Systematic Evaluative Reviews

The National Standard Project of the National Autism Center developed a similar model to evaluate interventions for problems associated with autism (2009), which used the term “established” to describe interventions with the highest level of support. Using their evaluative method, the National Autism Center (2009) characterized comprehensive ABA-based interventions as being “established” treatments for autism.

Wong and colleagues (2013), as part of the Autism Evidence-Based Practice Review Group, describe a process for the identification of clinical practices that have sufficient empirical support to be termed “evidence-based.” The group stated in regards to the strength of evidence of ABA “Twenty-seven practices met the criteria for being evidence-based (see table 7, page 20)….evidence-based practices consist of interventions that are fundamental applied behavior analysis techniques (e.g., reinforcement, extinction, prompting), assessment and analytic techniques that are the basis for intervention (e.g., functional behavior assessment, task analysis), and combinations of primarily behavioral practices…”

Federal Agencies

The Centers for Disease Control (see types of treatment) indicated that a “… notable treatment approach for people with an ASD is called applied behavior analysis (ABA). ABA has become widely accepted among health care professionals and is used in many schools and treatment clinics….”

The National Institute of Mental Health (NIMH) noted that ABA has become widely recognized as an effective treatment for individuals with autism (see treatment options section).

The National Institute of Child Health and Human Development stated that “… applied behavior analysis (ABA), [is] a widely accepted approach that tracks a child's progress in improving his or her skills…”

The Surgeon General of the United States stated, "Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior" (1999).

Case Studies

Literature reviews by Hanley, Iwata, and McCord (2003) and Beavers, Iwata, and Lerman (2013) collectively identified 435 peer-reviewed articles where functional analysis of problem behavior was reported. Studies listed below represent a sample of the large-scale consecutive controlled case series studies involving functional analysis. These studies demonstrate that functional analysis is highly effective in identifying the controlling variables for problem behavior.

Functional analysis across a variety of settings (inpatient, residential)
Participants: 154 cases
Results: Conclusive assessment results in over 90% of cases
Reference: Iwata BA, Pace GM, Dorsey MF, Zarcone JR, Vollmer TR, Smith RG, Rodgers TA, Lerman DC, Shore BA, Mazalesk JL, et al. (1994). The functions of self-injurious behavior: An experimental-epidemiological analysisJournal of Applied Behavior Analysis, 27(2), 215-240.

Functional analysis in school settings
Participants: 69 cases
Results: Conclusive assessment results in over 90% of cases
Reference: Mueller MM, Nkosi A, Hine JF. (2011). Functional analysis in public schools: A summary of 90 functional analysesJournal of Applied Behavior Analysis, 44(4), 807-818.

Functional analysis of severe problem behavior
Participants: 176 cases with severe problem behavior
Results: Conclusive assessment results in over 90% of cases
References: Hagopian LP, Rooker GW, Jessel J, DeLeon IG. (2013). Initial functional analysis outcomes and modifications in pursuit of differentiation: A summary of 176 inpatient casesJournal of Applied Behavior Analysis, 46(1), 88-100.

ABA-Based Focused Treatment for Problem Behavior.

Studies employing rigorous single-case experimental designs describing ABA focused interventions for problem behavior have been reported for four decades. The following sample of large-scale consecutive controlled case series studies provide further support for the effectiveness of these interventions. Findings from these studies parallel findings from reviews and meta-analysis of small-n studies.

Functional communication training for treatment of problem behavior
Participants: 21 inpatient cases with IDD
Results: 80% or greater reduction in problem behavior in 90% of cases
Reference: Hagopian LP, Fisher WW, Sullivan MT, Acquisto J, LeBlanc LA. (1998). Effectiveness of functional communication training with and without extinction and punishment: A summary of 21 inpatient casesJournal of Applied Behavior Analysis, 31(2), 211-235.

Function-based treatment for severe problem behavior
Participants: 138 inpatient cases with IDD
Results: 90% or greater reduction in problem behavior in over 83% of cases
Reference: Asmus JM, Ringdahl JE, Sellers JA, Call NA, Andelman MS, Wacker DP. (2004). Use of a short-term inpatient model to evaluate aberrant behavior: Outcome data summaries from 1996 to 2001Journal of Applied Behavior Analysis, 37(3), 283-304.

Functional-based treatment delivered by care providers (mostly parents) for severe problem behavior
Participants: 42 outpatient cases with IDD
Results: 80% or greater reduction in problem behavior in 95% of cases
Reference: Kurtz PF, Fodstad JC, Huete JM, Hagopian LP. (2013). Caregiver- and staff-conducted functional analysis outcomes: A summary of 52 casesJournal of Applied Behavior Analysis, 46(4), 738-749.

Functional communication training for treatment of severe problem behavior
Participants: 50 inpatient and outpatient cases with IDD
Results: 80% or greater reduction in problem behavior in 86% of cases
Reference: Rooker GW, Jessel J, Kurtz PF, Hagopian LP. (2013). Functional communication training with and without alternative reinforcement and punishment: An analysis of 58 applicationsJournal of Applied Behavior Analysis, 46(4), 708-722.

REVIEW PAPERS

Broadly speaking, review papers summarize the published literature on a specific topic (e.g., diagnosis, type of assessment or treatment procedure). The reader is referred to recent reviews on comprehensive and focused ABA-based interventions for problems associated with autism:

Recent reviews on ABA-based procedures for persons with intellectual and developmental disabilities (IDD):

Reported wandering behavior among children with autism spectrum disorder and/or intellectual disability.
Journal of Pediatrics. July 2016.
Rice CE, Zablotsky B, Avila RM, Colpe LJ, Schieve LA, Pringle B, Blumberg SJ.

Population impact of preterm birth and low birth weight on developmental disabilities in US children.
Annals of Epidemiology. April 2016.
Schieve LA, Tian LH, Rankin K, Kogan MD, Yeargin-Allsopp M, Visser S, Rosenberg D.

Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2012.
MMWR Surveillance Summary. April 2016.
Christensen DL, Baio J, Van Naarden Braun K, Bilder D, Charles J, Constantino JN, Daniels J, Durkin MS, Fitzgerald RT, Kurzius-Spencer M, Lee LC, Pettygrove S, Robinson C, Schulz E, Wells C, Wingate MS, Zahorodny W, Yeargin-Allsopp M.

Demographic profile of families and children in the Study to Explore Early Development (SEED): Case-control study of autism spectrum disorder.
Disability and Health Journal. January 2016.
DiGuiseppi CG, Daniels JL, Fallin DM, Rosenberg SA, Schieve LA, Thomas KC, Windham GC, Goss CW, Soke GN, Currie DW, Singer AB, Lee LC, Bernal P, Croen LA, Miller LA, Pinto-Martin JA, Young LM, Schendel DE.

Prevalence and characteristics of autism spectrum disorders among 4-year-old children in the Autism and Developmental Disabilities Monitoring Network.
Journal of Developmental and Behavioral Pediatrics. January 2016.
Christensen DL, Bilder DA, Zahorodny W, Pettygrove S, Durkin MS, Fitzgerald RT, Rice C, Kurzius-Spencer M, Baio J, Yeargin-Allsopp M.

Presence of an epigenetic signature of prenatal cigarette smoke exposure in childhood.
Environmental Research. January 2016.
Ladd-Acosta C, Shu C, Lee BK, Gidaya N, Singer A, Schieve LA, Schendel DE, Jones N, Daniels JL, Windham GC, Newschaffer CJ, Croen LA, Feinberg AP, Daniele Fallin M.

2015

Estimated prevalence of autism and other developmental disabilities following questionnaire changes in the 2014 National Health Interview Survey.
National Health Statistics Report. November 2015.
Zablotsky B, Black LI, Maenner MJ, Schieve LA, Blumberg SJ.

Autism spectrum disorder prevalence and proximity to industrial facilities releasing arsenic, lead or mercury.
Science of the Total Environment. July 2015.
Dickerson AS, Rahbar MH, Han I, Bakian AV, Bilder DA, Harrington RA, Pettygrove S, Durkin M, Kirby RS, Wingate MS, Tian LH, Zahorodny WM, Pearson DA, Moyé LA 3rd, Baio J.

Autism spectrum disorder symptoms among children enrolled in the Study to Explore Early Development (SEED).
Journal of Autism and Developmental Disorders. June 2015 [Epub ahead of print]
Wiggins LD, Levy SE, Daniels J, Schieve L, Croen LA, DiGuiseppi C, Blaskey L, Giarelli E, Lee LC, Pinto-Martin J, Reynolds A, Rice C, Rosenberg CR, Thompson P, Yeargin-Allsopp M, Young L, Schendel D.

Does autism diagnosis age or symptom severity differ among children according to whether assisted reproductive technology was used to achieve pregnancy?
Journal of Autism and Developmental Disorders. May 2015 [Epub ahead of print].
Schieve LA, Fountain C, Boulet SL, Yeargin-Allsopp M, Kissin DM, Jamieson DJ, Rice C, Bearman P.

Association between assisted reproductive technology conception and autism in California, 1997-2007.
American Journal of Public Health. May 2015.
Fountain C, Zhang Y, Kissin DM, Schieve LA, Jamieson DJ, Rice C, Bearman P.

Trends in the prevalence of autism spectrum disorder, cerebral palsy, hearing loss, intellectual disability, and vision impairment, metropolitan atlanta, 1991-2010.
PLoS One. April 2015.
Van Naarden Braun K, Christensen D, Doernberg N, Schieve L, Rice C, Wiggins L, Schendel D, Yeargin-Allsopp M.

Comparison of perinatal risk factors associated with autism spectrum disorder (ASD), intellectual disability (ID), and co-occurring ASD and ID.
Journal of Autism and Developmental Disorders. March 2015 [Epub ahead of print].
Schieve LA, Clayton HB, Durkin MS, Wingate MS, Drews-Botsch C.

Age at autism spectrum disorder (ASD) diagnosis by race, ethnicity, and primary household language among children with special health care needs, United States, 2009-2010.
Maternal and Child Health Journal. February 2015 [Epub ahead of print]
Jo H, Schieve LA, Rice CE, Yeargin-Allsopp M, Tian LH, Blumberg SJ, Kogan MD, Boyle CA.

Association of assisted reproductive technology (ART) treatment and parental infertility diagnosis with autism in ART-conceived children.
Human Reproduction. February 2015.
Kissin DM, Zhang Y, Boulet SL, Fountain C, Bearman P, Schieve L, Yeargin-Allsopp M, Jamieson DJ.

A review of the differences in developmental, psychiatric, and medical endophenotypes between males and females with autism spectrum disorder.
Journal of Developmental and Physical Disabilities. February 2015.
Rubenstein E, Wiggins LD, Lee LC.

2014

Using standardized diagnostic instruments to classify children with autism in the Study to Explore Early Development.
Journal of Autism and Developmental Disorders. October 2014 [Epub ahead of print].
Wiggins LD, Reynolds A, Rice CE, Moody EJ, Bernal P, Blaskey L, Rosenberg SA, Lee LC, Levy SE.

Screening for developmental delays among young children—National Survey of Children’s Health, United States, 2007.
MMWR Surveillance Summaries. September 2014.
Rice CE, Van Naarden Braun, K, Kogan MD, Smith C, Kavanagh L, Stickland B, Blumberg SJ.

Brief Report: Independent validation of autism spectrum disorder case status in the Utah Autism and Developmental Disabilities Monitoring (ADDM) Network site.
Journal of Autism and Developmental Disorders. July 2014. [Epub ahead of print]
Bakian AV, Bilder DA, Carbone PS, Hunt TD, Petersen B, Rice CE.

Centers for Disease Control and Prevention. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010. MMWR Surveill Summ. 2014;63(SS02);1-21.

Potential impact of DSM-5 criteria on autism spectrum disorder prevalence estimates.
JAMA Psychiatry. March 2014.
Maenner MJ, Rice CE, Arneson CL, Cunniff C, Schieve LA, Carpenter LA, Van Naarden Braun, Kirby RS, Bakian AV, Durkin MS.

Prevalence and impact of unhealthy weight in a national sample of US adolescents with autism and other learning and behavioral disabilities.
Maternal and Child Health Journal. February 2014 [Epub ahead of print].
Phillips KL, Schieve LA, Visser S, Boulet S, Sharma AJ, Kogan MD, Boyle CA, Yeargin-Allsopp M.

Population attributable fractions for three perinatal risk factors for autism spectrum disorders, 2002 and 2008 Autism and Developmental Disabilities Monitoring (ADDM) Network.
Annals of Epidemiology. January 2014.
Schieve LA, Tian LH, Baio J, Rankin K, Rosenberg D, Wiggins L, Maenner MJ, Yeargin-Allsopp M, Durkin M, Rice C, King L, Kirby RS, Wingate MS, Devine O.

2013

Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning – Autism and Developmental Disabilities Monitoring Network, USA, 2008.
Developmental Medicine and Child Neurology. October 2013.
Christensen D, Van Naarden Braun K, Doernberg NS, Maenner MJ, Arneson CL, Durkin MS, Benedict RE, Kirby RS, Wingate MS, Fitzgerald R, Yeargin-Allsopp M.

Recurrence of autism spectrum disorders in full- and half-siblings and trends over time: a population-based cohort study.
JAMA Pediatrics. October 2013.
Grønborg TK, Schendel DE, Parner ET.

Childhood vision impairment, hearing loss and co-occurring autism spectrum disorder. Disability and Health Journal. July 2013.
Kancherla V, Van Naarden Braun K, Yeargin-Allsopp M.

Urbanicity and autism spectrum disorders.
Journal of Autism and Developmental Disorders. June 2013.
Lauritsen MB, Astrup A, Pedersen CB, Obel C, Schendel DE, Schieve L, Yeargin-Allsopp M, Parner ET.

Mental health surveillance among children - United States, 2005-2011.
Morbidity and Mortality Weekly Report, Surveillance Summaries. May 2013.
Perou R, Bitsko RH, Blumberg SJ, Pastor P, Ghandour RM, Gfroerer JC, Hedden SL, Crosby AE, Visser SN, Schieve LA, Parks SE, Hall JE, Brody D, Simile CM, Thompson WW, Baio J, Avenevoli S, Kogan MD, Huang LN.

Frequency and pattern of documents diagnostic features and the age of autism identification.   
Journal of the American Academy of Child and Adolescent Psychiatry. April 2013.
Maenner MJ, Schieve LA, Rice CE, Cunniff C, Giarelli E, Kirby RS, Lee LC, Nicholas JS, Wingate MS, Durkin MS.

Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007-2012.
National Health Statistics Reports. March 2013.
Blumberg SJ, Bramlett MD, Kogan MD, Schieve LA, Jones JR, Lu MC.

Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism: a population-based study.
Journal of the American Medical Association. April 2013.
Christensen J, Grønborg TK, Sørensen MJ, Schendel D, Parner ET, Pedersen LH, Vestergaard M.

Evaluating changes in the prevalence of autism spectrum disorders.
Public Health Reviews. March 2013.
Rice CE, Rosanoff M, Dawson G, Durkin MS, PhD, Croen LA, PhD, Singer A, Yeargin-Allsopp M.

Periconceptional folic acid and risk of autism spectrum disorders.
Journal of the American Medical Association. February 2013.
Berry RJ, Crider KS, Yeargin-Allsopp M.

Autism Spectrum Disorder Reclassified: A Second Look at the 1980s Utah/UCLA Autism Epidemiologic Study.
Journal of Autism and Developmental Disorders. January 2013.
Miller JS, Bilder D, Farley M, Coon H, Pinborough-Zimmerman J, Jenson W, Rice CE, Fombonne E, Pingree CB, Ritvo E, Ritvo RA, McMahon WM.

2012

Comparison of a broad-based screen versus disorder-specific screen in detecting young children with an autism spectrum disorder.
Autism. December 2012.
Wiggins LD, Piazza V, Robins DL.

Predictors of ascertainment of autism spectrum disorders across nine US communities.
Journal of Autism and Developmental Disorders. December 2012.
Pettygrove S, Pinborough-Zimmerman J, John Meaney F, Van Naarden Braun K, Nicholas J, Miller L, Miller J, Rice C.

Autism after infection, febrile episodes, and antibiotic use during pregnancy: an exploratory study. Pediatrics. December 2012.
Atladóttir HÓ, Henriksen TB, Schendel DE, Parner ET.

Occurrence and family impact of elopement in children with autism spectrum disorders.
Pediatrics. November 2012.
Anderson C, Law JK, Daniels A, Rice C, Mandell DS, Hagopian L, Law PA.

The Study to Explore Early Development (SEED): A Multisite Epidemiologic Study of Autism by the Centers for Autism and Developmental Disabilities Research and Epidemiology (CADDRE) Network
Journal of Autism and Developmental Disorders. October 2012.
Schendel DE, Diguiseppi C, Croen LA, Fallin MD, Reed PL, Schieve LA, et al.
[Key Findings]

Short report: Improving record-review surveillance of young children with an autism spectrum disorder. Autism. September 2012.
Wiggins LD, Robins DL, Yeargin-Allsopp M.

Patterns of contact with hospital for children with an autism spectrum disorder: a danish register-based study.
Journal of Autism Developmental Disorders. August 2012.
Atladóttir HO, Schendel DE, Lauritsen MB, Henriksen TB, Parner ET.

Using maternally reported data to investigate the association between early childhood infection and autism spectrum disorder: the importance of data source.
Paediatric and Perinatal Epidemiology. July 2012.
Atladóttir HÓ, Henriksen TB, Schendel DE, Parner ET.

Retention of autism spectrum diagnoses by community professionals: findings from the autism and developmental disabilities monitoring network, 2000 and 2006.
Journal of Developmental and Behavioral Pediatrics. June 2012. 
Wiggins LD, Baio J, Schieve L, Lee LC, Nicholas J, Rice CE.

Parent-Reported Prevalence of Autism Spectrum Disorders in US-Born Children: An Assessment of Changes within Birth Cohorts from the 2003 to the 2007 National Survey of Children's Health
Maternal and Child Health Journal. April 2012.
Schieve LA, Rice C, Yeargin-Allsopp M, Boyle CA, Kogan MD, Drews C, and Devine O.

Concurrent medical conditions and health care use and needs among children with learning and behavioral developmental disabilities, National Health Interview Survey, 2006-2010.
Research in Developmental Disabilities. March – April 2012.
Schieve LA, Jarquin VG, Boulet SL, Visser SN, Rice CE, Van Naarden Braun K, Boyle CA.

Parental Age and Autism Spectrum Disorders
Annals of Epidemiology. March 2012.
Parner ET, Baron-Cohen S, Lauritsen MB, Jørgensen M, Schieve LA, Yeargin-Allsopp M, Obel C.

Prevalence of Autism Spectrum Disorders — Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008.
Morbidity and Mortality Weekly Report. March 2012.
Corresponding author: Jon Baio, EdS, National Center on Birth Defects and Developmental Disabilities, CDC. [Community Report]

Support for a dimensional view of autism spectrum disorders in toddlers.
Journal of Autism and Developmental Disorders. February 2012.
Wiggins LD, Robins DL, Adamson LB, Bakeman R, Henrich CC.

Association between parental nativity and autism spectrum disorder among US-born non-Hispanic white and Hispanic children, 2007 National Survey of Children’s Health
Disability and Health Journal. January 2012.
Schieve LA, Boulet SL, Blumberg SJ, Kogan MD, Yeargin-Allsopp M, Boyle CA, Visser SN, & Rice C.

Autism spectrum disorders and health care expenditures: The effects of co-occurring conditions
Journal of Developmental and Behavioral Pediatrics. January 2012.
Peacock G, Amendah D, Ouyang L, Grosse S.