What is evidence-based practice?
Evidence-based practice is best defined by Sackett and colleagues (1997) as “…the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” Evidence-based practitioners take steps to determine which interventions have research to support their use, determine which interventions have the highest quality research support and then make informed treatment decisions taking into account the unique needs of their patients. This is in direct contrast to practitioners who solely rely on tradition, “common practice,” folklore or intuition when making treatment decisions.
Why is there a need for evidence?
Autism has received a tremendous amount of attention in the media over the past decade and has captured the attention of politicians, sports figures, and celebrities.
Each of these individuals claim to know the right thing to do and the best treatments to seek. A search of “autism treatments” on the internet produces more than 164,000,000 results and identifies well over 50 commonly used treatments. Families just beginning to cope with a diagnosis are faced with an overwhelming amount of information that is very difficult to navigate. As a result, it is critical to provide a framework for families to evaluate treatment claims and decide which will be most effective for their child. This allows families to determine practices and treatments that are evidence-based.
When did this focus on evidence begin?
While attempts to regulate the quality of goods and services has occurred for decades, the current focus on evidence-based practice began in medicine in the 1970s when medical doctors began to criticize the lack of current research summaries for prevailing practices.
In 1992, the Cochrane Collaboration was established to ensure that systematic reviews of medical interventions existed and were accessible. A focus on evidence-based practice continues in medicine with insurance companies often requiring proof of effectiveness for a procedure to be covered. Evidence-based practice is also the current focus of many national professional organizations in the United States and is included with their ethics codes. In 2001, the focus on evidence-based practice moved into the realm of education with the passage of the No Child Left Behind Act. This federal mandate calls for the use of evidence-based practices in the classroom.
Where is the evidence?
While the ideals of No Child Left Behind were applauded by many, special educators are now faced with the fact that the field of special education research is still in its infancy.
In fact, evidence continues to be lacking in many areas for the following reasons:
- Evidence is not demanded by consumers.
- There is disagreement over what constitutes acceptable evidence.
- Practices that are researched in a laboratory setting do not easily translate into clinical practice.
- It is difficult to conduct solid research studies in classrooms and clinics.
How should I evaluate the evidence?
Although there is no single standard for evaluating evidence, most would agree that solid evidence includes:
- Research demonstrating that a treatment works better than no treatment and better than a placebo. (This means that the research study used a control group.)
- Research demonstrating positive effects occurred only when the treatment was in use and ruled out other explanations for the positive effects. (This means the results were causal not just correlational.)
- Research that is published in peer-reviewed journals and has been replicated by other independent researchers.
When should I consider a treatment?
A treatment meeting all three of the above criteria should be considered to have strong support for its use. A treatment meeting one or two of the above criteria has weaker support, but still may be worth considering, depending upon the unique needs of the individual.
Additionally, treatments should be manualized, which means that there are clearly written instructions for their use, ensuring that the treatment is delivered in the manner intended. However, no manual can substitute for the specialized clinical training and experience needed to carry out the treatment.
When should I be skeptical?
The following are signs that a treatment may not have solid evidence to support its use:
- The treatment is expensive and not covered by insurance companies, school districts, or other funding sources.
- The treatment can only be conducted in a few locations inside or outside of the country.
- The treatment relies solely on testimonials or anecdotes for evidence.
- Practitioners of the treatment do not have specialized training, licensure, or certification from a reputable college or university.
Where should I go for assistance?
In the area of autism, reviews and summaries of the current evidence have already been completed by several reputable groups including the New York State Department of Health, the American Academy of Pediatrics, and the Surgeon General’s Office.
Each of these groups recommends the use of intensive behavioral treatment based on methods of applied behavior analysis (ABA) as an evidence-based treatment for autism. Currently, there are no other treatments for autism that have the same level of research support as ABA.
What books should I read?
Maurice, C., Green, G., & Foxx, R.M. (2001). Making a Difference: Behavioral Intervention for Autism. Austin, TX: ProEd.
Myers, S.M., Johnson, C.P. and the Council on Children with Disabilities (2007). Management of Children with Autism Spectrum Disorders. American Academy of Pediatrics Clinical Report. Pediatrics, 120 (5).
New York State Department of Health Publications (1999). Clinical Practice Guidelines: Report of the Recommendations. Autism and Pervasive Developmental Disorders, Assessment and Intervention for Young Children (Age 0 -3 years).
Strain, P. S., & Dunlap, G. Being and Evidence-Based practitioner. Pamphlet can be found in the Recommended Practices section @ www.challengingbehavior.org
1 Sackett, D. L., Richardson, W. S., Rosenberg, W. & Haynes, R. B. (1997). Evidence-Based medicine: How to practice and teach EBM. New York: Churchill Livingstone.