Evidence-based Interventions in Autism Spectrum Disorder (ASD)
Autism Spectrum Disorders (ASDs) Services
Final Report on Environmental Scan
March 9, 2010
Recent estimates from the Centers for Disease Control and Prevention (CDC) indicate that the number of children diagnosed with autism is increasing. As the number of individuals diagnosed with Autism Spectrum Disorders (ASD) rises, budgetary constraints limit the capacity of states to provide related services and supports. To make the most effective use of limited resources, federal and state policymakers need empirical data to make informed decisions about which services and support systems are safe and cost-effective. Currently, relatively little is known about the effectiveness of many autism interventions and services. Few initiatives and studies have focused on providing information about the most effective services for individuals with ASD. To address this information need, the Centers for Medicare and Medicaid Services (CMS) contracted with IMPAQ International, LLC to conduct an environmental scan of the scientific evidence regarding the efficacy, effectiveness, safety, and availability of ASD-related psychosocial services and supports for children, transitioning youth, and adults with ASD. This report describes findings from the literature review, including data on the evidence base for interventions for individuals with autism across the age span as well as data on the significant costs associated with caring for individuals with autism. These data provide CMS with much-needed information to inform policy and funding decisions related to ASD services and supports.
The environmental scan focused on behavioral and psychosocial interventions (e.g., behavioral therapy services/supports) and did not include services traditionally considered medical or pharmaceutical. The search included manuscripts published in the ten years prior to the start of the environmental scan (1998 through 2008). An Information Gathering Template was developed to extract the most relevant information from each article reviewed. Each study was rated on a 9 point scale based on the rigor of the research design (e.g., study design, sample selection and potential for selection bias, sample size, effect on participants). The researchers grouped the interventions into the following three levels based upon the pool of evidence provided by the manuscripts reviewed: IMPAQ International, LLC Page ii Final Report on Environmental Scan Autism Spectrum Disorders (ASDs) Services Project.
- Level 1: Evidence-Based Interventions
- Level 2: Emerging Evidence-Based Interventions
- Level 3: Unestablished Interventions
Interventions were placed in levels 1, 2, or 3 based on the National Professional Development Centers (NPDC) criteria for assessing evidence-based practices. The researchers also reviewed relevant cost and funding literature relating to ASDs in the environmental scan. The results of this scan provide key information on each intervention category within the three evidence levels as well as a synthesis of the cost and funding articles.
Overview of Major Findings
While considerable evidence exists for interventions that target children, little evidence exists for interventions that target transitioning youth and adults with ASD.
A total of 214 studies covering 31 interventions were reviewed for children. Of these 31 interventions, almost half (48 percent) were rated as evidence-based, 42 percent were rated as emerging evidence-based, and 10 percent were rated as unestablished.
We reviewed studies providing evidence on 15 different interventions for transitioning youth with ASD. The majority of interventions (73 percent) were rated as unestablished. Few interventions (7 percent) met the criteria for evidence-based practices.
We found evidence of the effectiveness of only nine interventions for adults with ASD. One-third of the interventions (33 percent) were rated as evidence-based, only one intervention was rated as emerging evidence-based, and the majority (56 percent) was rated as unestablished.
The scan highlights the need for further research into effective interventions for individuals with ASD, specifically interventions that can be successfully implemented within community settings.