Evidence-Based Practices for Students with Autism Spectrum

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EVIDENCE–BASED PRACTICES FOR STUDENTS WITH

AUTISM SPECTRUM DISORDER

A Dissertation

Presented to the

Faculty of

California State Polytechnic University, Pomona

In Partial Fulfillment

Of the Requirements for the Degree

Doctorate

Educational Leadership

Lindsey M. Denniston

2017

SIGNATURE PAGE

DISSERTATION: EVIDENCE-BASEDPRACTICES FOR AUTISM SPECTRUM DISORDER

AUTHOR: Lindsey M. Denniston

DATE SUBMITTED: Summer 2017

College of Education and Integrative Studies

Dr. Amy Gimino Dissertation Committee Chair Department of Education

Dr. Joanne Van Boxtel Department of Education

Dr. Shannon Avery Principal Pinion Hills Elementary School

ACKNOWLEDGEMENTS

I want to thank my family and friends who offered support from simply asking

“How is it going?” to listening to me rant and rave over the last three years. Every word

was helpful and meaningful to me.

To my committee for offering support and pushing me to better myself in ways I

would not have thought possible three years ago. Thank you.

A special thank you to my sisters Jamie and Amber, and brother-in-law Joe who stepped up and listened to me talk endlessly about my topic and lent an ear for me often.

Maybe one day you “will actually read” the whole thing. You were and are appreciated.

Mom, you “always knew I was smart”. From the bottom of my heart I love you and thank you for shaping me into the person I am today. That little girl with her hair sticking out everywhere, papers flying, and dragging her jacket became a doctor!

Kalise and Kylan, I love you more than anything in the world. I’ll remember working on “homework” while watching endlessly the Lion King, Cars and your latest obsessions as “cuddle time”. Anything worth doing requires working hard.

Roger, I know I drove you crazy and you returned my stress with love even if not the dishes. I would never have done this without you. Thank you for always trying to be a better man and making me a better woman right along with you. Meh!

Lastly, I dedicate this paper to my dad and grandpa Garcia. You may not have lived to see this day, but I was always your “A student”. I know “my best friend Chito” is watching me now proudly with a smile and laughing when I reveal my “A student” status. Look Dad, now I am “Dr. A student”.

ABSTRACT

Evidence-based practices (EBP) are required to be used for all students including

those students with Autism spectrum disorder (ASD; Individuals with Disabilities

Education Act [IDEA], 2004; No Child Left Behind [NCLB], 2002; Education Sciences

Reform Act, 2002); yet, there continues to be a research to practice gap with the

percentage of special educators utilizing EBP around 30% (Hess, Morrier, Heflin, &

Ivey, 2008; Lilienfeld, Marshall, Todd, & Shane, 2015; Spencer, Detrich, & Slocum,

2012; Stahmer, Collings, & Palinkas., 2005). This survey study investigated elementary special educators’ current definitions of EBP for students with ASD, the sources of information they consult for information about EBP, and their use and beliefs about EBP for students with ASD. A modified version of the Autism Treatment Survey [ATS]

(Morrier, Hess, & Heflin, 2006) was administered to special educators in an Inland

Empire District in Southern California. Results indicated that respondents defined EBP

as researched practices with positive outcomes and utilized three sources for information

regarding EBP: conferences and trainings, pre-service programs, and online materials.

All of the respondents reported using six practices: naturalistic interventions, differential

reinforcement (reinforcement), extinction, modeling, prompting, antecedent based

interventions, and functional behavior assessments. Practices that fell below the

acceptable reported use threshold of 70% included: pivotal response training (PRT),

cognitive behavior therapy, scripting, video-modeling, and self-management. All

practices, except for pivotal response training (PRT), had a greater reported use than

reported belief that the practice was an EBP. Implications, limitations and directions for

further research are discussed.

Table of Contents

SIGNATURE PAGE ...... ii

ACKNOWLEDGEMENTS ...... i

ABSTRACT ...... ii

LIST OF TABLES ...... viii

LIST OF FIGURES ...... ix

CHAPTER 1: INTRODUCTION ...... 1

Defining and Diagnosing Autism Spectrum Disorder (ASD) ...... 2

Prevalence ...... 6

Characteristics of Students with ASD...... 7

Autism and Education ...... 11

Identification of Evidence-based Practice ...... 16

EBP Training ...... 20

Problem Statement ...... 21

Context for the Study ...... 23

Purpose Statement ...... 25

Research Questions ...... 25

Definition of Terms...... 25

Assumptions ...... 27

Generalizability ...... 28

iii Significance...... 28

Summary and Organization of this Study ...... 28

CHAPTER 2: LITERATURE REVIEW ...... 30

Equity, Caring, and Competency ...... 30

Equity ...... 31

Caring ...... 33

Competency ...... 35

Effective professional development...... 39

Durlak and DuPre’s Implementation Model ...... 41

Evaluating Research for Evidence-Based Practices ...... 48

What Works Clearinghouse ...... 49

Best Evidence Encyclopedia ...... 52

Evaluative Method for Determining EBP in Autism Tool ...... 52

Other Individual Researchers ...... 54

National Professional Developmental Center ...... 55

Categories of Evidence-Based Practices for Students with ASD ...... 57

Evidence-Based Practices ...... 58

Communication ...... 59

Social Skills ...... 63

Academic Skills ...... 66

Multiple Domains ...... 67

NonEBP ...... 72

iv Communication ...... 73

Behavior ...... 73

Multiple Domains ...... 76

Interventions to Service Students with ASD ...... 80

Summary ...... 84

CHAPTER 3: METHODOLOGY ...... 86

Design ...... 86

Survey Instrument ...... 87

Sample...... 88

Data Collection ...... 90

Data Analysis ...... 91

Validity ...... 92

Positionality ...... 93

Summary ...... 93

CHAPTER 4: RESEARCH FINDINGS ...... 95

Respondents ...... 96

Classroom Demographics ...... 96

Definition of Evidence-Based Practices ...... 100

EBP Are from Research ...... 101

Variety of Strategies ...... 101

Sources of Trainings ...... 102

Trainings and Conferences ...... 103

Online Materials ...... 104

Courses ...... 104

Evidence-Based Practices Use or Nonuse and Beliefs ...... 105

Response Rates at the 70% Standard ...... 106

Communication ...... 110

Behavior ...... 110

Social Skills ...... 113

Academic Skills ...... 116

Multiple Domains ...... 116

Open Responses ...... 121

CHAPTER 5: CONCLUSIONS, DISCUSSION, AND RECOMMENDATIONS ...... 123

Conclusions ...... 125

How Do IE Special Educators Define EBP for Students with ASD? ...... 125

What Sources do Special Educators Use to Incorporate EBP for Students with

ASD? ...... 126

What EBP and NonEBP are Teachers Using and Believe are EBP? ...... 127

Communication...... 130

Social skills ...... 133

Academic skills...... 134

Multiple domains...... 135

vi Discussion ...... 139

Implications...... 142

State and Federal Policy...... 142

Districts ...... 145

Educators...... 148

Limitations and Recommendations for Further Research ...... 150

Final Thoughts ...... 152

REFERENCES ...... 154

APPENDIX A INFORMED CONSENT...... 209

APPENDIX B MODIFIED ATS SURVEY ...... 210

vii

LIST OF TABLES

Table 1 Evidence-Based Programs and Descriptions for Students with ASD ...... 17

Table 2 Percentages of Students with ASD Serviced in Genral Education or Other

Environments ...... 32

Table 3 Factors Affecting Implementation ...... 42

Table 4 Primary and Secondary Indicators for Evaluting Research ...... 54

Table 5 Most Used Practices Acording to ATS by Domain ...... 83

Table 6 Demographic Data for District ...... 89

Table 7 EBP with Total Responses Greater Than 70% ...... 106

Table 8 EBP Reported Use and Belief ...... 109

Table 9 Communication and Behavior Responses by Percentage of Reported Use and

Belief ...... 111

Table 10 Social Skills and Academics EBP By Percentages of Reported Use and Belief

...... 113

Table 11 Multiple Domains EBP By Percentages of Reported use and Belief ...... 117

viii LIST OF FIGURES

Figure 1. Decision Making Process Of Teacher Competency, Utilizing Equity, And

Caring To Inform EBP Use...... 31

Figure 2. Respondent Educators Students' Age Ranges ...... 97

Figure 3. Types of Credentials Held by Respondents ...... 98

Figure 4. Type of Classroom of Respondents...... 99

Figure 5. Respondents Years of Teaching Experience by Percentage ...... 100

CHAPTER 1: INTRODUCTION

Special education has a history of exclusion (Shapiro & Stefkovich, 2011). Laws and cases such as Brown vs. Board of Education (1954) and the Individuals with

Disabilities Education Act (IDEA, 2004) were implemented to counteract the exclusion of students with disabilities and assure educational benefit for students with disabilities.

The Education Sciences Reform Act (2002) requires California schools to use Evidence- based practices (EBP), defined as instructional techniques with demonstrated effectiveness “bridging the research-to-practice gap and improving student outcomes,” including students with ASD (Cook & Cook, 2013, p. 71). Autism spectrum disorder

(ASD) has increased in the identified population steadily since its introduction into the academic conversation in the 1940s (Kanner, 1943; Baio, 2014; O’Brien, 2013).

Although the use of EBP is required and many researchers have advocated the use of

EBP to improve ASD symptoms (Alexander, Ayres, & Smith., 2015; Hess, et al., 2008;

Morrier, Hess, & Heflin, 2011; Odom, Boyd, Hall, & Hume, 2010; Simpson, 2005), studies have demonstrated that many teachers still do not apply EBP in their classrooms

(Hess, et al., 2008; Wong et al., 2015).

This dissertation examined this policy to practice gap by describing special educators’ definitions, use, beliefs of EBP, and the sources information they consult pertaining to EBP for students with ASD. Chapter 1 includes the background to the problem including the definition of ASD, the prevalence of the disorder, characteristics of the disorder and the history of ASD in education. The chapter then identifies and describes current EBP for students with ASD in the areas of behavior, communication, social skills and academic performance. Chapter 2 presents teachers’ decision-making

process focusing on equity, caring, and competency, as a framework for supporting

students with ASD. The chapter discusses how EBP practices are defined and established,

explores the implementation of EBP and non-EBP for students with ASD in the aforementioned areas, and identifies areas needing further research. Chapter 3 describes the methods used to collect and analyze data for this survey study. Chapter 4 presents the study results for each research question, and Chapter 5 discusses the conclusions of the

study and provides implications and recommendations for further research.

Defining and Diagnosing Autism Spectrum Disorder (ASD)

Kanner (1943) was the first to identify ASD in his observations regarding the

shared behavioral characteristics of several adolescents. In Kanner’s (1943) article, he

labeled a series of behaviors infantile autism, which debuted the first research in autism

(Thompson, 2013). By 1949, early infantile autism was established as withdrawal from

people or lack of socialization, a desire for sameness or unusual relation to objects,

mutism or language that does not serve the need for communication, and unusual

language patterns (Kanner, 1949). Originally, ASD was thought to develop through

psychosis (Lai, Lombardo, & Baron-Cohen, 2014; Thompson, 2013; Bettelheim, 1967).

Now, combinations of environmental and biological factors are thought to account for

ASD development such as genetics and environmental toxins (Corrales & Hebert, 2011;

Lai et al., 2014). A new definition developed from research over time and the belief that

with early intervention autism (ASD) could be treated successfully (Lai et al., 2014).

Rimland (1964) in his pivotal book Infantile Autism: The Syndrome and Its Implications

for a Neural Theory of Behavior, began to describe criteria for a consistent definition.

Creak (1964) also provided a definition with nine points of reference, though she

acknowledged not every child would present all nine traits. Several years later, Rimland

(1971) updated his checklist to differentiate infantile autism from other childhood

disorders, but despite these efforts, the uniformity of a definition for autism was lacking.

As the 1970s approached, Rutter (1978) in his writing asked, “To what set of phenomena

shall we apply the term autism?" (p. 141) to advocate a set of criteria for consistency. To

further complicate matters, some scholars referred to autism as psychosis as their opinion

differed regarding the limited definition offered from Kanner (1943) and Schopler,

Reichler, DeVellis, & Daly (1980).

Some view ASD as an extreme of a continuum of traits such as those featured on

scales used to diagnosis ASD (Lai, Lombardo, Chakrabarti, & Baron-Cohen, 2013). For example, a person who identifies and notes details more than others (Baron-Cohen,

Wheelwright, Skinner, Martin, & Clubley, 2001). Constantino (2011) views ASD as the

severe end of a spectrum of impairments that are highly inheritable and quantitative.

Studies demonstrate that characteristics of ASD are present within the typically

developing groups, just at lower levels than at the higher impairment end of

ASD continuum (Baron-Cohen, Wheelwright, Hill, Raste, & Plumb, 2001;

Gökçen, Petrides, Hudry, Frederickson, & Smillie, 2014; Hoekstra, Bartels, Cath, &

Boomsma, 2008; Jones, Schullin, & Meissner, 2011).

The Diagnostic and Statistical Manual of Mental Disorders III (DSM-III)

published by the American Psychiatric APA, 1980) attempted to provide a consistent definition for autism by including the three characteristic features of autism first introduced by Kanner (1943): delays in communication, social skills, and irregular or repetitive behaviors (Thompson, 2013). It also set the criteria for a diagnosis of ASD as:

(a) onset before 30 months, (b) pervasive lack of response to people, (c) deficits in language development, (d) if speech is present peculiar speech patterns such as echolalia,

(e) bizarre responses to the environment for example resistance to change, and (f) absences of delusions or hallucinations.

Between the DSM-III (APA, 1980) and the next revised edition, the definition became broader (APA, 1987; "DSM-III III and DSM-III III-R Diagnosis of Autism,"

1988; Lai, et al., 2014). In subsequent editions, ASD was referred to as pervasive developmental disorder (PPD) and focused on three key characteristics consistent with the first diagnosis that included, impairments in socialization and speech, restrictive and repetitive behavior, and stereotyped behavior (APA, 1994; 2000). It also included a new feature of subtypes of ASD under the broad category of PDD, including: autistic disorder,

Asperger’s disorder, pervasive developmental disorder not otherwise specified, and childhood disintegrative disorder (APA, 2000).

The most current DSM 5th edition (APA., 2013b) outlines criteria for a diagnosis of ASD and emphasizes social communications and interaction, and restrictive and repetitive behaviors. The patient must present communication impairments across multiple contexts that may range from lack of developed conversation to lack of eye contact and vary on a continuum from mild to severe (APA., 2013a). For instance, a child not making eye contact would be considered to have a mild impairment; whereas, a child who does not speak at all would be considered to have a more severe impairment.

The patient must also present repetitive or restrictive patterns of movement, such as body rocking or finger movements (APA., 2013b; Rodrigues, Gonclaves, Costa, & Soares,

2013). The DSM-5 uses the term autism spectrum disorder (ASD) with specifiers to

promote individualized assessment and treatment programs (APA, 2013b; Lai, et al.,

2013). For the purposes of this study, the term autism spectrum disorder (ASD) is used as an all-encompassing term including Asperger’s, autism, and pervasive developmental disorder (PDD).

The definition of ASD in the DSM-5 has some key differences from prior editions

(APA, 2013a). The early onset feature from the first inclusion in the DSM- III (APA,

1980) remains, as there must also be a history of developmental symptoms from early childhood, but diagnosis can occur later than before (APA, 2013a). This early onset feature addressed the manifestations of impairments later when they are more noticeable

(APA, 2013a; Lai et al., 2014). Other impairments may manifest as well, though they are not as specified in the DSM-5 as in the previous editions (APA, 2013a; Lai et al., 2014).

An intellectual or other disability cannot better explain the impairments though comorbidity of certain other disorders is possible, such as developmentally delay (APA,

2013a). Excluded from the DSM-5 is the language component (APA, 2013a). Language issues are now presented under the umbrella term of communication deficits or a new diagnostic category of Social (Pragmatic) Communication Disorder (APA, 2013a). In the

DSM-5, the current term autism spectrum disorder (ASD) without any subtypes is used

(APA, 2013a; Lai, et al., 2013), and specifiers are provided to allow for more individualized assessment and treatment programs (APA, 2013a; Lai, et al., 2013).

According to the APA (2013a):

Researchers found that these separate diagnoses were not consistently applied across different clinics and treatment centers. Anyone diagnosed with one of the four

pervasive developmental disorders (PDD) from DSM-IV should still meet the criteria for

ASD in DSM-5 or another, more accurate DSM-5 diagnosis (para. 2).

Although the new edition may eliminate a small number of students receiving an

ASD diagnosis, particularly for those who previously qualified under Aspersers and

pervasive developmental delays, it allows for more specific and clear definitions (APA,

2014; Lobar, 2016; Matson, Kozlowski, Hattier, Horovitz, & Sipes, 2012).

Prevalence

Autism spectrum disorder (ASD) has seen an increase in diagnosis since it was

first identified by Kanner in 1943, mostly attributed to the change in definition from a

mental disorder to a treatable disorder, improvements in diagnostic tools (e.g., the Autism

Diagnostic Observation Schedule [ADOS]), and inclusion of ASD in IDEA for special

education services (APA, 1980; 2013; 2014; Baio, 2014; Brock, 2014; Lai, et al., 2014;

Improving Autism Care, 2014; Rutter, 2005; Thompson, 2013). From 2000 to the

present day, an increase of 78% to 120% is estimated to have occurred in the population

(Baio, 2014; O’Brien, 2013). O’Brien (2013) approximates about one in 50 while Baio

(2014) estimates one in every 68 children are diagnosed with a form of ASD. Lai et al.

(2014) estimate the worldwide prevalence to be about 1%. More than 70% of people with

ASD demonstrate comorbid conditions, including about 31% with intellectual delays

(Baio, 2014; Lai, et al., 2014). Male children are more likely to be diagnosed then

females with a ratio of 1 in 42 males and 1 in 189 females (Baio, 2014). All ethnic groups are susceptible to a diagnosis though the prevalence is slightly larger among

Whites (Baios, 2014; U.S. Department of Education, National Center for Educational

Statistics, 2016). Finally, children from higher income tracts are more likely to be

diagnosed than children in lower tracts and their identification is often between 6 to 16 months earlier due to more educated and informed parents and better access to health care and developmental services (Durkin et al., 2015; Fountain, King, & Bearman, 2011;

Mazurek, et al., 2014). Overall, ASD transcends race, gender, ethnicity, and socioeconomic status (Burkett, Morris, Manning-Courtney, Anthony, & Shambley-Ebron

2015; Durkin, et al., 2015; Mazurek et al., 2015; Zuckerman, Mattox, Sinche, Blaschke,

& Bethell, 2014).

Characteristics of Students with ASD

Parents and teachers typically identify unusual behaviors self-regulation, and communication as areas of concern that affect the academic performance of student with

ASD (Goldstein, Naglieri, Rzepa, & Williams, 2013; Oliveras-Rentas, Kenworthy,

Roberson, Martin, & Wallace, 2011). This study separates social skills from communication for analyses, because while there is overlap in the two skill domains, the primary purpose of communication is to respond or initiate interaction, while social skills are meant to increase experiences that prevent isolation and loneliness (Spain & Blainey,

2015; White & Roberson-Nay, 2009). The following section provides an overview of common characteristics students with ASD display in each of the aforementioned areas.

Communication. Brown and Elder (2014) define communication as “the process of exchanging information in different forms with other people” (p. 219).

Communication is a complex process that involves understanding language and nonverbal cues and symbols (Heflin & Alaimo, 2007). Goldstein et al. (2013) administered several Autism Spectrum Rating Scales (ASRS) to a large representative sample of youth with ASD with and without formal diagnosis of psychological disorders,

and found approximately 20 communication and social skills domains. Although their study combined social skills and communication, their study also identified features of communication and social skills separately within the domain (Goldstein et al., 2013).

For instance, peer and adult socialization were social skills, while atypical language was a feature of communication (Goldstein et al., 2013). Areas identified under communication, excluding those with a focus on social skills, include deficits or manifestations of: echoing, subject over focus, speech out of context, odd pronoun use, odd speech, immature language, language off topic, difficulty maintaining conversations, inappropriate responses to peers or adults, smiling at inappropriate times or lack of smiling, avoids talking to peer or adults, lack of emotional expression, and lack of listening (Goldstein et al., 2013). Odd pronoun usage, immature language, and speech out of context were frequently cited features of communication delays (Goldstein et al.,

2013, p. 1010).

Behaviors. Goldstein et al. (2013) sought to identify behavioral symptoms of

ASD and found 26 unusual behaviors. Respondents indicated that individuals with ASD often “insist on certain routines” and “line up objects in a row” (Goldstein et al., 2013, p.

1008). They also identified 16 common self-regulatory behaviors related to attention, impulsivity, and noncompliance (Goldstein et al., 2013, p. 1008). Respondents, indicated behaviors of students with ASD, under these authors’ definition, included: arguing with other children; having difficulty waiting their turn; finding routine changes upsetting or reacting to routine changes; pica, interrupts, fidgets, impatient, smell, noise or touch sensitivity; and attachment to objects (Goldstein et al., 2013).

In a similar study, Hanson et al. (2016) administered their Behavior and Sensory

Interests Questionnaire (BSIQ) to determine behaviors associated with ASD and identify individuals with developmental disabilities in relation to the typically developing population. Their study found six categories of behavior, including: (a) stereotyped behaviors, (b) compulsive and ritualistic behaviors, (c) rigidity, (d) aggression and self- injurious behavior, (e) language perseveration, and (f) perseverative interests.

Social skills. Students with ASD often lack age appropriate social communication skills due to their difficulty interpreting visual social ques and maintaining conversations

(Mahan & Matson, 2011; Schreiber, 2011). Individuals with ASD also may exhibit other social deficits. Some of these deficits include: social problems with peers and adults, inappropriate play, responding to peers and adults appropriately, understanding feelings, grasping humor and social cues, listening, maintaining eye contact, and talking to peers and adults.

Although their peers typically do not reject students with ASD, the students with

ASD often isolate themselves, prefer to operate in the periphery, and choose to play alone at recess (Rotheram‐ Fuller, Kasari, Chamberlain, & Locke, 2010). Self-isolation is commonly seen when observing playground interactions because they may lack the skills to participate appropriately in games (Lang et al., 2012). This social isolation usually increases as students with ASD progress into the upper grades (Rotheram‐ Fuller et al.,

2010). Social interactions with typical peers and teachers offer the primary venue through which students learn academic, social, vocational, self-determination, and other functional skills required for short and long-term success (Carter et al., 2014). The continued isolation among students with ASD often suppresses their development of

social communication and self-regulation skills (Goldstein et al., 2012). Social isolation also may contribute to their sense of loneliness as well co-morbid disorders, such as anxiety and depression (Koegel, Kim, Koegel, & Schwartzman, 2013).

Academic performance. The lack of oral language skills among some students with ASD contributes to low reading comprehension and performance in other subjects

(Johnson, Barnes, & Desrochers, 2008). Asberg, Kopp, Berg-Kelly, and Gillberg (2010) investigated the oral language skills and reading performance of girls with ASD by comparing results on academic assessments with those of the TD population on phonetic and comprehension assessments. Though the girls with ASD could not be distinguished overtly from the typically developing population of girls, 40% of the girls with ASD manifested with a reading and writing disorder compared with 4% of the TD population

(Asberg et al., 2010). In their study, Johnson et al. (2008) found inferential skills and knowledge of story structure predicted later reading comprehension performance which is often poor in students with specific language impairments, a diagnostic component of

ASD (APA, 2013a; Johnson et al., 2008). Thus, the lack of appropriate communication development of students with ASD often contributes to the low reading performance of students (Asberg et al., 2010; Catts, Adolf, & Weismer, 2006; Nation et al., 2006; Nation,

Cocksey, Taylor, & Bishop, 2010; Oliveras-Rentas et al., 2011). According to Nation et al. (2006), the decoding and basic reading skills of many students with ASD remain intact, but students are affected by impairments in comprehension (Huemer & Mann,

2010; Jones et al., 2009).

Mathematical ability in students with ASD follows the typically developing (TD) population though some clinically significant areas of weakness in skills occur based on

expected performance of cognition, such as low IQ in skills in areas such as number sense in nonsymbolic numbers (Burton, Anderson, Prater, & Dyches, 2013; Hiniker,

Rosenberg-Lee, & Menon, 2016). Wei, Lenz, and Blackorby (2013) also found that students with ASD have difficulties in applied problems and calculation, but noted some students demonstrated hypercalculia, an increased ability in math calculation. Fleury et al. (2014) reviewed the wide range of skills and research pertaining to students with ASD and noted that giftedness can occur, even though most demonstrate weaknesses in skills such as word problems, remembering mathematical operations, and calculation. Fleury et al. (2014) offered cognitive constructs, or profiles, in an attempt to explain the academic difficulties of students with ASD related to auditory and visual processing, detail focused processing, executive function, theories of mind, and memory.

Despite some common areas of need such as communication, behavioral, social, and academic areas, the wide variation of performances among individuals with ASD reminds researchers that individual differences, as well as comorbid conditions, affect their abilities (Charman et al., 2011; Fleury et al., 2014; King, Lemons, & Davidson,

2013). Overall behavior, communication, social skills, and academic performance among youth with ASD affect future functioning into adulthood, including community involvement and life skills (Gray et al., 2014).

Autism and Education

A series of laws and court cases heard from the 1950s through the 1980s, promoted equity for students with ASD (Shapiro & Stevkovich, 2011). After the enactment of Brown v. Board of Education (1954) which eliminated separate but equal, the parents of students with disabilities were able to successfully lobby for the rights of

their students. In 1958, the Education of Mentally Retarded Children Act was passed to

support the education of students with special needs by providing grants to institutes of

higher learning to educate teachers on students with mental retardation (Brownell,

Sindelar, Kiely, & Danielson, 2010). In subsequent court hearings such as the

Pennsylvania Association for Retarded Children vs. Commonwealth of Pennsylvania

(1972), schools were prevented from limiting education opportunities for the lack of toilet

training or the perceived inability to learn (Brownell et al., 2010). Before these laws,

students with disabilities were often excluded from educational opportunities (Brownell, et al., 2010). Laws began to acknowledge that not everyone needs the same tools to make academic gains.

In the 1970s, Congress passed the Education for All Handicapped Children Act, which further guaranteed opportunities for education of students with disabilities in an inclusive setting similar to what was done with Brown vs. Board of Education (Spring,

2015). With the case of Mills vs. Board of Education of District of Columbia (1972), the

cost associated with servicing students could not be a limiting factor in providing the

required service needs. Section 504 of the Rehabilitation Act (1973) stated that

individuals with disabilities in the United States should not be excluded from

participation in any program receiving federal assistance, such as public schooling.

Therefore, laws began supporting the public education of students with disabilities.

Although at this time, all students were guaranteed the right to enter school, there were no standards for what constituted a disability.

In the 1997, the Education for All Handicapped Children Act was changed to the

Individuals with Disabilities Education Act (IDEA, 1997), which was reauthorized in

2004. These acts enacted a set of procedures for determining eligibility for special

education and limiting the over representation of minorities receiving special education

services (Spring, 2015; U.S. Department of Education, 2010). IDEA (1997) also required

parental consent for evaluation and designated several qualifying conditions including:

(a) intellectual disability (formerly known as mental retardation), (b) hearing impairment,

disturbance (ED), (f) orthopedic impairment, (g) autism (ASD), (h) traumatic brain injury

(TBI), (i) other health impairment, (j) multiple disabilities, (k) developmental delay for children 3-10 (DD), (l) acquired brain injury (ABI), or (m) specific learning disability

(SLD).

After IDEA (1997), the Education Sciences Reform Act (2002) attempted to

ensure that scientifically based practices, EBP, were utilized in schools. The act set

standards for scientific evaluation, which advocates for sound research methods and

designs that provide replication information and assistance identifying and selecting methods for improvements in education. The Education Sciences Reform Act (2002) developed the National Board for Education Sciences to oversee scientific evaluation of research in education. It provides for federal funds and grants for research in education.

The final role of the board is to promote the dissemination of researched practices for use

in classrooms.

With the development of the No Child Left Behind Act (NCLB, 2002), the

government tried to address the issue of inequities, by closing the educational gaps, for

minorities and students in special education (Cortiella, 2010). This law required that assessment information be made public and accounted for in annual yearly progress

(AYP) data for each school (NCLB, 2002). Special education students’ data were also

collected to determine if academic gains were being met (NCLB, 2002). NCLB also

addressed the issue of teacher quality by defining a highly qualified category for both

general education teachers and special education educators to improve equity in service delivery (NCLB, 2002). NCLB (2002) added the necessity of EBP by requiring scientifically based programs to ensure students are reading by the end of third grade at a

3rd grade proficiency level.

Laws and policies, such as IDEA (2004) and NCLB (2002), were developed to

ensure students with special needs were gaining academically to address the past injustice

of exclusion from school services (Shapiro & Stefkovich, 2011). The main benefits of

IDEA (1997; 2004), Education Sciences Reform Act (2002), and NCLB (2002) have

been the emphasis on inclusion of students with disabilities and Free Appropriate Public

Education (FAPE). As more than half of students prior to IDEA were excluded from

public services entirely, the implementation of IDEA defined where students should be

educated (Spring, 2016). The least restrictive environment (LRE) available to meet the

students’ needs, which is often the general education classroom, was emphasized in the

early 2000s (Spring, 2016). The offer of a Free Appropriate Public Education (FAPE)

within the least restrictive environment (LRE) became the new model for inclusive

education with the passage of NCLB (2002). The FAPE provision allows for education

at no cost, extending beyond public schools to private schools, when assessments

determine courses or schools would appropriately meet students’ needs (IDEA, 2004).

Inclusion has been a challenge for many general education teachers not equipped

to adapt their instruction to meet the needs of students with a variety of disabilities now

included in their classrooms. IDEA (2004) specified that all teachers receive training in servicing students with disabilities by adding this requirement to teaching credential programs. NCLB (2002) demanded the highly qualified option for not only general education, but also special educators.

Recently, the Every Student Succeeds Act (ESSA) of 2015 replaced NCLB

(2002). Like NCLB (2002), ESAA (2015) requires federal accountability of the states through assessments, but provides some flexibility in how the assessments are conducted

(Korte, 2015). Unlike NCLB (2002), ESSA allows states to set their own accountability goals and submit them to the state instead of achieving federally mandated goals (Korte,

2015). ESSA (2015) continues to require that students with disabilities along with other sub-groups, be monitored to determine progress and achievement.

Legislation and policies no longer operate separately for students with disabilities

(Shapiro & Stefkovich, 2011). IDEA (2004) and NCLB (2002) clarified the inclusive practices to ensure that education is for all students. As such, polices that dictate practice for general education students or typically developing students, also encompass those with disabilities (NCLB, 2002). The Education Science Reform Act (2002), NCLB

(2002), and ESSA (2015) as well, require the use of evidence-based practices (EBP) in education. Although the literature indicates parents, teachers, and administrators desire the use of EBP for implementing programs for students with ASD (Callahan, Henson, &

Cowan, 2008), the varying characteristics and needs of students with ASD present challenges to identifying EBP. As a result, there are limited EBP designated for this population (Callahan, et al., 2008; Simpson, 2008), and there is an inherent policy to practice gap (Lilienfeld, et a., 2015).

Identification of Evidence-basedPractice

One explanation for the gap in policy (e.g., requirements of NCLB, 2002; and the

Science Education Reform Act, 2002) and practice is the fact there is no single standard for what qualifies as EBP for students with ASD. Several authors and organizations, such as the Alexander et al. (2015); Best Evidence Encyclopedia (n.d.); Odom, Collet-

Klingenberg, Rogers, & Hatton (2010); Reichow, Barton, Sewell, Good, and Wolery

(2010); and the What Works Clearinghouse [WWC] (2014); offer tools such as checklists

to identify EBP by evaluating the strength of research methods (e.g., large sample sizes,

use of control groups and random or nonrandomized trials, and the reliability validity of

measures (Odom, Collet-Klingenberg et al., 2010; Reichow et al., 2008). As a result of

their work, Odom, Collet-Klingenberg et al. (2010) identified 24 EPB for students with

ASD. Subsequently, the National Professional Developmental Center on Autism

Spectrum Disorder [NPDC] (2016a) and Wong et al. (2015) added four additional

practices, including newly added cognitive behavior training (CBI), modeling, scripting,

and structured play group. They also dropped one practice, structures worked systems,

from their list of EBP (American Speech-Language-Hearing Leader, 2014).

Table 1 identifies and describes current EBP for students with ASD in the areas of behavior, communication, social skills and academic performance. While some carry over between the practices exists, they are grouped according to the primary strategy, which they target (Alexander, Ayres, & Smith 2015; Odom Collet-Klingenberg et al,

2010). The National Professional Developmental Center on Autism Spectrum Disorder

(NPDC, 2016b) also provides a matrix for implementation that specifies which skill area and age range the EBP have been shown to be effective. For instance, they list eleven

domains including: social, communication, joint attention, behavior, school-readiness,

play, cognitive, motor, adaptive, vocational, mental, and academic (NPDC, 2016b).

While the domains for behavior, communication, social skills, and communication have

been used here the other categories were not included due to the lack of use by many

other researchers in the field (Alexander et al., 2015; Goldstein et al., 2013; Hess, et al.,

2008; Stahmer et al., 2005; Wong et al., 2015). Available in the matrix were age levels

where a practice has been endorsed as evidence-based for students with ASD from the

following three categories: 0-5, 6-14, and 15-22 years of age. For example, extinction

has demonstrated to be an EBP for improving social skills for 6- 14-year-old students and an EBP for communication for students in all three age groups, 0-5, 6-14 and 15-22 years of age, but not an EBP for academics (NPDC, 2016b).

Table 1 Evidence-Based Programs and Descriptions for Students with ASD

Evidence-basedPractice Description

Communication Tool to initiate communication exchanges and interactions Picture Exchange Communication System (PECS) Behavior Decrease an interfering behavior and Antecedent-Based Intervention (ABI) increase engagement by modifications of the environment Cognitive Behavior Instruction that leads to control of cognitive process of behavior Differential Reinforcement Strategy that reinforces alternative (DRA/I/O/L); Reinforcement behaviors to replace undesirable behavior; purposeful ignoring of undesirable behavior; reinforcing more desirable behaviors Extinction Behaviorally based strategy that withdraws or terminates the reinforcer of an interfering behavior to reduce or eliminate the behavior; often used in conjunction with DRA

Evidence-basedPractice Description Functional Behavior Assessment (FBA) System in which the function of behavior is determined by the use of data collection. Response Interruption/ Redirection The physical prevention or blocking of interfering behavior with redirection to more appropriate behavior Social Skills Strategies designed to increase social Peer-mediated Instruction/ Intervention engage ment by teaching peers to initiate (PMI) and maintain interactions Pivotal Response Training (PRT) An approach that teaches the learner to seek out and respond to naturally occurring learning opportunities Self-Management A method in which learners are taught to monitor, record data, report on, and reinforce their own behavior Social Narratives Written narratives that describes specific social situations in some detail and is aimed at helping the individual to adjust to the situation or adapt their behavior. Structured Play Groups Small group characterized by modeling an activity with specific roles of the adult/teacher to scaffold the activity based on activity goals Social Skills Training (Groups) Small group instruction with a shared goal or outcome of learned social skills in which participants can learn, practice, and receive feedback. Academic Adult directed trial instruction utilizing Discrete Trial Teaching (DTT) reinforcements to teach a skill and/or reinforce a behavior Multiple Domains Use of computers to teacher academic and Computer Aided Instruction and Speech communication skills; includes computer Generating Devices tutors and modeling; academic focuses on vocabulary and grammar Exercise (ECE) Improve physical fitness and increase desired behaviors and decrease undesired behaviors Replace inappropriate communication acts with effective communication Functional Communication Training behaviors/skills (FCT) Modeling Modeling to allow acquisition of skills and generalization of skills and new behaviors Naturalistic Interventions A variety of strategies that closely resemble typical interactions and occur in natural settings, routines, and activities

Evidence-basedPractice Description Parent-Implemented Interventions Strategies that recognize and use parents as the most effective teachers of their children; individualized intervention to increase positive learning outcomes Prompting When the target stimulus does not provide the response a stimulus that pairs with the target stimulus to provide the desired response Task Analysis and Training Behaviorally based antecedent teaching strategy that breaks down steps and links them for prompting Time delay Behaviorally based antecedent teaching strategy that promotes errorless learning; teaches skills in the naturalistic environment with a structure in place to increase probability of desired action Scripting Verbal or written description of a model for a specific skill or situation Video Modeling (VM) Utilizes assistive technology as the core component of instruction and allows for modeling; includes basic video modeling of another, video self-monitoring, point of view video modeling, and video prompting. Visual Supports Tools that enable a learner to independently track events and activities; may allow learner to process information quickly

Note. Adapted from “Evidence-based practices in interventions for children and youth with autism spectrum disorders” by Odom, Collet-Klingenberg, et al. (2010). Preventing School Failure: Alternative Education for Children and Youth, 54(4), p. 277-278; “Using Time-Delay to Improve Social Play Skills with Peers for Children with Autism” by Liber, Frea, & Symon, 2008, in Journal of Autism and Developmental Disorders, 38(2), 312-323. 10.1007/s10803-007-0395-z; and “Evidence Based Practices” by NPDC (2014). Retrieved from: http://autismpdc.fpg.unc.edu/evidence-based-practices.

Determining EBP for students with ASD can be problematic for parents and

teachers. When guidance is provided by some popular organizations, such as autism.com

and autism-society.org, which aim at providing information directly to parents, limited

guidance was in fact offered (DiPietro, Whiteley, Mizgalewicz, & Illes, 2013;

Stephenson, Carter, & Kemp, 2011). For instance, claims made using evidence that was not cited or cited using general terms such as “research has shown” without references to

authors, makes it difficult for those searching for EBP to determine true EBP (DiPietro et

al., 2013, p.125). Thus, trying to distinguish true EBP from new practices may lead

practitioners to choose methods that appear to be EBP, but are not (DiPietro et al., 2013).

In addition, parents of students with ASD often combine multiple practices making it

difficult to determine the safety and efficacy of the practices (Bokwer, D’Angelo, Hicks,

& Wells, 2011). For instance, Goin-Kochel, Myers, and Macintosh (2007) found, on

average, parents of children with ASD had utilized between seven and nine practices and

were currently using between four and six practices.

EBP Training

There are several resources available for educators and parents to learn more

about EBP. The National Developmental Professional Center on Autism Spectrum

Disorders (NDPC; 2014) published modules with resources for 24 of the 27 focused interventions of EBP noted by Odom, Cox, & Brock (2013) and Wong et al. (2015) to provide information and professional development for anyone interested in supporting

students with ASD. Modules are being developed for the other three newly identified practices: scripting, cognitive behavior interventions (CBI) and structured playgroups

(NDPC, 2014).

Autism Internet Modules through partnerships with the Ohio Center for Autism

and Low Incidence (OCALI), provides free on-line modules for anyone seeking to learn

more about EBP for students with ASD and other topics related to ASD, such as

assessment (Autism Internet Modules [AIM], n.d.). These modules include topics such

as discrete trial teaching, functional communication training, other practices to utilize

with students with ASD, and medication information for students with ASD. Also

available are assistive technology internet modules to learn more about specific

technology uses to develop self-help and other skills.

Within the state of California, the California Autism Professional Training and

Information supports the implementation and training for individuals at the local level to

utilize EBP and assist students to access the common core state standard (California

Autism Professional Training and Information Network [CAPTAIN], n.d.). CAPTAIN

(n.d) partners with multiple agencies in an attempt to improve the use of EBP for all

stakeholders who would benefit from EBP knowledge. Currently, there three on-line trainings are available, along with annual summits and conferences.

Problem Statement

While laws were enacted to ensure EBP for students with ASD, there continues to be insufficient use of EBP or use of non-reliable methods (Cook & Cook, 2013), and some parents are becoming dissatisfied (Starr & Foy, 2012). Since EBP are mandated for students with ASD by NCLB (2002) and IDEA (2004), schools that fail to use EBP can find themselves facing costly lawsuits and due process hearings costing districts up to

$50,000 (Schopler, 1998; Yell, 2012; Yell, Katsiyannis, Drasgow, & Herbst, 2003).

Parents of students with ASD are more likely to file for due process than parents of other students with other disabilities (Burke & Goldman, 2015).

Organizations and research assist in the use of EBP, but skilled educators are also required to implement EBP effectively. While organizations provide databases with articles hoping to improve the use of EBP, educators still need to be aware of the organizations and possess the skills to make sense of the technical and complex reviews

(Hansen, 2014). As Simpson (2008) notes, “Even the most scientifically valid methods

are only as effective as the individuals who use them” (p. 9). Teacher skill, training, and knowledge are important factors in practice, as well as other dimensions such as motivation, outside the range of this work (Phillips, 2014; Renta-Davids, Jiminez-

Gonzalez, Fandos-Garridos, & Gonzalez-Soto, 2016; Simpson, 2008).

Educators currently do not recommend EBP to parents according to Christon,

Arnold, and Myers (2015). When educators among other practitioners working with students with ASD were surveyed about their recommendation of psychosocial EBP, the

mean rate of recommending EBP was 2.65 out of 4. While this was significantly greater

than other practitioners such as medical staff, and speech and language therapists, it

leaves room for improvement in the recommendation of self-reported EBP

recommendations. Also, noted are even rarer recommendations of EBP often occurring

under comprehensive treatment models (CTM) that deliver an entire treatment package

(Christon, et al., 2015). How well will students be prepared to become members of their

communities if educators continue to utilize unproven practices or not recommend EBP

to service students with ASD? Continuing to utilize fad and other nonEBP treatments

after evidence research supports the discontinuance of such approaches further illustrates

the research to practice gap (Lilienfeld et al., 2015). Hess et al. (2008) demonstrates that

this gap continues in servicing students with ASD with less than 30% utilizing EBP. By

utilizing EBP, educators may expect positive results for students with ASD leading to

gains in communication, behaviors, social skills, and academics.

The prevalent use of non-EBP for treating ASD symptoms contributes to the

policy to practice gap for students with ASD (Matson, Adam, Williams, & Rieske, 2013;

Simpson, 2005). Non-evidence-basedmethods can hinder the progress of EBP (Simpson,

2005; Matson et al., 2013). The quick fix promises, provided by some non-EBP

programs, have led educators and parents to try varying methods, such as dietary changes

(e.g. Borchardt, 2015; Dawson, 2015; Ryan, 2016) and in some instances, can decrease

the independence of students who use them (Travers, Tincani, & Lang, 2014). Students

have a finite amount of time in school and while several weeks of instruction to test a

practice seem harmless, the continued use of nonEBP can amount to permanent losses of

instructional time that accumulate to a significant loss of up to 4 weeks a year or up to 2

years over the course of a student’s academic career (Travers, 2017). The false hope

provided by using nonEBP as well as the limited time and resources of educators, can

amount to a real tragedy that also contributes to teacher burnout, teacher attrition, and frustration for the professionals utilizing unsuccessful methods (Billingsley, 2004; Chan

& Nankervis, 2015; Lilienfeld, et al., 2015; Travers, 2017).

Context for the Study

The study took place in the Inland Empire (IE) region of Southern California, which encompasses the counties of Riverside and San Bernardino inland from the beach cities, into the deserts of Palm Springs and just North of San Diego. The population of over 4 million in the IE has increased over the last decade (United States Census Bureau,

2016). The Autism Society (2017) Inland Empire chapter, which began servicing the area in the 1960s and has grown to meet the growing needs of the community, which estimates over 12,000 individuals living with ASD. As the population of the IE is estimated to continue its growth in population, the numbers of individuals diagnosed with

ASD will also continue to rise (United States Census Bureau, 2016). The Southwest

Autism Task Force (SATF) was developed in 2010 to meet the growing crisis in the IE to address the following concerns:

• ASD is the fastest growing developmental disability in the U.S.

• ASD receives less than 5% of the research funding of other childhood

diseases

• These is no cure for ASD, but early intervention and diagnosis show

promising results

• More children are diagnosed with ASD than diabetes, AIDS, and cancer

combined (League of California Cities, 2014).

The SATF promoted public awareness of ASD by creating a resource guide for services, including evidenced-based practices that show research support, and providing services to allow individuals the necessary supports to transition into adulthood (League of California Cities, 2014). Despite organizations in the IE and across the U.S. promoting the use of research-based programs for the treatment of symptoms of ASD, there remains an underutilization of these programs in the United States (Autism Society,

2017; Hess et al., 2008; Odom, Boyd, et al., 2010; Odom, Collet-Klingenberg, et al.,

2010; Wong et al., 2015).

This study aimed to expand upon prior research on the use of EBP for students with ASD by special educators. In the past, educators in the IE have demonstrated a lack of knowledge of EBP. For instance, educators in a study by Stahmer et al. (2005) reported they used five practices consistently that were not considered EBP for students with ASD and they reported they did not consult educational journals for clarification on

EBP. Since 10 years have passed since the 2005 study by Stahmer et al., another

examination is warranted to determine the current usage of EBP for students with ASD and the sources educators consult to support the use of EBP in their classrooms.

Purpose Statement

The purpose of this study was to determine the most widely used EBP and nonEBP for students with ASD in the Inland Empire (IE), specifically in the areas of communication, behaviors, social skills, and academic deficits. The researcher was interested in discovering how special educators defined EBP strategies and what resources they utilized to identify EBP strategies for instructional purposes.

Research Questions

The following questions guided this study:

• How did special educators in the Lemon School district define EBP for students

with ASD?

• What sources did they use to incorporate EBP for students with ASD?

• What EBP and nonEBP for students with ASD did special educators use were

EBP to address communication, behavior, social, and academic deficits and did

they believe the practices were EBP?

Definition of Terms

• ASD (Autism spectrum disorder)- A manifestation of delays in social,

communication, and restrictive and repetitive behaviors (APA, 2013a).

• Evidence-based practice (EBP)- “Programs or practices shown by sound research

to meaningfully and positively impact student outcomes” (Cook, Tankersley, &

Landrum, 2013, p. 3).

• Fidelity- The “extent to which the innovation (practice) corresponds to the

originally intended program (a k a adherence, compliance, integrity, faithful

replication)” (Durlak & DuPre, 2008, p. 329).

• Free Appropriate Public Education (FAPE)- Education services that have been

provided at public expense, without charge under an educational program (IEP)

that meet California educational standards at an appropriate elementary school

(IDEA, 2004).

• Implementation- Use of a practice by group of participants (Durlak & DuPre,

2008).

• Inclusion: “Provide appropriate educational opportunities and supports to students

with the full range of disability characteristics and levels in chronologically age-

appropriate, general education classes those students would attend if they were

not labeled disabled” (Giangreco, Sutter, & Hurley, 2013, p. 122).

• Intervention- Treatment program that may or may not meet EBP criteria

• Least Restrictive Environment (LRE)- To the extant appropriate children are

educated with peers who are not disabled and students with disabilities are not

removed from the general education environment unless the severity of the

disability with the inclusion of aides and services cannot satisfactorily be

achieved (IDEA, 2004).

• Special educators- educators who are certified by the state of California to

conduct educational assessments, plan and implement instruction, develop

transitional plans, provide positive behavior supports, collaborate in an IEP, and

develop communication and social skills with students (California Commission

on Teacher Credentialing [CTC], 2017). This excludes service providers such as

adapted physical educators (APE), occupational therapist (OT), and speech and

language pathologist which require a separate added authorization or provide a

service in one particular domain (CTC, 2017).

Assumptions

The author made the following assumptions:

• Students were appropriately diagnosed with ASD with identifying assessments.

• Special educators held the correct credentialing under California law to service

students with special needs and the appropriate ASD authorization.

• Special educators were familiar with the laws requiring EBP.

• The respondents were knowledgeable about EBP and answered the survey

honestly.

Only those who met the criteria for participation were sent the survey and included in the

results.

Limitations

While attempts were made to adhere to standards of rigorous research, several

limitations of this study were present. The district where the research took place was the

recipient of a grant from the NPDC (n.d.) aimed at providing education for EBP for ASD.

This may have increased the use of EBP that other districts in the area may not have

experienced. The survey used to report the findings also had limitations. While the validity of the Autism Treatment Survey (ATS) was demonstrated the modified version of the ATS utilized in this study, did not undergo the same level of rigorous review. The modified survey was reviewed by three dissertation committee members and was then pilot tested and refined to enhance the clarity of the instrument. Another limitation was

the fact participants provided self-reported data. Since no observations were completed,

there is no way to verify the accuracy of participants’ reported use of each EBPs.

Furthermore, the study did not explore the fidelity of the respondent’s use of EBP for

students with ASD and as Durlak and DuPre (2008) acknowledge, some adaptions of

EBP are expected for successful implementations. Finally, due to the timing of the study, there was a low response rate. Thus, the results may not accurately convey the responses of all special educators within the district.

Generalizability

The results of this study are most likely to apply to the Lemon school district, and similar districts with similar demographics. As well, this study only investigated special educators’ practices, which may differ from general education teacher practices. Finally, this study explored the EBP used by elementary and adult special educators which may differ from those working in middle and high school settings.

Significance

The use of EBP for students with ASD addresses two significant issues in education (Cook et al., 2013). Cook et al., (2013) postulates that if EBP for students with

ASD are not currently in use, the implementation of EBP will likely increase the academic achievement of students. Secondly, by understanding the current definitions and practices of special educators, policies can be developed and training can be provided to address the needs of educators to assistant in implementation of EBP (Aron & Loprest,

2012).

Summary and Organization of this Study

Chapter 1 reviewed the criteria for a diagnosis of ASD, presented educational

policies regarding instruction of students with disabilities, discussed the policy to practice gap and provided background on EBP. Chapter 2 describes the decision-making process of teachers using equity, caring, and competency as a framework for understanding how special educators can better support students with ASD. The chapter discusses special educator preparation and then describes the methods used to evaluate research and identify EBP to support the behavior, communication, social skills, and academic needs of students with ASD. The chapter ends by discussing classroom implementation of EBP for students with ASD, describing sources of information and training for EBP. Chapter 3 provides the methodology for the study and Chapter 4 reviews the results. Lastly,

Chapter 5 discusses the results and offers recommendations for policy, administrators, and educators for EBP for students with ASD and advice on study designs for further research in the field.

CHAPTER 2: LITERATURE REVIEW

As the proverb states, it takes a village to raise a child. Educators function as a

team to provide for the education of all students. Teachers are responsible for what

happens inside the classroom and spend most of their time with students; therefore, it is

important to foster positive teacher-student relationships and provide a school culture

where students are valued. It is also important to foster a positive school environment,

with educators who are competent to do so (Sergiovanni, 1979; Sergiovanni, 2004a;

Sergiovanni, 2004b). This study considered the competency of teachers and their use of

caring and equity in their decision-making as a framework for understanding how teachers can better support students with ASD. This literature review begins by presenting this framework and then discussing how practices are established. It continues by presenting EBP for students with ASD under the categories of communication, behavior, social skills, and academics and discussing commonly-used practices that have not been established as EBP under the same categories. The chapter concludes by examining the current implementation of EBP for students with ASD and identifying needs for further research.

Equity, Caring, and Competency

The decision-making process of teachers that focuses on teacher equity, caring, and competency provides the framework for understanding how special educators can better support students with ASD. Figure 1 shows how these three areas interact with knowledge of EBP at the center of the decision-making process to inform the practices teachers select for students with ASD.

equity

caring EPB

competency

Figure 1. Decision making process of teacher competency, utilizing equity, and caring to inform EBP use Equity

As described in Chapter 1, special education policy has been driven by recent legislation that requires rigorous instructional practices and accountability (Thorius &

Maxcy, 2015). Despite legislation aimed at increasing equity, and macro-level policies,

such as the Science Reform Education Act (2002), NCLB (2002), and IDEA (2004),

districts and schools do not consistently recommend inclusive environments (Farrell,

2004; Thorius & Maxcy, 2015; Welner, 2001; U.S. Department of Education, 2016).

Inclusion improves social, cognitive, and communication functioning (Sansosti &

Sansosti, 2012; Stahmer & Ingersoll, 2004). A main concern is that inclusive

environments continue to remain underutilized for students diagnosed with ASD (U.S.

Department of Education, 2016). Although the general education classroom (often called

regular) is most often considered the ideal placement (IDEA, 2004; Thorius & Maxcy,

2015; Yell & Katsiyanni, 2004), students with ASD are often educated outside of the

general education environment (U.S. Department of Education, 2016). According to the

U.S. Department of Education (2016), 39.9% of students with ASD are serviced in general education settings at least 80% of the school day. As shown in Table 2, the other

60.1% spend less than 80% of their time in the general education environment or in other environments such as separate schools, residential facilitates, home/hospital, correctional facilitates, or parent placements in private school environments (U.S. Department of

Education, 2016). Despite the emphasis on inclusion, Carson (2015) cautions educators

to consider the students’ needs to determine if an inclusive environment is the most

appropriate. Also, Carson (2015) criticizes the common practice among educators and

individualized education program (IEP) members of determining placement based on the

availability of services, instead of determining placement based on a student’s needs.

Table 2 Percentages of Students with ASD Serviced in General Education or Other Environments

80% or more of 40-79% of time Less than 40% of Other

their time in spent in General time spent in Environments

General Education Education General Education (No Gen. Ed.)

Percentage 39.9 18.0 32.8 9.2

Note. Adapted from: 38th Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act, 2016. U.S. Department of Education.

Educator partiality provides the foundation for an IEP team to ensure that one

perspective does not sway the entire team’s decisions and multiple points of view are

included in the decision-making process. One way to ensure the LRE and equitable decision-making is through a necessity-based approach. According to Carson (2015), this approach requires making available the necessary accommodations and modifications that lead to the LRE. Like Carson (2015), Crockett (2014) advocates for a student’s necessary needs to be decided first, and then the placement and practice decisions should be made to meet those needs. That way, schools do not choose the placement based on the available options (Crockett, 2014). Limiting placement and treatment decisions to student needs ensures that program and treatment options benefit students with ASD. As advocated by Saban (2011), educators need to be aware of their partiality when forming decisions. They also need to acknowledge laws, equity concerns, and utilize social justice in their decision-making. By providing for inclusive education training for all teachers, all educators can be prepared to increase participation and decrease exclusion for students with disabilities (Florian, 2012). By collaborating with general educators, parents, principals, and special educators, the foundation for developing and selecting the best available treatment programs and placements can be created for students with ASD

(Able, Sreckovic, Schultz, Garwood, & Sherman, 2014).

Caring

Caring educators offer resiliency to obstacles of social justice and equity.

Noddings (2012b) encourages educators “to learn what the cared-for is going through,

[by] put[ting] aside our own projects and listen” (p. 4). By listening, to what an individual in the IEP team says, the listener gains a more thorough understanding, so the educator can better respond to the needs and concerns expressed in the multidisciplinary team, including the parent and student by making an informed decision for which

practices to utilize (Noddings, 2012a; 2012b). Marks (2011) emphasizes the goal of

special educators should be for a quality life for their students:

Special educators need to let the public know that we aren’t engaged in charity

work, but that we’re doing serious work guided by a vision of a society in which

individuals are provided with equity and opportunities to be fully integrated

members in our communities. We must move beyond teaching basic self-care

skills to teaching about self-determination and self-advocacy. (p. 80)

Eccleston (2010) believes special educators are required to be collaborators in

today’s inclusive classrooms. He further explains that they need to possess knowledge,

thoughtfulness, compassion, and leadership. He emphasizes that educators should listen

and that the face time of collaborative efforts cannot be underrepresented. While barriers exist to collaboration such as time and motivation, collaboration has many benefits that make it a viable option for teachers in special education (Eccleston, 2010; Ware, 1994).

Farrell’s (2004) definition also included the quality of the participation, not just time

spent with general education peers. For instance, Farrell (2011) called attention to the fact that some schools were celebrated for their inclusive practices while little to no

interaction between special education and general education students took place (Farrell,

2004). For instance, students with special needs were serviced in separate classrooms on

the same campuses as general education students. According to Farrell (2004), for

inclusion success “all pupils must actively belong to, be welcomed by and participate in a

mainstream school and community-that is, they should be fully included” (p. 7).

Inclusion support findings for students with ASD by improving social functioning

measured by peer interactions, cognitive functioning measured by increased intelligent

quotient (IQ), academic skills, and communication skills, such as the use of pragmatic

language, phrases, and single word use (Sansosti & Sansosti, 2012; Stahmer & Ingersoll,

2004). Communication, therefore, becomes the forefront of a caring special educator

(Eccelston, 2010).

Special educators must continue to collaborate to widen their understanding of

interventions with a research based practices that may benefit students with ASD who do

not always benefit from the interventions of typically developing students (Bruhn, Gorsh,

Hannan, & Hirsch, 2014; Gresham, Van, & Cook, 2006; Mesibov & Shea, 2010;

Sansosti, 2010). Durksen, Klassen, and Daniels (2017) identify collaboration as a key

factor in the motivation for continuing professional learning.

Competency

Teachers develop their competency through training that falls under two

categories. The first category is pre-service programs that occur during the credentialing

stage. The second category is professional development that typically occurs via district

in-service. Each of these categories are described below.

Teacher pre-service preparation. Teacher preparation programs are designed to

meet NCLB’s (2002) and now ESSA’s (2015) highly qualified requirements. In order to teach special education in California, teacher candidates must obtain a Preliminary

Education Specialist Instruction Credential in a specialist area such as Mild/Moderate

Disabilities (M/M) or Moderate/Severe Disabilities (CTC, 2016). To achieve this preliminary instruction credential and earn their highly qualified status, candidates must complete the following six requirements:

1. Obtain a baccalaureate degree from an accredited institution

2. Satisfy basic skill requirements such as the California Basic Elements

Skills Test (CBEST) and other examinations

3. Verify subject matter competency through an examination or coursework

4. Pass the Reading Instruction Competence Assessment (RICA)

5. Complete a course or exam about the U.S. Constitution

6. Complete an approved credential (CTC, 2016).

An authorization to teach students with ASD is also included in the coursework and appears on the Education Specialist Instruction Credential as a separate authorization after June 2010 (CTC, 2016). As defined by the Commission on Teacher Credentialing

[CTC] (2010), the ASD authorization permits:

The holder is authorized to conduct assessments, provide instruction, and

special education related services to individuals with a primary disability of

autism across the continuum of special education program options at the grade

and age levels authorized by the prerequisite credential. (p. 2)

Former Education Specialist Instruction Credentials in moderate to severe disabilities

(M/S) and those credentials earned after June 2010 include the ASD authorization based on course work designed to prepare educators to instruct students with ASD (CTC,

2012). Otherwise, those who did not complete the required coursework covering ASD were able to obtain one year waivers at an employers’ request (CTC, 2016).

Finally, to achieve a Clear Education Specialist Instruction Credential, a beginning teacher must complete an approved induction program geared for special educators, typically during the first two years of service as an educator (CTC, 2016). The

induction program must provide sufficient resources to novice educators and meet

program design standards (CTC, 2016):

• Program rational and design

• Communication and collaboration

• Support providers and professional development providers

• Formative assessment systems

• Pedagogy

• Universal access, equity for all students

• Standard six highlights the needs of students with special needs and offers

support for implementing accommodations and modifications

Standard six addresses the equity and caring components of the aforementioned

framework surrounding the needs of students with special needs and offers support for

implementing accommodations and modifications (CTC, 2008).

Program quality. Despite assurances of adequately preparing educators for teaching, several researchers have highlighted limitations of preparation programs. Winn and Blanton (2005) found preparation programs were deficient in effectively preparing teachers for collaboration, and in understanding legal requirements and the eligibility classification system (U.S. Department of Education, Office of Postsecondary

Education, 2016). Holdheide and Reschly (2008) noted that there is a lack of EBP knowledge provided to both general and special educator candidates in educator preparation programs and recommended that skills in the areas of learning strategies, classroom organization, behavior management, and scientifically-based reading instruction need to be further developed in teacher preparation programs.

Barnhill, Polloway, and Sumutka (2011) investigated pre-service preparation practices specifically geared toward servicing students with ASD. After surveying institutes of higher education (IHE) analyzing the breath of course work and depth of topics on ASD, they found 51% IHE respondents indicated their programs did not offer pre-service training in ASD. Of the programs that offered course work in ASD, 75% were developed in the last one to seven years. Topics covered in depth in their programs included: (a) behavior intervention plans, 69%; (b) functional behavior assessments,

67%; (c) positive behavior supports, 67%; (d) assessment procedures and methods, 63%;

and (e) characteristics, definition and causes of ASD, 52%. Between one third and one

half of the IHEs reported in depth training on collaboration with parents and other

professionals, visual supports, and discrete trial training, with an overview provided for

the majority of specific intervention skills such as Floortime, Communication System

(PECS) as well as legal implications in the field. Though specific interventions were

discussed, no information was provided regarding the research-based evidence of the practices. Barnhill et al. (2011) also uncovered the majority of IHEs developed their own programs independently from the state which accounts for the large variation in

ASD preparation programs.

Changes over the last decades in beliefs about what teachers should know and be able to do have affected both pre-service teacher preparation programs and professional development (Brownell, Sindelar, Kiely, & Danielson, 2010; Forzani, 2014). Brownell et al., (2010) details the previous emphasis of pre-service coursework on disability specific knowledge and intervention, but now coursework focuses on how students should be

educated. Brownell et al. (2010) suggests a shift to assessment and effective instructional

models, or EBP. Both Forzani (2014) and Brownell et al. (2010) emphasize collaboration that must be present for general as well as special educators in the current academic climate and believe it must be part of any preparation program for educators. The next section, describes ensuring professional development teachers.

Effective professional development. Professional development (PD) is the continuing education of teachers typically offered within districts. In their book

Managing Professional Development Education, Glover and Law (2012) summarize research on professional development and emphasize effective PD meets four needs:

• Individual needs- developing the skills and knowledge to teach effectively

and grow as a professional;

• Departmental, year or group needs- developing common approaches and

sharing expertise within a team situation;

• Whole institutional needs-establishing common value which determine

common values for the school; and

• Multi-institutional needs which can be interrupted as groups of schools

working together to meet a common need or goal. (p. 31)

Glover and Law (2012) also provide case studies to address each of these needs.

To institute a change in practice, or to encourage a new practice to be utilized, professional development (PD) needs to address change models. Pfeiffer and Sutton

(2000) coined the term the knowing-doing gap to describe that just knowing about a phenomenon does not automatically translate to implementation. Hannay and Earl

(2012) suggest teachers must change their practices and mindset from a make and take mentality to one that contains a social component required to change teacher practices in

the 21st century (Dede, 2010). Necessary for success now are skills in collaboration, communication, critical and innovative thinking, and creativity (Dumont, Istance, &

Benavides, 2010; Hannay & Earl, 2012). Additionally, change is difficult because it

“expects that teachers challenge and reconstruct deeply embedded practices and beliefs”

(Vetter, 2012, p. 27). Hannay and Earl (2012) relate that some teachers must change their practices in order to adopt new program(s) into their schema. Those individual operators must unlearn the previous individual mentality and reconstruct their thinking with the new social and collaborative model (Hannay & Earl, 2012). Training, or PD, institutes changes in practices, including implementation of EBP for students with ASD (Odom,

2009).

Researchers evaluate the effectiveness of professional development based on the implementation (use) and effectiveness (quality) of targeted practice(s), and the terms they use to describe these aspects vary. Dane and Schneider (1998) referred to implementation as efficacy and effectiveness as fidelity. O’Donnell (2008) also referred to implementation as efficacy or use of a practice, but used effectiveness, rather than fidelity, to describe the quality of the implementation of the practice. For example, the efficacy for EBP for students with ASD would be the percentage of special educators using the practice, although efficacy could also be used to describe how often an individual uses an EBP. Whereas, the effectiveness of EBP for students with ASD would be the extent special educators are utilizing EBP as they were designed. Durlak and

DuPre (2008) defined implementation as the use of a practice within a set of educators and fidelity as the extent to which the practice is implemented as intended; their definition has been used by other researchers (Nilsen, 2015; Odom, Boyd et al. 2010; Stirman,

Kimberly, Cook, Calloway, Catro &, Charns, 2012) and will be used in this study. Durlak

and DuPre (2008) emphasized that PD evaluator should also consider features such as

quality, program reach, and adaption. Durlak (2015) added although implementation is

complex because of the many features, it is an “essential field of inquiry for

understanding what happens when evidence-based programs are brought into new

settings” (p. 1126).

Durlak and DuPre’s Implementation Model

Durlak and DuPre (2008) identified 23 factors that influence the implementation of practices in a meta-analysis that was organized by community, provider characteristics, characteristics of the innovation, organizational capacity, and factors related to the prevention support system, highlighted in Table 3. Especially noteworthy, is the authors’ definition of successful implementation occurring between 60-80% within the timeframe or percentage of a group that used a practice with fidelity, meaning they used the practice as originally intended (Durlak & DuPre, 2008). The authors clarified use and fidelity are not expected to reach 100% since adaptions are necessary to make practices work in varying settings (Durlak & DuPre, 2008). Fixsen, Naoom, Blase,

Friedman, and Wallace (2005) agreed and suggested a 60% rate of use within a group of practitioners with fidelity for EBP implementation. The factors affecting use and fidelity of implementation, presented in Table 3, interact and overlap to influence the implementation rate and fidelity of implementation of the practice (Durlak & DuPre,

2008).

Table 3

Factors Affecting Implementation

Community Provider Characteristics Organizational Factors Related Factors (Individual) of the Capacity to the Characteristics Innovation Prevention Support System Prevention Perceived Need Compatibility General Technical Theory and of Intervention Organizational Assistance Research Factors Politics Self-Efficacy Adaptability Specific Staffing Training Considerations

Funding Perceived Benefit Specific Practices of Intervention and Processes Policy Skill Proficiency Note. Adapted from “Implementation Matters: A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation” by Durlak, & DuPre, 2008, American Journal of Community Psychology, 41, p. 327-350. http://dx.doi.org/10.1007/s10464-008-9165-0. Copyright Springer Science+Business Media, LLC 2008.

Community factors. According to Durlak and DuPre, (2008), various community

and organizational factors contribute to the implementation rate of a practice. Politics,

such as laws, availability of funding to support practices, and the social policy for

implementing new procedures, either help or hurt the implementation of a new practice.

Laws such as NLCB (2002), IDEA (2004), and the Science and Education Reform Act

(2002) all contributed to the introduction of EBP for students with ASD in California

schools. Features such as cost and availability of the research make some practices more

likely to be implemented then others (Dingerfelder & Mandell, 2011). Funding,

especially for expensive discrete trial style practices, influenced how and what practices

that schools utilized (Yell & Katsiyanni, 2004).

Characteristics of the individual. Durlak and Du Pre (2008) added an

individual’s recognition of need, perceptions of the benefits of the implementation, self-

efficacy, and skill proficiency greatly impact implementation (Durlak & DuPre, 2008).

Educators are not likely to use EBP when they do not believe they can use them and think

they do not have the skills to use them effectively (Aaron, 2005; Durlak & DuPre, 2008).

As defined by Bandura (1995), self-efficacy is the belief that one is able to execute a course of action. Self-efficacy also effects implementation of educators (Durlak &

DuPre, 2008). Concurrent with other research on self-efficacy, acceptability and PD

impacted the implementation process of EBP (Donnell, & Gettinger, 2015; Odom, 2009).

Other factors are a teacher’s characteristics, motivation and willingness to be trained and

to utilize programs (Durlak & DuPre, 2008, Hall & Hord, 2014) available time, knowledge of EBP, and skills and trust in the program (Cook & Odom, 2013; Fixsen et al., 2005).

Characteristics of the innovation. Durlak and DuPre (2008) demonstrate that the

innovation itself may offer barriers or ease depending on the adaptability of the practice

to match the current organization’s agenda. Those innovations with greater flexibility to

become adaptable to the current organization will increase implementation. Thus, EBP

that are adaptable for classroom use may be implemented faster than other practices.

Knowledge of the reason why one should use an EBP for students with ASD that aligns

with norms in the classroom setting, also contributes to the use of a practice (Durlak &

DuPre, 2008; Frederickson & Cline, 2009). Thus, a student’s characteristics influence if and how the teacher adapts EBP for the student (Durlak & DuPre, 2008; Frederickson &

Cline, 2009; Lubas, Mitchell, De Leo, 2016).

Dingerfelder and Mandell (2011) add that advantage, compatibility, and the complexity of the practice as it is introduced also contribute to whether a practice will be

implemented. Advantage describes how well the practice fits with the current

organizational structure and needs of the organization (Dingerfelder & Mandell, 2011;

Durlak & DuPre, 2008; Greenhalgh, Robert, MacFarlane, Bate, & Kyriakidou, 2004).

Compatibility refers to how well the practice fits in with the current belief system of the

organization. Finally, complexity or how difficult it is to use the practice, determines if a

practice is used (Dingerfelder & Mandell, 2011; Greenhalgh et al., 2004).

Organizational capacity. Furthermore, organizational features, such as shared

decision making with community input, along with effective leadership before, during,

and after a change has occurred, increase the likelihood of sustaining the change (Durlak

& DuPre, 2008). Kam, Greenberg and Walls (2003) maintain that EBP implementation efforts are improved when principals and other administrators support these efforts.

Fixsen et al. (2009) offer in their framework for states and other agencies that structures

to support implementation need to be in place. Fixsen et al. (2009) recommend that

states and others, such as districts, provide teams to provide internal support, but also

outside monitoring, or external support, to provide feedback and data to facilitate the

implementation. Communication is also essential in their framework for implementation,

with data traversing between the practitioners and managers (Fixsen et al., 2009).

Factors related to the prevention support system. The factors related to the

prevention support system features are things that are done “to prepare providers

effectively for their new tasks” (Durlak & DuPre, 2008, p. 338). Training and technical

assistance is often needed to continue to support implementation (Durlak & DuPre,

2008). According to Fixsen, Blase, Naoom., & Wallace (2009), “[Educators, or

practitioners] are accountable for “making it happen”: for assuring that effective

interventions and effective implementation methods are in use to produce intended

outcomes for children and families” (p. 215). Supports for training are required to

successfully implement EBP (Fixsen et al., 2009), and technical assistance resources need

to be in place once an implementation has begun (Durlak & DuPre, 2008). The lack of technical assistance, as well as the burden of the programs themselves, such as the lack of adaptability or compatibility, can limit EBP use (Dingfelder & Mandell, 2011; Durlak &

DuPre, 2008; Lerman, Vorndran, Addison, & Kuhn, 2004; Simpson, 2003).

Other PD models. There are a few other noteworthy models for supporting the

use of EBP. Durlak and DuPre (2008) recommended enlightened professional

development approaches as a model for PD for educators working with students. This

enlightened PD includes training that provides: modeling, role play, collaboration, shared

decision making, emotional support, and performance feedback. Odom’s (2009) model

includes: teaming, coaching and consultation, communities and practice, online

instruction, web based video and visual access, and web based interactive system to

increase fidelity of implementation of EBP for students with ASD.

Fixsen et al. (2005), Fixsen (n.d.), and the National Implementation Research

Network (NIRN) also created a framework for PD. They included five features of their

framework for implementing EBP:

• Sources- best example, of the practice

• Destination- individual educators using the practice

• Communication link- group of individuals that work toward the

successfully use of EBP with fidelity

• Feedback-information and performance flow

• Influence. (p. 12)

Fixsen et al. (2005) illustrated that the quality of the practice operates independently of

the implementation process and offered four stages of implementation in the following

order: (1) Exploration, (2) Installation, (3) Initial implementation, and (4) Full operation.

Exploration is the beginning stages of development when educators begin to investigate

the practice (Fixsen et al., 2005). Next, installation includes setting up systems to begin

using the practice (Fixsen et al., 2005). Then initial implementation occurs and the fear

of change, anxiety, and the struggles that occur during implementation may cause the

practice to fail. In the final full implementation phase, the practice is fully integrated

(Odom’s et al., 2013). As implementation is a process and not an event, it takes time for

implementation to occur with fidelity (Fixsen et al., 2005).

Implementation following PD.

Several researchers have documented EBP implementation following EBP PD.

Lerman et al. (2004) found after completing a five-day consecutive workshop for four

hours to learn skills in prompting, fading, communication, and reinforcement, the

educators demonstrated over 60% of users utilizing the skills and improved effectiveness outcomes for most participants. Suhrheinrich et al., (2012) and Stahmer et al., (2015)

demonstrated that with increased hours of training and coaching teachers can use

evidence-based practices (EBP) with fidelity, as designed by creators (Durlak & DuPre,

2008). The hours necessary to achieve competency vary by the practice. Some teachers

required many hours and several years to achieve fidelity to an EBP with less structured

programs (Stahmer et al., 2015). For example, programs such as discrete trial teaching

(DTT) are highly structured because they include specific steps, procedures, and require

little teacher judgment (Stahmer et al., 2015). Educators acquired structured skill

programs quickly (Stahmer et al., 2015). Less structured activities, such as pivotal

response training (PRT) that requires more personal judgment and a more naturalistic

setting, were possibly more difficult for teachers to implement in a classroom

environment and took longer for teachers to implement with fidelity (Stahmer et al.,

2015; Suhrheinrich et al., 2012). In fact, some teachers in training opted not to attempt

the practice of PRT entirely in its first year of implementation (Stahmer et al., 2015).

Other training in EBP, investigated by Kretlow, Cooke, and Wood (2012), provided

initial training in EBP, and follow-up demonstrated that teachers were able to increase the

use of EBP with fidelity.

In conjunction with the NPDC, Odom et al. (2013) developed a two-year

implementation model and PD in EBP for students with ASD for educators. In their model, during the first-year of implementation, educators create goals and an action plan with teams. Then, they take an online course with an intensive summer workshop with

NPDC staff. Next teachers begin implementation of the model by linking students’ goals with EBP and begin data collection. A coach provides ongoing assistance into the second year. Online training and summer institutes end year two with support continuing for fall

implementation and goal attainment. For the EBP reviewed, all, but PRT, saw an

increase in use and fidelity as noted by observations by as much as 20% or more using

this model. Next, ways that research is evaluated to determine support for EBP for

students with ASD is discussed.

Evaluating Research for Evidence-Based Practices

The next section describes methods that have been used to evaluate research and

identify EBP, followed by a critique of the current system and recommendations for

future practice. Understanding scientific evidence is necessary to fully understand EBP.

As noted by Travers (2017):

…A general understanding of the features of science and pseudoscience,

common errors in thinking, and a systematic approach to examining

claims is crucial for professionals, intent on adhering to an evidence-based

profession. (p. 202)

Pseudoscientists make sensational claims, ignore oppositional evidence to their

beliefs, choose to include only evidence that supports their claim, use vague language to

prevent verification, avoid criticisms and condemn dissenting opinions (Travers, 2017).

On the contrary, scientists evaluate and critique research used to determine EBP. As

previously discussed in Chapter 1, the Education Sciences Reform Act (2002) set forth

methods for evaluating EBP. Following, several organizations and researchers began to

set forth criteria for determining EBP, such as reliability and validity measures for

determining EBP. Their methods for evaluating EBP are discussed next and assist

educators in determining which practices have a true scientific basis to be determined as

an EBP. Multiple evaluative methods such as checklists are becoming available to help

educators identify EBP. Yet, there is no single set of agreed upon standards for

determining EBP for students with ASD (Odom, Collet-Klingenberg et al., 2010;

Travers, 2017).

What Works Clearinghouse

In 2014, the What Works Clearinghouse (WWC) was developed to provide a

body of research to assist educators in identifying EBP. The WCC does not conduct studies; instead, it reviews literature on interventions to determine the merits behind the practice (WWC, n.d.b). According to WWC (n.d.a), “Not all education research is equal.

Identifying well-designed studies, trustworthy research, and meaningful findings to

inform decisions and improve student outcomes can be tricky” (p. 3). WWC (2014)

developed a rating scale to evaluate study designs and recommend EBP based on a set of

study design standards staff developed. In order to be considered for evaluation, a study

must be peer reviewed, though they do not limit their inclusion to journal articles (WWC,

n.d.a). The study must also employ one of these four types of study designs: (a)

randomized controlled trials, (b) quasi-experimental with a comparison group, (c) regression discontinuity designs, and (d) single case designs (not single case studies with a single individual). Studies with random assignments receive the highest ratings, while quasi-experimental designs, or those with design issues or flaws (e.g., high attrition rates) can only meet the EBP standard with reservations (WWC, 2014). Other quasi- experimental designs, such as non-matched pairs using two schools not accounting for other characteristics (e.g., socio-economic status or gender), can only receive meets standards with reservations due to the generalizability and the possible cofounding factors found within the study designs (WWC, 2014). Some factors that contribute to a does not met standards rating include attrition, confounding variables, face validity, and reliability (WWC, 2014).

Not until 2010 did the WWC acknowledge single case study designs in a report by Kratochwill et al. (2010). In their report, they outlined goals and threats to internal and external validity like replication. They established three criteria for establishing practices: Meets Evidence Standards, Meets Evidence Standards with Reservations, or

Does Not Meet Evidence Standards. For single case studies to attain Meets Evidence

Standards it must provide an independent variable. The study must also be measured by more than one accessor within a 20% variance over at least three points in time, with at least 5-6 data points and five or more phases. Items that do not meet these criteria are categorized as Does Not Meet Evidence Standards for fewer than four data points and four phases or Meets Evidence Standards with Reservations for three data points and less than four phases.

WWC (2014) rates studies based on their reliability (i.e., the consistency of the measurement and ability to repeat the findings), validity (i.e., the accuracy of the measure and applications to others or generalizability of findings), and whether they were completed in single or multiple settings. Without reliability, a study cannot be considered valid (Creswell, 2012). Scott and Morrison (2005) add that to meet validity standards a study should be able to be replicated in real life settings. Yet, determining replication is difficult to attain in school settings because students are not randomly assigned to schools and differing classroom conditions (Odom, Collet-Klingenberg et al., 2010; Reichow, et al., 2008).

Once studies have been deemed reliable and valid, WWC (2014) rates interventions as having as a strong evidence base, moderate evidence base, or minimal evidence base based on having (a) a positive effect, (b) a potentially positive effect, (c)

no discernable effect, (d) a mixed effect, (e) a potentially negative effect, or (f) a negative effect. Finally, an improvement index score is given in the form of a percentile “which can be interpreted as the expected change percentile rank for an average comparison

group student if the student had received the intervention” (WWC, 2014, p. 10). For

example, a 10-percentile rank score could be interpreted in an expected outcome of a 10

percent gain in scores (WWC, 2014). While a positive effect or determination of a strong

evidence base does not guarantee results for every student in every setting, practices that

meet these high standards demonstrate a high likelihood of success (WWC, 2014).

Although the WWC (2014) sets high standards for EBP, it has been criticized for

not evaluating many studies utilizing the quasi-experimental designs that are often used

to conduct research on students with ASD, such as single case studies as well as not

exclusively addressing students with ASD (Odom, Collet-Klingenberg et al, 2010;

Simpson, 2005). Single case study standards have recently been developed, but they are still in the pilot stages and require more research before they can be utilized (Kratochiwill et al., 2010). IEP placements, school locations that meet LRE, and other factors for students in special educational settings make meeting the WWC (2014) criteria difficult for the ASD population. Furthermore, EBP developed from the general population are problematic when applying the results to children with ASD, because their needs differ

(Mesibov & Shea, 2010). Since typically developing students may show improvements in a program that has little or no effect among students with ASD, research must include students with ASD in the design in order for an intervention to effectively be determined an EBP for this population (Mesibov & Shea, 2010).

Best Evidence Encyclopedia

Another entity that has evaluated EBP is the Best Evidence Encyclopedia (n.d.) a partnership between the Johns Hopkins University School of Education's Center for Data-

Driven Reform in Education (CDDRE) and the Institute of Education Sciences U.S.

Department of Education. The Best Evidence Encyclopedia “intended to give educators and researchers fair and useful information about the strength of the evidence supporting a variety of programs available for students in grades K-12” (Best Evidence

Encyclopedia, n.d., para. 1). Best Evidence Encyclopedia’s (n. d.) inclusion criteria for evaluation are similar to WWC (2014); it focuses on studies with control groups and experimental groups as well as studies that take place at least over a 12-week period.

While it does not focus exclusively on studies on student with ASD, it includes studies that focus on achievement outcomes (Best Evidence Encyclopedia, n.d.). It also provides a rating system for the effectiveness of a practice based on effect size and sample size with the most beneficial evidential practices receiving a rating of strong evidence of effectiveness and the next a moderate level of effectiveness (Best Evidence Encyclopedia, n.d.). Those with the weighted mean between positive .10 and .19 or an insufficient sample size receive a rating of limited evidence of effectiveness, strong evidence of modest effects, limited evidence of effectiveness, or weak areas with notable effect (Best

Evidence Encyclopedia, n.d.).

Evaluative Method for Determining EBP in Autism Tool

Additionally, Reichow, Volkmar, and Cicchetti (2008) created an Evaluative

Method for Determining EBP in Autism tool to evaluate group and individual case study research specific to students with ASD. The tool includes a checklist to rate the overall

effectiveness of the research method, based on rigor, strength, and standards for the method. An overall score is then assigned to the research based on strong, adequate, or weak evidence as described below:

• Strong research - must receive a high rating on all the primary quality indicators,

besides the primary areas, they meet secondary quality characteristics in at least

four areas from secondary indicators

• Acceptable research - at least four primary indicators must be met and at least two

secondary indicators

• Weak research - less than four primary indicators and less than two secondary

strength indicators

As part of Reichow’s et al., (2008) checklist tool, primary and secondary indicators are provided for research strength. As shown in Table 4, primary indicators include features such as inclusion of participant characteristic, independent and dependent variables for primary indicators and focus on the research methodology.

These core features are necessary for a sound methodological approach and the more present, the stronger the research approach. Primary indicators are “deemed critical for demonstrating the validity of the study” (p. 1312). Secondary indicators, for example, inter-observer reliability, while important, are not fundamental in research design. They add to the reliability and validity of research, but not as much as the primary indicators.

While not absolutely necessary to validity, secondary indicators are still valuable; therefore, a minimum of four for strong research, or two for acceptable research must be included in their checklist or the study will be considered weak. Table 4 identifies the

primary and secondary characteristic indicators used by Reichow et al., (2008) to

determine the quality of research.

Table 4 Primary and Secondary Indicators for Evaluating Research

Primary Indicators Secondary Indicators Independent Variables Inter-observer Agreement Participant Characteristics Random Assignment Comparison Conditions Blind Raters Dependent Variable Fidelity Strong Link Between Research Question, and Effect Size Analysis Statistical Analysis with adequate Generalization and / or Maintenance sample size and power Attrition Social Validity

Note. Adapted from: “Development of the Evaluation Method for Evaluating and Determining Evidence Based-Practices in Autism” by Reichow, Volkmar, & Cicchetti, 2008, Journal of Autism and Developmental Disorders, 38(7), p. 1311-1319.

Other Individual Researchers

Odom, Collet-Klingenberg, Rogers, and Hatton (2010) also presented criteria for evaluating practices. They used an all or nothing approach where four criteria were required to be met to qualify as a practice that meets EBP. The first criterion was that

only participants birth through 22 years old must participate in the study. The second

criterion required a dependent variable from the design. The third criterion was the

research must demonstrate significant gains in the targeted skill. Lastly, the research must

demonstrate sufficient experimental control to avoid threats to validity. Research could

only be used to support a practice if all four research criteria were met.

Odom, Collet-Klingenberg et al. (2010) used similar criteria for determining

programs’ effectiveness as Reichow, Volkmar, and Cicchetti’s (2008) including: (a) the

amount of participants, (b) the use of control groups, (c) random or nonrandomized trials,

(d) reliability, and (e) validity of measures (Odom Collet-Klingenberg et al., 2010;

Reichow et al., 2008). Their method evaluates the rigor of the study and provides a consistent method for evaluating a variety of experimental designs. The method from

Odom Collet-Klingenberg, et al. (2010) differed from Reichow’ s et al. (2008) in small ways. For example, primary and secondary quality indicators are included in Reichow’s et al. (2008) evaluative method, but Odom, Collet-Klingenberg et al. (2010) has one level of strength indicating similar criteria such as experimental control, which are included in both. Reichow et al. (2008) includes studies of lessor rigor designs due to the secondary indicators, but requires more studies, between 5 and 10 by multiple researchers, which are excluded in Odom, Collet-Klingenberg et al. (2010).

Similarly, Slocum, Spencer, and Detrich (2012) offer their criteria for evidence- based practice, which they refer to as “empirically supported treatment” as follows: (a) thorough procedures to investigate the question asked, (b) effectively screening the literature to specific questions (c) evaluating the methodology quality, and (c) measuring the strength of the studies on a predetermined scale. Other authors (see Briggs, 2008;

Cook, Tankersley, & Landrum, 2009; Gersten et al., 2005; Horner et al., 2005) have provided similar guidelines for how EBP reviews should be conducted to provide the highest quality of research possible.

National Professional Developmental Center

Most recently, the National Professional Developmental Center on Autism Spectrum

Disorder (NPDC; n.d.a) provided three criteria for a practice to become an EBP:

• Two randomized or quasi-experimental design studies by two separate researchers

• Five high quality single subject designs, with three different researchers and at

least 20 participants, and

• Combination of the above with one randomized or quasi-experimental and three

high quality single subject designs by three separate researchers or researcher

groups.

Their criteria for quality designs are taken from a combination of research by Odom,

Boyd et. al. (2010) Nathan and Gorman (2007), Rogers and Vismara (2008), Horner et al.

(2005), Gersten et al. (2005), and Chambless and Hollon (1998), and are currently being used in research by Wong et al. (2015).

WWC (2014), Odom et al., (2010), and others have begun the process for establishing EPB standards for students with ASD, but as Lubas et al. (2016) advocate, there is a need for a clear definition of EBP that allows for replications and a clear understanding of the individual characteristics under which a practice becomes EBP.

While there are many ways to evaluate to determine EBP, two features were present in most evaluation methods. The first is a study design that meets large experimental control (WWC, 2014). True random controlled trials, and random assignment outcomes are not always possible, so when experimental control is not feasible, then several studies, (e. g. at least three) are needed that demonstrate a similar result (Odom, Collet-

Klingenberg et al., 2010; Reichow et al., 2008; WWC, 2014). The second feature is positive gains achieved on a dependent variable (Odom, Collet-Klingenberg et al., 2010).

These gains could be in the form of a decrease in targeted behaviors or a gain in the use of other behaviors (e.g., a decrease in hitting behaviors or an increase in the use of a

visual communication card). These key features indicate a likely EBP (Odom, Collet-

Klingenberg et al., 2010; Reichow et al., 2008).

Experimental design remains a limiting factor for research in schools as random

assignments are not always possible (Lubas, Mitchell, & De Leo, 2016). For example,

Alexander et al., (2015) evaluated the effectiveness of research designs using Odom’s

Collet-Klingenberg et al. (2010) criteria for many studies investigating the evidence base of practices. Only two studies in their evaluation met the design criteria due to the quasi- experiential design for group experiments and the lack of data points and inter-rater reliability of single case studies (Alexander et al., 2015). Most studies utilize individual rather than group designs and these designs are less likely to allow for replication since individual characteristics of ASD symptomology typically are not included (Alexander et al., 2015; Lubas et al., 2016). After determining the evidence base of a practice, educators must also determine what areas the practice may benefit. The next section presents and categorizes the various EBP interventions that have been identified thus far.

Categories of Evidence-basedPractices for Students with ASD

Several researchers offered categories of practice for students with ASD.

Alexander et al. (2015) utilized Odom’s et al. (2010) evaluation tool to review studies published in peer-reviewed journals that trained teachers to determine the effectiveness of group and individual interventions with school age children and children with ASD.

After evaluating the practices, Alexander et al. (2015) grouped the EBP into six categories: “(a) Behavioral Intervention Strategies, (b) Naturalistic Interventions, (c)

Discrete Trial Training, (d) Positive Behavioral Support Strategies, (e) Pivotal Response

Training, and (f) Other Strategies” (p. 18). Hess et al. (2008) also grouped practices into

categories after administering the Autism Treatment Survey (ATS) consisting of 43 items

related to EBP and non-EBP based on five categories previously identified by Simpson at

al. (2005): (a) interpersonal relationships, (b) skill based, (c) cognitive, (d) psychological/

biological/ neurological, and (e) other. The third grouping, by NPDC (2016b) also offered areas of intervention. In their Matrix of Evidence-based Practices by Outcome and Age, they offer twelve areas of intervention categories: social, communication, joint

attention, behavior, school readiness, play, cognitive, motor, adaptive, vocational, mental,

and academic (NPDC, 2016b). The matrix further offers which age range the EBP supports broken down in the following age ranges: (a) 0-5, (b) 6-14, and (c) 15-22

(NPDC, 2016b). Based on these resources, educators must determine which practices to

implement to service their students with ASD.

The NPDC (2016a) provides the most recent criteria for what constitutes an EBP

for students with ASD. They also include age ranges and domains for EBP utilization

with their criteria for identifying EBP for students with ASD. The next section

summarizes EBP identified by NPDC (2016a) by domains.

Evidence-basedPractices

Below is a summary of current EBP shown to improve students’ communication,

behavior, social skills and/or academic achievement using one or more of the NPDC (n.d)

criteria for determining research to support EBP (Alexander et al., 2015; Odom,

Kliningberg, et al., 2010; Wong et al., 2015). A few EBP, cut cross across multiple

domains. If the practice is primarily used for a specific function, even when it may cross

multiple domains, it is included under the primary category of utilization based on the

research available for the practice. For example, Picture Exchange Communication

System (PECS) addresses social skills, but the majority of research identifies it as a practice for communication and thus it is included under the heading of communication practices (NPDC, 2016b). Otherwise, it is included in the multiple domains category at this end of the discussion.

Communication

Communication practices have shown improvements in initiating and functional communication (NPDC, 2016b). While many practices address communication at the elementary age, one practice is used primarily. Other practices that effect communication as well as other domains are discussed under multiple domains.

• Picture Exchange Communication System (PECS) utilizes pictures to generate

communication and has demonstrated improvements in functional

communication, initiation, improve severe impairments of speech, and decrease

problem behaviors (Bonder & Frost, 2001; Charlop-Christy, Carpertner, Le,

LeBlanc, & Kellet, 2002; Flippin, Reszka, & Watson, 2010; Lerna, Esposito,

Conson, Russo, & Massagli, 2012; Thiemann-Borque, Brady, McGuff, Stump, &

Naylor, 2016). There are six phases of implementation for PECS: (1) Physical

exchange of a picture for desired item, (2) Expanding spontaneity whereas the

communication partners vary and distance traveled increase, thus increasing

generalization, (3) Picture discrimination that requires the student to select from

a variety of symbols, (5) Responding by answering a question, and (6) Response

and spontaneous comments (Bonder & Frost, 2001; Bondy & Frost, n.d.;

Thiemann-Borque et al., 2016).

Behavior

Behavior practices aspire to limit problem behaviors and increase desired

behaviors (Griffin, 2017). There are six interventions that are explained and used mostly

for behavior interventions. Many of these approaches are based on applied behavior

analysis (ABA) or applied behavior intervention (ABI) principles of data analysis associated with antecedents and consequences, the behavior (Kearney, 2015). As with communication, behavior interventions that may also be used within other domains are discussed under multiple domains.

• Antecedent behavior intervention (ABI) supports the use of preventive measures

to displace problem behaviors (Sigafoos, Green, Payne, O’Reilly, & Lancioni,

2009). Reinforcers and punishers are added and removed from the environment to

facilitate generalization and maintenance of desired behaviors (Powers, 2013).

Preferred leisure activities can also be used to engage the student with the desired

outcome (Sigafoos et al., 2009). Utilizing strategies such as chaining, modeling,

task sequencing, strategy training, prompting, object training, social stories, peer-

mediations, and time delay, authors have demonstrated an average weight effect

of .67, a moderately large effect (de Bruin, Deppeler, Moore, & Diamond, 2013).

• Cognitive Behavior, also known as cognitive-behavior therapy (CBT) is used to

modify an individual’s thinking and behavior to recognize the patterns of their

maladaptive thinking (Gaus, 2007; Scattone & Mong, 2013). CBT requires

exposure and prevention techniques that change the thinking model of participants

(Krebs, Murray, & Jassi, 2016; Watson & Rees, 2008). CBT requires

modifications from traditional practices and expanding of barrier skills to make

CBT successful with students with ASD (Reaven, Blakeley-Smith, Culhane-

Shelburne, & Hepburn, 2012). Atypical features, such as self-regulation

difficulties, social understanding challenges, rigid thought processes, and poor

generalization skills in students with ASD, require self-care remedies to make

CBT successful for students with ASD (Ozsivadjian & Knott, 2011; Wood et al.,

2009). CBT demonstrates improvements on behavior outcomes for adolescents

(McKay, 2016). For instance, Wood et al., (2009) found after CBT training, a girl

with ASD was able to regulate her anxiety in 4 or 5 out of 10 episodes to prevent

further escalation of emotional episodes. Improvements were also seen in

ritualization and aggressive outbursts. A variety of methods were employed in

their study with individuals based on their needs including exposure and response

prevention, behavior experiments, goal setting, identifying cognitive distortions,

and cognitive behavioral links.

• Differential reinforcement and reinforcement are similar approaches because they

both provide a consequence for a behavior that reinforces the behavior for future

use (NPDC, 2016). It is based on principles from Skinner’s book (1966)

identifying operant conditioning that detailed the effects of reinforcements on

behavior and later applied to Skinner’s (1957) work on language. A clearly

established theory in behavior, (see Pitts, 1971; Ramnero, 2008; Strickland, 2001)

it operates under the assumption that behaviors that are rewarded will continue

and those that are punished or not rewarded (or not reinforced) will discontinue

(Skinner, 1966). Differential reinforcement differs from reinforcement by

ignoring non-desired behaviors with the rationale that reinforcing functional

behaviors will extinguish the non-desired and interfering behaviors (NPDC,

2016). Differential reinforcement can lead to increases in desired non-prompted

responses (Hausman, Ingvaarsson, & Kahng, 2013; Kartsen & Carr, 2009).

• Extinction involves reducing or limiting unwanted behavior by withdrawing or

terminating the reinforcer that maintains the interfering behavior (NPDC, 2016).

Based on theories of classical condition with rewards and punishments, extinction

hopes to terminate behavior (Hall & Hall, 1998; Gottlieb & Begej, 2014;

Hoffman, & Falcomata, 2014; Kuhn, Lerman, Vorndran, and Addison, 2006;

Pavlov, 1927; Schieltz, Wacker, Ringdahl, & Berg, 2017). Kuhn et al. (2006)

note that interrupting a behavior chain’s final response can lead to an extinction of

the response.

• Functional behavioral assessments are used to address severe behavior concerns

by providing a clear definition or description of the behavior, predicting the time

and place instances may occur, and predicting the function of the behavior

(Rogers, 2001). While very labor intensive, the benefits of and FBA include

identifying environmental factors that contribute to the continuation of the

behavior and allowing for targeted interventions to generate appropriate

replacement behaviors (Rogers, 2001). Questionnaires such as the Questions

About Behavior Function (QABF) were created to limit the intensive nature of

documentation required of FBAs (Matson, Tureck, & Rieske, 2012).

• Response interruption and redirection (RIRD), also referred to as redirection, is

based on Skinner’s (1957) antecedent and consequence events whereby an

environmental stimulus maintains the behavior or promotes the discontinuance of

a behavior (Colón, Ahearn, Clark, & Masalsky, 2012). Ahrens, Lerman, Kodak,

Worsdell, & Keegan (2001) and Colón et al. (2012) found decreased vocalization

behavior and improved appropriate language after the use of RIRD where

interruption of undesired vocalization behavior was redirected to appropriate

behavior using verbal praise. RIRD has also demonstrated deceases in repetitive

and stereotype motor behaviors in students with ASD (Ahrens et al., 2001;

Pastrana, Rapp, & Frewing, 2013). During Martinez and Betz’s (2013) review

they uncovered that all studies investigating RIRD consisted of controlled

environments during evaluations; consistent with the review explored by Ahearn

et al. (2007).

Social Skills

Social skill interventions attempt to engage students with ASD in positive interactions with peers and others (Perry, Neitzel, & Engelhardt-Wells, 2010). As overlap between practices occurs, these six practices are discussed for their primary function of improving social outcomes (NPDC, 2016).

• Peer mediated instruction and interventions involve systematic ways peers are

taught to engage students with ASD in positive social interactions (Sperry, et al.,

2010). As Sperry et al. (2010) declared, “When implemented effectively, the

quality and quantity of social interactions between students with ASD and their

peers increases and can lead to more positive outcomes for children and youth

with ASD” (p. 261). Peer-mediated instructions early review by Odom and Strain

(1984) offered three effective peer-mediated approaches: (a) proximity, having

socially competent peers to act as models for students, though not specifically

trained in interaction strategies; (b) prompting and reinforcing, teaching peers

specific strategies to reinforce or prompt a response or behavior; and (c) peer

initiation, having peers originate interactions with students with ASD (Watkins et

al., 2015).

• Pivotal Response Training (PRT) is based on the four pivotal learning variables

that allow students to make generalized improvements: motivation, responding to

multiple cues, self-management, and self-initiations (NPDC, 2016; Stockall &

Dennis, 2013). To use PRT with fidelity, Suhrheinrich et al. (2013) offer their

criteria for observations: gain attention, provide a clear opportunity

for instruction, maintain tasks (i.e. simple tasks are paired with difficult tasks),

allow choice, and allow turn taking (shared control), and provide multiple

cues, continent consequences, direct reinforcement, and reinforce attempts.

• Self-management includes utilizing the individual to determine appropriate and

inappropriate behavior (Wong et al., 2014). Social problem solving is the basis of

this practice, that requires the use of evaluating social context and responding

appropriately to the setting (Koegel, Park, & Koegel, 2014). Tools such as

journals and diaries can be used as well as modeling strategies in conjunction with

other self-management techniques (Koegel et al., 2014; Palmen, Didden, & Arts,

2008). Elaborated responses and reciprocal question asking were increased

following self-management interventions implementations (Koegel et al., 2014;

Palmen et al., 2008).

• Gray (2017) promoted Social Stories (SS) in the 1990s as a “social learning tool

that supports the safe and meaningful exchange of information between parents,

professionals, and people with autism of all ages” (carolgraysocialstories.com,

2017). While SS refer to her copywrited stories (see her social story sites for more

information), social narratives are similar in that they provide stories to illustrate

and describe socially appropriate behavior (Doody, 2015). For instance, social

narratives can be used to provide understanding that to help yourself to a tray of

cookies refers to taking one or two and not the whole tray (Doody, 2015). Social

narratives may also be used in conjunction with technology such as on an IPad

(Doody, 2015).

• Structured play groups are defined as small group interactions with specific goals

(Wong et al., 2015). Actives are planned with roles predetermined and

scaffolding built in to support the student in the group activity (Wong et al.,

2015). Strauss et al. (2014) recognized that while structured, more naturalistic

settings that combine student interest were more successful. Improvements in

engagement, such as eye contact, and initiation of play were observed following

structured play groups (Strauss et al., 2014). Manning and Wainwright (2010)

observed that play predicted social outcomes indicating the importance of play on

social skills.

• Social skills training, or groups, previously were a separate entity, but are now

combined under the NPDC with structured play groups due to similarities (n.d.).

For the purposes of this study it is listed as a separate practice than structured play

groups and is characterized by individual or group instruction “designed to teach

learners to appropriately interact with typically developing peers” (Fettig, 2013,

para. 1). Social training is based on principles that students with ASD lack the

theory of the mind that positions how to interpret the actions of others (Baron-

Cohen, Leslie, & Frith, 1986; Feng, Lo, Tsai, & Cartledge, 2008; Kerr & Durkin,

2004). Social skills training teaches students to interpret the behavior instead of

just completing task and is shown to be effective for generalizing social skills

such as expressing emotions and conversation skills (Feng et al., 2008). Features

of social skills training include manuals to guide the treatment and peer support

(Koenig et al., 2010).

Academic Skills

Academic achievement is one of the primary functions of schools (Spring, 2015).

Increasing engagement in academic content is discussed with the singular practice of discrete trial teaching (Goodman & Williams, 2007).

• Discrete trial teaching (DDT) is a “systematic instructional procedure designed to

maximize learning opportunities using the scientific principles of ABA [applied

behavior analysis]” (Gongola & Sweeny, 2012 p. 184). DTT, originally

developed by Loovas (1987), is based on principals of reinforcement, prompting,

and fading and involves a highly-structured environment to help students learn

academic and other skills (Gongola & Sweeny, 2012; McKenney & Bristol,

2015). Skills are practiced repeatedly until mastered, and continue through

generalization when they can be conducted individually, thus allowing for skills

to be targeted at the rote level (e.g., imitation, personal facts) through complex

tasks (eg., answering questions; Gongola & Sweeny, 2012; Simpson, 2005).

While DTT may be used across domains, its primary use is for teaching academic

content.

Multiple Domains

The 12 practices under multiple domains offer a combination of supports of the

four domains of communication, behavior, social skills, and academics. While five

practices, computer aided instruction and speech generating devices, may be used to

address all four domains, one practice, task analysis, address three domains, and four

practices, exercise, functional communication training (FCT), prompting and scripting

address two domains areas in the elementary ages. Each practice is explained and the domains addressed discussed.

• Computer aided instruction utilizes technology to aide students with ASD (Odom

et al., 2015). It has been used for a wide variety of academic skills including

vocabulary, reading, and problem solving (Goldsmith & LeBlanc, 2004) as well

as, to improve communication and play related social skills (Goldsmith &

LeBlanc, 2004; Kagohara et al., 2013). Bernard-Opitz, Sriram, and Nakhoda-

Sapuan (2001) demonstrated improvements with computer aided instruction with

text to speech devices involving generating multiple solutions to problems as well

as solving social skill problems. Students with ASD have demonstrated

improvements at stimuli presented visually, with less emphasis on the social

aspect of the teacher/ student interaction, and tend to be responsive to computer

use (Ramdoss et al., 2011).

• Exercise, or physical activity, included swimming, yoga, weight bearing exercise,

equine therapy, trampoline training, and other forms of physical activity

preceding the stimulus effect, have resulted in a variety of improved classroom

behaviors (Dillion, Adams, Goudy, Bittner, & McNamara, 2017). Exercise has

demonstrated improvements in social behaviors and self-stimulation behaviors for

some students with ASD (Pan, 2010; Rosenthal-Malek & Mitchell, 1997). Also,

classroom engagement can increase following physical activity (Lourenco,

Esteves, Corredeira, & Seabra, 2015).

• Functional Communication Training (FCT) “seeks to establish the skills and

create the environmental conditions under which a socially appropriate

communication response, rather than problem behavior, will be used to access

reinforcement” (Krutz, Boelter, Jarmolowicz, Chin, & Hagopian, 2011, p. 2935).

The original creators Carr and Durand (1985) describe FCT as replacing

undesirable communication behaviors (e.g., seeking attention or avoiding a

difficult tasks) with appropriate communication behaviors. Durand and

Moskowitz (2015) found by instructing students in appropriate responses to meet

the function of the communication behavior, undesirable behaviors were

extinguished or lessoned.

• In vivo, or live, modeling has been widely researched as a tool to promote

behaviors and social skills (Rigsby-Elredge & McLaughlin, 1992). With the

increase in availability of technology, comparisons of in vivo modeling with

video modeling (VD) occurred (Wilson, 2013). Though results, are inconsistent

over which method produces increased results both demonstrate a promising

outcome for increasing behaviors with some maintenance of skills (Charlop-

Christy, Le, & Freeman, 2000; Gena, Couloura, & Kymissis, 2005; Wilson,

2013).

• Naturalistic interventions, “include child centeredness, embedded learning

opportunities, a responsive style of interaction, and the utilization of the natural

environment as a learning context” (Harjusola-Webb & Robbins 2012, p. 99).

Naturalistic interventions mimic the natural environment, therefore increasing the

meaning for the student and generalizations of skills to their environment

(Ingersoll, Lewis, & Kroman, 2007; Ingersoll & Schreibman, 2006). Language,

such as expressive communication, social plays skills, gestures, and joint attention

skills have all demonstrated improvements using a naturalistic approach

(Harjusola-Webb & Robbins, 2012; Ingersoll, Lewis, & Kroman, 2007; Ingersoll

& Schreibman, 2006).

• Symon (2005) demonstrated that parents can serve as expert trainers to improve

children’s functional verbal language in the home environment as a parent

implemented intervention. Parent implemented interventions have been shown to

improve social communication and behavior skills in pre-school and elementary

age children using previously identified EBP (NPDC, 2016; Rocha, Schreibman,

& Stahmer, 2007). Benefits of parent training are particularly useful for those

who live geographically distant from centers that specialize in treatment for ASD

or other rural areas (Koegel, Symon, & Koegel, 2002). Parents were often taught

pivotal response techniques to utilize with their child in the home environment

(Koegel et al., 2002; Symon, 2005).

• Hayes (2013) stated, “Prompting is where an adult or peer assists a learner to

acquire a new skill. Prompts can be gestural, verbal, visual, or physical” (p. 52).

Prompting has seen increases in success for students’ reading ability (Spector,

2011). When reviewing reading skills Browder, Ahlgrim-Delzell, Sooner, Mims,

and Baker (2009) describe prompting as when the target stimulus does not

provide the response, the teacher will provide a stimulus, often verbal, that pairs

with the target stimulus to provide the desired response. In Knight and Sartini’s

(2015) review of prompting literature, they found strong evidence to support the

use of prompting for reading comprehension skills such as making inferences,

using facts, and understanding analogies as well as pre-reading skills. In addition,

science and math skills were also supported including vocabulary and ability to

solve word problems (Knight & Sartini, 2015).

• Scripting involves the use of using written scripts or audio recordings as a model

for appropriate language for students (Brown, Krantz, Mcclannahan, & Poulson,

2008). Scripting includes fading techniques that allow language to be generalized

and unscripted language increases (Brown et al., 2008; Sarokoff, Taylor, &

Poulson, 2001; Wichnick-Gillis, Vener, & Poulson, 2016). Students are taught

script phrases to mastery and then instructed to use the script with fading of

prompts over time (Ganz, Kaylor, Bourgeois, & Hadden, 2008). Scripting can

also be used to decrease perseverative speech and socialization, such as gaining

attention and interactive play (Ganz et al., 2008; Hundert, Rowe, & Harrison,

2014).

• Task analysis and training refer to a set of steps to follow to complete a task and

in some instances, individuals may also self-monitor the completion of each step

(Parker & Kamps, 2011). Parker and Kamps (2011) found task completion and

activity engagement increased with the use of task analysis. Task analysis has also

been shown to increase social behaviors, such as initiation and improve scores the

Peer Acceptance Questionnaire and the Social Skills Rating System (SSRS) from

teachers (Thiemann & Goldstein, 2004).

• Time delay can be summarized as a feature of prompting where there is a gradual

increase in the time between the stimulus and the verbal prompting response

(Browder et al., 2009). Time delay takes place in two phases. The first requires

understanding of the verbal repertoire required to complete the task, such as

displaying a picture or the object and labeling and modeling the appropriate

response (Leung, 1994). In the second phase, modeling is delayed for a short

time and then the interval between prompting and the stimulus is gradually

increased, from 2 seconds to 5 seconds, to 10 seconds, until spontaneous requests

are made (Leung, 1994). Time delay experienced a large interest in the late 1980s

and 1990s with many studies highlighting the social and communication benefits

of the intervention used to increase appropriate phrases, ask questions, request

objects and use appropriate praises, such as please and thank you (Charlop &

Trashowech, 1991; Charlop & Walsh, 1986; Leung, 1994; Matson, Sevin, Box,

Francis, & Sevin, 1993; Taylor & Harris, 1995).

• Video modeling (VM) utilizes technology, such as videocassette recordings

(VCR), smart phones, IPads and IPods to deliver interventions in communication,

behavior, social, and academic skills (Charlop & Milstein, 1989; Goldsmith &

LeBlanc, 2004; Haring, Kennedy, Adams, & Pitts-Conway, 1987; Kagohara et al.,

2013; Odom et al., 2015). VM technology is one of the most readily available

practices for parents, educators, and clinicians (Goldsmith & LeBlanc, 2004). VM

interventions typically involve the student watching a video, modeling the desired

behavior, and then given an opportunity to imitate the behavior (Axelrod, Bellini,

& Markoff, 2014). This process is continued until the student is able to

consistently display the behavior (Macpherson, Charlop, & Miltenberger, 2015).

Benefits of VM present by Ennis-Cole (2015) “include its use in natural settings,

control over the modeling procedure, repetition, convenience, and consistency”

(p. 174).

• Visual supports provide nonverbal expressions to aide students with ASD

(Dyrbjerg, Vedel, & Pedersen, 2007). Dyrbjerg et al. (2007) describe visual

supports as a roadmap or guide, for students with ASD giving them the directions,

appropriate behavior, and manual for how the world works. Visual supports

include graphic symbols to represent desires, for example to play, or objects

(Johnston, Nelson, Evans, & Palazolo, 2003). Visual supports can assist in

making abstract tasks concrete for students and also allows them to anticipate

what comes next to relieve anxiety and the exhibition of problematic behaviors

(Breslin & Rudisill, 2011; Liu & Breslin, 2013).

NonEBP

A number of nonEBP used by service providers have been identified with either no support, or little or emerging support due to insufficient research (Paytner & Keen,

2015). Some of the practices utilized under these categories include: (a) Auditory integration training, (b) facilitated communication, (c) holding therapy, (d) music therapy, (e) sensory integration (sensory diet, deep tissue therapy), (f) sign language, (g) vitamin therapy, and (h) weighted vest/clothing (Stahmer, Collings, & Palinkas, 2005).

While some practices such as music therapy may require more time to emerge as EBP for students with ASD, some, such as facilitated communication, have continued to thrive despite abundant evidence of their lack of results (Lilienfeld, Marshall, Todd, & Shane,

2015; Paynter & Keen, 2015; Wombles, 2015). The majority of these non-EBP have been developed to address the communication and behavior needs of students with ASD or a combination of the four EBP domains (communication, social, behavior, and academic concerns). Thus, these practices will be presented under three domains: communication, behavior, and multiple domains.

Communication

• Facilitated communication involves the use of a therapist or educator,

supporting the hand or fingers of a participant while the participant

writes, types, or points to objects, but further evaluation of the method

have demonstrated effects may result from ideomotor, or unconscious,

movements of the therapist (Saloviita, 2016). Several authors have

provided research to support the discontinuance of facilitated

communication, but despite the mounting evidence of its ineffectiveness,

it remains a practice that continues to have research published advocating

for its use (Chan & Nankervis, 2015; Lilienfeld et al., 2015; Saloviita,

2016; Travers et al., 2014; Wombles, 2015).

Behavior

• Auditory integration provides for sensory stimulation to improve

maladaptive behaviors such as stereotypy, or sensory abnormalities

sometimes exhibited by students with ASD (LaFrance et al., 2015).

Auditory integration involves the continued exposure to music via

headphones in an effort to lessen the hypersensitivity to sounds (LaFrance

et al., 2015). Some oppose the use of auditory integration due to the

hearing damage that may ensue by excess sound use (Lucker, 1998).

Other reviews also demonstrate the mixed results achieved with auditory

integration which lead to it not being currently recommended as an EBP

(LaFrance et al., 2015; Rossignol, 2009).

• Holding therapy involves forced holding where the participant is required

to be held for a specific time interval or until the participant meets the

eyes of the therapist or parent (Kurtz, 2008; Research Autism: Improving

the Quality of Life, 2016). Holding therapy began as a therapy often used

with adopted and foster youth as a treatment for those who suffered from

neglect under the model of attachment therapy (Howe & Fearnley, 2003;

Sudbery, Shardlow, & Hunington, 2010). The use of holding therapy

continued with children with ASD as a means of intervening on behavior

with the assumption that behavior disorders resulted from the stress of a

bond not forming appropriately with a parent and child (Kurtz, 2008).

While authors continue to generate case studies using non-generalizable

means to promote single examples for support for the practice, other

authors highlight the harm, including investigations for child abuse that

have taken place regarding holding therapies practices (Kurtz, 2008;

Mercer, 2012; Sudbery et al., 2010).

• Sensory integration involves the use of tactile and visual stimuli to

replace undesirable behaviors (Ayres, 2005; Moore, Cividini-Motta,

Clark, & Ahearn, 2015; Piazza, Adelenis, Hanley, Goh, & Delia, 2000).

Sensory integration theory proposes that students who lack typical

sensory input produce atypical behaviors such as repetitive behaviors, as

the result of their inability to process sensory information (LaFrance,

Miguel, Donahue, & Fetcher, 2015). Two sensory integration practices

often used for students with ASD include sensory diet, providing sensory

stimulus during intervals, and deep pressure therapy, applying pressure to

the skin and joints (Moore et al., 2015). From their review of the research

on sensory integration Lang et al. (2012) found 3 out of 25 suggesting

effectiveness of sensory integration. Others provided no discernible

effect, or even an increase in negative behaviors (Lang et al., 2012). Of

the studies that demonstrated effectiveness, critics have found research

design issues that do not provide the rigor necessary to deem sensory

integration an EBP (Lang et al., 2012; Rossignol, 2009).

• Sign language has been implemented to promote successful

communication for students with ASD (Seal & Bonvillian, 1997).

Researches have reported a wide variety of results both positive and

negative from the use of sign language with this population (Cornelius

Habarad, 2015; Scattone & Billhofer, 2008). Thus, educators should be

cautious when selecting sign language as an intervention for students until

more research can clarify under what conditions sign language may be

successful (Scattone & Billhofer, 2008).

Multiple Domains

• Music therapy provides “songs and music used as a medium through

which student’s goals may be addressed” (Fluery, Thompson, & Wong,

2015, p. 91). Kurtz (2008) offers music therapy as a tool to meet social,

communicational, and educational needs. Songs have been used to target

social skills, such as greetings for the morning transition and while they

have shown some success the intervention may need modifications (Kern,

Wolery, & Aldridge, 2007). Music therapy may prove to be an EBP, but

Fluery et al. (2015) cautions against using music therapy until more

research has been published justifying its effects for students with ASD.

• Vitamin therapy and other alternative medicines are estimated to be used

by over 50% of children diagnosed with ASD (Hanson et al.,

2007). Hanson et al. (2007) found most families perceived vitamins and

other alternative medicines as helpful or not effective, and perceived them

to be non-harmful. Some families chose to use vitamins and other

alternative therapies to avoid unsafe conventional medications and

conventional medication side effects (Hanson et al., 2007). Particularly,

vitamin B6, and magnesium used as dietary supplements are consumed to

reduce ASD symptoms by improving speech and language (Whitehouse,

2013). These vitamins are necessary for the formation of

neurotransmitters, which are hypothesized to be a possible cause in the

development of ASD (Whitehouse, 2013). While studies exist that

demonstrate the benefits of vitamin therapy, the studies do not satisfy the

rigor required to label vitamin therapy as an EBP (Nye & Brice, 2005;

Whitehouse, 2013).

• Weighted vests gain support from two theories: homeostatic theory and

operant functions theory (Hodgetts, Magill-Evans, & Misiaszek, 2011).

Homeostatic theory supports the use of a vest due to an over or under

stimulation interrupted by the individual with ASD (Hodgetts et al., 2011).

The operant theory supports the use of a weighted vest due to the reward,

or reinforcement, of stimulation (Hodgetts et al., 2011). The use of the

weighted vest is posturized to help students with ASD modulate and

regulate sensory input (Hodgetts et al., 2011; Olson & Moulton, 2004;

Reichow, Barton, Sewell, Good, & Wolery, 2010). The lack of

consistency and use of weighted vests concurrently with other practices

makes the practice suspect due to the absence of experimental control

(Olson & Moulton, 2004; Reichow et al., 2010). When experimental

control is implemented, weighed vests do not show any increase in

engagement of students (Reichow et al., 2010; Stephenson & Carter,

2009).

Limitations of EBP

Several authors acknowledge the limitations of EBP including generalizability, teachers’ abilities to comprehend research, and practices that are still being evaluated

(Cook, & Cook, 2013; Dingfelder, & Mandell, 2011; Lubas, et al., 2016; Spencer,

Detrich, & Slocum, 2012). These areas are debated below.

The first limitation of EBP is that they are not generalizable and will not work for

every student in every situation (Cook & Cook, 2013). With the wide variation of needs

and characteristics, not every student will benefit from every EBP (Cook & Cook, 2013;

Lubas, et al., 2016). Lubas et al. (2016) agreed and offered the individual characteristics

of the student are more important than the research studied and should dictate the

practices utilized (Cook, Tankersley, & Landrum, 2009). They critiqued the concept of

EBP with the wide range of the spectrum and possible medical and psychiatric comorbidities. Thus, a practice may be beneficial for one student or students with one characteristic, but not meet the rigors of generalization to other students with ASD or only benefit students in a specific environment. Consequently, the research to practice gap complaint from practitioners is that research does not apply to real world scenarios in classrooms, and limiting factors of the classroom environment constrain the rigor of research that may be conducted (Knight, Sartini, & Spriggs, 2015; Lubas, et al.,2016;

Mesibov, & Shea 2011; Rogers, & Vismara, 2008; Spencer, Detrich, & Slocum, 2012).

Secondly, teachers must have the skills necessary to review and critique research to determine which settings, characteristics, and other considerations must be made to determine when, where, and how a practice will work (Lubas, et al.,2016; Rogers, &

Vismara, 2008). The educator component necessary to evaluate student’s individual needs are highlighted in this author’s framework and is illustrated by Lubas et al. (2016):

From both intervention and research perspectives, it is important to acknowledge

that children with ASD do not necessarily have the same social, behavioral, or

communication challenges as another child diagnosed with ASD. In addition, the

wide range of the spectrum-and the medical and psychiatric comorbidities-creates

a vast array of individual differences among children diagnosed with ASD. (p.

190)

Other authors advocate the teacher and student relationship is also fundamental in informing students’ development and determining which practices and how they should be implemented (Leflot, Onghena, & Colpin, 2010; Lubas et al., 2016; Serpell &

Masburn, 2012).

Lastly, the concern is that practices not labeled as an EBP may benefit students with ASD and may not have generated enough support to be labeled an EBP (Cook &

Cook, 2013; Lubas et al., 2016). Yet, without use, it will be difficult to gather sufficient evidence to allow the practice to become and EBP. While EBP are ideal, other programs have been utilized to service students with ASD that have not received the label such as the practices of scripting, cognitive behavior interventions (CBI), and structured play groups which recently experienced identification as an EBP for students with ASD

(NPDC, n.d.). A practice that does not currently have the EBP label may still benefit students when research has been conducted.

Knight et al. (2015) believe that educators should first consider EBP before applying less verified practices. Dingerfelder and Mandell (2011) concur and explain that often ASD practices are adopted before claims can be validated. While Lord et al. (2005) believe practices should be examined when done in controlled settings, Dingerfelder and

Mandell (2011) disagree and believe for EBP to diffuse to the communities “linking intervention development and the settings in which we hope interventions ultimately will

be used” (p. 607) must occur first. Dingerfelder and Mandell (2011) continue to advocate

that researchers should facilitate the implementation procedures of practices and work

with communities to invent practice to meet their needs with research to improve the

diffusion of the practice.

Interventions to Service Students with ASD

Odom, Boyd, Hall and Hume (2010) identify two classes of interventions to

service students with ASD. The first is comprehensive treatment models (CTM), which

are meant to treat multiple characteristics such as behavioral, communication, and social

outcomes for students with ASD (Odom et al., 2010). These are often branded practices

and curriculum features that offer intensive components over the course of weeks,

months, or years (Rogers & Vismara, 2008). CTMs are all-encompassing programs

geared to treat each aspect of the symptoms of ASD (Wong et al., 2015). Examples of the

CTMs include the Lovaas method, which uses DTT methods to train students and the

Treatment and Education of Autistic and related Communication-handicapped Children

(TEACCH) program based on structured teaching methods and the Denver Model based on naturalistic and parent involved strategies to improve behavior (Smith, Groen, &

Wynn, 2000; Marcus, Scholper, & Lord, 2000; Mesilbov & Shea 2010; Wong et. al.,

2015).

The second is focused interventions practices (FIP; Boyd, McDonough, &

Bodfish, 2012; Odom, Boyd et al., 2010). FIP are meant to target a specific behavior and are used for a short duration (Odom et al., 2010). The FIP differ in organization as CTMs are centered on a conceptual framework, intensity, standard procedures, and time of intervention; they are geared to be long term plans for treatment (Odom, et al., 2010). FIP

are targeted practices such as Picture Exchange Communication System (PECS) meant to address one domain, communication, though they may be utilized to address other areas

(Bondy, & Frost, n.d.; Boyd, McDonough, & Bodfish, 2012). Authors have investigated both CTM and FIP use in schools.

Stahmer, Collings, and Palinkas (2005) investigated the reported use about EBP among educators in Southern California by conducting focus group interviews with early intervention service providers of students with ASD. One focus group mentioned the use of 13 strategies and six strategies were consistently listed among participants of all the focus groups (Stahmer et al., 2005). The six strategies mentioned across all groups included: applied behavior analysis (ABA, or ABI), Floor Time, occupational therapy

(OT) which includes sensory integration, PECS, sign language, and Social Stories, also known as social narratives (Stahmer et al., 2005).

Hess et al. (2008) administered their Autism Treatment Survey (ATS) to 185 general education and special education teachers to determine which EBP are currently being utilized across preschool through 12th grade classrooms including CTM and FIP.

Their research uncovered that classroom type such as general education or special education, as well as grade level were factors in the interventions selected. Hess’s et al.

(2008) Autism Treatment Survey (ATS) was broken up into five categories for ease of selection for the participants: (a) interpersonal relationships, (b) skill-based, (c) cognitive,

(d) psychological/ biological/ neurological, and (e) other (Hess et al., 2008).

The ATS included options for amount of use of CTM and FIP, including one for not used, and a short definition were provided for each practice and an area was provided for participants to add practices used not listed in the survey. The survey was piloted by

volunteers from Georgia State University and revised to assure the reliability and validity

of the survey. Participants indicated the most widely used interventions by percentage of

use were: (a) sensory integration, (b) gentle teaching, (c) music therapy, (d) cognitive behavioral modification, and (e) art therapy.

Sensory integration had the greatest self-reported use with 92.86% utilizing the practice as well as across all the grade levels surveyed. Class type and grade also affected the reported strategies used with special educators being the only respondents utilizing visual schedules and several other practices. Additionally, each grade level reported using varying strategies with some grade levels being the sole practitioner of a strategy.

For example, preschool teachers did not utilize PECS, and structured teaching was only utilized in middle schools. According to the ATS, only 28.6% of Georgia’s educators are using EBP or a practice considered promising for students with ASD. Of the top five reported strategies utilized, none of them meet criteria for EBP though social stories

(narratives) have since met criteria under inclusion as EBP (Hess et al., 2008; NPDC,

2015).

Within each domain, or category of practice, educators reportedly utilized different practices as noted in Table 5. The five most common practices were: assistive technology for skills based, gentle teaching for interpersonal relationships, cognitive behavioral modifications for cognitive, sensory integration for physiological/ biological neurological, and music therapy for other (Hess et al., 2008). Only 28.6% of Georgia educators used a practice, acknowledged at the time of the study, to be considered EBP or a promising EBP practice (Hess et al., 2008).

Table 5 Most Used Practices According to ATS by Domain

Skills Based Interpersonal Cognitive Physiological/ Other Relationships Biological Neurological Assistive Gentle Teaching Behavioral Sensory Music technology Modification Integration

Note. Adapted from “Autism treatment survey: Services received by children with autism spectrum disorders in public school classrooms.” by K. Hess, Morrier, Heflin and Ivey, 2008. Journal of Autism and Developmental Disorders. P. 38(5), p. 961-971.

Educator’s Understanding of Evidence-basedPractices

Stahmer et al., (2005) investigated the opinions of educators in their examination of practices used in Southern California for students with ASD. Although participants thought the strategies they used were EBP, none of the participants mentioned having read any research reviews or papers on any of the practices. Additionally, participants could not agree on which practices were EBP, were unsure of 20% of the strategies, cited

50% of the practices as EBP, and had poor research on 30% of the strategies they listed identifying them as nonEBP. At the time of the study, none of the programs mentioned were considered EBP, but today DTT, PECS, Social Stories (social narratives), and visual supports are considered to have a strong support for the practice (Stahmer et al., 2005;

NPDC, n.d.a.). Strategies such as music therapy and sign language have not been identified as EBP (Hess, Morrier, Heflin, & Ivey, 2008; Stahmer et al., 2005; NPDC,

2016b). Participants were only partially successfully in identifying EBP as they identified music therapy, occupational therapy (OT) and sensory integration training as EBP though they were not, and are still not, considered EBP. Yet they were successful in identifying

DTT, ABA, PECS, and PRT as EBP (Hess, et al., 2008; Stahmer et al., 2005; NPDC,

2016b). Stahmer et al. (2005) also discovered that many of the strategies utilized were in

a modified form as all participants admitted to adapting the programs to meet their

classroom or students’ needs, which can affect the fidelity of the practices and

demonstrates the training required for service providers.

Using a similar approach, Auert, Trembath, Arciuli, and Thomas (2012) conducted focus groups to understand the EBP knowledge of parents whose students were receiving speech pathologist services, with students diagnosed with ASD.

Transcripts were read five times by the author, and notes and codes were added during the readings to discover themes (Auert et al., 2012). Their results indicated that parents placed greater emphasis on EBP than did the speech and language pathologists. Auert et al., (2012), Hess et al., (2008) and Stahmer et al., (2005) demonstrated that educators of students with ASD did not put emphasis on utilizing practices demonstrated as EBP.

While a few studies, such as Hess et al., (2008), Odom et al., (2010), Collet-

Klingenberg et al., (2010) and Stahmer et al., (2005) explored EBP use for students with

ASD, they are more than five years old. Current research is necessary to uncover current

trends in EBP use to determine the gains, if any, have occurred in EBP use. As well, new

EBP that have been uncovered by educators need to be disseminated to address the

research and policy to practice gap.

Summary

Teachers are the educational leaders who form part of the collaborative system

with other IEP team members to develop educational plans based on student’s needs.

While laws such as IDEA (2004) and NCLB (2002) mandate that students with disabilities, particularly students with ASD, to receive educational benefit using EBP, teachers continue to use programs in their classroom with little to no research support

(Hess et al., 2008; Simpson, 2005). With the prevalence of ASD rising in California, particularly in the Inland Empire, it becomes vital that teachers are using quality practices to support the communication, behavioral, social, and academic needs of students (CDC,

2016). Barriers to change exist for special education teacher use of EBP for students with

ASD, but as resources have become available, specifically for students with ASD, it is important to determine if changes in the research and policy to practice gap have occurred. The methodology of this current study, detailed in Chapter 3 discerns the current use of EBP for students with ASD by a sample of special educators in the Inland

Empire region of Southern California.

CHAPTER 3: METHODOLOGY

As the population of students with a diagnosis of ASD rises, services that are

developed to meet their particular needs are more important than ever before (O’Brien,

2013; Spring, 2015).). Students with ASD have different needs than those of the

typically developing population so discovering practices that meet their specific needs become essential to ensure their academic achievement (Mesibov & Shea, 2010). The

National Professional Developmental Center on Autism Spectrum Disorders (NPDC;

2016a) identified 27 evidence-based practices (EBP) to demonstrate improvements in communication, behavior, social, and academic achievements. To determine how decisions regarding the use of EBP and nonEBP support students with ASD are made by special educators in a targeted district (i.e., “the Lemon District”) in the Inland Empire region of Southern California. This study addressed the following research questions:

• How did special educators in the Lemon School district define EBP for students

with ASD?

• What sources did they use to incorporate EBP for students with ASD?

• What EBP and nonEBP for students with ASD did special educators use were

EBP to address communication, behavior, social, and academic deficits and did

they believe the practices were EBP?

Design

A survey design was selected to discover the current practices of Southern

California, Inland Empire elementary special education teachers. An online survey adapted from the Autism Treatment Survey (Morrier, Hess, & Heflin, 2006) was employed to collect quantitative and qualitative data to provide breadth of understanding

on the current use of EBP and a depth of understanding about special education teachers’

beliefs about EBP and their selection of practices to support students with ASD in

schools (Palinkas et al., 2015; Tashakkori & Teddlie, 2003). Survey methods are

appropriate for generating information about beliefs and policy issues (Creswell, 2012).

A cross-sectional research design allows for the researcher to generate data about the

current views of respondents (Creswell, 2012).

Survey Instrument

The ATS was developed by Morrier et al. (2006) and used by Hess et al. (2008)

and Morrier et al. (2011) to uncover EBP for students with ASD in the state of Georgia

and sources of information about EBP as reported by general and special education

teachers. As part of the verification process, experts in the field of ASD research

reviewed the survey and provided feedback which was used to enhance the survey

(Morrier et al., 2011; Vogt, 2007). The researcher selected the ATS to increase content

validity, while assessing the replicability of findings regarding the current use of EBP

among special educators in Southern California (Vogt, 2007). The ATS was in the

process of being updated (personal correspondence Morrier, 2016), but as the most

current version was not available at the time of research development the original ATS was modified by the researcher to address the research questions, shorten the duration of the survey, reflect the credentials and current EBP in California, and allow the

participants the opportunity to elaborate their responses.

The survey, shown in Appendix B, consisted of 42 items. The first seven

questions asked for demographic information about the participant and his/her classroom,

such as the amount of years teaching and the type of credential held. The researcher

added open-ended questions to capture participants’ definitions of EBP and the sources

they used to learn about EBP.

Next the survey included 26 multiple-choice items for all 27 communication,

behaviors, social skills, and academic EBP to ascertain if special educators had used the

practice and if they believed it to be an EBP. The practices of computer aided instruction

and speech generating devices were combined into one practice. The researcher adjusted

the formatting of these items to streamline the survey and provide insight into EBP

beliefs. The original survey asked about EBP use and provided three options: yes,

currently; in the past, but not this year; and no, never (Morrier et al., 2006). This

modified survey provides six options: (a) yes, I have used and yes, it is an EBP, (b) yes, I

have used it and I am unsure if it is an EBP; (c) yes, I have used it and no, it is not an

EBP; (d) no, I have not used the practice and yes, it is an EBP; (e) no, I have not used the

practice and I am unsure if it is it is not an EBP ; and (f) no, I have not used the practice

and no, it is not an EBP.

Sample

The sample was drawn from an Inland Empire elementary through high school

district with special education educators, defined as those holding a teaching credential

with authorization to serve in a mild/moderate or moderate/severe program or equivalent

degree that would meet the criteria of highly qualified in a preschool to 6th grade or adult

classroom in California (Commission on Teacher Credentialing, 2012; NCLB, 2002). At the time of the study there were over 11,000 people living with autism (ASD) in the

Inland Empire with a dramatic increase in the ASD population over the last decade

(Autism Society, 2017). For instance, Chaffey Joint Unified High School District in the

Inland Empire had an increase from two students with ASD in 2002 to 103 students in

2011 (DiMartino, 2011). The district was selected for the variety of classroom types

available and sizes to allow for a large sample from the local population. In addition, the

district was willing to distribute the survey to special education teachers at a busy time at

the end and beginning of the 2016-2017 and 2017-2018 academic years. Pseudonyms

were used to protect the confidentiality of the participants.

The Lemon School District contained just over 8,000 students. At the time of the

study, approximately 214 students with ASD attended the district (Lemon School

District, 2011). This school was also a recipient of a two year NPDC grant beginning in

2015 to support teacher training on the use of EBP (Lemon School District, 2015). Table

6 highlights the demographic data from the district, which includes the total school

population, the special education population, including the students with ASD, and the

special education teachers.

Table 6 Demographic Data for District

2015-2016 Lemon

Student Population 8,368

Special Education Population 646

ASD Population 214

Special Education Teacher * 48

Note: * denotes special education teacher population for the 2016-2017 school year.

Data Collection

The researcher contacted a representative of the Lemon district who contacted eligible special education teachers who met the criteria of NCLB (2002) highly qualified teachers and serviced students with ASD as a special teacher in a classroom setting in

May, June, or August 2017. These teachers were contacted via e-mail through the assistant superintendent, who forwarded the cover letter with a link to the survey provided by the researcher. In order to continue with the survey, participants needed to first provide informed consent to participate and acknowledge that they can withdrawal their consent at any time.

Included in the invitation to complete the survey was informed consent. The researcher received internal review board (IRB) approval to conduct research with human subjects from her respective institution of higher education (IHE). As part of the e-mails

to district representatives, an introduction letter stating the nature of the survey was

included. The letter contained an introduction of the researcher, confidentiality, where

data may be utilized, and informed consent. Informed consent stated that participants

were not required to participate and described discomforts that may occur as a result of

their participation, such as time to complete the survey. Participants were also informed

that they may withdraw their consent at any time. Contact information for the researcher

and the IRB were provided in case of questions or concerns. The link to the survey was

also included. Once participants selected the survey, the cover letter was again provided.

Before participants were allowed to continue to the survey, they had to acknowledge by

selecting yes, they consent to participate in the survey. The survey was administered

online using Qualtrics over a three-week time span between May 2017 through June

2017. Reminder emails were sent to encourage a response. The survey was opened again in August 2017 to gain more respondents. The same procedure was followed with emails from the researcher forwarded from the representative of the district. A reminder email was sent out after a week and then a final reminder e-mail was sent out before the survey was closed.

Data Analysis

A total of 12 elementary educators that included one emotionally disturbed class, two participants who taught adult students, one occupational therapist (OT), and one adapted physical education (APE) responded to the survey. The elementary educator data were included because they met all previous criteria. Because the response rate was low, the adult educators’ data were also included. Since the OT and APE are service providers and not educators their responses were excluded from analysis. One respondent only completed the demographic data so their responses were excluded. The targeted sample was 48 educators. However, the actual sample was n=12 (25%).

Durlak and DuPre (2008) recommend for an implementation to be considered successful, it should be used by 60-80% of possible participants. For the purposes of this study, a more rigorous definition was utilized with a success rate of 70% or greater of participants reporting use of a practice to adhere to the theme of thorough research design. Since self-report data are not as reliable as observational data, the researcher decided to apply a higher standard of use (Durlak & DuPre, 2008). As O’Connell (2008) argues, there is a need for measurement of the amount of use of a practice as well as investigations into the fidelity of implementation.

Frequency data and percentages were reported on the most widely used EBP for the educators. As well, percentages of EBP for students with ASD beliefs were reported.

For open-ended items, open coding was utilized to uncover teachers’ practices and definitions of EBP. The researcher determined initial coding by first reviewing each of the response items. Then, a second review was conducted to identify relevant categories.

The researcher color coded the data looking for similar terms and continued to review, and group responses based on their similarities and nuances, such as “training” and

“conferences” These terms were categorized and used to develop three themes, trainings and conferences, online materials, and preservice programs. Then specific responses were selected to illustrate the themes presented in chapter 4. The researcher consulted with her dissertation chair and committee to in an attempt to ensure consistency and enhance the interpretive validity of the findings (Neuman, 2014).

Validity

While the ATS has demonstrated validity, modifications were made to the survey to report recently developed EBP and to answer the specific questions addressed in this research (Hess et al., 2008; Morrier et al., 2006; Morrier et al., 2011; NPDC, 2016). The modified survey was pilot tested, as recommended by Creswell, (2012) and Saris

Gallhofer (2014), in order to ensure the content validity of the modified survey. Four educators outside of Lemon District completed the survey to ensure the directions and questions were clear and to uncover any technical issues. This was similar to the process reported by Hess et al. (2008) and Morrier et al. (2011) in their review of the validity of the ATS instrument. While the original ATS was determined to be reliable, the

modifications to the survey may affect the validity of the current instrument (Hess et al.,

2008; Morrier et al., 2011).

While analyzing the data, the researcher used a grounded approach in an attempt

to enhance the interpretive validity of the results. For instance, in vivo coding was

applied to definitions and sources so that the statements accurately reflected participants

responses as a “theory is grounded in the data and it is not forced into categories”

(Creswell, 2012, p. 429; Neuman, 2014).

Positionality

As a special education instructor who entered the profession in support of family members with disabilities, it is important to acknowledge my positionality on the subject of special education. As a representative of both family members and a district representative in IEP meetings, I offer a unique understanding of the special education system. As Hemelsoet (2014) concedes, a researcher cannot be completely separated

from their self, ideas, and beliefs, and these ideas of self-merge together. Accordingly,

my ideas as a mother of a child in special education as well as a conservator of my adult

uncles who have exited the special education system affect my decisions as a special

education instructor.

Summary

This study used a modified version of Morrier et al.’s (2006) Autism Treatment

Survey to further the understanding of EBP within schools by uncovering which practices

are currently being utilized by special educators to support students with ASD and how

special educators are uncovering these practices. Continued research in EBP as well as

universal standards for evaluating research used to identify EBP for students with ASD

are needed to provide researchers and the public with a better understanding the reliability and validity of EBP (Odom et al., 2010). Chapter 4 reviews the results of the survey and presents respondents’ definitions of EBP for students with ASD, sources of information regarding EBP, and respondents’ reported use and beliefs of the EBP.

CHAPTER 4: RESEARCH FINDINGS

Autism Spectrum disorder (ASD) continues to demonstrate an increased

prevalence in the United States (Baio, 2014; O’Brien, 2013, 2013). Current estimates

indicate between one and fifty and one and sixty-eight people are diagnosed with ASD

(Baio, 2014; O’Brien, 2013, 2013). With the increase in diagnosis, concurrently there

has also been a movement in education that requires evidence–based practices (EBP) to

educate students in schools (NCLB, 2002; Science Education Reform Act, 2002). While

laws require the use of EBP, there continues to be disagreement over what constitutes

EBP for students with ASD. Researchers and organizations have begun to define

practices for special educators’ use and research criteria for evaluating the quality of

methodology (Hess, et al., 2008; Wong et al., 2015). The National Professional

Developmental Center (NPDC; 2016a) offers 27 EBP that have met their criteria. While

EBP are available, Hess et al. (2008) have demonstrated that many educators still do not

utilize EBP.

Morrier et al. (2006) created the Autism Treatment Survey (ATS) to ascertain

which practices were utilized for students with ASD in Georgia. This survey was

adapted as outlined in Chapter 3, to determine which EBP special educators in Lemon

USD, the targeted district in California, were utilizing after undergoing training by the

NPDC (2016) to improve EBP implementation for students with ASD. This Chapter

presents the survey results and answers the following research questions:

• How did special educators in the Lemon School district define EBP for students

with ASD?

• What sources did they use to incorporate EBP for students with ASD?

• What EBP and nonEBP for students with ASD did special educators use were

EBP to address communication, behavior, social, and academic deficits and did

they believe the practices were EBP?

The Chapter begins by providing demographic data on the respondents. Next the

respondents’ definitions of EBP, and the sources of information they use for EBP are

reported. The chapter ends by summarizing the EBP and nonEBP respondents use to

address communication, behavior, social and academic needs of students and their beliefs

about their EBP status.

Respondents

The survey was sent to 48 special educators in the Lemon school district and

25% (n=12) respondents met the criteria of teaching in the district and serving as special

education teachers or adult educators that work with adults with ASD. Six respondents from other districts along with two service providers who instruct in occupational therapy

(OT) and adapted physical education (APE) were eliminated from the analysis because they did not meet the criteria. Creswell (2012) acknowledges that a large response rate allows findings to be more generalizable, but “even a small return rate may not be biased and be acceptable in survey research” (p 390). Since not all of the participants responded to each open response survey question, the total number of responses presented varies by question.

Classroom Demographics

The classroom demographics of educators by students’ age range are provided in

Figure 2. Among the 12 participants that responded to all items, 2 (17%) indicated they

taught three ranges of ages and 1 (8%) indicated they taught two age ranges. Among the

survey respondents, 2 (17%) indicated they taught children five years or younger (preschool and transitional kindergarten, 2 (17%) indicated they taught children 5-7 years

(kindergarten to 2nd grade), 5 (42%) mentioned they taught older children 8-10-years (3rd-

5th grade) 4 (33%) mentioned they taught older children 11-13 (6th to 8th grade), and no respondents mentioned they taught adolescents 14 - 17. In addition, 2 (17%) indicated they taught 18- 22 year olds (adult, and adult transition). Their response data were included to generate more information about the districts’ practices.

18 or over

11-13 years

8-10 years

5-7 years

5 years or younger

0 1 2 3 4 5 6

Figure 2. Respondent Educators Students' Age Ranges Figure 3 presents the number of respondents who held different credential types. As noted in the figure, the certification held by respondents also varied. Five of the respondents (42%) also held more than one credential with one (8%) participant holding three credentials. Among the 12 participants who responded to this question, only 3 (25%) of the respondents indicated they held an autism authorization with 5 (42%) also indicating they held a clear moderate to severe credential. The majority held other

credentials with 6 (50%) of respondents holding either a single subject general education credential, intern credential, or an early childhood credential. Only 1 (8%) participant held a preliminary mild/moderate credential, and 1 (8%) participant a clear moderate to severe credential. The respondent who taught emotionally disturbed, one participant (8%) stated they did not hold any credentials.

Other

Clear Moderate/Severe

Preliminary Moderate/Severe

Clear Mild/Modertate

Preliminary Mild/Modertate

Autism Authorization

0 1 2 3 4 5 6 7 Number of Type of Credentials Held by Respondents

Figure 3. Types of Credentials Held by Respondents Figure 4 displays the type of classroom teachers used in servicing students with

ASD. Among the 12 participants that responded to this question, 31%, taught specialized academic instruction, and another 2 (17%) taught self-contained ASD classes. Another

23% of respondents indicated they taught other classroom types such as moderate to severe intellectually delayed (ID) which would also be considered specialized academic instruction, emotionally disturbed, and early start. Including the classes that were ID moderate to severe and emotionally disturbed in specialized academic instruction brought the percentage up to 50(6). Two respondents (15%) taught adult transitions.

98 When asked how long they had taught students with ASD, 50% (6 out of 12) of the respondents indicated the same amount of years of service. One of the respondents indicated she had not taught students with ASD, but also stated she had taught over 250 students with ASD in her career; her responses were included to acknowledge what she had learned about EBP and her definition of EBP. When asked about the numbers of students with ASD they had taught over the course of the career, the number of students ranged from 0 to 250, and one respondents indicated hundreds. The average of students serviced with ASD was 30.

Figure 4. Type of Classroom of Respondents

Figure 5 presents the total years of education service for respondents. Among the

12 participants who responded, 33% (4) had taught three years or less, and 17% (2) of those were first year teachers. None of the participants taught between 4- 9 years, and one participant taught between 10-20 years (8%), with the majority of 7 out of 12, 58%,

of participants with 17 to 42 years’ experience. Three (25%) had taught between 20-30 years, and 4 (33%) had taught over 30 years.

33% 33%

8% 25%

1-3 years 10-20 years 20-30 years 30 or more

Figure 5. Respondents Years of Teaching Experience by Percentage Definition of Evidence-basedPractices

To discover special education teachers’ definitions of EBP for students with ASD, participants were asked to respond to item 10, “Please type in an answer that explains your use of evidence-based practices with students with Autism Spectrum Disorder

(ASD). How do you define Evidence-basedpractices for students with ASD? (short answer) Please explain.” Ten of the 12 participants responded to this item and based on in vivo coding, the following two themes emerged: (a) EBP are from research, and (b) variety of practices. Percentages will not add to 100% due to the overlap of responses by participants. Of the respondents, 8 of 12 (75%) provided a definition of the practice.

While the majority could define EBP, 4 of the respondents (25%) did not provide a

100

definition, stated they were not familiar, or EBP was not applicable to their current situation.

EBP Are from Research

The majority of respondents, 6 of the 12 (50%) identified EBP as research that support students with ASD by the use of strategies. One participant defined EBP as

“specific, well-defined practices that have been more than empirically shown to be effective - practices that result in measurable evidence of effectiveness.” Two others provided similar definitions stating, “Current evidence shows that these teaching techniques work,” and “Practices that have been studied and found to be effective.” Many of the respondents’ definitions emphasized outcomes with labels such as “effective”,

“positive results,” “measurable effectiveness,” and as noted in IDEA (2004) “educational benefit.” One participant identified the National Professional Developmental Center

(NPDC) on Autism Spectrum Disorder (ASD) declaring that “best practices that are supported by research, e. g. the 27 EBPs defined by the NPDC.” Five out of six respondents (80%) who identified EBP as research, also stated they were “tasks”,

“routines”, “strategies”, or “techniques” that lead to results, while one respondent simply stated EBP “are strategies to implement with the instructions of students with autism.”

Variety of Strategies

Of those that responded, three of the respondents out of the 12 (25%) identified specific practices that can be used with students. Two of the 3 (67%) respondents stated visual supports (cues), modeling, and social stories (social narratives). Additionally, listed by 1 of the 3 (33%) respondents were the specific practices of task analysis,

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reinforcements, prompting, and redirection. As well, one additional respondent indicated, “the 27 EBPs defined by the NPDC.”

Several patterns emerged with respondents who did not answer question 10 or indicated they did not have students with ASD; 4 of the 12 or 33% of the respondents did not answer the question or indicated they did not have any students with ASD. One participant wrote simply “ASD” as their definition. The age range of students that educators taught included those working with under 5-year-old students for 2 out of 4 of these respondents. As well, 2 out of 4 respondents (50%) indicated they had taught 0 students with ASD this year. Respondents on questions related to sources of support also suggested they “do not know,” had never had training, or did not answer the source questions.

Of the respondents, 8 of 12 (75%) provided a definition of EBP. While the majority could define EBP, 4 of the respondents (25%) did not provide a definition, stated they were not familiar, or EBP was not applicable to their current situation.

Exploring avenues that provided their sources for support for these definitions were also explored and are revealed in the next section.

Sources of Trainings

To answer question 2, “What sources did they use to incorporate EBP for students with ASD?” respondents were asked to provide a short answer to two items. These questions were to uncover the sources that provided information to the special educators on of EBP for students with ASD and identify what source(s) they found as the most useful. Ten of the 12 (83%) of the participants responded to item 41 that asked, “Which sources of trainings have provided information on the use of EBP specifically geared

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toward students with ASD?” Eight of the 12 participants (75%) responded to item 42 that asked, “What sources of training have been the most useful. Please explain.” The following in vivo codes, emerged: (a) trainings and conferences, (b), online materials, and (c) courses. The most common reported source of support were trainings, and the least common reported source were online materials.

Trainings and Conferences

Among the 10 participants that responded to item 41, 6, or 60%, identified trainings and conferences as sources of information for EBP for students with ASD, and one respondent, with 37 years of teaching experience, specified trainings inside the district and specific agencies outside the district. The other, 5 (80%) respondents did not specify whether the training occurred inside or outside the district. One respondent specified hands on training, “information provided in conjunction with hands on experience, modeling or video examples, coaching by experienced practicioner (sic).

NOT powerpoints (sic)”. One (8%) participant mentioned support based on individual needs and those listed to provide the support were occupational therapist (OT), speech therapist, and by a separate respondent an individual to provide support were specialists.

Trainings for specific EBP and programs were also identified by 2 of the responses to question 41 and 42 of the 10 respondents who answered the questions. The

EBP they listed included, discrete trial teaching (DTT), structured teaching, augmentative and alternative communication (AAC) - a type of speech generating device, picture exchange communication system (PECS), applied behavior analysis (ABA) another name for applied behavior intervention (Spreckley & Boyd, 2009), and pivotal response training (PRT). While acknowledging EBP, a few respondents also recognized additional

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trainings, such as Crisis Prevention Intervention (CPI, 2017) - a preventative and

interceptive practice for professionals to safely respond to violent, anxious or hostile

individuals; Cardio-Pulmonary Resuscitation (CPR); and a speaker named Temple

Grandin, for providing useful information. Temple Grandin is a professional living with

ASD who writes and presents about her experiences as an adult with the disorder and advocates for students (Grandin, 2012). General trainings and conferences were also included in the responses. Those identified as the most useful sources by one respondent were the website of CAPTAIN, training, and specialist.

Online Materials

Among the 10 participants that responded to either question providing sources, 3

or 30% also listed “Online materials,” and all three respondents indicated they taught a

self-contained autism class, though one was a transition program for adult students. One of the respondents who taught a self-contained classroom and possessed both an ASD authorization and an intern credential, mentioned the California Autism Professional

Training and Information Network (CAPTAIN, n.d). The website, discussed in Chapter

2, contains training materials for video modeling, reinforcement, and visual supports

(CAPTAIN, n.d). Also, one participant, who taught adult educators and for 25 years, mentioned professional publications, but did not stipulate journal or research articles.

Courses

Among the 10 who responded to item 10, 2 or (20%) identified courses taken in their credential program as sources for EBP. Furthermore, both respondents listed the same local college stating, “classes at CSUSB [California State University San

Bernardino]” and “courses as part of my credential program at CSUSB”. Both of these

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respondents were novice educators with only 1 year of teaching experience. Both mentioned working with students with ages ranging from 11-13 years old, with one also including students 5-10 years old. Interestingly, when asked how they define EBP, both of these respondents mentioned that EBP occurs from researched practices. The same two respondents listed their CSUSB courses as the sources they thought were the most useful. None of the respondents suggested the autism certification as a source of training, though newly credentialed educators would have this built into their credential program.

Evidence-basedPractices Use or Nonuse and Beliefs

In order to address the research question 3, “What EBP and nonEBP for students with ASD did Inland Empire (IE) special educators use and believe were EBP to address communication, behavior, social, and academic deficits?” participants were asked to indicate if they have used each of the 27 EBP (yes versus no) and if they believed a practice was an EBP (yes, no, unsure). The research applied Durlak and DuPre’s framework to identify EBP with the total respondents indicating they used a practice at greater than 70%. Table 7 provides an overview of the results in order of percentage of

EBP reported use (i.e., from most to least reported use) under the headings of communication, behavior, social skills, academics, and multiple domains for each practice. For the 27 EBP practices included in the survey, 21 or 78% met this 70% standard. Next, Table 8 presents the results in order of percentage of EBP use (from most to least reported use) along with the percentage of respondents that believed the practice was an EBP. The section concludes, with a detailed analysis of participants’ responses for each category (communication, behavior, social skills, academics, and multiple domains).

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Response Rates at the 70% Standard

Table 7 presents a summary of EBP response rates for the 12 participants that responded as yes, they used the practice for each EBP. As shown in Table 7, 91-100% of the respondents reported they used 10 or 37% of the 27 listed EBP, 81-90% reported they used 8 or 30% of the listed EBP, and 3 or 11% reported they used 70- 80% of the listed

EBP. Only 6 or 22% of the EBP did not meet the 70% standard.

Table 7 EBP with Total Responses Greater Than 70%

Percent Communication Behavior Social Skills Academics Multiple Domains 91-100% n/a Antecedent Social Skills n/a Modeling; Based Training Naturalistic Interventions; (Groups) Interventions; Differential Prompting; Reinforcement/ Task Analysis Reinforcement; and Training; Extinction; Time Delay; Functional Behavioral Assessment

81-90% Picture Response Social n/a Exercise (ECE); Exchange interruption/ Narratives Visual Supports; Communication Redirection (Stories); Functional System (PECS) Peer Communication Mediated Training (FCT) Instruction/ Intervention; Structured Play Groups

70-80% n/a n/a n/a Discrete Computer Aided Trial Instruction and Teaching Speech Generating Devices

Note. Not applicable is signified by n/a in the table.

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Of the domains, multiple domains and behavior had the most reported use at the

70% standard or greater. Multiple domains had 10 of the 12 or 83% of the practices meet the standard. For behavior 5 of the 6 (83%) of the EBP met the implementation standard.

Social skills had 5 out of 6 (83%) meet reported use, but of the 100% reported use practices, none fell under the domain of social skills. Behavior had the most practices implemented at 100% with 4 out of the 5 meeting the 70% criteria implemented at 100%.

Modeling, and naturalistic interventions under multiple domains were also implemented at 100% and address behavior. All EBP that met 100 % reported use occurred under behavior or multiple domains. Practices utilized by 100% of the survey participants included: modeling, prompting, naturalist intervention, extinction, functional behavioral assessment, and direct reinforcement/ reinforcement.

Table 8 provides an overview of respondents reported EBP reported use and beliefs. For each question, respondents were given the option to state if they had used a practice (i.e., yes, I have used it or no, I have not used it) and to assess their belief about the evidence-base (i.e., yes, it is an EBP, no it is not an EBP, or I am unsure if it is an

EBP).

Data from this survey support that the majority, 22 of the 27 EBP, were being utilized by 70% or more of the respondents with several practices being utilized by all of the respondents. Practices utilized by 100% of the survey participants included: modeling, prompting, naturalist intervention, extinction, functional behavioral assessment, and direct reinforcement/ reinforcement. When asked to describe other practices not listed on the survey they utilized, only 2 practices emerged; the nonEBP of a gluten free diet and sensory strategies (Lang et al, 2012; Rossignol, 2009; Widyahening

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& Ismail, 2011). The next section provides a summary of results for each of the EBP use

and belief listed by domain and level of reported use, with the most utilized practices discussed first. Meaningful patterns that emerged based on respondents’ demographics are discussed. Last, the open response practice items identified by participants are revealed.

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Table 8 EBP Reported Use and Belief as an EBP

EBP Yes, I have No, I have Yes, it is an No, it is used it not Used it EBP not or I am unsure it is an EBP Naturalistic Interventions 100% 0% 67% 33% Differential Reinforcement, 100% 0% 75% 25% Reinforcement Extinction 100% 0% 67% 33% Modeling 100% 0% 67% 33% Prompting 100% 0% 83% 17% Antecedent based interventions 100% 0% 58% 42% Functional Behavioral Assessment 100% 0% 67% 33% (FBA) Task Analysis and Training 92% 8% 92% 8% Time Delay 92% 8% 75% 25% Discrete Trial Teaching 92% 8% 92% 8% Social Skills Training 92% 8% 58% 42% Visual Supports 92% 8% 83% 17% Exercise (ECE) 92% 8% 50% 50% Structured Play Groups 83% 17% 58% 42% Response interruption; Redirection 83% 17% 67% 33% Peer Mediated Instruction/ 83% 17% 50% 50% Intervention Social Narratives (Stories) 83% 17% 75% 25% Picture Exchange Communication 83% 17% 75% 25% System (PECS) Functional Communication 75% 25% 67% 33% Training (FCT) Parent Implemented Interventions 75% 25% 58% 42% Computer Aided Instruction and 75% 25% 75% 25% Speech Generating Devices Pivotal Response Training (PRT) 67% 33% 75% 25% Cognitive Behavior Interventions 67% 33% 50% 50% Scripting 67% 33% 58% 42% Video Modeling 58% 42% 42% 58% Self-Management 50% 50% 42% 58% Note. Items under the line indicate not meeting reported use standards.

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Communication

Only item 22, Picture Exchange Communication System (PECS) falls under the

communication category. Among the 12 participants that responded, 10 or 83% indicated

they used PECS and the majority, 9 (75%) correctly indicated that it was an EBP. Two

respondents, both who held other credentials and taught 11 – 13-year-old students, were

unsure of its EBP status, both not using it. One respondent, who also held other

credentials and taught 11 – 13-year-old students, reported using but was unsure if it was an EBP (8%). Since only one item fell under this category, other communication practices are highlighted under multiple domains. The percentage of reported use and belief about PECS are provided in Table 9.

Behavior

Behavior items included EBP that addressed preventing and improving behaviors.

As shown in Table 8, item 20, differential reinforcement or reinforcement, item 30

extinction, and item 31, antecedent based interventions (ABI) had reported use rates of

100%. Item 36, Functional behavior assessments (FBA) had a reported use rate of 90%.

Item 35, Response interruption and redirection (RIRD) or redirection, had a reported use

rate of 83%. Item 25 Cognitive behavior interventions had a reported use rate of 63%.

Table 9 lists each of the response percentages for EBP that fall under behavior and the

communication and includes the percent of respondents that either believed or did not

believe the practice was an EBP. Following the table, each of the EBP outcomes are

detailed.

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Table 9 Communication and Behavior EBP Responses by Percentage of Reported Use and Belief

EBP Use Belief Nonbelief Differential 100% 75% 25% Reinforcement; Reinforcement Extinction 100% 67% 33% Antecedent Based 100% 58% 42% Interventions Functional 100% 67% 33% Behavioral Assessment Picture Exchange 83% 75% 25% Communication System (PECS) Response interruption; 83% 67% 33% Redirection Cognitive Behavior 67% 50% 50% Intervention

Item 20, Differential reinforcement or reinforcement was reportedly used by all

12 or 100% of the respondents, and 9, 75%, believed it was an EBP. Next, 2 respondents

(17%) reported they used it, but thought it was not an EBP. One reported using reinforcement (8%), but was unsure of its EBP status.

Item 30, extinction was similar to reinforcement a 100% reportedly used rate (12 respondents) and 8 (67%), also believing it was an EBP. In contrast, one respondent that reported using the practice believed it was not an EBP and 3 respondents (25%) that reported using the practice were unsure if it was an EBP. The two respondents (100%) that were unsure if it was an EBP both taught students under five years.

Item 31, antecedent based interventions were reportedly utilized by all 12, 100% of respondents and it was believed to be an EBP by 7 respondents, or 58%. While 2 respondents (17%), reported using antecedent based interventions, they believed it was

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not an EBP and 3 (25%) respondents that reported using it, but were unsure if it was an

EBP.

Item 36, functional behavioral assessments (FBA) had reported utilization by all

12 (100%) of the respondents and 8 respondents (67%) believed it was an EBP. While

all of the respondents reported using FBA, 2 (17%) were unsure of its EBP status. Two

respondents, 17%, reported using it, but thought it was not an EBP. The two educators

who taught children under five selected they used it, but were unsure if it was an EBP.

Both (100%) of the respondents who selected yes, they had used it, but no it was not an

EBP held clear moderate to severe credentials.

Item 35, response interruption or redirection was reported to be used by

respondents with 10 out of 12 (83%) having used the practice and 8 out of 12 (75%),

believing it was an EBP. Another 6 respondents (67%) agreed it was an EBP and had

reported using it, but 2 (17%) reported using it while believing it was not an EBP. An

extra 2 respondents (17%) reported utilizing response interruption or redirrection, but

were unsure of its status as an EBP. An additional respondent (8%) stated they had not

used it, but thought it was not an EBP. Both (100%) respondents who taught self-

contained classes used it and believed it was an EBP.

Item, 25, cognitive behavior intervention had 75% or 8 respondents out of 12 respondents reported using it and 6 (50%), believed it was an EBP. Another 2 respondents (17%) used it, but stated that it was not an EBP. In addition, one respondent

(8%) indicated they had not used it, but believed it was an EBP. Three (25%) of those surveyed had not used it and were unsure if it was an EBP. All of those with an ASD certification, 3 (100%) identified it was an EBP and that they used this practice, and both

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educators who taught under five year olds were unsure of cognitive behavior being and

EBP.

All but cognitive behavior interventions, had a high reported use rate over or equal to 90%. This indicates a need for behavior interventions when servicing students with ASD and will be discussed further in Chapter 5.

Social Skills

Social skills EBP items are described next and are summarized in Table 10. The first practice, item 32, social skills training (groups), had a reported use rate of 92%. Item

18, peer-mediated instruction or intervention had a reported use rate of 82%. Item 26, social narratives and Item 38, structured play groups reported use rate were both 83%.

Item 23, pivotal response training (PRT) had a reported use of 67%, while item 37, self- management, had a reported use rate of 50%. Table 10 shows the percentages of each response for social skills and academic practices by percentage of use and also contain the percentage of belief as an EBP.

Table 10 Social Skills and Academic EBP By Percentages of Reported Use and Belief

EBP Use Belief nonbelief Social Skills Training 92% 58% 42% (Groups) Discrete Trial Teaching 92% 92% 8% Peer Mediated 83% 50% 50% Instruction/ Intervention Social Narratives 83% 75% 25% (Stories) Structured Play Groups 83% 58% 42% Pivotal Response 67% 75% 25% Training (PRT) Self-Management 50% 42% 58%

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Item 32, social skills training (groups) had a reported use rate of 11 of 12 or (2%) respondents and 7 respondents (67%), believed it was an EBP. Two respondents (17%) did not believe it was an EBP, and 1(8%) was unsure if it was an EBP. One participant

(8%) was unsure of it as an EBP and had not used it.

Item 18, peer-mediated instruction or intervention had a reported use rate of 8 out of 12 (75%), and (6) 50%, believed it was an EBP. Five out of 12 respondents (42%) reported they had used it and believed it was an EBP, but an additional 2 respondents

(17%) had used it while unsure if it was an EBP. Another 3 respondents reported using peer-mediated instruction, but believed it was not an EBP. Two respondents (17%) reported they had not used it, one believing it was an EBP and the other unsure of its EBP status. Both (100%) educators who taught under five year olds were unsure if it was an

EBP.

Item 26, social narratives, or social stories, were reportedly used by 10 out of 12 respondents (83%) and 10 (83%) also had the belief of social narratives as an EBP. Of those who used the practice, two (17%) were unsure of its EBP status, but none of the respondents believed it was not an EBP who used it. A different participant (8%) reportedly had not used social narratives and thought it was not an EBP. Furthermore, one respondent (8%) had not used it, but believed it was an EBP.

Item 38, structured play groups had a reported use rate of 8 out of 12 (67%) and 9

(75%), believe it was an EBP for students with ASD. Eight respondents, (67%) used the practice and thought it was an EBP. One respondent (8%) reported using the practice and was unsure of its EBP status and one selected reported use, but thought it was not an

EBP. For the four respondents who indicated they had not used the practice, one (8%)

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believed it was and EBP, another believed it was not, and the final 2 respondents (17%)

indicated they were unsure if structured play groups were an EBP. The two respondents

(100%) who taught self-contained classes used and identified structured play groups as an

EBP.

Item 23, PRT had 8 of 12 respondents (67%), believed PRT was an EBP for students with ASD. Among those respondents, 4 (42%) reported they had not used the practice. One respondent (8%) reported having used PRT while not believing it was an

EBP. One (8%) respondent had not used it and was unsure about PRT being an EBP.

The two respondents who had reported not using the practice and were unsure if it was an

EBP held clear moderate/severe multiple subject credentials.

Item 37, self-management had a reported use rate of 6 out of 12 (50%) and 7 out of 12 (58%) believed it was an EBP. Of the respondents, 5 respondents (42%), reported use and thought it was an EBP with one respondent (8%) reporting using it, but not believing it as an EBP. This practice had the lowest reported use rates of all the 27 practices. Three respondents (25%) were unsure of self-management as an EBP, and 2

(17%) respondents did not use it, but believed it was an EBP. One respondent (8%) selected that they had not used it and thought it was not an EBP. Both (100%) self- contained ASD classes reported using self-management and thought it was an EBP. As well, both (100%) of the educators who taught under 5-year-old students were unsure if it was an EBP and reported they had not used self-management.

Only two of the six social skill practices, self-management and PRT, did not meet the 70% reported rate for use. Possible explanations for this and the higher use rates of the other practices is discussed in chapter five. Academic practices are reviewed next.

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Academic Skills

Item 13, discrete trial teaching (DDT), was the only practice identified

exclusively under academic skills; others are reviewed under multiple domains. DDT

had 11 out of 12 (92%) of respondents use it and think it was an EBP. One participant

(8%) reported use of DDT while believing it was not an EBP. One respondent (8%) had

yet to use it though they also agreed it was an EBP. The participant who stated he had not

used it also stated they taught students under 5 and held an early childhood credential.

The percentages of use for DDT is included in Table 10 with social skill frequencies as

only one practice was identified exclusively to primarily address academic skills. The

respondent who had not used the practice, but believed it was a EBP taught students

under 5 years old. Both (100%) of the self-contained instructors reported utilizing the

practice and identified it as an EBP. The final category, multiple domain respondents’ answers are discussed next.

Multiple Domains

Table 11 presents the reported use and belief of respondents for each of the

multiple domain practices. Item 27, modeling, item 15, naturalistic interventions, and

item 12, prompting, had reported use rates of 100%. Item 16, task analysis, and item 21,

time delay, had reported use rates of 92%. Item 24 visual supports, and item 17 exercise

had reported use rates of 92%. Item 34, functional communication training (FCT) had a

reported use rate of 83%. Item 14, computer aided instruction and speech generating

devices, had a reported use rate of 75%, followed by item 19, parent implemented

interventions, and item 29, scripting, each with a reported use rate of 67%. Item 28, video

modeling (VM), had a reported use rate of 58%, the second lowest of all the EBP.

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Table 11 Multiple Domains EBP by Percentage of Reported Use and Belief

EBP Use Belief nonbelief Modeling 100% 67% 33% Naturalistic 100% 67% 33% Interventions Prompting 100% 67% 33% Task Analysis and 92% 92% 8% Training Time Delay 92% 75% 25% Visual Supports 92% 83% 17% Exercise 92% 50% 50% Functional 75% 67% 33% Communication Training (FCT Computer Aided 75% 75% 25% Instruction and Speech Generating Devices Parent Implemented 75% 58% 42% Interventions Scripting 67% 58% 42% Video Modeling 58% 42% 58%

Item 27, modeling was reported to be used by 100% of the 12 respondents and 8 out of 12 respondents (67%) believed it was an EBP for students with ASD. Of the respondents, 8 (67%), believed it was an EBP. One (8%) thought it was not an EBP, and

3 (25%,) were unsure if it was an EBP.

Item 15, naturalistic interventions were another EBP reported to be utilized by

100% or 12 of the respondents and 8 (67%) believed it was an EBP for students with

ASD. Two respondents (17%) believed it was not an EBP, and 2 other respondents were unsure (17%) if it was an EBP.

Item 12, prompting was reportedly used by 100% of the 12 respondents and 10

(83%) believed it was an EBP for students with ASD. One respondent (8%) believed it was not an EBP, and 1 indicated they were unsure (8%) if it was an EBP. One respondent

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(8%) who taught students in the 10-year-old age range, thought it was not an EBP and held an other credential.

Item 16, task analysis and training was reported to be used by 11 out of 12 (92%)

respondents, and 10 (83%) respondents thought it was an EBP. One (8%) reported they

had used the practice, but that it was not an EBP. One (8%) respondent thought it was an

EBP, but had not used task analysis. The respondent who identified it as a nonEBP held

a preliminary M/S credential.

Item 21, time delay, like task analysis, was reportedly used by 11 out of 12 (92%)

of respondents and 8 (67%) believed it was an EBP. Similarly, one respondent (8%) used

it, but thought it was not an EBP and also one respondent (8%) used it, but was unsure if

it was an EBP. The one respondent who had not used the practice, was unsure if it was

an EBP, for a total of 2 (17%) of the respondents unsure of its status as an EBP. Nine

respondents (75%), believed it was an EBP and also reported using the practice. Both

(100%) educators who taught the under five-year-old age group were unsure if it was an

EBP. Both educators who taught adults reported utilizing time delay.

Item 24, visual supports were also used reported to be used by the majority of the

respondents, 92% or 11 out of 12. In addition, the majority, 83%, 9 respondents,

believed it was an EBP. Only one participant believed it was not an EBP and one was

unsure of its EBP status who reported using it. One respondent 8%, had not used it, but

believed it was an EBP. The respondent who had not used it taught students under five

years old. All the educators for ages 5-13 and adults reported using the practice.

Item 17, exercise was also highly reported to be used by respondents with a total

of 92% or 11 out of 12 respondents and 6 believed it was an EBP. Exercise had one of

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the lowest beliefs about its EBP status with only 6 (50%) of those who used it though it

was an EBP and another 3 (25%) were unsure if it was an EBP. One respondent (8%)

thought it was not an EBP and had not used it. Both respondents who taught under five-

year-olds reported using it, but were unsure if it was an EBP. Every respondent (4) who

had an other credential reported using exercise. Both (100%) adult educators reportedly

used the practice and thought it was an EBP.

Item 34, FCT was reported to be used by 10 respondents out of 12 (83%) and 6

(50%) believed it was an EBP. Of those 10 that used it, 5, 50%, believed it was an EBP,

2 (20%) believed FCT was not an EBP, and 3 (30%) were unsure if it was an EBP. Five

out of 6 (83%) respondents who acknowledged it as an EBP reported to use it. Another 3

(25%) respondents reported not using it with those split with 1 (8%) thinking it was an

EBP, 1 thinking it was not an EBP, and the 1 unsure of its stance as an EBP. Both of the

respondents who taught under five-year-olds were unsure of its status as an EBP.

Item 14, computer aided instruction or speech generating devices also had 9 of 12

respondents, 83% report to use the practice and believe it was an EBP. Eight (67%)

reportedly used the practice and thought it was an EBP. Next, one (8%) reportedly used

it and thought it was not an EBP (8%). Three respondents (25%) had not used the

practice with one (8%) each believing it was an EBP, not sure if it was an EBP and

stating it was not an EBP. This practice was not utilized by any of the respondents who

taught students under five years old, but was reported to be used by all respondents who

taught 5-10 year olds (100%). Again, both (100%) teachers of self-contained ASD classes reported using the practice and recognized the practice as an EBP for students with ASD.

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Item 19, parent implemented interventions had a reported use rate of 9 of the 12

(75%) respondents reported to use the intervention and 5 (42%) believed it was an EBP.

Three (25%) respondents thought it was not an EBP. One (8%) respondent was unsure if

it was an EBP. There were 3 respondents (25%), who mentioned they had not used the

practice and those were split with 2 (17%) believing it was an EBP and the other 1 (8%)

unsure it is was an EBP. Both educators who taught 5-7-year-olds reported they had used

parent implemented interventions.

Item 29, scripting had a reported use rate 8 of out of 12 (67%), and the 7 (58%)

believed it was an EBP. Of the 7 respondents (58%) who thought it was an EBP, 5 (71%)

respondents reportedly used it, and 4 (29%) respondents had not. Another 4 respondents

(33%) were unsure if it was an EBP, of those 2 (50%) respondents had not used the

practice and 2 (50%) had used scripting. One respondent (8%) identified it as a nonEBP,

and that respondent reported using scripting. Both of the educator respondents for

students under 5 years were unsure if it was an EBP.

Item 28, video modeling (VM) had the second lowest reported use rate of the 27 practices with 7 out of 12 (58%) respondents and the same for belief. Only 5 out of 7

(71%) reportedly used the practice believing it was an EBP. One (8%) believed it was not

an EBP and one (8%) was unsure if VM was and EBP that reported to use VM. Four

respondents (33%) were unsure if VM was an EBP. Both (100%) adult educators

reportedly used VM. Both (100%) educators who taught students under five had not used

it and were unsure if it was an EBP.

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Open Responses

Open responses were collected for question 39, “Please describe and explain any

other practices you are using.” For write in items, only three practices were reported by

one participant. The first differential reinforcement (DRO or DRI) was included in the

multiple-choice options. Two new practices included were the nonEBP of a gluten free diet and sensory integration. These items were identified by the head start teacher who taught students 5 or younger, who had also been teaching students with ASD for over 30 years. No additional details were provided so it was unclear what type of sensory support the participant referred such as auditory integration, sensory integration, weighted vests, or another type of sensory support. This respondent had also identified teaching 20 students with ASD in the course of their career.

Overall, the survey respondents indicated they utilized the majority of EBP for

students with ASD (22 out of 27). While all were reportedly used, some appear to be

more utilized then others with 7 practices reportedly used by all respondents: modeling,

extinction, prompting, differential reinforcement (reinforcement), functional behavioral

assessment, naturalistic intervention, and antecedent based interventions. Five practices

were not utilized at the 70% reported use standard: pivotal response training, cognitive

behavior therapy, scripting, video modeling and self-management.

The data suggest that while improvements have been made in knowledge of EBP,

there is still room for improvement as 16 of the 27 (59%) practices did not have both the

knowledge and reported use of the practice by at least 70% of the respondents. As well,

many of the practices had large discrepancies between the belief of a practice as an EBP

for students with ASD and use with many practices being used when respondents were

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unsure or believed a practice was not an EBP. In fact, only one practice had a belief higher than its reported use, the under 70% reported used practice of PRT. A discussion of possible explanations for the low or high reported use rates is presented in the next chapter. Chapter 5 also identifies limitations from the current research as well as recommendations for further review and study design.

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CHAPTER 5: CONCLUSIONS, DISCUSSION, AND RECOMMENDATIONS

Evidence-based practices (EBP), as previously highlighted in Chapters 1 and 2, provide the best available evidence for supporting the communication, behavior, social, and academic needs of students with ASD (Slocum et al., 2012). The framework presented in Chapter 2 demonstrates equity, caring, and competency are necessary for an educator to effectively support students with ASD. Educators need to listen and learn about students’ needs and then provide students with what they need based on their individual characteristics, rather than providing them with services or class types based on what is currently available in the school environment (Carson, 2015; Crockett, 2014;

Ferraioli, & Harris, 2011). In order for this to happen, teachers need effective training to gain competence through preservice programs, authorizations to support students with

ASD, and professional development (PD). All of these features inform the decision- making process of educators to select the appropriate programs and EBP for students with ASD.

Determining EBP requires a review of research methodology along with examination of the practice themselves (Odom, Collet-Klingenberg et al., 2010). While research designs with random assignment are considered the gold standard of controlled research designs, they are not feasible for most research involving students with ASD

(Odom, Collet-Klingenberg et al., 2010). Thus, many authors such as Odom, Collet-

Klingenberg et al. (2010), and Reichow et al. (2008,) and organizations like the Best

Evidence Encyclopedia (n.d.) and NPDC (2016) have created guidelines to help others evaluate the quality of quasi-experimental and case studies to identify EBP for students with ASD (Hess et. al., 2008; Nay & Fetherstonaugh, 2007; Simpson, 2005). Although

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EBP have been determined, prior research by Hess et al. (2008) suggest that under 30% of educators are utilizing EBP for students with ASD (NPDC, 2016). In their study of

EBP use among educators in the Inland Empire (IE) of Southern California, Stahmer et al. (2005) found that many educators, as low as 23% for some practices, did not report utilizing EBP for students with ASD. This dissertation updates and expands upon

Stahmer et al.’s (2005) research by addressing the following questions pertaining to special educators during the 2016-2017 academic year:

• How did special educators in the Lemon School district define EBP for students

with ASD?

• What sources did they use to incorporate EBP for students with ASD?

• What EBP and nonEBP for students with ASD did special educators use were

EBP to address communication, behavior, social, and academic deficits and did

they believe the practices were EBP?

Chapter 3 detailed the methodology used to address these questions. An online survey

utilizing multiple responses and several short answer questions allowed the researcher

to gain knowledge on the EBP use among special educators in the Lemon District

located in the Inland Empire (IE) region of Southern California. The survey was

distributed to 48 special educators at Lemon USD and 12, including two adult

educators were included in the study. Chapter 4 presented the results of the survey

pertaining to each of the research questions, and this chapter discusses the

conclusions drawn from the results and discusses implications and recommendations

for further research.

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Conclusions

This researcher sought to discover the definitions, sources, and use of EBP among

special educators in the Lemon school district. The researcher also sought to ascertain the special educators’ beliefs about the practices they reported using (e.g., was each practice considered EBP, non EBP, or was the special educator unsure). The conclusions for each research question are presented next.

How Do IE Special Educators Define EBP for Students with ASD?

Overall the definitions of EBP provided by the special educators were fairly consistent. Most respondents used terms such as “support” and “assist” as well as

“effective or positive results (benefit).” For instance, one respondent wrote EBP were

“studied and found to be effective.” Another mentioned, “They (EBP) provide the

greatest educational benefit, and produce positive results.” Often the respondents

identified specific practices such as PECS or emphasized the research that supported the

use of a practice. Unlike prior research, where the definitions of EBP were provided to

participants, this study allowed educators to provide their own definition for EBP

(Stahmer et al., 2005). In addition, most respondents’ definitions were consistent with the NPDC (2016) that emphasize “positive results” or outcomes, likely due to the fact

Lemon Unified School District had provided two years of training in the 27 EBP identified by the NPDC (2016).

Several teachers also did not provide their definitions of EBP and a few noted defining EBP were not applicable (“n/a”) to their classroom. Odom et al. (2010) has demonstrated with training educators can be taught to use EBP for students with ASD

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successfully. Educators may need to continue to receive training in EBP for students with ASD to improve EBP use in classrooms.

What Sources do Special Educators Use to Incorporate EBP for Students with

ASD?

This study uncovered three reported sources for learning about EBP among the

Lemon School District special educators: trainings and conferences, online materials, and

preservice training. In addition, several offered no sources with responses such as, “I

have not experienced training in this area.” Unlike the previous study by Hess et al.

(2008), parents and other teachers were not named as sources for learning about EBP.

However, Hess et al. (2008) also cited parents and teachers as the least likely source of

knowledge about EBP for students with ASD. A few participants expressed they were not

aware of sources for training for EBP information. For instance, two respondents listed

their sources of information as “do not know” and “I have no information on this.”

Morrier et al. (2011) found that years of experience did not affect EBP for

students with ASD reported use among special education and general education teachers

in Georgia. Consistent with Morrier et al.’s study (2011), this research found that years of

experience did not affect reported use of EBP for students with ASD. Novice educators

in this study identified their pre-service programs more than trainings, programs, and

online resources; whereas, the veteran educators indicated individual hands on training,

conferences, and training on particular practices as sources for EBP. Online materials,

including journal articles, were only sourced by three of both new and veteran educator

resspondents.

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Although California requires ASD certification to service students with ASD with coursework in the preservice programs for all mild to moderate and moderate to severe credential holders, only 25% of the respondents stated they possessed this certification

(CTC, 20017). None of the participants acknowledged the ASD certification which indicates it was not considered a major source of bringing attention to EBP for these respondents. Not identifying the ASD certification may also be due to the embedment of the certification into their program by the majority (67%) of the reported moderate to severe credential holders.

What EBP and NonEBP are Teachers Using and Believe are EBP?

Overall, educators reported using some EBP despite their belief in their research base. For example, seven practices were utilized by all respondents: differential reinforcement (reinforcement), extinction, prompting, naturalistic interventions, modeling and antecedent based intervention. Though respondents reported they utilized these practices, they were often unsure of their EBP status. The reported use and beliefs about an EBP ranged from 42% -92% of respondents and not one of the 27 practices had 100% of respondents clear on its EBP status.

The majority of survey respondents had over 20 years of education experience.

Though 31% of the responses were generated from novice teachers, with three or under years of experience, and 54% of the responses were generated from teachers with over 20 years of teaching experience. One of the novice teachers indicated they had served as an assistant for over 30 years. Thus, the results of the survey, may reflect more experienced teachers with over 20 years-experience, though Morrier et al. (2010) found years of experience did not significantly affect EBP for students with ASD implementation.

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Consistent with Morrier et al. (2010) years of experience did not drastically affect the responses of novice special educators who identified trainings, and online resources at similar rates as their more experiences peers. However, unlike Morrier et al. (2010), they identified their pre-service programs at greater frequencies than veteran special educators.

Earlier, in Chapter 1, prospective domains of need for students with ASD were discussed, including communication, behavior, social, and academic outcomes as well multiple domains for practices that address more than one potential need area. Avenues for further research in each of these areas will be listed in this Chapter while the previous chapter presented the results of the survey, this section offers possible explanations for the outcomes.

Students with ASD may present with needs in the areas of communication (APA,

2013a; Goldstein et. al, 2013, behavior (APA, 2013a; Goldstein et. al, 2013; Hanson et al., 2016; Mahan & Matson, 2011) social skills (APA, 2013a; Goldstein et. al, 2013;

Mahan & Matson, 2011; Schreiber, 2011) and academic skills (Huemer & Mann, 2010;

Jones et al., 2009). Consistent with Stahmer et al. (2005), this study found that special educators reported using EBP with students for ASD. Yet, contrary to prior research by

Stahmer et al. (2005) and Hess et al. (2008), special educators reported using EBP for students with ASD at greater frequencies than in the past. As well, unlike Stahmer et al.

(2005), reported use of a practice did not mean the respondent believed it was an EBP.

Here the majority of EBP for students with ASD had a greater reported use than belief as

EBP.

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The EBP that did not meet reported use threshold included: pivotal response training (PRT), cognitive behavior interventions, scripting, video modeling, and self- management. While they did not meet the threshold of this study, three of the practices, cognitive behavioral interventions, and scripting met Durlak and DuPre’s (2008) criteria of at least 60% reported use. A discussion of these EBP is presented next in order from most to least reported use.

• Naturalistic interventions

• Differential reinforcement (reinforcement)

• Extinction

• Modeling

• Prompting

• Antecedent based interventions

• Functional behavioral assessment

• Task analysis and training

• Time delay

• Discrete trial teaching

• Social skills training

• Visual supports

• Exercise

• Response interruption and redirection

• Peer mediated instruction (intervention)

• Functional communication training

• Social narratives (stories)

129 • Picture exchange communication systems (PECS)

• Parent implemented interventions

• Structured play groups, and

• Computer aided instruction and speech generating devices

Those that did not meet reported use criteria included: pivotal response training (PRT), cognitive behavior interventions, scripting, video modeling, and self-management. While they did not meet this criterion, three of the practices met Durlak and DuPre’s (2008) criteria of at least 60% with PRT, cognitive behavioral interventions, and scripting with respondents reporting reported use at 67%. The EBP are discussed further in order from most to least reported use.

Communication. Some potential areas of need for students with ASD include concerns in communication such as immature language, odd speech, difficulty maintaining conversations, and staying on topic (Goldstein et. al., 2013). To assist students to communicate effectively, the use of EBP in the area of communication are necessary. Travers et al. (2014) offers that expressing an individuals’ critical thinking should be the purpose of education and the need to express themselves appropriately is necessary to achieve this goal.

Among the EBP to support communication, PECS offered the most promising results. Though educators used it, many were unsure if it was an EBP. The use of this practice was consistent with the rates identified with Stahmer et al. (2005) between 90-

100% of respondents reported implementing PECS in their study compared to 83% in this study, though at the time of Stahmer’s et al.’s (2005) study PECS was considered a promising practice. As well, PECS was reportedly used at a similar rate of other

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practices that address communication needs in this dissertation, such as functional communication training (83%) computer aided instruction and speech generating devices

(75%) that feel under multiple domains

Behavior. Students with ASD may also exhibit unusual behaviors including self- regulatory behaviors, stereotype behaviors, compulsive and ritualistic behaviors, rigidity, aggression, self-injurious behaviors, language preservation and perseverative interests

(Goldstein et al., 2013; Hanson et al., 2016). These behaviors make educating students in the general education classroom difficult. As well, injuries to the students themselves and others, make interventions necessary for students who exhibit behavior concerns

(Crosland & Dunlap, 2012; Hayes, 2014). EBP for students with ASD to support behavior are discussed next.

Differential reinforcement and reinforcement are derived from clearly established behavioral principles based on operant conditioning (see Pitts, 1971; Ramnero, 2008;

Strickland, 2001). This well-established research base in psychology may have contributed to the reported use of differential reinforcement and reinforcement by 100% of respondents. Extinction may also have benefited from its long-standing history in psychology. It was reportedly utilized by 100% of the respondents and has a clear research based on principles of another well-known theory of behavior, classical conditioning (Hall & Hall, 1998; Gottlieb & Begej, 2014; Hoffman, & Falcomata, 2014;

Pavlov, 1927; Schieltz, Wacker, Ringdahl, & Berg, 2017). The longevity of these behavior principles may have contributed to the reported use of differential reinforcement

(reinforcement) and extinction.

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All of the respondents indicated they used antecedent based interventions (ABI) and functional behavior assessments (FBA), yet many remained unsure if they were EBP.

Three respondents indicated that they were unsure of ABI as an EBP, and two respondents stated that it was not an EBP. ABI was reported to be used by the educators who taught 8-13-year-old students

Response interruption and redirection (RIRD), had an 83% reported use rate.

RIRD uses reinforcement and is primarily used to address stereotypy (Ahearn et al.,

2007; Martinez & Betz, 2013). Martinez and Betz’s (2013) and Ahearn's et al., (2007) reviews uncovered that all studies investigating RIRD used controlled environments for their evaluations. This lack of use in natural environments may have been a hindrance to the respondents (25%) that reported they opted not to use the practice (Durlak & DuPre,

2008).

Cognitive behavior therapy (CBT) nearly met the criteria of Durlak and DuPre

(2008) with 67% reported usage but did not meet the reported use threshold for this research. Reaven et al., (2012) declared that CBT departs from traditional methods that may make it a more difficult skill for educators to implement, which may account for the reported nonuse by about a third of this study’s respondents.

Besides CBT, all the behavior practices met the 70% reported use threshold for this study, four at 100% reported use. This high reported use of behavioral interventions for students with ASD highlights a possible need that occurs across age groups and classroom types. Both educators instructing an ASD self-contained class reported utilizing response interruption or redirection.

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Social skills. Social skills are necessary to engage students in positive social interactions (Sperry et al., 2010). Self-isolation may occur in students with ASD which can be problematic as social interactions are necessary to teach academic, social, vocational, and other necessary skills (Carter et al., 2014; Lang et al., 2011). To increase the success of students who may exhibit social deficits, such as lack of initiation of play or engagement such as eye contact, EBP that target these skills can be applied (Strauss et al., 2014). Strauss et al. (2014) also emphasizes that social skills EBP should be utilized to support students with ASD.

Social skills training had a 92% reported use rate that met the threshold for this study and was identified by the majority of respondents (58%) as an EBP. Like the similar practice of structured play groups with 83% reported use and 58% of the respondents believing it was and EBP, a larger percentage of respondents were unsure or did not believe social skills training and structured play groups were EBP. These findings support the NPDC’s (n.d) recent combination of structured play groups and social skills training into one practice. The reliance on students, similar to peer-mediated instruction, may affect why respondents were unsure or did not believe structured play groups was an

EBP (O’Donnell, 2008).

Among the respondents 83% reported they used peer-mediated instruction and

50% were unsure or believed the intervention was not an EBP. As previously acknowledged by Perry et al. (2010) and Odom and Strain (1984), peer mediated instruction is an effective EBP, but only if students are trained to engage in prompting and reinforcement strategies. The fact peer-mediated instruction relies on students and

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not the teacher may account for the respondents’ lack of clarity regarding its EBP status

(O’Donnell, 2008).

The majority of respondents (83%) reported they used social narratives or stories.

The wide use of the term social story may have branded the practice into widespread use by the efforts of Gray (2017) who promoted the use of social stories to increase social skills in children. In addition, social narratives and DDT were identified as EBP by educators in the IE in Stamer's et al. (2005) research. These practices have continued to generate support as EBP which likely contributed to the high percentage of reported use by the respondents in this study.

Pivotal response training (PRT) fell just under the reported use threshold of this study with 67% reported use. Exposure to PTR within other practices, such as parent implemented interventions (Koegel et al., 2002; Symon, 2005) and self-management training (Stockall & Dennis, 2013) may have contributed to the reported use of the practice by some of the study respondents. Stahmer’s et al.’s (2015) acknowledgment that

PRT can be difficult to implement, may have contributed to about a third of respondents not using the practice.

Self-management was another practice that had reported use rates under acceptable levels. In fact, it had the lowest reported use rate of 50%. Despite being utilized as a component of other techniques such as PRT, it was underutilized by respondents (NPDC, 2016; Stockall & Dennis, 2013).

Academic skills. Another area of need for students with ASD may be academic skills. One of the primary functions of public schools is to provide students with the necessary skills to function in society (Spring, 2015). Knowledge of the three Rs,

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reading, writing, and arithmetic are and will continue to be an important feature of education in schools. By providing a quality education that addresses the needs of all citizens, in this case students with ASD, schools can promote equal opportunities for their graduates (Spring, 2015). The singular practice under academic skills, DDT, was identified as an EBP by 92%, of the respondents and was one of a few practices that shared the same reported use rate as belief in its evidence base. The lack identified EBP targeting academic skills for students with ASD at this time means that educators must rely on EBP aimed at the general population.

Discrete trial teaching (DTT) was also identified by Stahmer et al. (2005) as an established EBP among educators in the IE (Stahmer et al., 2005). Consistent with

Stahmer’s et al. (2005) study, an overwhelming 92% of respondents identified it as an

EBP. Barnhill et al. (2011) had identified it as a source of training in many preservice programs and Alexander et al. (2015) had even used it as a category for their effectiveness evaluation tool, all of which may have contributed to respondents’ beliefs in its EBP status.

Multiple domains. Practices under multiple domains are most important as they can address more or all of student need areas. By improving communication and social skills at the same time, an EBP can utilize the finite amount of instruction time to achieve greater benefits (Travers, 2017).

All respondents indicated they used modeling as an EBP. Modeling is as a feature of many practices, such as peer mediated instruction (Odom & Strain, 1984).

Merriam and Bierema (2014) also highlight modeling as an important practice for educator instructing students. Modeling was also cited by educators, as an important

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feature in their understanding of EBP. As one respondent declared, "information provided in conjunction with hands on experience, modeling or video examples,” as well as coaching improves their practice, so naturally educators would also use modeling in their classroom.

Naturalistic intervention had 100% reported use among special educators in this study. The fact that naturalistic intervention emphasizes natural rather than controlled environments, including real world scenarios, may contribute to its appeal and high reported use, in spite of natural setting practices usually being more difficult to implement (Stahmer et al., 2015; Strauss et al., 2014; Suhrheinrich et al., 2012).

Another practice utilized by 100% of the respondents was prompting. Prompting is a skill used in several practices, including ABI and time delay, and is featured in many of the trainings for educators (Browder et al., 2009; De Bruin et al., 2013; Lerman et al.,

2004). Prompting was also mentioned by respondents in this survey as a feature of training in their explanations of sources of EBP for students with ASD. The high reported use of modeling, naturalistic interventions, and prompting is likely motivated by the fact these practices support multiple areas of need including communication, behavior, social and academic skills (Knight & Sartini, 2015; NPDC, 2016; Spector, 2011).

Task analysis emphasizes task completion and was reportedly used by 92% of the respondents (Parker & Kamps, 2011). Task analysis is most likely a desirable EBP because it is designed to help students complete tasks. Additionally, task analysis features prompts, another highly utilized EBP, that may make the practice relatively easy to implement (Parker & Kamps, 2011).

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Almost all respondents, 92%, reportedly used time delay, a feature of prompting

(Browder et al., 2009). Time delay features naturalistic components that educators in this study and authors promote as beneficial for interventions (Liber, et al., 2008). Its similarity to prompting possibly contributed to the high use of time delay by special educators.

Visual supports appear also had a high 92% reported use rate. The fact visual supports address communication, behavior, social skills, and academic skills possibly contributed to its appeal. Visual supports are considered EBP for elementary ages in multiple domains. However, for upper grade students, visual supports are only considered an EBP for social skills. This study found educators working with adults with ASD also appeared to use visual supports to support social skills.

Functional communication training (FCT) is designed to improve communication

skills (Carr & Durand, 1985). While it was reportedly utilized by a 75% of the

respondents as a practice to improve communication, it may have been used in an attempt

to improve behaviors.

Although exercise, was reportedly used by 92% of respondents, only a few

believed it to be an EBP. A high percentage of respondents (50%) either were unsure or

believed it was not an EBP for students with ASD. This finding is consistent with Hess

et. al.’s (2008) study that found many teachers use practices not identified as EBP.

Computer aided instruction and speech generating devices were combined on the

NPDC (n.d.) and were also combined into one survey item for this study. This

combination of practices possibly confused respondents on the evidence-base status of

the practices. While many, 75%, reportedly used and 75% believed both were an EBP,

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many also selected the item was not an EBP. The variation of responses may be due to

some believing computer aided instruction was an EBP, but not speech generating

devices or vice-versa

Parent-implemented interventions were reportedly used by 75% of respondents.

This practice had a high rate of use by respondents who did not identify parents as a

source of information on EBP for students with ASD. This finding returns us to the

framework discussed in Chapter 2 that suggests that collaboration within an IEP team

improves EBP implementation. Since respondents did not view parents as a source for

EBP for students with ASD, it is reasonable that they did not consider a practice that

required parents and EBP. Able, et al. (2014) acknowledged the collaborative home to

school feature of parent implemented interventions may make this practice appealing to

educators.

Scripting fell slightly below the study’s reported use threshold at 67%. The matrix offered by NPDC (2016b) indicates scripting can be used for communication and social deficits, which are the core features of an autism diagnosis (APA, 2013a). Yet scripting was not reported to be believed as an EBP for students with ASD. Scripting, therefore, may have had barriers that limited its use.

Video modeling (VM), while similar to modeling, was used to a lesser degree than live modeling. Goldsmith and LeBlanc (2004) and Ennis-Cole (2015) identified technology as one of the most easily accessible practices for educators, yet it was reportedly used by only 58% of the special educators. Live modeling was reported to be utilized by all the participants, yet there was a low use of VM; this lack of use of VM may be attributed to the technology component. Ennis-Cole (2015) offers many benefits

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of VM over live modeling such as consistency, repetition, and control over the setting, yet despite these benefits respondents did not report using VM. Courduff, Szapkiw, and

Wendt (2016) presented four barriers to technology implementation for special educators:

(a) opportunities, (b) dispositions, (c) pedagogy, and (c) small steps with the last referring to gradual experiments in technology. Courduff et al. (2016) in their study supported that educators’ skills and knowledge of technology, as well as underlying beliefs about technology, are essential for special educators to effectively implement technology.

Ennis-Cole (2015) states that planning and technology assistance are necessary to implement technology effectively. The process of integration will only improve with gradual small steps over time (Courduff et al., 2016; Kopcha, 2012).

Discussion

This study drew from the research of Hess et al. (2008), Morrier et al. (2010) and

Stahmer et al. (2005) to identify opinions of a sample of special educators regarding their knowledge of EBP for students with ASD, as well as their use of EBP for students with

ASD. The findings were consistent with previous studies of EBP for students with ASD, but with some differences. While previous studies such as Stahmer et al. (2005) and

Hess et al. (2008) indicated low reported use of EBP for students with ASD, ranging on average between 5%-30%, this study found 22 out of 27 or 81% of the EBP for students with ASD were reportedly used by 70% or more of the respondents (Morrier et al., 2011).

This increase in use is likely due to attempts to improve EBP for students with ASD through a grant that provided educators and parents with training through the NPDC and other outreach programs such as CAPTAIN. This study also found that 11 of the 27 or

40% of the practices were properly identified as EBP by at least 70% of the respondents.

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The use of specific practices by this sample of special education teachers in the IE was consistent with Stahmer et al’s. (2005) findings about practitioners’ use of EBP for students with ASD. PECS remains a widely utilized EBP, with over 70% reported use, as well as applied behavior analysis (ABA or ABI), discrete trial training, and social stories.

Other external factors appear to affect the selection of practices. As noted by Stahmer et al. (2005), “It appears that program marketing, availability of training, provider preference, and external factors such as parent requests influence the use of specific practices more than whether the practice has any evidence of efficacy” (p. 74).

Respondents in this study reported they used more practices than they believed were

EBP. For instance, exercise and social skills training were reportedly used even though most respondents realized they were not EBP for students with ASD. Unlike the findings presented by Stahmer et al. (2005), participants in this study did not see parents as a source of EBP information, nor did they report consulting journals or scientific papers as a credible source of information. The time needed to consult journal articles may present a barrier to special educators, but the need for continued training was shared by respondents in this study and Stahmer et al.’s (2005) study. The most reported implemented practices at 100% were: naturalistic interventions, differential reinforcement (reinforcement), extinction, modeling, prompting, functional behavior assessments, and antecedent based interventions. The least implemented EBP for students with ASD were: PRT, cognitive behavior intervention, scripting, video modeling and self-management. Two nonEBP, sensory support (integration) and a gluten free diet, mentioned as used by one of the respondents.

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Consistent with Hess et al.’s (2008) study, the top reported EBP used by special educators in Georgia and California were: social narratives and computer aided instruction and speech generating devices (assistive technology). While nonEBP were not explored as in depth as they were in Hess et al.’s (2008) study, the mention of sensory integration as a utilized practice indicates educators continue to utilize nonEBP though research suggest the discontinuance of their use (LaFrance et al., 2015; Lang al., 2012;

Lucker, 1999; Reichow et al., 2010; Rossignol, 2009; Stephenson & Carter, 2009).

Differences occurring between this study and that of Hess et al.’s (2008) study may be due to time, as new practices have been identified as EBP. At the time of the Georgia study, social narratives, cognitive behavioral, computer aided instruction and speech generating devices (assistive technology) were not considered EBP, but were recently identified as EBP for students with ASD (NPDC, 2016). From this dissertation’s inquiry, the top practices utilized were prompting, modeling, naturalistic interventions, extinction, functional behavioral assessment, antecedent based interventions, and differential reinforcement (reinforcement).

Overall, this study suggests increased use of EBP and highlights the continued need to support both new and veteran teachers in implementing EBP. Although reported

EBP use has increased from the 28% seen in Hess et al.’s (2008) study, video modeling

(VM) and self-management results in this study were close to the previous use with 50% reported use for both practices. The novice educators in this study acknowledged preservice programs as sources for their knowledge in EBP for students with ASD, but for those currently in the classroom, hands-on trainings with specialists appear to be most helpful sources of knowledge. The belief of practices as an EBP was inconsistent with

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Stahmer’s et al.’s (2005) study; whereas Stahmer’s et al.’s (2005) participants believed the practices that were reported as being utilized were also reported as being EBP. This study featured the belief of practices as being less than the use of a practice for all, but one practice, PRT.

Implications

The results from this study provide implications for federal and state policy, as well as for districts and special educators to support the use of EBP for students with

ASD and help close the policy to practice gap.

State and Federal Policy

Policies including ESSA (2015), NCLB (2002) and the Sciences and Education

Reform Act (2002) require the use of EBP for all students. As indicated by teacher responses from this survey, it remains difficult for educators with all the available information to determine true EBP (DiPietro et al., 2013). Organizations such as

CAPTAIN (n.d.) and the NPDC (2016) have attempted to fill this need. yet many educators may be unaware of such organizations. Already established organizations, such as the What Works Clearinghouse (WWC; n.d.a) and the NPDC (n.d.a.), should be endorsed through state and federal policy as sources to educate the public and dispel confusion on what practices are considered EBP for students with ASD.

At this time, several researchers and organizations (i.e., Best Evidence

Encyclopedia, n.d.; NPDC, 2016; Reichow et al. 2008; WWC, 2014) provide varying criteria and tools for identifying EBP. A central state or federal agency or organization should standardize the criteria used to evaluate both quasi-experimental and single- subject design studies as suggested by Bruin al. (2013). The WWC (2014) has set forth

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preliminary standards for single subject designs which are most appropriate for research

on special populations, such as students with ASD (Odom Collect-Klingenberg et al.,

2010). As an already establish source of EBP information, the WWC (n.d.a) has the influence and reach to disseminate criteria for identifying EBP effectively. The WWC

(n.d.a.) may identify and refine pre-existing instruments, such as those developed by the

NPDC (n.d.a), and Reichow et al. (2008) and develop new instruments to assist researchers and practitioners with contributing evidence to EBP and nonEBP.

Standardizing and endorsing the work of the WWC (n.d.a) warrants consideration, and a special branch of the WWC (n.d.a.) could be created to oversee the identification of EBP specific to students with ASD.

Policy should set standards for the evaluation of practices as well. Several models

exist for evaluating criteria of reliability and validity, such as that developed by Best

Evidence Encyclopedia (n.d.), Reichow et al. (2008), Odom, Collet-Klingenberg et al.

(2010), and the NPDC (2016). While they offer similar resources and checklists to

evaluate practices, even among these organizations, differences in identifying EBP occur.

Using an established source, such as the NPDC (n.d.), or WWC (n.d.) for the specific

purpose of evaluating research to determine which practices are EBP is warranted.

Standardizing the amount of research needed, such as three experimental or quasi

experimental studies, and the type of research needed, for example five single case

studies with at least 20 participants, would help regulate what practices are identified as

EBP for students with ASD.

As well, official endorsement of a single organization to determine EBP,

disseminate which practices are EBP and identify appropriate training to use EBP

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successfully, is needed. The NPDC (n.d.) has begun this process by providing a matrix for educators use as well as provide trainings for districts and educators interested in EBP for students with ASD, yet other organizations exist that attempt to identify EBP (NPDC,

2016). By declaring an official source of information such as the NPDC (n.d.), for declaring which practices are EBP for students with ASD, the guess work will be taken out of identifying EBP. This official source of information would allow teachers to focus their attention on how best to implement these programs successfully in their classrooms, rather than researching best practices to use with their students.

Another factor that may increase EBP use is the continued review of EBP knowledge in preservice credential programs. Barnhill et al.’s (2011) found only about

50% of their respondents’ institutions of higher education (IHE) offered coursework on

ASD. Travers (2017) believes, “Knowledge of EBPs is a fundamental aspect of special education preparation and professional development” (p. 196). Credential programs may want to include sources for EBP as part of course work in the ASD authorization.

Although, coursework specific to exceptional children, including those with ASD, is included with pre-service programs, a more detailed emphasis on EBP for students with

ASD may be necessary (Barnhill et al., 2011; CTC, 2012). Preservice programs were the third most identified source of EBP information for students with ASD by the study respondents and these programs provided the primary source from which the novice teachers drew their EBP knowledge.

For educators already servicing students, additional training options are necessary, especially since respondents conveyed trainings were their primary source of

EBP knowledge. The NPDC (n.d.) offers trainings and information regarding EBP.

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Educators’ use of EBP by the NPDC (n.d.), or another designated local organization such as CAPTAIN (n.d.), may be promoted as a source for districts to inform educators and others on EBP. If a central organization oversees trainings in EBP, the organization also needs to assess the fidelity of use of each of the practices. Durlak and DuPre (2008),

Kam et al. (2003), and Durlak (2015) stated that not only the use of practices, but fidelity of practices led to implementation success. Further recommendations for district trainings are discussed next.

Districts

Professional development is necessary to change educators’ practices (Durlak &

DuPre, 2008; Hall & Hord, 2014; Odom, 2009; Reeves, 2009). The results of this study highlight the specific practices of one district in the Inland Empire and demonstrates how training in EBP for students with ASD may help close the policy to practice gap. The success of reported use may have been due to the two-year training the district received from the NPDC (n.d.). Prior research by Hess et al. (2008) and Stahmer et al. (2005) had low reported use of EBP, around 30% of respondents; whereas this study demonstrates much higher reported use, over 70% of respondents for the majority (22 out of 27) of

EBP. Although the study results may be applicable to other districts that have received training by the NPDC (n.d.), further research, with larger samples across multiple contexts, is needed to determine the generalizability of the findings. Regardless, some important discoveries were exposed in this research that suggest steps Lemon USD and other districts can take if they wish to increase implementation of EBP for students with

ASD.

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First, the findings suggest Lemon USD and other school districts should provide educators with information regarding what practices are and are not EBP. In this study, exercise was reportedly used by many participants (92%), but only 50% of respondents believed it was an EBP. For the most part, belief about a practice did not appear to affect the reported use of the practice. Among the 27 EBP, 22 (81%) had more respondents report using the practice than report they believed the practice was an EBP, which included all of the practices with 100% reported use. These practices, presented in order from most reported use to least use, included: naturalistic intervention, differential reinforcement (reinforcement), extinction, modeling, prompting, antecedent based interventions, functional behavior assessment, time delay, visual supports, social skills training, exercise, response interruption (redirection), peer mediated interventions, social narratives, picture exchange communication systems (PECS), functional communication training, parent implemented interventions, structured play groups, cognitive behavior interventions, scripting, video modeling, and self-management. This Lemon USD and others can start by providing information to educators about the evidence base of these and other nonEBP, such as sensory integration and vitamin therapy, mentioned by one of the respondents.

Second, the findings suggest Lemon USD and other school districts should provide information about EBP through the primary reported source of information in this study, training. Durlak and DuPre (2008) as well as Lerman et al. (2004) offered that with training educators could learn skills for EBP in a few hours. Both veteran and novice educators in this study identified trainings as their most reported source for EBP information for students with ASD. Districts wanting to increase their educators’ use of

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EBP may look to established sources such as the NPDC (2016) and CAPTAIN (n.d.) to provide education and training. Odom’s et al. (2013) study, demonstrated educators could achieve fidelity of implementation in two years by providing technical assistance. This technical assistance entails not only supporting practices, but “maintaining educators’ motivation and maintaining providers’ motivation and commitment, (to) improve their skills levels where needed, and support local problem-solving efforts” (Durlak & DuPre,

2008, p. 339). This technical assistance can include modeling, role playing, collaboration, shared decision making, and performance feedback to improve the execution of a practice

(Durlak & DuPre, 2008; Stahmer et al., 2015). Stahmer et al. (2015) included video modeling as part of the training in successful implementation. The collaboration piece was also emphasized in the framework, presented in Chapter 2, as a possibly effective tool to inform the decision-making process of educators for EBP for students with ASD

(Deluca, et. al., 2017; Eccelston, 2010; Lentz, 2012; Sansosti & Sansosti, 2012; Stahmer

& Ingersoll, 2004). The use of Odom’s et al. (2013) or Stahmer’s et al. (2015) model may benefit districts with a desire to improve EBP for students with ASD.

Third, the findings suggest Lemon USD and other school districts should include coaches to provide individualized support for EBP use. Coaching was highlighted by respondents in this study as assistance by “experienced practitioner(s).” Odom’s et al.

(2013) demonstrated gains with coaches for implementation support. Moreover,

Suhrheinrich et al. (2013), Suhrheinrich (201l), and Stahmer et al. (2015) found fidelity of implementation increased when educators were provided with coaches. Districts should consider the emotional support provided by coaches that can assist in maintaining and changing implementation practices (Durlak & DuPre, 2008). As Suhrheinrich (2011)

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demonstrated, adding a coach to trainings improved EBP implementation by a group of respondents from 30% following one coaching session to 40% following two coaching sessions. Improvement of only 15% were made with only workshop trainings

(Suhrheinrich et al., 2013). One respondent stated he wanted “individual training(s) for individual needs” which is consistent with the literature suggesting coaching may increase the success of any district implementation plan (Durlak & DuPre, 2008; Lerman et al., 2004; Odom’s et al., 2013; Suhrheinrich et al.,2013; Suhrheinrich, 201l; Stahmer et al., 2015). This continued support may be fundamental in maintaining the use of EBP as supports may enhance the self-efficacy of educators and their willingness to persist at using EBP despite implementation challenges (Donnell & Gettinger, 2015; Durlak &

DuPre, 2008; Odom, 2009; Odom, 2013).

Educators

Educators are instrumental to making change and closing the research to practice and policy to practice gap (Lilienfeld et al., 2015). The findings of this study suggest educators are likely utilizing many practices with limited belief about their evidence- base. Educators must decide what, when, why, and how to use practices to benefit students (Durlak & DuPre, 2008; Frederickson & Cline, 2009).

Principals and other administrators are key to successful implementation of programs (Kam et al., 2003). But supports from principals alone are not sufficient to successfully implement programs. Other factors, such as sufficient resources, and ongoing collaboration among parents, teachers, other staff and the community can contribute to successful implementation. Durlak and DuPre (2008) add technical assistance is also needed to enhance implementation success.

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Teachers must also learn about and decide to use EBP (Travers, 2017).

Respondents in this study did not believe practices many of the practices they reported using (81%, 22 out of 27 EBP) were EBP for students with ASD. Educators in this study mentioned they learned about EPA through trainings, pre-service programs, and online resources. Professional development can be provided through the district through local organizations similar to CAPTAIN (n.d.). If left on their own, educators need to know where they can ascertain credible information about EBP. While deciding what practices to use to support students with ASD as identified in this author’s framework, educators and the IEP teams need to consider the individual needs of the student and select practices that are likely to provide positive outcomes, or as one respondent stated,

“practices that result in measurable evidence of effectiveness” to provide for a legally defensible IEP (Carson, 2015; Crockett, 2014; Knight et al., 2015; Stahmer et al., 2005;

Travers, 2017; Yell et al., 2003). While all practices will not work for all students, EBP for student with ASD increase the likelihood of success (WWC, 2014). Educators may also assist by collecting data on the practices they use or volunteering to participate in studies that seek to clarify and add the EBP knowledge-base.

Besides understanding specific EBP, Travers (2017) believes educators need to develop skills so they can evaluate and distinguish questionable research and interventions. As conveyed by the findings of this study, educators reportedly use practices despite the fact they do not believe or are unsure about their EBP status, possibly, because they are more interested in the outcomes of using the practice. The change process is also problematic because it “expects that teachers challenge and reconstruct deeply embedded practices and beliefs” (Vetter, 2012, p. 27). Educators must

149

be aware that outcomes, although not guaranteed by the use of EBP, are more likely with their use (Cook & Cook, 2013; Lubas, et al., 2016). Travers (2017) continues:

by developing an understanding of how errors in thinking are used to promote and

defend unproven interventions, special educators and related professionals can

better adhere to an evidence-based approach, while protecting their students with

disabilities from potential harms associated with ineffective practices. (p. 202)

Limitations and Recommendations for Further Research

Despite efforts for sound research design, this study has several limitations. One limitation of this study was the fact a survey was used to gather information about special educators’ reported use of EBP for students with ASD. In order to validate the findings, further research needs to observe teachers’ classroom practices (Durlak and DuPre,

2008). Another limitation of the study was the survey instrument itself. Although the survey was modeled after Morrier’s et al. (2006) valid instrument, it did not undergo the same level of rigorous analyses. This instrument was reviewed for clarity and validity by the dissertation committee, but future researchers should explore the validity of this and other such survey instruments. A third limitation of the study was the low response rate due to the timing of the survey. The survey was distributed during the last two weeks of the 2016-2017 school year and the first two weeks of the 2017-2018. Despite the researcher’s requests and gentle reminders to complete the survey, the teachers’ willingness to participate was likely impacted by the added assignments and responsibilities associated with the close and start of the school years. Future researchers should try to administer surveys at times when teachers’ workloads are diminished.

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The demographic features of the sample and selected district also limit the generalizability of the findings. Due to the limited sample size and fact the results reflect a district that had received extensive EBP training, the results of the study are not likely to generalize to special educators in the Inland Empire and beyond. The majority of survey respondents had over 20 years of education experience. Though a few survey responses, 4 (31%), were generated from novice teachers, with under three years of experience, and 54% of the respondents had over 20 years of teaching experience. One of the novice teachers indicated they had served as an assistant for over 30 years. Only one participant indicated she taught between 4-15 years. Thus, the results of the survey are most likely to reflect and apply to more experienced teachers with over 20 years’ experience. A much larger sample of participants from varying backgrounds and districts is needed.

Further research is needed to garner information about specific EBP and nonEBP.

Researcher into the quality, or fidelity of implementation and clarification over what conditions or characteristics of the students’ practices are more successful, may help educators selected which EBP for students with ASD would meet their students’ needs.

The primary question that remains is: why are some practices utilized while others are not? For example, the practice of modeling was highly utilized, yet a similar EBP video modeling (VM) had the second lowest use. The diffusion process offered by

Dingerfelder and Mandell (2011) may as well explain while certain practices become utilized while others remain unused. While other researchers have illuminated barriers to implementation in general, such as time (Courduff et al., 2016) and resources (Lubas et al., 2016; Suhrheinrich et al., 2013), it is important to understand the particular barriers to

151

the use and fidelity of specific EBP. Practices such as exercise that had a high use, but not belief as an EBP, may offer other benefits, such as eliminating hyperactivity that may make them desirable practices for educators to utilize with students, with and without

ASD. While observation data take more time to gather, they are more reliable then self- reported data (Durlak & DuPre, 2008). Thus, future researchers should gather observation data to ascertain use and fidelity of EBP for students with ASD. Future researchers should also consider using semi-structured interviews to gain more understanding and clarification of respondents’ knowledge of EBP and sources of information regarding EBP for students with ASD. For example, a respondent in this study identified the speaker Grandin Templeton as their most useful source of training, but it was unclear how the speaker assisted the respondent.

Additionally, contributions of this study were made to the literature. The first included the use of four domains versus the six or more utilized by other authors, including a category for multiple domains for practices that may be used to address more than one domain area (Alexander et al. 2015; NPDC, 2016b). Secondly, categorization of the 27 EBP of the NPDC (2016b) into these domains. These categories may be utilized by educators as well as researchers into EBP for students with ASD investigations.

Final Thoughts

While improvements have been demonstrated in the use of EBP, there is still room for growth in the implementation and knowledge of special educators in the use of these practices. Educators continue to utilize practices regardless of their beliefs about the evidence base of the practices. Many reported using practices when they stated they were not an EBP or when were unsure if a practice was an EBP. Laws generated to

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improve the use of EBP have not had the desired effect, and more needs to be done to close the research to practice gap and assure that students with ASD are being educated using the best available techniques.

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APPENDIX A INFORMED CONSENT

INFORMED CONSENT TO PARTICIPATE IN A SURVEY STUDY As Part of the Doctorate Program in California State Polytechnic University, Pomona

As a special education teacher, you are invited to participate in a research study on Evidence- basedPractices and Students with Autism Spectrum Disorder. This form provides you with information about the study. The Cal Poly Pomona Institutional Review Board has reviewed and approved for conduct this research involving human subjects under protocol IRB-17-2. Lindsey Denniston is conducting the study for a dissertation, supervised by Dr. Amy Gimino, Associate Professor in the Department of Education. This modified Autism Treatment Survey will take approximately 30 minutes to complete and includes short answer and multiple-choice options. The survey will be confidential, meaning that no specific responses may be associated with you as an individual. The consent form and link to the survey will be sent from a representative of the school district to applicable special education educators in the district to protect confidentiality from the researcher. Educators may decline to participate without penalty or loss of benefits to which the subject is otherwise entitled, and you, the subject, may discontinue participation at any time without penalty. No compensation is offered for your participation. Discomforts from completing the survey may include time to complete the survey. Benefits to completing the survey include satisfaction with assisting in furthering research and broadening your knowledge.

The data will be utilized in a dissertation, possibly a research presentation, publication, and reports to the districts. As a condition of using the survey, the data will be analyzed by Dr. Michael Morrier Program Director, Screening and Assessment at Emory University School of Medicine and colleagues, the original creators of the Autism Treatment Survey. The data will be available for Dr. Morrier and colleagues further use in the ongoing research on Evidence-based practice for students with Autism Spectrum Disorder. The informed consent form may be printed from the survey for your records. If you have any questions about your rights as a research participant, complaints about the informed consent process of this research study, or experience with an adverse event (something goes wrong), please contact Bruce Kennedy, Compliance Officer of the California State Polytechnic University Pomona Office of Research at (909) 869-4215. Information about research at Cal Poly is also available at the Cal Poly Pomona IRB website, http://www.cpp.edu/~research/irb/introduction/index.shtml

Researchers: Primary Investigator: Lindsey Denniston Faculty member: Dr. Amy Gimino Associate Doctoral Candidate Professor in the Department of Education Phone #: (951)220-7717 Phone #: (909)869-4915 Email Address: [email protected] Email Address: [email protected]

Doctoral Program in Educational Leadership College of Education and Integrative Studies California State Polytechnic University, Pomona 3800 Temple Ave, Pomona, California 91768 http://www.cpp.edu/~ceis/doctoral-studies/index.shtml

Your participation is entirely voluntary and will contribute greatly to this research. Thank you for your willingness to participate. Survey Link:https://cppedu.az1.qualtrics.com/jfe/form/SV_77HGbjOdRcvjHOR

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APPENDIX B MODIFIED ATS SURVEY

About Your Class

1. What are the chronological ages of the students in your class this year? (check all that apply)

nd ○ 5 years or younger (preschool/transitional kindergarten) ○ 5-7 years (K-2 grade) ○ rd th th th 8-10 years (3 – 5 grade) -13 ○ 1years 1 (6 – 8 grade)

2. My district calls my class: ○ G eneral Educa the day) Resource ○ C o lla b o ra tiv e -Contained ○ ○ S e l f Autism - ○ O th e r S e lf Contained (please describe) ○ Combination (please describe) ○Other (please describe)

______3. District school in which school is located: ______

4. My class has: _____ children with an Autism Spectrum Disorder this year

______approximate amount of students with Autism Spectrum Disorder previously taught

About You

1. I have been teaching ______years. I have been teaching children with ASD for ___years. 2. My certification category is:

○ preliminary mild/moderate multiple subject ○ clear mild/moderate multiple subject

○ preliminary moderate/severe multiple subject ○ clear moderate/severe multiple subject ○ Other: ______

Please type in an answer that explains your use of evidence-based practices with students with Autism Spectrum Disorder (ASD).

3. How do you define evidence-basedpractices for your students with ASD? Please explain. (Short answer).

Practices

We would like to get a general idea of the specific strategies that you use with children with Autism Spectrum Disorders (ASD) in your classroom. Please indicate whether or not you have used the following treatments in your classroom this school year (since

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August 2016) and if you believe this practice is an evidence-basedpractice (EBP) “yes”, “no” or “unsure.” For example, if you have used a practice, but believe it is not an EBP you would mark “Yes, I have used it and No, it is not an EBP.” If you have never heard of a practice, you would mark, “no, I have not used it and I am unsure if it is an EBP.”

1. Prompting: When the target stimulus does not provide the response a stimulus that pairs with the target stimulus to provide the desired response. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 2. Discrete Trial Teaching: Adult directed trial instruction utilizing reinforcements to teach a skill and/or reinforce a behavior • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 3. Computer aided instruction/Speech Generating Devices: Use of computers to teacher academic and communication skills; includes computer tutors and modeling. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 4. Naturalistic interventions: A variety of strategies that closely resemble typical interactions and occur in natural settings, routines and activities. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 5. Task analysis and training: Breaks down steps and links them for prompting. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP

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• No, I have not used it and I am Unsure if it is an EBP 6. Exercise: Physical activity preceding activities. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 7. Peer mediated instruction:/intervention: The use of peers to initiate and maintain interactions. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 8. Parent Implemented: Parents serving as experts to improve children’s functioning in the home environment. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 9. Reinforcement (includes differential reinforcement): Purposeful ignoring of undesirable behavior; reinforcing more desirable behaviors. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 10. Time delay: Antecedent teaching strategy that promotes errorless learning; teaches skills in the naturalistic environment with a structure in place to increase probability of desired action. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 11. Picture Exchange Communication System (PECS): (includes picture making devices such as Boardmaker): Tool to initiate communication exchanges and interactions.

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• Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 12. Pivotal Response Training: Use of four variables to increase skill use: motivation, responding to multiple cues, self-management, and self-initiations. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 13. Visual Supports (this includes visual schedules): Tools that enable a learner to independently track events and activities. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 14. Cognitive Behavioral Intervention (includes Cognitive Learning Strategies, Cognitive Scripts, and Cognitive Behavior Modification): Instruction that leads to control of cognitive process of behavior. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 15. Social Stories (Social Narratives): Written narratives that describe specific social situations in some detail. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 16. Modeling (does not include video modeling): Live modeling of desired behavior/action. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP

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• No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 17. Video modeling (does not include live model modeling: includes basic video modeling of another, video self-monitoring, point of view video modeling, and video prompting): Utilizes assistive technology as the core component of instruction and allows for modeling. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 18. Scripting (SC): Verbal or written description of a model for a specific skill or situation. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 19. Extinction: Withdraws or termination of reinforcers • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 20. Antecedent based interventions: Decrease in interfering behavior and increase engagement by modifications of the environment. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 21. Social skills training (groups): Small group instruction with a shared goal or outcome of learned social skills. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP

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22. Functional communication training (FCT): Replace inappropriate communication acts with effective communication behaviors/skills. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 23. Response interruption/redirecting: The physical prevention or blocking of interfering behavior with redirection to more appropriate behavior. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 24. Functional behavioral assessment (FBA): System in which the function of behavior is determined by the use of data collection. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 25. Self-management: Methods in which learners are taught to monitor, record data, report on, and reinforce their own behavior. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP 26. Structured Play Groups: Small group characterized by modeling an activity with specific roles of the adult/teacher to scaffold the activity based on activity goals. • Yes, I have used it and Yes, it is an EBP • Yes, I have used it and No it is not an EBP • Yes, I have used it and I am Unsure if it is an EBP • No, I have not used it and Yes, it is an EBP • No, I have not used it and No it is not an EBP • No, I have not used it and I am Unsure if it is an EBP

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1. Please list any other practices that you are using in your classroom based on an IEP or parent request. For example, special diets, etc. (short answer) ______

Please indicate your opinions regarding the sources of training you have received.

1. Which source(s) of training have been the most useful? Please explain: ______

2. Which source(s) of training have provided information on the use of EBPs specially geared toward students with ASD? ______

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