two reviews used quasi-experimental designs
(e.g., clinical controlled trial) rather than randomized con-
COMPREHENSIVE TREATMENT MODEL trolled trials (RCTs), and their sample sizes were small. Fur-
ther studies are needed to establish the effectiveness of EIBI.
The comprehensive treatment model (CTM) involves in- Recently, another line of intervention called naturalistic
tensive training in various developmental areas, including developmental behavioral intervention (NDBI) [26] was in-
language, cognitive function, social interaction, communi- troduced, which combines behavioral principles with a de-
cation, and self-help skills. This training is based on behav- velopmental approach that emphasizes social ability and
ioral principles and is typically started soon after the diagno- learning in a natural context. NDBI, along with EIBI, is ef-
sis of autism [7,8]. Early intervention, ideally before the age of fective in young children with ASD. The Early Start Denver
3 years, is recommended soon after the diagnosis. It is con- Model (ESDM) [27] is a prominent example that has been ex-
ducted in a one-on-one format for a few hours daily for an tensively investigated. Compared with traditional EIBI, ESDM
average of 2–4 years. focuses on improving the social development and commu-
Early Intensive Behavioral Intervention (EIBI) [15] was nication skills of children with ASD by facilitating their so-
designed to teach specific skills in language, cognitive func- cial interaction with their caregivers in daily living settings
tion, self-help, social interaction, and motor skills using dis- [28]. Although limited, a few review studies have reported
crete trial training (DTT), which follows the principles of the positive effects of ESDM on improving children’s social
ABA. This service is provided by a team of professional communication, language, and adaptive behaviors. For ex-
therapists and implemented face-to-face with the child in a ample, Waddington et al. [29] reviewed 15 ESDM studies, and
structured environment for a few hours per day for a few the results showed improvements in language, imitation skills,
years, and active parental participation is required. and social communication after 3 to 12 months of ESDM in-
Six review studies that tested the effectiveness of EIBI re- tervention. Fuller et al. [30] conducted a meta-analysis of 12
ported significant improvements in IQ and adaptive behav- ESDM outcome studies (6 RCTs and 6 quasi-experimental
iors consistently 12 months after EIBI [16-21]. Some studies designs). The average effect size of ESDM (Hedge’s g) was
have also reported positive changes in other developmental 0.357 (p=0.024) across diverse developmental areas, which
areas. For instance, Reichow and Wolery [19] reported that is a medium effect size, indicating moderate improvements.
the EIBI group showed additional improvements in recep- Among these, cognitive function (g=0.412) and language (g=
tive and expressive language compared to the treatment-as- 0.408) showed significant improvements [30]. In addition to
usual (TAU) group. Reichow et al. [20] analyzed the effect the ESDM, other models have gained attention and demon-
sizes (Hedge’s g) for each area. The results showed the aver- strated similar effectiveness. These include Joint Attention,
age of medium to large effect sizes (language [g=0.50–0.57], Symbolic Play, Engagement and Regulation (JASPER) [31],
daily communication [g=0.74], social interaction [g=0.42], Early Social Interaction [32], and Pivotal Response Treat-
and self-help skills [g=0.55]) in the EIBI group compared to ment [33].
TAU group. In Korea, treatment outcome studies on EIBI and NDBIs are
Recently, a few studies have explored factors affecting the rare. One study [34] examined the effectiveness of 6 months
effectiveness of EIBI. Caron et al. [22] found that treatment of EIBI in 19 children aged 2–5 years in an EIBI center using
dosage (the amount of time spent on therapy) and adher- a one-group pre- and post-test design. The study showed sig-
ence (compliance with the treatment program’s contents and nificant improvements in the developmental scores of the
procedures) were positively correlated with treatment effec- children, along with improved parental quality of life. How-
tiveness. Based on these findings, they recommended ad- ever, it is difficult to generalize the effectiveness of the EIBI
ministering EIBI for 25–40+ hours per week for 12–24 months. in Korea because the study lacked a comparison group and
Zwaigenbaum et al. [23] emphasized the importance of ear- had a small sample size.
ly intervention, reporting that interventions started before
the age of 3 had more positive effects than those started af-

30
 KM Chung, et al.

FOCUSED INTERVENTIONS often used to enhance communication skills in individuals with

ASD. It involves teaching the use of alternative communica-
In the focused intervention, therapists provide tailored tion methods, such as visual cues (signs, symbols, pictures,
interventions to individuals of all age groups in areas where and so forth), sign language, and communication aids [45].
deficits are reported, such as social skills, social communica- The picture exchange communication system (PECS) is
tion, sleep, feeding, toilet training, and emotion regulation the most widely used AAC intervention, which teaches indi-
(e.g., anxiety, anger, and so forth). The main approach is be- viduals to use pictures to communicate their needs (e.g., re-
havioral intervention, which is typically conducted for a rel- quest items and name objects). The PECS follows six steps for
atively short period with the goal of improving a specific tar- each communication skill using various ABA strategies, such
get behavior. In this study, we reviewed effective interventions as shaping, differential reinforcement, and stimulus control
for the core symptoms of ASD, such as social skills and com- [46]. Two review studies, which included 27 and 15 studies,
munication, as well as combined symptoms, including sleep, respectively, found that PECS was effective in enhancing com-
eating problems, toilet training, and emotional difficulties. munication, such as initiating conversations and making de-
mands [47,48]. Additionally, the PECS has shown particular
CORE SYMPTOMS effectiveness for children aged 0–5 years (toddlers to pre-
school) and 6–14 years (school-age) [41]. However, a meta-
Social skills analysis of 11 studies found that the PECS had small to me-
Social skills training (SST) is the most widely researched dium effect sizes in improving overall speech abilities [49].
intervention aimed at improving social skills, a core symp- Additionally, few studies have reported the spontaneous de-
tom of ASD. It is usually delivered face-to-face by experts in velopment of verbal speech during PECS training. However,
specialized institutions or teachers and peers in schools un- further evidence is required [46].
der the supervision of experts [35]. In SST, which is typically
conducted in 8–13 sessions over 6–12 weeks, specific social COMBINED SYMPTOMS
skills such as greetings, initiating and responding to conver-
sations, giving compliments, sharing, and matching facial ex- Sleep
pressions are taught through repetitive practice [36,37]. Individuals with autism and their parents frequently re-
Some studies have reported limited effects of SST on im- port sleep problems as a comorbid symptom. A recent review
proving social skills [35,36,38]. However, rigorous RCTs found that behavioral interventions increased sleep time and
have recently shown promising results. Two meta-analyses sleep efficiency, as well as a decrease in sleep latency, com-
found that the intervention group showed a medium (Hege’s pared to the control group [50,51]. Another review that ana-
g= 0.51) [39] to large effect size (Hege’s g=0.81) [40] in im- lyzed behavioral interventions for sleep problems found that
provement in social skills and social responsiveness com- different techniques were recommended depending on the
pared to the non-intervention group. specific sleep problem [52]. For instance, a faded bedtime1) is
SST has been demonstrated to improve social skills effec- effective in initiating and maintaining sleep, whereas extinc-
tively in individuals of all ages, including infants (0–5 years tion2) and scheduled awakening3) are effective during night-
old), children (6–14 years old), and adolescents/adults (15–22 waking and night terror attacks, respectively. In terms of age,
years old) [41]. Especially for children aged three years, a so- faded bedtime was applied to children aged 5–9 years, and
cial skills intervention model named JASPER has been intro- the extinction technique was applied to children aged 2–12
duced, and its effectiveness has accumulated [42,43]. JASPER years, both of which were effective [52]. Sleep hygiene and
aims to improve joint attention and teach play skills. A re- behavior interventions for improving sleep habits, such as
view of 19 studies on the efficacy of JASPER by Waddington bedtime routines and sleep schedules, are not sufficient but
et al. [44] found that those who received JASPER training necessary components of most behavioral sleep interven-
showed significant improvements in at least one area, such tions [52,53].
as joint attention, joint engagement, playing skills, and lan- 1) Bedtime fading is a technique that involves temporarily adjusting a child’s bedtime to
coincide with their natural sleep onset time. This helps ensure that the child falls
guage, compared with the control group. However, despite asleep quickly. Over time, the bedtime is gradually moved to the targeted sleep onset
its effectiveness, the JASPER is not easy to access in Korea time. Various behavioral techniques can be used during this process to facilitate
sleeping.
because of the lack of manuals or guidelines. 2) Standard extinction involves parents ignoring all disruptions that occur during bed-
time. This means that the parent puts the child to bed and does not interact with
them until the morning.
Social communication 3) Parents wake up their child approximately 15 minutes before the usual time that the
Augmentative and alternative communication (AAC) is child experiences spontaneous night wakings.

http://www.jkacap.org 31
Behavioral and Educational Intervention for Individuals With ASD

Eating problem 3–12 years. However, further evidence is required [65]. Urine
Approximately 50% of individuals diagnosed with autism training should be continued until children reach 24 months
report eating problems, such as food refusal or food selec- of age, followed by bowel training when the urine training is
tivity. Similar to sleep, behavioral interventions based on completed.
ABA are effective in addressing these eating problems. A me-
ta-analysis of 23 intervention studies [54] reported an in- Emotional difficulties
crease in food intake when contingent reinforcement (CR)4) As children with autism grow into adolescence and adult-
and non-removal of the spoon (NRS)5) were used in combi- hood, they often report emotional difficulties, such as de-
nation (improvement rate difference [IRD]=0.69) in children pression, anxiety, and anger, in addition to ongoing behav-
with ASD under 6 years. However, a small effect size was ioral problems [66]. Recent studies have shown that cognitive
reported for the reduction of mealtime problem behaviors, behavioral therapy (CBT), an evidence-based treatment for
such as tantrums (IRD=0.39). For severe food selectivity and depression, anxiety, and anger, can be successfully applied to
related mealtime problem behaviors, a treatment package adolescents and adults with autism [67-69]. However, con-
that includes both antecedent manipulation (such as stimu- sidering that CBT requires significant verbal and cognitive
lus fading) and consequence-based procedures (such as NRS skills, it is important to assess the verbal, cognitive, and emo-
and differential reinforcement) has been reported to be ef- tional abilities of adolescents and adults with autism before
fective [55]. implementing CBT [70,71]. In Korea, access to CBT for indi-
While experts typically lead interventions, there are re- viduals with autism is limited because very few experts pro-
ports that active participation by parents can be more effec- vide CBT for adolescents and adults with autism.
tive in generalizing and maintaining the effects of eating in-
terventions [55,56]. PARENT EDUCATION
Toilet training Parental education refers to the provision of either infor-
Evidence has accumulated from diverse ABA-based toilet mation or specific skills or both to parents to support their
training programs for individuals with autism [57]. A review children appropriately. Psychoeducation provides knowl-
of 28 toilet training intervention studies found that techniques edge and strategies to deal with autism issues. However, its
such as shaping6), graduated guidance7), scheduled toileting8), effectiveness has yet to be investigated [72]. In contrast, par-
and stimulus control9) were effective. In clinical practice, these ent-mediated interventions (PMI) involve training parents to
techniques are often used in combination and are tailored to implement various intervention techniques directly with their
the age and cognitive abilities of individuals [58,59]. children. They have been frequently used for comprehen-
The most typical toilet training for children with autism sive early intervention and intervention of challenging be-
is a modification of rapid toilet training (RTT), originally haviors [73].
devised by Azrin and Foxx [58,60,61]. The RTT is an inten-
sive training method that combines positive reinforcement, PMI for comprehensive early intervention
positive punishment, and scheduled toileting, typically last- PMI has been actively pursued as a means of providing in-
ing 8 hours a day for 1–2 weeks [62,63]. This method has been terventions to young children with autism, typically in com-
reported to be particularly effective for individuals with au- bination with EIBI [15]. However, PMIs may also serve as pri-
tism and intellectual disabilities [64]. Specifically, it was ini- mary services in regions with limited accessibility to EIBI
tially designed for infants and toddlers aged 2–4 years, and [74]. While the quality of intervention and service hours for
a recent review showed promise for use in the age range of PMIs may not be comparable to those of therapist-led inter-
ventions, their advantages include high accessibility to treat-
4) Contingent reward refers to when the child receives positive reinforcement for com-
pleting a desired behavior. ment and high generalizability, mainly because treatment is
5) Non-removal of spoon involves an adult holding the spoon in front of the child’s provided by parents almost every day in diverse real-life set-
mouth until he or she takes a bite of food.
tings [75]. Numerous studies have reported improvements
6) In stimulus shaping, positive reinforcement is presented contingent on completion of
steps in the stimulus shaping hierarchy. in children’s communication skills, expressive and receptive
7) Therapist first provides the controlling prompt (e.g., physical prompt) and allows the language, and adaptive behaviors upon the implementation
learner to react independently by gradually removing the controlling prompt in the
subsequent sessions. of PMI [41]. Additionally, its collateral effects on parental ad-
8) A procedure where individuals are placed on the toilet with scheduled time and then justment and mental health, including maternal depression
positively reinforced when voiding occurs.
and parenting stress, are well-documented [76]. However, a
9) A procedure used to detail circumstances where a behavior is triggered by the exis-
tence or absence of a stimulus. review of 17 studies questioned the effectiveness of PMI due

32
 KM Chung, et al.

to inconsistencies in results across studies [77]. Another re- cause of their cost-effectiveness and accessibility.
cent meta-analysis study, including 19 RCTs, also reported PMIs are also recommended for managing sleep-related
small effect sizes (Hedge’s g=0.18–0.27) [78]. However, these problems, which are reported in 40%–80% of children with
review studies included trials using diverse intervention tech- autism [92]. PMI for sleep typically includes psychoeduca-
niques, such as floor time, massage, and ABA. Therefore, tion and hands-on training in recording a daily sleep diary,
caution should be taken when interpreting the effectiveness setting up a sleep hygiene routine, and applying faded bed-
of PMIs. times to reduce sleep problems [93]. A review of 11 PMI stud-
More recently, a parent-implemented Early Start Denver ies found that PMI is effective in reducing sleep-related mal-
Model (P-ESDM) has gained attention as an alternative to adaptive behaviors, such as sleep resistance and waking at
therapist-led ESDM, whose effectiveness has been well-doc- night, and in improving overall sleep time in children with
umented [79]. In P-ESDM, certified ESMD trainers teach autism [92].
parent-specific behavioral skills, such as joint attention and In Korea, there have been a few PMI studies focused on
imitation, to facilitate social interaction with their child. Par- reducing challenging behaviors. These studies have report-
ents are then encouraged to apply these skills to their chil- ed a decrease in challenging behaviors in children [94,95], as
dren’s everyday routines and activities in their homes and well as a reduction in parenting stress and an improvement
other daily living settings [80]. Although no systematic re- in parental self-efficacy [94,96].
view of the effectiveness of P-ESDM is available, individual
studies have reported improvements in children’s parental OTHER INTERVENTIONS
interaction skills [81], social communication skills [82], lan-
guage development [83], and a reduction in autism symptoms Speech-language therapy
[84]. Due to high parental preference for P-ESDM, more ef- Speech and language therapy (SLT) is the most common
forts have been made to disseminate it, including the devel- special education program for children with autism [97]. SLT
opment of internet-based P-ESDM, which has also demon- is not a specific intervention but rather a general term encom-
strated effectiveness [83,85]. passing a wide range of therapies implemented by speech-
In Korea, single-subject design studies have reported in- language pathologists (SLPs). Therefore, the targeted skill
creased joint attention [86] and improvements in social in- development areas of SLT are highly diverse, and SLPs may
teraction and communication behaviors [87,88] for PMI. employ various heterogeneous intervention models depend-
However, further studies with better experimental designs ing on their trained practice area. A recent review reported
are required to conclude their overall effectiveness. that the developmental-naturalistic model is the most exten-
sively studied approach, followed by ABA, in SLT for indi-
PMI for challenging behaviors viduals with autism [97]. Therefore, it is recommended that
Studies investigating the effectiveness of PMI for challeng- parents seeking SLT services first evaluate whether the inter-
ing behaviors, such as aggression and self-injurious behav- vention goals of a prospective SLP are appropriate for their
iors, have been actively conducted. In this type of PMI, a cer- child’s needs and whether the intervention model employed
tified ABA therapist (e.g., BCBA or BCaBA10)) runs individual is evidence-based [98].
or small-group sessions for 4–16 weeks to teach parent-spe-
cific behavioral skills to deal with challenging behaviors, Sensory integration therapy
which include both didactic lectures and hands-on training Sensory-based interventions aim to enhance children’s
[89]. A meta-analysis reported that PMI reduced challenging levels of arousal and behavioral control through activities
behaviors (standardized mean difference [SMD]=0.67) and such as wearing weighted vests or swinging [99]. Although
hyperactivity (SMD=0.31) in children, as well as parenting it is often used as an intervention to improve core symptoms
stress (SMD=0.37) [90]. Recently, a study reported that tele- in children with autism, there is currently limited evidence
health-based PMI could be as effective as in-person PMI in supporting its efficacy [99,100].
reducing challenging behaviors [91]. Social distancing poli-
cies implemented during the COVID-19 pandemic have fa- Developmental approaches
cilitated the adoption of long-distance service delivery meth- Developmental approaches prioritize child-led spontane-
ods, including telehealth and internet-based services. These ous play and joint attention with adults to enhance the com-
are expected to continue even after the pandemic ends be- munication skills of young children with autism. In Korea, the
DIR/FloorTime [101] and Hanen’s More than Words [102]
10) B
 CBA, Board Certified Behavior Analyst; BCaBA, Board Certified Assistant Behav-
ior Analyst. See bacb.com for more information. programs have been introduced, but scientific evidence for

http://www.jkacap.org 33
Behavioral and Educational Intervention for Individuals With ASD

their effectiveness needs to be more consistent or sufficient tioning students that provides lessons promoting cognitive
[75,103]. and behavioral flexibility in everyday situations [112].

Treatment and Education of Autistic and Related FUTURE DIRECTION

Communication-handicapped Children
According to Wong et al. [41], the CTM category includes The traditional model of evidence-based practice has pri-
the Treatment and Education of Autistic and Related Com- marily relied on comparing averages from group compari-
munication-handicapped Children (TEACCH). Along with son studies, such as RCTs. Although this approach provides
ABA, it is one of the most widely recognized comprehensive valuable information about the effectiveness of treatments,
intervention models [104]. The TEACCH emphasizes the it does not reveal individual effects and differences. The
importance of creating a highly structured environment and mixed results often observed in group-comparison studies
actively using visual support to facilitate communication may be due to the heterogeneity of ASD symptoms. Hence,
and learning based on the theorized profile of the unique there is a growing need for personalized assessment and
strengths and needs of individuals with ASD [100]. While treatment approaches.
TEACCH has been widely used in clinical settings, such as In recent years, advancements in information and com-
special education or clinics, evidence for its effectiveness has munication technology and the Research Domain Criteria
been mixed. An earlier meta-analysis reported limited ef- model have facilitated the collection of digital phenotyping,
fectiveness [105]. However, more recent research has report- behavioral, and neurobiological data, and these datasets are
ed that it can improve cognitive and language skills, as well rapidly accumulating in the ASD population. These develop-
as reduce stress in caregivers [106]. Further research is re- ments promise to enable individualized assessment, treat-
quired to establish the effectiveness of TEACCH in autism ment customization, and real-time monitoring. Consequent-
interventions. ly, as tailored assessments and interventions become more
accessible in the near future, guidelines should reflect on
Social stories the implications of this transformative shift.
Social stories teach social cognition and appropriate so- Additionally, there have been recent developments in re-
cial behaviors for children with autism by using stories that search models, such as the Autism Europe Project and the
describe specific social situations in simple sentences for Autism Innovative Medicine Studies-2 (AIMS-2) Trials Proj-
children with autism [107]. Some single-subject design stud- ect, which are currently underway. It is essential to incorpo-
ies have found that social stories are effective in reducing rate the relevant results from these new models into future
inappropriate behaviors. However, recent systematic reviews guidelines, as they demonstrate promising outcomes and
have consistently concluded that there still needs to be more provide solid research results that support their efficacy.
evidence to consider social stories as evidence-based prac-
tice [107,108]. SUMMARY
Newly introduced interventions CTM
Newly introduced interventions are considered promis- • EIBI provides comprehensive intervention in most de-
ing, but further research is required to establish their evi- velopmental areas, including language, cognition, self-help
dence base. These interventions include PEERS, Pediatric skills, social skills, and adaptive behaviors. It typically begins
Autism Communication Therapy (PACT), Research Units before the age of 3 and involves receiving intervention for at
in Behavioral Intervention (RUBI), and Unstuck and On- least two years. Previous studies have reported significant
target interventions. The PEERS program targets teenage ad- improvements in the outcomes of children receiving EIBI.
olescents to improve their social competence and social skills, • In addition to the basic principles of EIBI, NDBIs, which
leading to enhancements in social skills, knowledge, social emphasize interacting with children in natural settings and
responsiveness, and overall social skills, encompassing social developing communication skills, have also been shown to
communication and social cognition [109]. PACT uses spe- improve language, imitation, and social initiation. However,
cific video feedback techniques to help recognize, respond more rigorous research is required to confirm the effective-
to, and enhance parent-child communication [110]. RUBI is ness of NDBIs.
a parent training program developed to decrease challenging
behaviors in children with ASD [111]. Unstuck and On-target Focused intervention
is a classroom-based intervention approach for high-func- • Social skills: SST, which teaches specific social skills based

34
 KM Chung, et al.

on behavioral principles, has consistently been shown to be Author Contributions

effective in improving social skills in individuals of all ages, Conceptualization: Kyong-Mee Chung. Data curation: all authors.
including infants, children, adolescents, and adults. Formal analysis: Eunsun Chung, Hoomyung Lee. Funding acquisi-
tion: Kyong-Mee Chung. Investigation: Eunsun Chung, Hoomyung
• Social communication: PECS, which uses picture cards to
Lee. Methodology: all authors. Project administration: Kyong-Mee
teach communication skills, is a well-established intervention Chung. Resources: Kyong-Mee Chung. Software: Kyong-Mee Chung.
that is effective in teaching individuals how to make requests Supervision: Kyong-Mee Chung. Validation: Kyong-Mee Chung. Vi-
or initiate conversations. However, further research is need- sualization: all authors. Writing—original draft: Eunsun Chung,
ed to establish its effectiveness in speech development. Hoomyung Lee. Writing—review & editing: Kyong-Mee Chung.
• Sleep: While the most effective techniques may vary de- ORCID iDs
pending on the specific sleep problem, behavioral interven- Kyong-Mee Chung https://orcid.org/0000-0002-1197-4156
tions such as delaying sleep time, gradual extinction, and Eunsun Chung https://orcid.org/0009-0005-8419-5195
scheduled awakening have been reported to be effective in Hoomyung Lee https://orcid.org/0009-0003-8382-3044
reducing sleep problems in individuals with autism.
• Eating problems: As with sleep problems, behavioral in- Funding Statement
terventions have been shown to reduce eating problems among This study was supported by the Ministry of Health and Welfare,
Behavior and Development Center, and the Headquarters of the Na-
individuals with autism. Contingent rewards and NRSs are
tional Autism and Developmental Disorders Centers.
the most commonly used and reported to be effective.
• Toilet training: Behavioral interventions such as shaping, REFERENCES
gradual guidance, scheduling, toileting, and stimulus con- 1) Hyman SL, Levy SE, Myers SM; COUNCIL ON CHILDREN
trol have been reported to be effective in toilet training in in- WITH DISABILITIES, SECTION ON DEVELOPMENTAL
dividuals with autism. AND BEHAVIORAL PEDIATRICS. Identification, evaluation,
and management of children with autism spectrum disorder. Pe-
• Emotional difficulties: CBT is the most effective treatment diatrics 2020;145:e20193447.
for emotional problems such as depression, anxiety, and an- 2) Skinner BF. The experimental analysis of behavior. Am Sci 1957;
ger in individuals with autism. Assessment of verbal and 45:343-371.
3) Watson JB. Behaviorism. Chicago, IL: University of Chicago Press;
cognitive abilities is required before CBT can be applied. 1930.
4) Lovaas OI, Schreibman L, Koegel RL. A behavior modification
Parent education and other non-behavioral approach to the treatment of autistic children. J Autism Child
Schizophr 1974;4:111-129.
interventions 5) Whitman TL, Scibak JW, Reid DH. Behavior modification with
• PMI, for comprehensive early intervention, which trains the severely and profoundly retarded: research and application.
parents to implement various intervention techniques with New York: Academic Press;1983.
6) Cooper JO, Heron TE, Heward WL. Applied behavior analysis.
their children directly, has been widely used, either in com- 2nd ed. Upper Saddle River, NJ: Pearson Education;2007.
bination with EIBI or as a standalone approach. In recent years, 7) Bradshaw J, Steiner AM, Gengoux G, Koegel LK. Feasibility and
P-ESDM has emerged as an effective intervention method effectiveness of very early intervention for infants at-risk for au-
tism spectrum disorder: a systematic review. J Autism Dev Dis-
for improving functions in children, such as parent-child in- ord 2015;45:778-794.
teractions and language. 8) Volkmar F, Siegel M, Woodbury-Smith M, King B, McCracken J,
• PMI for challenging behaviors, which teaches parent- State M. Practice parameter for the assessment and treatment of
children and adolescents with autism spectrum disorder. J Am
specific behavioral skills to deal with the behaviors of their
Acad Child Adolesc Psychiatry 2014;53:237-257.
children, has consistently been shown to be effective in re- 9) Centers for Disease Control and Prevention. Treatment and in-
ducing challenging behaviors, hyperactivity, and parenting tervention services for autism spectrum disorder [Internet]. At-
lanta, GA: Centers for Disease Control and Prevention [cited
stress.
2023 Mar 3]. Available from: https://www.cdc.gov/ncbddd/au-
• When considering an intervention method with uncer- tism/treatment.html.
tain evidence, it is important to have thorough discussions 10) Prior M, Roberts J. Early intervention for children with autism
spectrum disorders: ‘guidelines for good practice’ 2012 [Internet].
between parents and experts using the most up-to-date sci-
Canberra: Australian Government Department of Social Servic-
entific knowledge available. es [cited 2023 Mar 3]. Available from: https://www.dss.gov.au/
sites/default/files/documents/08_2014/6006_-_accessible_-_ear-
Availability of Data and Material ly_intervention_practice_guidelines_0.pdf.
The datasets generated or analyzed during the study are available 11) Society of Clinical Child and Adolescent Psychology. Autism
from the corresponding author on reasonable request. spectrum disorder [Internet]. Washington, DC: Society of Clini-
cal Child and Adolescent Psychology [cited 2023 Mar 3]. Avail-
Conflicts of Interest able from: https://effectivechildtherapy.org/concerns-symptoms-
The authors have no potential conflicts of interest to disclose. disorders/disorders/autism/.

http://www.jkacap.org 35
Behavioral and Educational Intervention for Individuals With ASD

12) Anderson SR, Cohen I, Cohen S, Cook T, Decker L, Grant C, et 28) Fulton E, Eapen V, Crnčec R, Walter A, Rogers S. Reducing mal-
al. Clinical practice guideline on assessment and intervention ser- adaptive behaviors in preschool-aged children with autism spec-
vices for young children with autism spectrum disorders (ASD): trum disorder using the early start Denver model. Front Pediatr
2017 update [Internet]. Albany, NY: New York State Department 2014;2:40.
of Health [cited 2023 Mar 3]. Available from: https://www. 29) Waddington H, van der Meer L, Sigafoos J. Effectiveness of the
health.ny.gov/publications/20152.pdf. early start Denver model: a systematic review. Rev J Autism Dev
13) Autism Task Force; Washington State Department of Health. Au- Disord 2016;3:93-106.
tism guidebook for Washington State: a resource for individuals, 30) Fuller EA, Oliver K, Vejnoska SF, Rogers SJ. The effects of the
families, and professionals [Internet]. Tumwater, WA: Washing- early start Denver model for children with autism spectrum dis-
ton State Department of Health [cited 2023 Mar 3]. Available order: a meta-analysis. Brain Sci 2020;10:368.
from: https://www.doh.wa.gov/Portals/1/Documents/8340/970- 31) Kasari C, Freeman S, Paparella T. Joint attention and symbolic
NonDOH-AutismGd-en-L.pdf. play in young children with autism: a randomized controlled in-
14) Maine Autism Institute for Education and Research. Maine par- tervention study. J Child Psychol Psychiatry 2006;47:611-620.
ent guide to autism spectrum disorders. Booklet 3: resource guide 32) Wetherby AM, Guthrie W, Woods J, Schatschneider C, Holland
for Maine families [Internet]. Orono, ME: Maine Autism Institute RD, Morgan L, et al. Parent-implemented social intervention for
for Education and Research [cited 2023 Mar 3]. Available from: toddlers with autism: an RCT. Pediatrics 2014;134:1084-1093.
ht t ps://umaine.edu /autisminstit ute/w p-content/uploads/ 33) Koegel RL, Koegel LK. Pivotal response treatments for autism:
sites/150/2016/02/MAIER-Parent-Booklet-3.pdf. communication, social, & academic development. Baltimore, MD:
15) Lovaas OI. Behavioral treatment and normal educational and in- 2006 Paul H Brookes Publishing;2006.
tellectual functioning in young autistic children. J Consult Clin 34) Koo BK, Chung KM. Effectiveness of an early intensive behavior
Psychol 1987;55:3-9. intervention for infants with ASD: a preliminary study. J Korean
16) Eldevik S, Hastings RP, Hughes JC, Jahr E, Eikeseth S, Cross S. Assoc Persons Autism 2018;18:1-30.
Meta-analysis of early intensive behavioral intervention for chil- 35) Cappadocia MC, Weiss JA. Review of social skills training groups
dren with autism. J Clin Child Adolesc Psychol 2009;38:439-450. for youth with Asperger syndrome and high functioning autism.
17) Makrygianni MK, Reed P. A meta-analytic review of the effec- Res Autism Spectr Disord 2011;5:70-78.
tiveness of behavioural early intervention programs for children 36) Bellini S, Peters JK. Social skills training for youth with autism
with autistic spectrum disorders. Res Autism Spectr Disord 2010; spectrum disorders. Child Adolesc Psychiatr Clin N Am 2008;17:
4:577-593. 857-873.
18) Peters-Scheffer N, Didden R, Korzilius H, Sturmey P. A meta-an- 37) Rao PA, Beidel DC, Murray MJ. Social skills interventions for
alytic study on the effectiveness of comprehensive ABA-based children with Asperger’s syndrome or high-functioning autism:
early intervention programs for children with autism spectrum a review and recommendations. J Autism Dev Disord 2008;38:
disorders. Res Autism Spectr Disord 2011;5:60-69. 353-361.
19) Reichow B, Wolery M. Comprehensive synthesis of early inten- 38) Williams White S, Keonig K, Scahill L. Social skills development
sive behavioral interventions for young children with autism based in children with autism spectrum disorders: a review of the inter-
on the UCLA young autism project model. J Autism Dev Disord vention research. J Autism Dev Disord 2007;37:1858-1868.
2009;39:23-41. 39) Gates JA, Kang E, Lerner MD. Efficacy of group social skills in-
20) Reichow B, Barton EE, Boyd BA, Hume K. Early intensive behav- terventions for youth with autism spectrum disorder: a systemat-
ioral intervention (EIBI) for young children with autism spectrum ic review and meta-analysis. Clin Psychol Rev 2017;52:164-181.
disorders (ASD). Cochrane Database Syst Rev 2012;10:CD009260. 40) Soares EE, Bausback K, Beard CL, Higinbotham M, Bunge EL,
21) Reichow B, Barton EE, Boyd BA, Hume K. Early intensive behav- Gengoux GW. Social skills training for autism spectrum disorder:
ioral intervention (EIBI) for young children with autism spectrum a meta-analysis of in-person and technological interventions. J
disorders (ASD): a systematic review. Campbell Syst Rev 2014;10: Technol Behav Sci 2021;6:166-180.
1-116. 41) Wong C, Odom SL, Hume KA, Cox AW, Fettig A, Kucharczyk S,
22) Caron V, Bérubé A, Paquet A. Implementation evaluation of early et al. Evidence-based practices for children, youth, and young
intensive behavioral intervention programs for children with au- adults with autism spectrum disorder: a comprehensive review. J
tism spectrum disorders: a systematic review of studies in the last Autism Dev Disord 2015;45:1951-1966.
decade. Eval Program Plann 2017;62:1-8. 42) French L, Kennedy EMM. Annual research review: early inter-
23) Zwaigenbaum L, Bauman ML, Choueiri R, Kasari C, Carter A, vention for infants and young children with, or at-risk of, autism
Granpeesheh D, et al. Early intervention for children with autism spectrum disorder: a systematic review. J Child Psychol Psychia-
spectrum disorder under 3 years of age: recommendations for try 2018;59:444-456.
practice and research. Pediatrics 2015;136(Suppl 1):S60-S81. 43) Shire SY, Gulsrud A, Kasari C. Increasing responsive parent-child
24) Reichow B, Hume K, Barton EE, Boyd BA. Early intensive behav- interactions and joint engagement: comparing the influence of par-
ioral intervention (EIBI) for young children with autism spectrum ent-mediated intervention and parent psychoeducation. J Autism
disorders (ASD). Cochrane Database Syst Rev 2018;5:CD009260. Dev Disord 2016;46:1737-1747.
25) Rodgers M, Marshall D, Simmonds M, Le Couteur A, Biswas M, 44) Waddington H, Reynolds JE, Macaskill E, Curtis S, Taylor LJ,
Wright K, et al. Interventions based on early intensive applied be- Whitehouse AJ. The effects of JASPER intervention for children
haviour analysis for autistic children: a systematic review and cost- with autism spectrum disorder: a systematic review. Autism 2021;
effectiveness analysis. Health Technol Assess 2020;24:1-306. 25:2370-2385.
26) Schreibman L, Dawson G, Stahmer AC, Landa R, Rogers SJ, Mc- 45) Mirenda P. Toward functional augmentative and alternative com-
Gee GG, et al. Naturalistic developmental behavioral interven- munication for students with autism: manual signs, graphic sym-
tions: empirically validated treatments for autism spectrum disor- bols, and voice output communication aids. Lang Speech Hear
der. J Autism Dev Disord 2015;45:2411-2428. Serv Sch 2003;34:203-216.
27) Rogers SJ, Dawson G. Early start Denver model for young children 46) Charlop-Christy MH, Carpenter M, Le L, LeBlanc LA, Kellet K.
with autism: promoting language, learning, and engagement. New Using the picture exchange communication system (PECS) with
York: Guilford Press;2010. children with autism: assessment of PECS acquisition, speech,

36
 KM Chung, et al.

social-communicative behavior, and problem behavior. J Appl Be- 67) Menezes M, Harkins C, Robinson MF, Mazurek MO. Treatment
hav Anal 2002;35:213-231. of depression in individuals with autism spectrum disorder: a sys-
47) Preston D, Carter M. A review of the efficacy of the picture ex- tematic review. Res Autism Spectr Disord 2020;78:101639.
change communication system intervention. J Autism Dev Disord 68) Sukhodolsky DG, Bloch MH, Panza KE, Reichow B. Cognitive-
2009;39:1471-1486. behavioral therapy for anxiety in children with high-functioning
48) Ostryn C, Wolfe PS, Rusch FR. A review and analysis of the pic- autism: a meta-analysis. Pediatrics 2013;132:e1341-e1350.
ture exchange communication system (PECS) for individuals 69) Sofronoff K, Attwood T, Hinton S, Levin I. A randomized con-
with autism spectrum disorders using a paradigm of communi- trolled trial of a cognitive behavioural intervention for anger man-
cation competence. Res Pract Pers Sev Disabil 2008;33:13-24. agement in children diagnosed with Asperger syndrome. J Autism
49) Flippin M, Reszka S, Watson LR. Effectiveness of the picture ex- Dev Disord 2007;37:1203-1214.
change communication system (PECS) on communication and 70) Lickel A, MacLean WE Jr, Blakeley-Smith A, Hepburn S. Assess-
speech for children with autism spectrum disorders: a meta-anal- ment of the prerequisite skills for cognitive behavioral therapy in
ysis. Am J Speech Lang Pathol 2010;19:178-195. children with and without autism spectrum disorders. J Autism
50) Cuomo BM, Vaz S, Lee EAL, Thompson C, Rogerson JM, Falk- Dev Disord 2012;42:992-1000.
mer T. Effectiveness of sleep-based interventions for children 71) Rotheram-Fuller E, MacMullen L. Cognitive-behavioral therapy
with autism spectrum disorder: a meta-synthesis. Pharmacother- for children with autism spectrum disorders. Psychol Sch 2011;48:
apy 2017;37:555-578. 263-271.
51) Keogh S, Bridle C, Siriwardena NA, Nadkarni A, Laparidou D, 72) Kasari C, Gulsrud A, Paparella T, Hellemann G, Berry K. Ran-
Durrant SJ, et al. Effectiveness of non-pharmacological interven- domized comparative efficacy study of parent-mediated interven-
tions for insomnia in children with autism spectrum disorder: a tions for toddlers with autism. J Consult Clin Psychol 2015;83:554-
systematic review and meta-analysis. PLoS One 2019;14:e0221428. 563.
52) Vriend JL, Corkum PV, Moon EC, Smith IM. Behavioral inter- 73) Bearss K, Burrell TL, Stewart L, Scahill L. Parent training in au-
ventions for sleep problems in children with autism spectrum dis- tism spectrum disorder: what’s in a name? Clin Child Fam Psy-
orders: current findings and future directions. J Pediatr Psychol chol Rev 2015;18:170-182.
2011;36:1017-1029. 74) Lee JD, Meadan H. Parent-mediated interventions for children
53) Weiskop S, Richdale A, Matthews J. Behavioural treatment to re- with ASD in low-resource settings: a scoping review. Rev J Au-
duce sleep problems in children with autism or fragile X syndrome. tism Dev Disord 2021;8:285-298.
Dev Med Child Neurol 2005;47:94-104. 75) Smith T, Iadarola S. Evidence base update for autism spectrum
54) Marshall J, Ware R, Ziviani J, Hill RJ, Dodrill P. Efficacy of inter- disorder. J Clin Child Adolesc Psychol 2015;44:897-922.
ventions to improve feeding difficulties in children with autism 76) Karst JS, Van Hecke AV. Parent and family impact of autism spec-
spectrum disorders: a systematic review and meta-analysis. Child trum disorders: a review and proposed model for intervention eval-
Care Health Dev 2015;41:278-302. uation. Clin Child Fam Psychol Rev 2012;15:247-277.
55) Sharp WG, Burrell TL, Jaquess DL. The autism MEAL plan: a 77) Oono IP, Honey EJ, McConachie H. Parent-mediated early inter-
parent-training curriculum to manage eating aversions and low vention for young children with autism spectrum disorders (ASD).
intake among children with autism. Autism 2014;18:712-722. Evid-Based Child Health 2013;8:2380-2479.
56) Ingersoll B, Dvortcsak A. Including parent training in the early 78) Nevill RE, Lecavalier L, Stratis EA. Meta-analysis of parent-medi-
childhood special education curriculum for children with autism ated interventions for young children with autism spectrum dis-
spectrum disorders. Topics Early Child Spec Educ 2006;26:179-187. order. Autism 2018;22:84-98.
57) Perez BC, Bacotti JK, Peters KP, Vollmer TR. An extension of 79) Rogers SJ, Estes A, Lord C, Vismara L, Winter J, Fitzpatrick A, et
commonly used toilet-training procedures to children with autism al. Effects of a brief early start Denver model (ESDM)-based par-
spectrum disorder. J Appl Behav Anal 2020;53:2360-2375. ent intervention on toddlers at risk for autism spectrum disorders:
58) Kroeger KA, Sorensen-Burnworth R. Toilet training individuals a randomized controlled trial. J Am Acad Child Adolesc Psychia-
with autism and other developmental disabilities: a critical re- try 2012;51:1052-1065.
view. Res Autism Spectr Disord 2009;3:607-618. 80) Vismara LA, Rogers SJ. Coaching parents of young children with
59) Coucouvanis JA. The potty journey: guide to toilet training chil- autism. In: Siller M, Morgan L, editors. Handbook of parent-im-
dren with special needs, including autism and related disorders. plemented interventions for very young children with autism.
Shawnee, KS: AAPC Publishing;2008. Cham: Springer;2018. p.191-208.
60) Azrin NH, Foxx RM. A rapid method of toilet training the insti- 81) Rogers SJ, Estes A, Vismara L, Munson J, Zierhut C, Greenson J,
tutionalized retarded. J Appl Behav Anal 1971;4:89-99. et al. Enhancing low-intensity coaching in parent implemented
61) Matson JL, Hattier MA, Belva B. Treating adaptive living skills of early start Denver model intervention for early autism: a random-
persons with autism using applied behavior analysis: a review. Res ized comparison treatment trial. J Autism Dev Disord 2019;49:
Autism Spectr Disord 2012;6:271-276. 632-646.
62) Doan D, Toussaint KA. A parent-oriented approach to rapid toi- 82) Zhou B, Xu Q, Li H, Zhang Y, Wang Y, Rogers SJ, et al. Effects of
let training. Int Electron J Elem Educ 2016;9:473-486. parent-implemented early start Denver model intervention on
63) Richardson D. Toilet training for children with autism. Nurs Child Chinese toddlers with autism spectrum disorder: a non-random-
Young People 2016;28:16-22. ized controlled trial. Autism Res 2018;11:654-666.
64) Anderson JR. Acquisition of cognitive skill. Psychol Rev 1982; 83) Vismara LA, Young GS, Rogers SJ. Telehealth for expanding the
89:369-406. reach of early autism training to parents. Autism Res Treat 2012;
65) Simon M, Wilkes-Gillan S, Chen YWR, Cordier R, Cantrill A, 2012:121878.
Parsons L, et al. Toilet training interventions for children with au- 84) Rooks-Ellis D, Howorth SK, Kunze M, Boulette S, Sulinski E. Ef-
tism spectrum disorder: a systematic review. Res Autism Spectr fects of a parent training using telehealth: equity and access to
Disord 2022;99:102049. early intervention for rural families. J Child Educ Soc 2020;1:141-
66) Ambler PG, Eidels A, Gregory C. Anxiety and aggression in ado- 166.
lescents with autism spectrum disorders attending mainstream 85) Vismara LA, McCormick CE, Wagner AL, Monlux K, Nadhan A,
schools. Res Autism Spectr Disord 2015;18:97-109. Young GS. Telehealth parent training in the early start Denver

http://www.jkacap.org 37
Behavioral and Educational Intervention for Individuals With ASD

model: results from a randomized controlled study. Focus Autism sensory processing interventions for children with autism spec-
Other Dev Disabl 2018;33:67-79. trum disorders. Autism 2015;19:133-148.
86) Nam BR, Lee SH. The effects of mother mediated joint attention- 100) Sandbank M, Bottema-Beutel K, Crowley S, Cassidy M, Dunham
focused play on precursors of joint attention and joint attention K, Feldman JI, et al. Project AIM: autism intervention meta-anal-
behaviors of toddlers with autism spectrum disorders. J Korean ysis for studies of young children. Psychol Bull 2020;146:1-29.
Assoc Persons Autism 2014;14:21-45. 101) Greenspan SI, Wieder S. Developmental patterns and outcomes
87) Lee HM, Chung KM. Effects of an early start Denver model-based in infants and children with disorders in relating and communicat-
parent training for parents of children with autism: a preliminary ing: a chart review of 200 cases of children with autistic spectrum
study. J Korean Assoc Persons Autism 2020;20:23-49. diagnoses. J Dev Learn Disord 1997;1:87-142.
88) Lim HS, Kim EK. Effects of parent-mediated pivotal response 102) Sussman F, Lewis RB. More than words: a guide to helping parents
training on social communicative behaviors of preschooler with promote communication and social skills in children with autism
autism spectrum disorder. J Emot Behav Disord 2013;29:121-148. spectrum disorder. Toronto: Hanen Centre;1999.
89) Bearss K, Johnson C, Smith T, Lecavalier L, Swiezy N, Aman M, 103) Carter AS, Messinger DS, Stone WL, Celimli S, Nahmias AS, Yo-
et al. Effect of parent training vs parent education on behavioral der P. A randomized controlled trial of Hanen’s ‘more than words’
problems in children with autism spectrum disorder: a random- in toddlers with early autism symptoms. J Child Psychol Psychia-
ized clinical trial. JAMA 2015;313:1524-1533. try 2011;52:741-752.
90) Tarver J, Palmer M, Webb S, Scott S, Slonims V, Simonoff E, et al. 104) Humphrey N, Parkinson G. Research on interventions for chil-
Child and parent outcomes following parent interventions for child dren and young people on the autistic spectrum: a critical perspec-
emotional and behavioral problems in autism spectrum disorders: tive. J Res Spec Educ Needs 2006;6:76-86.
a systematic review and meta-analysis. Autism 2019;23:1630-1644. 105) Virues-Ortega J, Julio FM, Pastor-Barriuso R. The TEACCH pro-
91) Lindgren S, Wacker D, Suess A, Schieltz K, Pelzel K, Kopelman T, gram for children and adults with autism: a meta-analysis of in-
et al. Telehealth and autism: treating challenging behavior at low- tervention studies. Clin Psychol Rev 2013;33:940-953.
er cost. Pediatrics 2016;137(Suppl 2):S167-S175. 106) Sanz-Cervera P, Fernández-Andrés I, Pastor-Cerezuela G, Tár-
92) Kirkpatrick B, Louw JS, Leader G. Efficacy of parent training raga-Mínguez R. The effectiveness of TEACCH intervention in
incorporated in behavioral sleep interventions for children with autism spectrum disorder: a review study. Pap Psicol 2018;39:40-
autism spectrum disorder and/or intellectual disabilities: a sys- 50.
tematic review. Sleep Med 2019;53:141-152. 107) Qi CH, Barton EE, Collier M, Lin YL, Montoya C. A systematic
93) Johnson CR, Turner KS, Foldes E, Brooks MM, Kronk R, Wiggs L. review of effects of social stories interventions for individuals
Behavioral parent training to address sleep disturbances in young with autism spectrum disorder. Focus Autism Other Dev Disabl
children with autism spectrum disorder: a pilot trial. Sleep Med 2018;33:25-34.
2013;14:995-1004. 108) Wahman CL, Pustejovsky JE, Ostrosky MM, Santos RM. Exam-
94) Shin HY, Chung KM. Effects of behavioral parent training for ining the effects of Social StoriesTM on challenging behavior and
parents of children with developmental disabilities: comparison prosocial skills in young children: a systematic review and meta-
of theory-based training and practice-based training. Kor J Clin analysis. Topics Early Child Spec Educ 2022;41:267-279.
Psychol 2014;33:221-242. 109) Laugeson EA, Frankel F, Gantman A, Dillon AR, Mogil C. Evi-
95) Chung KM, Lee Y, Park S, Suh YJ. The effect of behavioral parent dence-based social skills training for adolescents with autism
training on problem behaviors of persons with DD and collateral spectrum disorders: the UCLA PEERS program. J Autism Dev
effects on mothers: a single-group pre-post treatment design. Kor Disord 2012;42:1025-1036.
J Clin Psychol 2021;40:352-364. 110) Green J, Charman T, McConachie H, Aldred C, Slonims V, How-
96) Park HO, Kim JH. The effects of parental education program fo- lin P, et al. Parent-mediated communication-focused treatment in
cused on problem behavior of infants with developmental disabil- children with autism (PACT): a randomised controlled trial. Lan-
ities. J Dev Disabil 2021;25:83-105. cet 2010;375:2152-2160.
97) Binns AV, Smyth R, Andres A, Lam J, Oram Cardy J. Looking 111) Edwards GS, Zlomke KR, Greathouse AD. RUBI parent training
back and moving forward: a scoping review of research on pre- as a group intervention for children with autism: a community pi-
school autism interventions in the field of speech-language pa- lot study. Res Autism Spectr Disord 2019;66:101409.
thology. Autism Dev Lang Impair 2021;6:23969415211033171. 112) Cannon L, Kenworthy L, Alexander KC, Werner MA, Anthony L.
98) Ebbels SH, McCartney E, Slonims V, Dockrell JE, Norbury CF. Unstuck and on target! An executive function curriculum to im-
Evidence-based pathways to intervention for children with lan- prove flexibility for children with autism spectrum disorders.
guage disorders. Int J Lang Commun Disord 2019;54:3-19. Baltimore, MD: Brookes Publishing;2011.
99) Case-Smith J, Weaver LL, Fristad MA. A systematic review of

38