Evidence vs. Speculation: How to Know Which ASD Therapies Work
Do an online search for “autism therapy for children,” and you will get more than 90 million results offering everything from applied behavior analysis (ABA), equine therapy, restricted diets, hyperbaric chambers, speech therapy, occupational therapy, and alternating tactile stimulation, to behavioral therapy, chelation, electroconvulsive therapy and much more.
Parents want the best for their children and are willing to try anything that might help. But identifying a therapy that will help can be confusing. With so many options available, how can parents tell which therapies actually work?
The answer is “evidence-based therapy.” Simply put, “evidence-based” refers to a treatment that scientists have found to be effective at helping people with a specific problem. Looking for evidence of a therapy’s results can help you tell the difference between therapies that have been shown to help many kids with autism and therapies whose impact is unknown.
What is Evidence-Based Therapy?
Evidence-based therapy may sound complicated, but the basics are simple. First, it means scientific research has been conducted with enough participants who have shown statistically significant improvement. Scientists use advanced mathematical tools to determine whether participants improved due to the treatment, random chance or something entirely unrelated.
Second, evidence-based also means a panel of experts has reviewed the experiment and its results from various fields and duplicated by other qualified researchers.
The bottom line: An evidence-based therapy for autism is one the scientific community has deemed effective for a large number of children.
Parents are understandably swayed when they hear another parent talk about how much a therapy helped their child. Without scientific evidence, however, it is impossible to know what worked and why. One child’s improvement with an autism therapy does not necessarily transfer to another child.
Most unproven therapies will not hurt your child. The biggest risk is wasting time. The hours you spend each week on an untested autism therapy could be spent on an evidence-based therapy that has been proven to work. In the meantime, your child has missed opportunities to make progress.
Evidence-Based or Not?
Figuring out whether an autism therapy has scientific proof behind it and is likely to help your child does not have to be complicated. Asking a few simple questions can provide the information you need to make an educated decision.
- Is this therapy-evidence based? It may sound obvious, but you should ask this question about any therapy you are considering. A “no” answer is not necessarily the end of the conversation, but it can help you decide whether the therapy is worthwhile and where it might fit in your child’s treatment plan.
- How many studies have been conducted on this therapy? There is no exact right answer, but you should look for therapies with at least five to ten studies for each skill area or behavior being measured. For example, more than 600 research studies have proven that ABA is effective for children with autism.
- What types of children participated in the studies? As parents know, most children with autism need help in a number of Evidence that proves a therapy works for children who have difficulty speaking is only valuable if that is a challenge facing your child. Ideally, you are looking for studies that show results among children whose needs are similar to your child’s.
- Have experts from other disciplines confirmed the results? If a panel of speech therapists, behavior analysts and teachers have all confirmed the quality of a study, you can be more confident in the findings.
Additional resources can also be valuable. The National Autism Center published a 2015 report titled The National Standards Project, Phase 2, which is the largest review of autism research to date.
The report includes a list of groups that provide systematic reviews of autism research, such as The National Professional Development Center on Autism Spectrum Disorder and the Agency for Healthcare Research and Quality.
Watch Out for Red Flags
Not all autism therapy research is conducted with the same level of scientific quality. You do not need to become an expert in research methods or statistics, but a little skepticism can help you avoid therapies whose evidence is questionable.
Start by asking a trusted teacher, board certified behavior analyst (BCBA), speech-language pathologist, pediatrician or another clinician to help review the literature about an autism therapy you are considering.
Watch out for red flags:
- “Sales” Research
One or two studies that support an autism therapy may have been designed to produce positive results—especially if the research was conducted or sponsored by the company that is selling the therapy. Many people selling autism therapies are eager to get more business, so they may state that their treatment is evidence-based even if there is poor evidence or no evidence.
- No Data
The data and research methods behind a study should always be published so other researchers can review and duplicate the results.
Be wary of any research showing that one autism therapy delivers more and better results than any other therapy. Outcomes that seem too good to be true usually are, no matter how much you would love to see your child make that progress.
- Unestablished Therapies
A few large reviews of autism research provide lists of “unestablished interventions.” According to panels of autism experts from multiple disciplines, these autism therapies do not have enough evidence to show whether they are effective. The research that exists may not meet accepted standards, show no treatment effects or even show negative effects.
See the National Standards Project: Phase 2, page 72 for a list of unestablished therapies for autism.
Evidence-Based Therapy in Action
The evidence-based approach to autism treatment covers more than whether the therapy has been proven to work for kids with ASD. It also includes how that therapy is delivered, which professionals sometimes call “evidence-based practice.”
For example, a therapy provider should collect data during treatment. You may notice changes in your child’s behavior, but the provider should constantly gather data and share it to demonstrate progress. If the data does not show results after several months, it may be time to switch to a different evidence-based therapy.
It is important to remember that each child with autism has unique needs, so the fact that a therapy is evidence-based does not guarantee it will provide the best results for your child. Other evidence-based therapies may be more effective.
Professionals who use evidence-based practice should also talk with you about how the therapy works, how much follow-up is required at home and other considerations to help choose the evidence-based therapy that will work best for your child and your family.
Making an Educated Decision
The list of treatments for autism is almost endless and grows every year. The good news: There are always new ideas about how to help your child learn and improve. The bad news: Many of these ideas are untested and unproven.
The dilemma for parents is figuring out which therapies will help children reach their full potential. Therapies whose effectiveness is backed by scientific evidence are the best place to start and should be the foundation of your child’s treatment plan. Unestablished therapies without evidence behind them might help, but they are a gamble.
There are many ways to evaluate autism therapies, including word of mouth and online anecdotes. Examining the evidence supporting a therapy is one of the most powerful tools and one that can help you make the best decisions for your child.
Stephanie Bates is a board certified behavior analyst and the Director of Training, Quality and Privacy for Autism Home Support Services, which is the Midwest’s largest provider of in-home ABA therapy.
This article was featured in Issue 72 – Sensory Solutions For Life