courtesy of photoxpressThe goal of the National Standards Project was to investigate the strength of evidence for educational and behavior treatments for Autism Spectrum Disorders (ASD).

The report reviewed 775 studies conducted in a wide range of settings by educators, speech pathologists, psychologists, and occupational and physical therapists.
The study excluded research studies published after September 2007, those that did not include a numerical measure of effectiveness, studies that did not follow commonly agreed upon methodology, were not published in peer-reviewed journals, and were published in languages other than English.
The studies selected for inclusion sought to increase and/or decrease the following behaviors (as described by National Standards Project p. 44):
“Skills Targeted for Increase
Tasks required for success with school activities

Tasks that involve nonverbal or verbal methods of sharing experiences, emotions, information

Higher Cognitive Functions
Tasks that require complex problem-solving skills outside the social domain

Tasks that require social interaction with one or more individuals

Learning Readiness
Tasks that serve as the foundation for successful mastery of complex skills in other domains

Motor Skills
Tasks that require coordination of muscle systems to produce a specific goal involving either fine motor or gross motor skills

Personal Responsibility
Tasks that involve activities embedded into everyday routines

Identification of a placement into a particular setting

Tasks that involve non-academic and non-work related activities that do not involve self-stimulatory behavior or require interaction with other people

Tasks that involve the management of one’s own behaviors in order to meet a goal

Skills Targeted for Decrease
General Symptoms
General Symptoms includes a combination of symptoms that may be directly associated with ASD or may be a result of psychoeducational needs that are sometimes associated with ASD

Problem Behaviors
Behaviors that can be harmful to the individual or others, result in damage to objects, or interfere with the expected routines in the community

Restricted, Repetitive, Nonfunctional patterns of behavior, interests, or activity (RRN)
Limited, frequently repeated, maladaptive patterns of motor activity, speech, and thoughts

Sensory or Emotional Regulation (SER)
Sensory and emotional regulation refers to the extent to which an individual can flexibly modify his or her level of arousal or response to function effectively in the environment”

The Standards Report identified three categories of treatments: Established, Emerging and Unestablished.  Complete definitions of these interventions can be obtained in the report.
These treatments ranked in the Established level, indicating sufficient, high quality evidence of improvement in target behaviors for individuals with ASD. However, this does not mean that all individuals will benefit equally from these interventions:

* Antecedent Package {99 studies}
* Behavioral Package {231 studies}
* Comprehensive Behavioral Treatment for Young Children {22 studies}
* Joint Attention Intervention {6 studies}
* Modeling {50 studies}
* Naturalistic Teaching Strategies {32 studies}
* Pivotal Response Treatment {14 studies}
* Peer Training Package {33 studies}
* Schedules {12 studies}
* Self-management {21 studies}
* Story-based Intervention Package {21 studies}

The following treatments were placed in the Emerging level. Emerging Treatments are those for which one or more studies suggest the intervention may produce favorable outcomes, but additional evidence is needed of their effectiveness.

* Augmentative and Alternative Communication Device {14 studies}
* Cognitive Behavioral Intervention Package {3 studies}
* Developmental Relationship-based Treatment {7 studies}
* Exercise {4 studies}
* Exposure Package {4 studies}
* Imitation-based Interaction {6 studies}
* Initiation Training {7 studies}
* Language Training (Production) {13 studies}
* Language Training (Production & Understanding) {7 studies}
* Massage/Touch Therapy {2 studies}
* Multi-component Package {10 studies}
* Music Therapy {6 studies}
* Peer-mediated Instructional Arrangement {11 studies}
* Picture Exchange Communication System {13 studies}
* Reductive Package {33 studies}
* Scripting {6 studies}
* Sign Instruction {11 studies}
* Social Communication Intervention {5 studies}
* Social Skills Package {16 studies}
* Structured Teaching {4 studies}
* Technology-based Treatment {19 studies}
* Theory of Mind Training {4 studies}

The following treatments fell into the Unestablished level of evidence, indicating insufficient evidence of improvement (this may simply mean that controlled studies were not available, and does not indicate proof of ineffectiveness):

* Traditional Academic Teaching {10 studies}
* Auditory Integration Training {3 studies}
* Facilitated Communication {5 studies} – an additional caveat: a number of professional organizations discourage the use of Facilitated Communication due to ethical concerns.
* Sensory Integrative Package {7 studies}
* Gluten- and Casein-Free Diet {3 studies}

Note: Early studies suggested that the Gluten- and Casein-Free diet may produce favorable outcomes but did not have strong scientific designs. Better controlled research published since 2006 suggests there may be no educational or behavioral benefits for these diets. Further, potential medically harmful effects have begun to be reported in the literature. We recommend reading the following studies before considering this option:
1. Arnold, G. L., Hyman, S. L., Mooney, R. A., & Kirby, R. S. (2003). Plasma amino acids profiles in children with autism: Potential risk of nutritional deficiencies,Journal of Autism and Developmental Disabilities, 33, 449-454.
2. Heiger, M. L., England, L. J., Molloy, C. A., Yu, K. F., Manning-Courtney, P., &Mills, J. L. (2008). Reduced bone cortical thickness in boys with autism orautism spectrum disorders. Journal of Autism and Developmental Disorders,38, 848-856.

Although not a goal of the project, the National Autism Center provided a recommendation regarding the appropriate level of treatment (p. 31):
“The committee recommends that educational services begin as soon as a child is suspected of having an autistic spectrum disorder. Those services should include a minimum of 25 hours a week, 12 months a year, in which the child is engaged in systematically planned, and developmentally appropriate educational activity toward identified objectives. What constitutes these hours, however, will vary according to a child’s chronological age, developmental level, specific strengths and weaknesses, and family needs. Each child must receive sufficient individualized attention on a daily basis so that adequate implementation of objectives can be carried out effectively. The priorities of focus include functional spontaneous communication, social instruction delivered throughout the day in various settings, cognitive development and play skills, and proactive approaches to behavior problems. To the extent that it leads to the acquisition of children’s educational goals, young children with an autistic spectrum disorder should receive specialized instruction in a setting in which ongoing interactions occur with typically developing children.”
Read the complete report.