Choosing interventions for autism spectrum disorder

Choosing interventions for autism spectrum disorder

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Choosing evidence-based interventions for autism spectrum disorder

You wouldn't give your child a medicine if you didn't believe it worked, or if it hadn't been tested as effective and safe to use. So before you assume that an intervention for autism spectrum disorder (ASD) is effective and safe, it's best to look for reliable information about it.

Interventions that are based on scientifically validated and reliable evidence are the ones most likely to:

  • help your child
  • be worth the time, money and energy you have to invest
  • be safe for your child.

Here are some tips for choosing wisely and thinking critically about individual interventions.

Question the claims
Sometimes it's hard to know whether an intervention for ASD really helps children. Often this is because it's not clear what claims are being made about the intervention, or what the outcomes of the intervention are supposed to be.

For example, the claim might be that an intervention will help your child to 'behave better', 'be more social', or even 'cure' your child.

To find out whether claims are valid, you might ask:

  • How will you know whether the intervention has worked?
  • What does 'better', 'improvement' or 'cure' really mean? That is, what changes in your child should you expect to see?
  • How will the changes be measured?
  • Could the changes be measured by anyone (objectively)?
  • Is there a risk of bias, or of seeing what you want to see?

Question the evidence
It's easy to feel overloaded with information about interventions or convinced something will work - after all, you want to help your child. You might get conflicting advice (even from professionals) about what will help.

Under these circumstances, it's worth asking what evidence there is that the intervention does what it says - and how good that evidence is. You won't always be able to find clear and conclusive evidence. For example, the research might say the intervention helps only some children or some problems. It's still best to get as much information as you can.

Here are some questions that can help you work out what evidence there is for the intervention, and how good the evidence is:

  • Has the intervention been tested?
  • Has it been tried with children like your child?
  • Could the test be influenced by the person doing the research?
  • During the test, could other factors like parent or therapist expectations have influenced the results? What about the placebo effect?
  • Was a control group (or 'comparison group') used in the test?

Here are some questions you could ask about the science behind the intervention.

  • Have other people tested this therapy and come up with the same results? This also helps to ensure that the results one researcher got weren't because of other factors, and were in fact because of the therapy.
  • Were the results published in a scientific journal? This is important because results are looked at carefully by experts before they can be published in a journal. It means that you can rely on the results more than if the information is just on a website.
  • Were the results published more than once, or as part of a bigger study like a systematic review?
  • Can I get copies of what's published?
Evidence suggests that early interventions with a behavioural or educational focus have the best outcomes for most children with ASD. These interventions include those based on the principles of Applied Behaviour Analysis - for example, those that use Discrete Trial Training - and those that combine a behavioural and developmental approach.

Choosing interventions that fit your child and family

There are some practical and personal questions you'll need to consider alongside the evidence before committing yourself to an intervention. The following questions can help you decide whether an intervention is a viable option for your family:

  • Cost: is the intervention affordable? Can you get funding to help?
  • Time and involvement: some interventions are time consuming and need a lot of parent involvement. Can your family commit to this? What would you need to do to make it work?
  • Availability: is this intervention available in your area? Is there a way you can use it if it isn't? Are there places available in the program?
  • Child fit: does the intervention meet your child's current needs?
  • Family fit: does the intervention meet your family's goals and needs? Does the intervention fit with your family's beliefs and values? Or can adjustments be made to accommodate these?
Early intervention services often provide interventions and therapies as packages or programs. Read about the characteristics of a good intervention service.

Warning signs that interventions aren't worthwhile

Not all interventions work, and some can have risks. Here are some warning signs that an intervention might not be worth your time and money:

  • Claims that an intervention will cure your child or make your child 'normal': there is no cure for autism spectrum disorder (ASD).
  • Jargon: scientific-sounding language doesn't necessarily mean that the approach is scientific.
  • Interventions whose costs seem out of proportion to what they're offering: these might be more focused on profit than on helping your child.
  • Interventions that aren't appropriate for your child: these can waste time and energy that would be better spent on interventions that are likely to result in better outcomes.
  • Testimonials or anecdotes about the intervention: testimonials don't replace quality research. There might be many reasons why an intervention seems to have worked for families who give testimonials - for example, the family might have been doing something else that helped, the improvement might simply have been consistent with the child's expected development, or it might be the placebo effect.