The National Standards Project– Phase 2 - PowerPoint Presentation

 The National Standards Project– Phase 2
 The National Standards Project– Phase 2

The National Standards Project– Phase 2 - Description

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The National Standards Project– Phase 2

Superheroes social skills training, Rethink Autism internet intervention, parent training, evidence-based practices classroom training, functional behavior assessment: An autism spectrum disorder, evidence-based practices training track for school psychologistsUS Office of Education Personnel Preparation Grant H325K12306William Jenson, Ph.D., Elaine Clark, Ph.D., Julia Hood Ph.D., & John Davis, Ph.D.

Diana Askings McCarty, B.S.

University of Utah School Psychology Program

February 24, 2016




National Autism Center & National Standards Project

Evidence-Based Practice


Scientific Merit Rating Scale

Intervention Effects Rating Scale

Strength of Evidence Classification System




NSP-Phase 1

NSP-Phase 2

Other Systematic Reviews—NPDC



Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social interactions/communication and by restricted, repetitive patterns of behaviorASD occurs in approximately 1 in every 68 births (CDC, 2014)Societal costs for each individual with ASD across the lifespan is estimated at $3.2 million (Ganz, 2007)Intervention selection is complicatedA large number of interventions are available Different levels of intervention supportThe research is often confusing to parents, educators, and service providers

(National Standards Project-Phase 2, 2015)


The National Autism Center

May Institute’s Center for the Promotion of Evidence-based Practice“…a nonprofit organization dedicated to disseminating evidence-based information about the treatment of autism spectrum disorder (ASD), promoting best practices, and offering comprehensive and reliable resources for families, practitioners, and communities.” TrainingPublic PolicyResearch

(National Standards Project-Phase 2, 2015;


What is the National Standards Project?

The National Standards Project (NSP) is a comprehensive analysis of the interventions available for individuals with ASDStrength of evidence supporting interventionsAge, diagnosis, and skills/behaviors targetedLimitations of researchEvidence-based practice recommendationsIf you use effective intervention, the lifetime cost can be reduced by 65% (Jarbrink & Knapp, 2001)

(National Standards Project-Phase 2, 2015)


Evidence-Based Practice (EBP)

“…the integration of the best research evidence, professional judgment, and values and preferences of clients.” (Sackett et al., 2000)EBP has become the standard in the fields of medicine, psychology, education, allied health, and ASDKey Elements of EBPProfessional JudgmentValues and PreferencesCapacityResearch Findings

(National Standards Project-Phase 2, 2015)


Scientific Merit Rating Scale (SMRS)

Developed to objectively evaluate the strength of each study’s methodologyResearch DesignExperimental control; number of participants/groups; attrition; type of research designMeasurement of the DVAccurate and reliable data that represent the most direct/comprehensive target sampleMeasurement of the IVIntervention fidelity; implementation accuracy; percentage/type of sessions for data collectionParticipant AscertainmentWell-established diagnostic tools/procedures were used to determine participant inclusion; use of the DSM or ICD Generalization & Maintenance EffectsObjectively demonstrating intervention effects across time, settings, stimuli, responses, or personsRatings from 0 (poor)  5 (strong)

(National Standards Project-Phase 2, 2015)


(National Standards Project-Phase 2, 2015)


(National Standards Project-Phase 2, 2015)


SMRS Scores

Composite scoreResearch Design (.30) + Dependent Variable (.25) + Participant Ascertainment (.20) + Procedural Integrity (.15) + Generalization (.10)Score of 3, 4, or 5 Sufficient scientific rigorScore of 2Initial evidence about intervention effects, but more rigorous research is neededScore of 0 or 1Insufficient scientific rigor/evidence to suggest whether the intervention was or was not beneficial, ineffective, or harmful

(National Standards Project-Phase 2, 2015)


Intervention Effects Rating Scale

BeneficialSufficient evidence to support favorable outcomes resulted from the interventionIneffectiveSufficient evidence to support favorable outcomes did not result from the interventionUnknownNot enough information to confidently determine the intervention effectsAdverse (NSP-1)Sufficient evidence that the intervention was associated with harmful effects

(National Standards Project-Phase 2, 2015)


(National Standards Project-Phase 2, 2015)


Strength of Evidence Classification System

(National Standards Project-Phase 2, 2015)


Strength of Evidence Classification System

(National Standards Project-Phase 2, 2015)


Intervention Subclassification

Phase 1 was broken down into Treatment Targets, Age Groups, and Diagnostic GroupsIntervention Targets (14 targets in 2 categories)Skills IncreasedAcademic, Communication, Higher Cognitive Functions, Interpersonal, Learning Readiness, Motor Skills, Personal Responsibility, Placement, Play, Self-RegulationBehaviors DecreasedGeneral Symptoms, Problem Behaviors, Restricted/Repetitive/Nonfunctional Patterns of Behaviors/Interests/Activity (RRN), Sensory or Emotional Regulation (SER)Age Groups0-21 years22+ years

(National Standards Project-Phase 2, 2015)


Subclassification Process

(National Standards Project-Phase 2, 2015)


Phase 1

Released in 2009Research published between 1957 to 20077,038 abstracts initially identified775 studies after inclusion/exclusion criteria were appliedUnrelated to ASDUnrelated to the treatment of ASDNot empirical articles38 treatment categories identified by an expert panelReliability IOA .92

(National Standards Report, 2009)


Inclusionary & Exclusionary Criteria

InclusionaryPublished in peer-reviewed journals Diagnosed with ASDAutistic Disorder, Asperger’s Syndrome, and Pervasive Developmental Disorder-NOSThe treatments could be implemented in school systems, early intervention, home, hospital, and/or community-based programsExclusionaryRhett’s Disorder, Childhood Disintegrative Disorder, “At Risk” for ASD, & uncommon co-morbid conditionsOnly educational and behavioral treatments that target the core characteristics of ASDNon-empirical researchPrimary purpose to identify mediating or moderating variablesOver the age of 22Non-English publications

(National Standards Report, 2009)


Results- “Established”

11 treatments had sufficient evidence to confidently determine that the treatment produces beneficial effectsAntecedent Package (99)Behavioral Package (231)Comprehensive Behavioral Treatment for Young Children (22)Joint Attention Intervention (6)Modeling (50)Naturalistic Teaching Strategies (32)Peer Training Package (33)Pivotal Response Treatment (14)Schedules (12)Self-management (21)Story-based Intervention Package (21)

(National Standards Report, 2009)


Results- “Emerging”

22 treatments had 1+ studies to suggest beneficial intervention effects, but additional high quality studies are needed to draw firm conclusions

Augmentative and Alternative Communication Device (14)Cognitive Behavioral Intervention Package (3)Developmental Relationship-based Treatment (7)Exercise (4)Exposure Package (4)Imitation-based Interaction (6)Initiation Training (7)Language Training—Production (13)Language Training—Production & Understanding (7)Massage/Touch Therapy (2)Multi-component Package (10)Music Therapy (6)Peer-mediated Instructional Arrangement (11)Picture Exchange Communication System (13)Reductive Package (33)Scripting (6)Sign Instruction (11)Social Communication Intervention (5)Social Skills Package (16)Structured Teaching (4)Technology-based Treatment (19)Theory of Mind Training (4)

(National Standards Report, 2009)


Results- “Unestablished” &“Ineffective/Harmful”

5 treatments had little to no evidence to draw firm conclusions about treatment effectivenessAcademic Interventions (10)Auditory Integration Training (3)Facilitated Communication (5)Gluten- and Casein-Free Diet (2)Sensory Integrative Package (7)0 identified studies indicated sufficient evidence that a treatment is ineffective or harmfulEthical reasonsNot published

(National Standards Report, 2009)


Limitations & Discussion

Since Phase 1, the DSM criteria for ASD has changedDid not include individuals with ASD 22+ years old“At risk” or comorbid not includedTreatment categoriesOnly quantitative studies All articles were in EnglishDid not evaluate “real world” vs. laboratory settingsTreatment intensity not evaluatedLiterature review ended in September 2007

(National Standards Report, 2009)


Phase 2

Released April 2, 2015To provide updated information on intervention effectivenessReviewed studies between 2007 and February 2012Included studies with adults 22+ years oldReviewed studies since 198727 articles identifiedCategory Revision“Established” interventions are presented in more detail

(National Standards Project-Phase 2, 2015)


Phase 2—Goals

Primary goalsIdentify peer-reviewed intervention outcome studies for individuals with ASD since the publication of NSP-1Review interventions for individuals across the lifespanIncorporate feedback received regarding NSP-1 categorizationTo help parents, caregivers, educators and service providers understand how to integrate evidence-based interventions into a well-rounded, individualized educational/behavioral program

(National Standards Project-Phase 2, 2015)


(National Standards Project-Phase 2, 2015)


Expert Panel

Hanna C. Rue, Ph.D., BCBA-D (Chair)Grace Baranek, Ph.D., OTR/LJane I. Carlson, Ph.D., BCBA-DAlice Carter Ph.D.Marjorie H. Charlop, Ph.D., BCBARonnie Detrich, Ph.D.Melanie DuBard, Ph.D., BCBA-DGlen Dunlap, Ph.D.Peter Gerhardt, Ed.D.Lynne Gregory, Ph.D.Robert H. Horner, Ph.D.Kara Anne Hume, Ph.D.James K. Luiselli, Ed.D., ABPP, BCBA-DDaniel Martin, Ph.D., BCBA

Gail McGee, Ph.D.Samuel L. Odom, Ph.D.Cathy L. Pratt, Ph.D.Patricia A. Prelock, Ph.D., CCC-SLPRobert F. Putnam, Ph.D., BCBA-DSally J. Rogers, Ph.D.Carol M. Schall, Ph.D.Ilene S. Schwartz, Ph.D., BCBA-DMark D. Shriver, Ph.D.Tristram H. Smith, Ph.D.Brenda Smith Myles, Ph.D.Aubyn C. Stahmer, Ph.D., BCBA-DPamela J. Wolfberg, Ph.D.John G. Youngbauer, Ph.D.

(National Standards Project-Phase 2, 2015)


(National Standards Project-Phase 2, 2015)


Inclusionary & Exclusionary Criteria

InclusionaryPublished in peer-reviewed journals Diagnosed with ASDAutistic Disorder, Asperger’s Syndrome, and Pervasive Developmental Disorder-NOSThe interventions could be implemented in school systems, early intervention, home, hospital, vocational and/or community-based programs or clinic settingsExclusionary“autistic characteristics” or “suspicion of ASD”, & uncommon co-morbid conditions (except for individuals 22+)Only educational and behavioral treatments that target the core characteristics of ASDNon-empirical researchPrimary purpose to identify mediating or moderating variablesNon-English publications

(National Standards Project-Phase 2, 2015)



(National Standards Project-Phase 2, 2015)


Results- “Established”Under 22 years old

14 interventions had sufficient evidence to confidently determine that the intervention produces beneficial effects (**: NSP-1 “emerging”; underlined: Different from NSP-1)

Behavioral Interventions (NSP-1=298 NSP-2=155)Cognitive Behavioral Intervention Package ** (NSP-1=3 NSP-2=10)Comprehensive Behavioral Treatment for Young Children (NSP-1=21 NSP-2=20)Language Training—Production ** (NSP-1=10 NSP-2=2)Modeling (NSP-1=51 NSP-2=28)Natural Teaching Strategies (NSP-1=27 NSP-2=3)Parent Training (NSP-1=37* NSP-2=11)Peer Training Package (NSP-1=43 NSP-2=3)Pivotal Response Treatment ® (NSP-1=11 NSP-2=6)Schedules (NSP-1=11 NSP-2=2)Scripting ** (NSP-1=6 NSP-2=5)Self-management (NSP-1=21 NSP-2=10)Social Skills Package ** (NSP-1=14 NSP-2=21)Story-based Intervention (NSP-1=21 NSP-2=15)

(National Standards Project-Phase 2, 2015)


Results- “Emerging”Under 22 years old

18 interventions had 1+ studies to suggest beneficial intervention effects, but additional high quality studies are needed to draw firm conclusions

Augmentative and Alternative Communication DevicesDevelopmental Relationship-based TreatmentExerciseExposure PackageFunctional Communication TrainingImitation-based InteractionInitiation TrainingLanguage Training—Production & UnderstandingMassage TherapyMulti-component PackageMusic TherapyPicture Exchange Communication SystemReductive PackageSign InstructionSocial Communication InterventionStructured TeachingTechnology-based Intervention Theory of Mind Training

(National Standards Project-Phase 2, 2015)


Results- “Unestablished”Under 22 years old

Animal-assisted TherapyAuditory Integration TrainingConcept MappingDIR/Floor Time **Facilitated CommunicationGluten-free/Casein-free DietMovement-based InterventionSENSE Theatre InterventionSensory Intervention PackageShock TherapySocial Behavioral Learning StrategySocial Cognition InterventionSocial Thinking Intervention

13 interventions had little to no evidence to draw firm conclusions about intervention effectiveness

(National Standards Project-Phase 2, 2015)


Results- 22+ years old

Earliest study published in 19871 “established” interventionBehavioral Interventions (17)1 “emerging” interventionVocational Training Package4 “unestablished” interventionsCognitive Behavioral Intervention PackageModelingMusic TherapySensory Integration PackageMore research is needed

(National Standards Project-Phase 2, 2015)


Intervention Selection

A team of individuals should consider the unique needs of the individual as well as the environment that they live in (e.g., family situation, community, cultural and ethnic background)Consider implementing “established” interventionsDo not begin with “emerging” interventions but consider them if an “established” intervention is inappropriate or unsuccessful at producing positive outcomes.Only consider “unestablished” interventions if additional research produces supportive results

(National Standards Project-Phase 2, 2015)


Limitations & Future Directions

Only published, peer-reviewed research through January 2012Lack of information on race/ethnicity, gender, or SES Intervention categoriesRemember–even “established” interventions will not be effective for all individuals with ASDMore research is needed to identify variables that predict who will likely respond to interventionInterventions for “high-risk siblings” Level of functioning, intervention intensity, & social validity Qualitative studiesNon-English studiesImpact of cultural diversity

(National Standards Project-Phase 2, 2015)


Other Systematic Reviews

Centers for Medicare and Medicaid Services (CMS) Agency for Healthcare Research and Quality (AHRQ) The National Professional Development Center on Autism Spectrum Disorder (NPDC)

(National Standards Project-Phase 2, 2015)


Evidence-Based Practices for Children, Youth, and Young Adults with ASDThe goal of the NPDC was to promote the use of evidence-based practices (EBPs) for children and youth with ASD, birth to 22 years of ageComprehensive Treatment Models vs Focused Intervention PracticesTEACCH, ESDM, UCLA Young Autism ProgramDTT, Pivotal Response Training, Prompting, Video Modeling1st review released in 2010 (1997-2007)24 interventions identified as EBP Very similar results to NSP-1 Current review 2014 (1990-2011)

(Wong et al., 2014)



National set of external reviewers (N=159)InclusionIndividuals with ASD under 22 years oldCo-morbid conditionsBehavioral, developmental, or educational interventions and outcomes implemented at home, school, or the communityCompared to no intervention or alternative interventionExperimental group, quasi-experimental group, or single-case designLiterature search29,106 articles (ASD/Interventions)  456 articlesArticles categorizedEBP determined

(Wong et al., 2014)


Evidence-Based Practice Criteria



27 interventions identified as evidence-based practices

(Wong et al., 2014)

Antecedent-based Intervention


Cognitive Behavioral Intervention


Differential Reinforcement of Alternative, Incompatible, or Other Behavior


Discrete Trial Teaching



** (3;3)



Functional Behavior Assessment


Functional Communication Training **




Naturalistic Intervention


Parent-implemented Intervention


Peer-mediated Instruction and Intervention


Picture Exchange Communication System **


Pivotal Response Training






Response Interruption/Redirection






Social Narratives


Social Skills Training


Structured Play Group


Task Analysis


Technology-aided Instruction and Intervention **


Time Delay


Video Modeling


Visual Supports




24 interventions identified were not classified as EBP, but had some support; more research is neededFoundational applied behavior analysis techniques have the most support Idiosyncratic Behavioral Intervention PackageMany similarities to NSPDeveloping online modules (AFIRM) for each of the 27 identified practicesCurrently modules are available for 24 practices previously identified

(Wong et al., 2014)



Centers for Disease Control and Prevention. (March 28, 2014).

Morbidity and mortality weekly report

. Retrieved February 16, 2016, from



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, 5(1), 7-22.


: 10.1177/1362361301005001002

National Autism Center. (2009).

National standards report

. Retrieved January 31, 2016, from


National Autism Center. (2015).

Findings and conclusions: National standards project, Phase 2

. Retrieved January 31, 2016, from


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, L., Rogers, S. J., & Hatton, D. D. (2010). Evidence-based practices in interventions for children and youth with autism spectrum disorders.

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