Evidence-Based Practice Guidelines for Children with Autism - PowerPoint PPT Presentation

Evidence-Based Practice Guidelines for Children with Autism Spectrum Disorder (ASD) Bryden Giving, MAOT, OTR/L Email: bgiving@pieofmn.com

*All information shared within this presentation is a culmination of recommendations from a multitude of professional organizations, systematic reviews, and governmental bodies including: the American Occupational Therapy Association, Wisconsin Health Department, National Professional Development Center on Autism Spectrum Disorder, Academy of Pediatrics, and the Cochrane Collaboration * None of the presented information are opinions expressed by the presenter

What is Evidence-Based Practice? • Evidence-based practice (EBP) is the implementation of knowledge from clinical and professional expertise, patient-client unique circumstances and values, and best research evidence into current practice ( Law & MacDermind, 2014; Straus, Richardson, Glasziou, & Haynes, 2005; Wong et al., 2014) • EBP is associated with better outcomes and is more cost-effective than non-EBP approaches (Shin, Randolph, & Rauch, 2010; Straus et al., 2005) • The primary goal of EBP is to utilize research evidence to decrease the use of ineffective health-care practices and ensure you are providing ethical, effective, and best treatment (Baker & Tickle-Degnen, 2014; Law & MacDermind, 2014; Straus et al., 2005) • Providing EBP is a highly valued ideal of the American Occupational Therapy Association (AOTA) (American Occupational Therapy Association, 2017; Gillen et al., 2017) Professional Best And Clinical Research Expertise Evidence Patient / Client Unique Values and Circumstances

EBP and Occupational Therapy for Children with ASD • The range of cost in 2011 in medical expenses for treating children with ASD was between 12 billion and 60 billion dollars, which places an ethical pressure on practitioners to provide evidence-based interventions (Centers for Disease Control and Prevention, 2016) • Evidence-based interventions are practices or programs that have peer-reviewed, documented empirical evidence of effectiveness and the greatest potential to achieve targeted outcomes (Law & MacDermind, 2014; Straus, Richardson, Glasziou, & Haynes, 2005; Wong et al., 2014) • EBP is framework for how interventions and health-care methods are being evaluated by payers; it’s the gold standard for reimbursement of services, especially with our shift to PDPM (AOTA, 2019; Shin, Randolph, & Rauch, 2010; Straus et al., 2005) • All areas of health care are emphasizing strong links between research and practice (Shin, Randolph, & Rauch, 2010; Straus et al., 2005)

Details on Evidence Levels Suggested recommendations are based on available evidence and content experts’ clinical expertise regarding the value of using the interventions. Criteria for level of evidence and recommendations (A, B, C, I, D) are based on standard language (U.S. Preventive Services Task Force, 2012). Criteria are as follows: Recommendation / Description Adapted from Tomcheck & Koenig, 2016 Evidence Level A Strong evidence that practitioners should routinely provide the intervention to eligible clients. Good evidence was found that the intervention improves important outcomes and that benefits substantially outweigh cost and time. B Moderate evidence that practitioners should routinely provide the intervention to eligible clients. There is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial C Weak evidence that the intervention can improve outcomes. It is recommended that the intervention be provided selectively based on professional judgement and patient preferences. There is at least moderate certainty that the net benefit is small. I Insufficient evidence to determine if practitioners should routinely be providing the intervention. Evidence that the intervention is effective is lacking, of poor quality, or conflicting, and the balance of benefits and harm cannot be determined. There is no reason to assume these interventions are effective. Other interventions should be considered. D Recommend that practitioners do not provide the intervention to eligible clients. At least fair evidence was found that the intervention is ineffective or that harm outweighs benefits.

Interventions for Social Skills, Social Communication, Restricted and Repetitive Behaviors, Play performance, and Leisure Participation Task analysis to promote a child's participation in social interaction (A) [AFIRM, 2019] Group-based social skills training programs in both clinic-based and contextual settings to improve social skills (A) PECS to improve social communication (A) Naturalistic strategies (e.g., antecedent-based intervention, reinforcement) to improve joint attention (A) Behavioral techniques to improve participation in occupations (A) Early Start Denver Model to improve social communication, play performance, and leisure participation (A) Adapted from Tomcheck & Koenig, 2016

Interventions for Social Skills, Social Communication, Restricted and Repetitive Behaviors, Play performance, and Leisure Participation Cognitive Behavioral Intervention (CBI) teaches learners to examine their own thoughts and emotions, recognize when negative thoughts and emotions are escalating in intensity, and then use strategies to change their thinking and behavior (A) [AFIRM, 2019; Wisconsin Department of Health Services, 2016] GemIIni Systems to improve functional communication, social performance, and play (A) [AFIRM, 2019; Wisconsin Department of Health Services, 2016] Structured play groups to increase play performance (A) [AFIRM, 2019] Treatment and Education of Autistic and Communication Related Handicapped Children (TEACCH) to improve play performance and leisure participation (B) Social Stories to address behavioral difficulties, teach social skills, and promote functional communication (B) [Collet-Klingenberg & Franzone, 2008] Activity-based interventions to improve social skills (B) Parent-mediated interventions (e.g., parent-mediated communication-focused treatment, Autism 1-2-3) and imitation to improve social communication (B) Adapted from Tomcheck & Koenig, 2016

Interventions for Social Skills, Social Communication, Restricted and Repetitive Behaviors, Play performance, and Leisure Participation Computer-based interventions (social skills training, virtual reality, video modeling, and collaborative computer work) to improve social skills (B) Naturalistic behavioral interventions (e.g., milieu therapy, functional communication training, and pivotal response training) to improve social communication (B) Developmental interventions (e.g., relationship-based or floor time) to improve social communication (B) Parent-mediated interventions (e.g., parent-mediated communication-focused treatment, Autism 1-2-3) and imitation to improve social communication (B) Recess intervention, leisure group, and Social Stories to improve leisure participation (B) Adapted from Tomcheck & Koenig, 2016

Interventions for Social Skills, Social Communication, Restricted and Repetitive Behaviors, Play performance, and Leisure Participation Social Communication, Emotional Regulation and Transactional Support (SCERTS) to prompt child-initiated communication in everyday activities aiming to help children learn and spontaneously apply functional skills (C) [Wisconsin Department of Health Services, 2016] Hyperbaric Oxygen Therapy (HBOT) to improve core symptoms of Autism and associated symptoms of Autism (I) [Wisconsin Department of Health Services, 2016] Sensory-motor interventions to improve social communication (I) DIR / Floortime to improve a child‘s participation in play performance and socio-emotional relationships (I) [Wisconsin Department of Health Services, 2016] Brain Balance to improve the occupational participation of children with ASD (I) Vision Therapy to improve a child‘s participation in play, education, ADLs, and functional communication (I) PLAY Project to promote a child‘s joint attention, social skills, and play performance (I) [Wisconsin Department of Health Services, 2016] Adapted from Tomcheck & Koenig, 2016

Interventions For Sensory Integration and Sensory-Based Interventions Qigong massage to improve self-regulatory behaviors and reduce tactile abnormalities, autism symptoms, and parental stress (A) Sensory-adapted dentist office environment to reduce distress, pain, and sensory discomfort for children with ASD (B) ASI to address individualized goal areas with measurement by Goal Attainment Scaling (B) Multisensory activities to improve occupational performance and behavior regulation (B) Yoga to improve emotional regulation, decrease emotional distress, and improve self-soothing for adolescents (C) ASI to improve sleep, adaptive skills, Autism features, and sensory processing (C-I) Sensory diets integrated into child routines to meet sensory needs (I) [Wong et al., 2014] Adapted from Tomcheck & Koenig, 2016