Efficacy of Behavioral Interventions for Young Children with Autism Spectrum Disorders: Public Policy, the Evidence Base, and Implementation Parameters

Abstract

The complex and extensive deficits associated with Autism Spectrum Disorders, in concert with the substantial increase in prevalence over the last three decades, combine to present a challenge to individuals, families, communities, and government that has few parallels. This challenge is complicated by debate among service providers concerning appropriate treatment approaches and the evidence for efficacy. Within this backdrop, numerous healthcare reform initiatives have included coverage for Autism Spectrum Disorders, both enhancing and complicating the role of public education in the mix of provision of appropriate services. Basic principles of limited resources and expenditure accountability require that standards of care and evidence-based procedures be established and agreed upon. While this approach is common in health insurance policies and procedures, it is less so in public education. The purpose of this review is to provide impetus toward guidelines for comprehensive treatment services, as well as individual skill/behavior interventions, with respect to required service provider characteristics, setting, and "dosage" (number of hours per week for a designated time period). Quantitative analysis will permit progress in review panel deliberation for both insurance reimbursement and public services allocation by having appropriate comparisons with which to evaluate progress reported versus progress expected given the specific intervention program being provided.Keywords Autism spectrum disorder . ASD . Intervention . Evidence based . Efficacy . Dosage . Public policy . School . InsuranceThe increasing prevalence of Autism Spectrum Disorders (ASD) over the last few decades has presented both a complex problem with respect to the contributing factors for this increase and a significant and growing challenge for currently inadequate service delivery systems. Beginning in 1980 with the adoption of DSM-III (Diagnostic and Statistical Manual of the American Psychiatric Association) criteria for autism, with an estimated prevalence 4.5 per 10,000, to the present with estimates of 1 in 68 for children (Centers for Disease Control and Prevention [CDC] 2014), the magnitude of the increase has eluded definitive explanation. Public awareness and demand for information and services has also increased. As one index, the coverage of ASD in the popular press, in this example Time Magazine, has increased from three articles in the 1980s, to 11 in the 1990s, to 73 in the 2000s up to 2008. Such increased awareness has been paralleled by attention from professional groups to detect and treat ASD as early as possible. For example, the American Academy of Pediatrics recommends that children be screened for ASD twice by age three (Myers and Johnson 2007). 276-326 DOI 10.1007/s40489-014-0025-6 The goal of diagnosis and early identification, aside from needed basic research, is to permit the delivery of effective treatment and services. The timing of treatment and services can be a significant variable, but the mos...

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