Evidence-based practices (EBPs) have become a marked element of educational and therapeutic approaches to teaching and learning for students with ASD. The movement was captured and crystalized by the National Autism Center (National Autism Center [NAC] 2009) which carried out the first major review of evidence-based research in the field of autism that laid the foundation for the current emphasis on EBP. A research group at the National Autism Center completed a systematic review of the educational and behavioral treatment literature that focused upon the core characteristics of ASD; this literature was published between 1957 and the fall of 2007. The National Autism Center published the National Standards Report (2009) that detailed interventions that fell into groups of established, emerging, unestablished, and ineffective or hurtful. Interventions in the established group include those with sufficient “evidence” available to confidently determine that an intervention produces beneficial effects for individuals on the autism spectrum. That is, these practices are established as effective. Interventions in the emerging group include research on practices that although one or more studies suggest there is a beneficial intervention effect for individuals with ASD, additional high-quality studies are needed to confirm the consistency of the outcome. The unestablished group includes those strategies where little or no evidence exist in order to draw firm conclusions about the intervention’s effectiveness with individuals with ASD. The ineffective/harmful group was intended to include interventions with several high-quality studies that showed the intervention to be ineffective or harmful. However, there were no interventions included in the ineffective/harmful group. Table 10.2 Established, Emerging, and Unestablished Interventions illustrates the strategies in each group of the National Standards Report.

The review included quantitative research data sets (including experimental group, quasi-experimental group, and single-case designs) and did not include qualitative studies. The EBPs highlighted in the National Standards Report have rapidly become foundational criteria for federal funding of teacher education proposals and an established element of interventions for students with ASD.

Wong et al. carried out a follow-up systematic review of research in 2013 with the purpose of developing a report “that describes a process for the identification of EBPs and also to delineate practices that have sufficient empirical support to be termed evidence-based” (Wong et al. 2013, p. 7). The 2013 review, similar to the earlier review, includes research applicable to implementation in school or community early intervention systems, or home-, hospital-, and community-based programs. However, unlike the National Standards Report, it also included research on a number of studies in which the participant had additional learning issues (for example, intellectual and social-emotional). It wanted to address the issue that many traditional systematic review processes have excluded single-case design studies. The report highlighted two broad classes of interventions and identified them as comprehensive treatment models and focused intervention practices (Smith 2013). Comprehensive treatment models include practices designed to achieve a broad learning or developmental impact on the core issues of ASD. Focused interventions are designed to address a single skill or goal of a student with ASD. They address specific learner outcomes and tend to occur over a shorter time period than interventions associated with the comprehensive treatment models. Wong et al. (2013) recognize the symbiotic relationship between focused and comprehensive treatment interventions and highlight the point that they could even occur together; for example, peer-mediated instruction and the LEAP model. The 2013 review incorporated the intervention literature from the years subsequent to the National Standards Report (NAC 2009) initial review (i.e., 2007–2011). 29,105 published research articles were gathered relating to the broad areas of ASD and intervention and this was reduced to 456 with the application of inclusion criteria. Of the 456 studies that were included in the systematic review, 48 utilized a group design, but the majority of studies implemented a single-case design methodology (408). Twenty-seven evidence-based strategies emerged from this meta-analysis that covered a broad range of learner outcomes, as illustrated in Table 10.3: Nature of Learner Outcomes Across 27 Evidence-Based Strategies.

Table 10.4 lists the twenty-seven evidence-based strategies identified by Wong et al. (2013).

The intensive nature of evidence-based autism intervention, which relies heavily on one-to-one intervention, has caused many schools to turn to the growing number of computer-assisted interventions designed specifically for children with ASD.

Technology-aided instruction and intervention (TAII) is an evidence-based practice that is becoming increasingly popular (US Department of Education 2005). TAII meets evidence-based criteria with nine group design and 11 single-case design studies. The definition of technology interventions adopted for the meta-analysis included categories of computer-aided instruction and speech-generating devices/VOCA. In addition, different uses of different technology are also represented, including use of smart phones and tablet technology (Wong et al. 2013). TAII includes a group of interventions to address social, communication, behavior, joint attention, cognitive, school-readiness, academic, motor, adaptive, and vocational skills (Odom 2013). Indeed, students with ASD have shown positive gains using TAII (Hetzroni and Shalem 2005; Massaro and Bosseler 2006). Advantages of TAII include increased learning following consistency of a clearly defined task, reduced distractions leading to more focus of attention (Murray 1997), and supporting the ability to initiate, maintain, or terminate a behavior (Goldsmith and LeBlanc 2004). There are a number of TAII programs designed specifically for students with ASD that

Discrete trial training (DTT) is an effective teaching procedure derived from the principles of ABA and is used in teaching skills to students with autism. The primary focus is on skill acquisition when teaching early learning skills by breaking down skills into small, learnable parts appropriate to the developmental level of the child. DTT has four distinct parts: (1) the presentation of a stimulus, (2) the child’s response, (3) the consequence, and (4) a short pause between the consequence and the next presentation of stimuli. DTT promotes the development of communication/language, adaptive behavior, cognitive/academic skills, and social skills and reduces interfering behaviors. The structured procedures have been effective in teaching children a predictable process for learning.

Pivotal response training (PRT) is a naturalistic intervention that builds on learner initiative and interests, and supports developing (and increasing) communication skills, developing language, play, and social behaviors. PRT was developed to enhance pivotal learning variables: motivation, responding to multiple cues, self-management, and self-initiations of social interactions (Koegel and Frea 1993; Suhrheinrich et al. 2007). The skills are described as pivotal because they are the foundational skills upon which learners with ASD can make widespread and generalized improvements in many other areas (Suhrheinrich et al. 2007). Some central components of PRT include: child choice, reinforcement of successive attempts, incorporation of maintenance tasks, and direct/natural reinforcers that are contingent on appropriate behavior.

TeachTown Basics is an example of a computer-based (TAII) comprehensive intervention program that has the foundations of ABA. An empirical study of the program, which is described in more detail at the end of this chapter, provided documentation for supporting TAII as an evidence-based practice in the Wong et al. (2013) review. ABA involves constructing intervention strategies that outline the antecedents and consequences, which result in the increase in positive skills (Cooper et al. 2007). Data are collected in order to systematically determine interventions to produce positive outcomes for the individual. The instructional design of TeachTown Basics is heavily influenced by methodologies within ABA by integrating two evidenced-based strategies: DTT and PRT.