About this Document

Various sources (Steinbrenner et al., 2020; Wong et al., 2015) have identified approximately 27 interventions that have been shown to be effective for addressing core and associated features of autism. Evidence for their utility exists in the scientific literature related to behavioral interventions utilized to address behavioral excesses and deficits experienced by individuals with ASD. Practitioners are directed to these citations for more specifics regarding information on these practices, and the methods to determine their status as evidence-based.

Because not all of the identified EBPs have been shown to be effective to address challenging behavior, seven practitioners with expertise in assessment and treatment of challenging behavior reviewed the list of interventions and accompanying research citations supporting those interventions. We identified 13 interventions (from the list of 27) with research supporting their efficacy for addressing challenging behavior.

Important things to note as you review this document include:

• Much of the research documenting efficacy of various interventions was conducted in controlled research settings with highly trained implementers. As a result, the extent to which these interventions will yield similar results in less controlled settings and/or with implementers who are not highly trained is less well established. This limitation does not mean that these interventions are not evidence based but rather that their efficacy may depend on both the context they are implemented in and the skills of the implementers.
• Some of the 13 EBPs are a single strategy that is rarely used in isolation (e.g., extinction); whereas others are broad treatment packages (e.g., parent implemented instruction and intervention) that include subcomponents included in this list of 13 interventions.
• These approaches affect behavior through various mechanisms, including changes in motivating operations (i.e., antecedents), extinction, reinforcement/skill building (i.e., teaching or strengthening alternative behavior), and punishment.
• This document is limited to describing EBPs related to challenging behavior. Individuals with ASD may receive a number of different types of interventions related to various behavioral excesses, deficits, and skill development. For example, a person may participate in cognitive behavioral intervention to address anxiety and, as part of the intervention, learn strategies that lessen the likelihood of meltdowns and challenging behavior. Other people may take part in additional therapies such as music therapy or occupational therapy that are intended to include strategies to reduce challenging behavior (e.g., addressing sensory issues that lead to challenging behavior).
• We have focused this document on interventions that have evidence specifically related to addressing challenging behavior and recognize that this may preclude inclusion of other approaches (e.g., cognitive behavior therapy, occupational therapy) that may also be helpful. In other words, the fact that a specific intervention or approach does not yet have evidence supporting its effectiveness does not mean that it is not effective.
• There are several approaches that have been shown to be harmful (e.g., rapid prompting method, chelation therapy). Thus, we encourage anyone considering approaches other than those on this list and in this document to ensure the approach has not been found to be harmful or dangerous. Professional organizations such as the American Speech and Hearing Association and Association for Behavior Analysis International often publish positions statements and guidance related to ineffective and/or dangerous interventions.

On the following pages, these EBPs are described, as are variables that should be considered prior to implementation. Some EBPs overlap. For example, “Exercise” is a type of “Antecedent Based Intervention.” In such instances, the EBPs will be described together. The purpose of the following portion of this document is to describe the use of these EBPs in the context of intervention for challenging behavior exhibited by individuals with autism. Each EBP will be briefly described, and the considerations for its use based on the current level of challenging behavior will be addressed.