Use and Perceived Evidence-Base of Autism Spectrum Disorder Interventions By Allied Health Practitioners

Background: Recent reviews of the research have identified empirically-supported interventions for people with Autism Spectrum Disorders (ASD) (e.g., National Autism Centre, 2015; Wong et al., 2015). However, a research to practice gap is widely acknowledged (e.g., Cook, Cook, & Landrum, 2013) with continued use of interventions classified as unsupported (e.g., sensory integration), ineffective (e.g., facilitated communication), and/or harmful (e.g., chelation) reported by parents (e.g., Carlon, Stephenson, & Carter, 2014) and professionals (e.g., Kadar et al., 2012). Little is known about why specific practices are used by allied health professionals in the community, including their knowledge of the evidence base for their chosen practices, and what factors hinder or facilitate the use of empirically-supported treatments. This information is vital for bridging the research to practice gap and improving ASD intervention outcomes.

Objectives:  We aimed to explore reported levels of use of intervention strategies and their perceived evidence-base, and the impact of organisational culture, attitudes, and demographic variables on use of ASD interventions.

Methods:  Participants included 140 allied health staff (speech pathologists, occupational therapists, psychologists, and behaviour analysts) from across Australia who reported working with people with ASD. They completed an online survey that included measures of demographics, the Organisational Culture Questionnaire (Russell et al., 2010); the Evidence-based Attitudes Scales (Aarons, 2004), and the Intervention Practices Scale (Paynter & Keen, 2015). In addition, participants were asked to rate the level of empirical support for each practice.

Results:  Participants reported greater use of empirically-supported than emerging or unsupported practices. Participants’ use of empirically-supported, emerging, and unsupported practices was linked to the level of evidence of each category perceived by participants. This included greater use of unsupported practices by those rating them as having a stronger evidence base. Although participants generally rated unsupported practices correctly and more rarely used these practices, a significant minority reported continued use of unsupported and potentially harmful practices such as facilitated communication and reported beliefs that such practices were empirically-supported. Those who reported using more unsupported practices also reported greater openness to using a range of strategies and trended toward being more likely to use strategies if they personally appealed to them on the evidence-based attitudes scale. Greater use of empirically supported interventions showed a trend towards lower negative attitudes towards evidence-based practice. No significant links to organisational culture were found.

Conclusions:  This study adds to our understanding of the intervention practices used with people with ASD by allied health professionals. It also highlights the continued challenge of translating research to practice in ASD, in particular in terms of debunking misinformation about the effectiveness of strategies shown in research to be ineffective, an area that has to date received little attention. Future research using direct observation could extend this research through investigating the fidelity of implementation of practices and consistency with self-report. Such research would provide valuable insight into the strengths and needs of practitioners and would assist in developing strategies to support knowledge translation to allied health practitioners in the community.