National Clearinghouse on Autism Evidence & Practice (NCAEP): Updating a Large Scale Systematic Review of Behavioral Interventions for Children and Youth with ASD

Background: The National Professional Development Center on ASD (NPDC) completed a review of literature published between 1990-2011 and identified 27 evidence-based practices (EBPs) for individuals with ASD from birth through age 21. These findings have had a broad impact on the field since their publication in 2015 (e.g. seminal manuscript cited over 750 times; online AFIRM modules with over 60,000 users that support the use of each practice; identified by IACC as one of the top 20 scientific advances in ASD research). These findings are dated, however, and the National Clearinghouse on Autism Evidence and Practice (NCAEP) is conducting an updated review of the literature and new findings related to the identification of EBPs will be available for IMFAR 2019.

Objectives: The objectives of this session are to (1) identify new practices that have met the criteria for identification as an evidence based practice, (2) identify for whom they are effective (including race, ethnicity, and nationality data of study participants) and (3) identify for what outcomes the practices have an effect.

Methods: The NCAEP team used the same search strategy as the 1990-2011 systematic review, for peer-reviewed articles using variations of the terms (1) autism(e.g., ASD, Asperger) and (2) intervention (e.g., treatment, program, education). The inclusion criteria are experimental or quasi-experimental studies (single-case design and group design) that examine a behavioral, educational, or developmental (i.e., non-medical) intervention for individuals with ASD from birth through 22 years old. The following steps were completed for the systematic review: (1) search of 9 databases, (2) deduplication of search results, (3) title/abstract review (NCAEP team), (4) full-text review for inclusion (NCAEP team), (5) quality review, determination of effects, and preliminary data extraction (NCAEP trained external reviewers), and (6) consensus decision for quality and presence of effects as needed (NCAEP team). The NCAEP team is currently in the process, of reviewing and finalizing the data extraction, which is combining the information about effects, interventions, outcomes, and participants across the 1990-2011 and 2012-2017 reviews.

Results: The 2012-2017 review started with over 61,000 articles in the initial search. Currently, 640 articles have met quality criteria. See the PRISMA chart in Figure 1 for additional details about the numbers of articles during each phase of the review. Preliminary participant data indicates that more studies include 6-11.9 year-olds (56.9%) and 3-5.9 year-olds (44.6%) participants, with fewer studies including 12-14.9 year-olds (27.2%), 15-18 year-olds (18.8%), and the fewest studies including children under 3 years old (9%) and 19-22 year-olds (6%) . Also, only about 30% of included articles report race, ethnicity or nationality data. Early data shows that social (39.5%) and communication (21.0%) domains are the most common intervention targets.

Conclusions: The updated systematic review of behavioral and developmental interventions is an important step to continue to move research and practice forward to improve outcomes for children and youth with ASD. New evidence will likely shift current practice categories (e.g.technology based interventions), identify new EBPs, and provide additional data related to the efficacy of interventions for diverse populations.