Objectives and competences for the module

Understand what evidence-based interventions are: Define the concept and the importance of evidence-based interventions in the context of autism.

Develop skills to assess scientific evidence: Teach participants how to read and understand research studies, identifying solid methodologies and significant outcomes.

Distinguish between evidence-based and non-evidence-based interventions: Provide criteria and tools to evaluate the validity and efficacy of different interventions and treatments for autism.

Identify dangerous or non-evidence-based interventions: Provide information on identifying interventions that lack scientific foundation and could be harmful.

Module index

1. Introduction to Evidence-Based Interventions

Definition and explanation of the concept.
The importance of evidence-based interventions for autism.
Criteria for selecting the best therapy
Classification according to evidence evaluation systems, such as GRADE or SIGN.
AUTHERAPIES CLASSIFICATION SYSTEM

2. Criteria for Evaluating Interventions

Pre-Treatment Assessment and Foundations of Intervention
How to evaluate the scientific evidence of proposed interventions
Evidence versus anecdote.
The hierarchy of evidence
How to read and understand scientific studies.
Key questions to ask when evaluating an intervention.

3. Evidence-Based Interventions for Autism

How evidence-based interventions improve quality of life for people with autism.
Common elements of effective intervention programs
Strategies and adaptations for the comprehensive support of persons with autism

4. Non-Evidence-Based and Potentially Dangerous Interventions

Risk associated with these interventions
Strategies to avoid being misled by unfounded claims.

5. Resources and Tools for Decision-Making

Guides and databases of scientifically evaluated interventions.
Keeping up to date with research<
- RSS (Really Simple Syndication)
- Alerts and subscriptions
- Webs, blogs, wikis.
- Academic social networks
- Keeping up to date

1. Introduction to evidence-based interventions

Identifying evidence-based interventions is critical to effectively addressing challenges in a variety of fields, from public health to education. In a world where information abounds, but is not always reliable, the ability to discern which interventions are supported by a strong scientific evidence base becomes an invaluable resource.

This chapter will explore key methods and approaches for distinguishing between interventions that have been shown to be effective for people with autism and those that lack strong support, thus providing practical guidance for making informed decisions.

This chapter will also help you find simple and effective ways to stay up to date on autism treatment and learn more about current evidence-based interventions. By using tools such as journal alerts, academic social networks, and RSS feeds, you can access the latest research and advancements, ensuring that your knowledge remains relevant and informed by the most recent scientific evidence.

1.1 Definition and explanation of the concept

The term evidence-based interventions refers to practices or measures that are applied in various fields, such as medicine, psychology, education or public policy, and that are supported by sound and reliable scientific evidence. The aim of this approach is to provide more effective and personalized care, based on concrete and reliable data, which are substantiated by multiple research and orderly clinical trials. This concept has developed over the years and its importance has multiplied in contemporary medicine, where the amount of scientific information that emerges daily can be overwhelming for both medical professionals and patients (Association for Behavioral and Cognitive Therapies, 2023).

Evidence-based interventions involve a process that begins with asking questions about the patient's health and diagnosing conditions. Next, evidence supporting various interventions is sought and evaluated. Practitioners not only consider the best available treatment, but also evaluate its applicability to the patient's particular situation, considering the patient's medical history, comorbidities and personal preferences. This collaborative approach translates into more precise and effective care, better matching treatment options to the specific needs of each individual (Lyra, 2022).

The concept of evidence-based treatment began to take shape in the 1990s, when a group of researchers at McMaster Medical School in Canada promoted the idea that medical practice should focus on the strongest available evidence for clinical decision-making. From this initiative, guidelines and protocols were created that helped standardize medical procedures and encouraged the use of systematic reviews and meta-analysis as a central methodology in medical research. These methods not only synthesize evidence from various studies, but also establish a solid foundation on which to build effective and safe interventions.

As progress has been made in data collection and analysis, the term has evolved and diversified, incorporating tools such as clinical evidence-based medicine, the development of medical training programs focused on evidence-based treatments, and the implementation of health policies that prioritize the use of evidence in resource and treatment decisions. This has allowed medicine to evolve toward a more scientific model, where clinical knowledge and skills are complemented by a solid research base.

In addition, evidence-based therapies also promote patient safety. By using evidence-supported practices, risk is minimized and less variability in treatments is promoted. This is especially relevant in an environment where there may be multiple treatments for the same condition, some of which may not be based on the best available evidence. Therapies not only improve health outcomes, but also promote a culture of transparency and accountability in healthcare.

Despite the benefits of evidence-based treatment, its implementation faces multiple challenges. One of the main obstacles is resistance to change on the part of some practitioners, who may be entrenched in traditional practices or distrustful of new evidence. In addition, limited time in patient care can make it difficult for practitioners to evaluate the latest information and apply it to their daily practice. Continuing education and training programs are crucial to overcome this resistance and foster a culture of learning and adaptation.

Another significant challenge is related to the accessibility of information. In many cases, the latest evidence may not be readily available to all health professionals, especially those working in resource-limited settings. This can lead to inequities in the medical care offered to different populations. To address this problem, it is essential to invest in infrastructure and resources that facilitate access to up-to-date and relevant information for all parties involved in healthcare.

Looking ahead, evidence-based treatment is expected to become even more relevant as technology and access to information continue to evolve. Artificial intelligence and machine learning have the potential to revolutionize how evidence is analyzed and implemented in clinical practice. These technological advances can facilitate the personalization of treatments, tailoring interventions to the unique characteristics of each patient, which in turn will improve health outcomes and decrease complications.

In addition, the integration of digital tools, such as mobile applications and telemedicine platforms, is expected to further improve accessibility and patient-professional interaction. These technologies will not only facilitate access to evidence-based information, but will also provide opportunities for patients to actively participate in making decisions about their health care, fostering a more collaborative approach to health care.

As a professional, family member or person with autism, you may have wondered why it is important that evidence-based guidelines exist for the treatment of people with autism (Ratnani I et al, 2023). This question serves as the foundation for the next content, where we will explore the significance of evidence-based guidelines in autism treatment, their impact on care quality, and how they shape decision-making for professionals, families, and individuals with autism.

1.2 The importance of evidence-based interventions for autism

Therapies for people with autism are used to improve communication and develop social skills, as well as to manage problem behaviors and increase independence in daily activities among others. They also focus on helping individuals understand and regulate their emotions, contributing to their overall well-being. Early intervention, as explained in Module 1, is key to maximizing development and quality of life. These therapies provide support to families by offering them tools and strategies to cope with the challenges associated with autism (Reichow, 2012; Warren, 2011).

These are essential for the treatment of autism because they ensure that the interventions used are effective and safe, as well as backed by rigorous scientific research. Evidence-based therapies have been shown to be effective in controlled, peer-reviewed studies and avoid unsubstantiated interventions that could be harmful or provide no real benefit.

Another key aspect is that they help optimize available resources, such as time, money and effort, ensuring that they are invested in truly effective methods while avoiding approaches that lack evidence or may be potentially harmful. Furthermore, because they are backed by scientific studies, they minimize the risk of adverse effects and avoid the application of ineffective strategies that could delay an individual's progress.

They also provide a reliable framework for tailoring treatments to the specific needs of each individual, ensuring appropriate support based on their profile and level of development. At the same time, they facilitate collaboration between healthcare professionals, therapists and educators, promoting the use of validated and scientifically based approaches.

In addition, they ensure that interventions are ethical and respect the rights of people with autism, always prioritizing their well-being and autonomy (Pinos & Merinero, 2023).

However, despite the clear benefits of evidence-based therapies, individuals with autism and their families are often vulnerable to interventions that lack scientific support. The complexity of autism, combined with the emotional and financial burden on families, can make them more susceptible to treatments that promise quick results without solid evidence. This vulnerability underscores the importance of relying on scientifically validated guidelines to avoid ineffective or even harmful approaches.

With this in mind, the next section will delve into why evidence-based guidelines are crucial for autism treatment and how they serve as a safeguard against misleading or unproven interventions.

1.3 Criteria for selecting the best therapy as a professional, family or a person with ADS

Autism is not a disease but a neurodevelopmental condition that accompanies individuals throughout their lives. Its neurobiological origins shape the structure and functioning of the nervous system, leading to characteristic challenges in two main areas: communication and social interaction, as well as flexibility of thought and behavior. However, beyond these core features, the experience of autism is highly individualized, with each person presenting a unique combination of strengths, challenges, and needs.

Since no two people with autism are alike, intervention must be tailored to each individual. Autism manifests differently from person to person and evolves over time, requiring personalized support strategies that adapt to developmental stages, therapeutic goals, family expectations, and available resources. In many cases, a multidisciplinary approach is necessary, involving various professionals to provide comprehensive support that enhances both present and future well-being for individuals with autism and their families.

The complexity of autism has led to a proliferation of intervention options—some well-supported by scientific evidence, others based on anecdotal reports or unverified claims. Unlike other conditions with standardized treatments, autism requires careful selection of therapies, ensuring that chosen interventions are backed by rigorous research, including randomized controlled trials, meta-analyses, and systematic reviews. Frameworks such as GRADE and SIGN help assess the strength of evidence and determine the clinical applicability of interventions.

The primary goal of evidence-based therapies is to foster improvements in social, communicative, and adaptive skills while enhancing the overall quality of life of individuals with autism and their families. However, safety must always be a priority. Some alternative treatments, such as chelation, restrictive diets without medical supervision, or so-called "miracle cures," pose serious risks and lack scientific validation. Recognized health organizations, including the World Health Organization (WHO), the American Academy of Pediatrics (AAP), and the National Institute of Mental Health (NIMH), emphasize the importance of avoiding unproven interventions that could cause harm or delay effective treatment.

Flexibility is another critical aspect of successful interventions. Effective therapies should be adaptable to the unique needs of each individual and applicable across different environments, including home, school, and community settings. The involvement of caregivers, educators, and family members is essential to ensuring continuity and meaningful progress. Furthermore, professionals delivering these interventions should have specialized training and certification in evidence-based approaches, ensuring high-quality, up-to-date care aligned with the latest research.

Finally, accessibility and sustainability must be considered. The cost-benefit ratio of therapies should be evaluated to ensure they are not only effective but also economically viable for families and healthcare systems. Equitable access to evidence-based interventions, regardless of socioeconomic status or geographic location, is fundamental to promoting the well-being of individuals with autism.

Given the complexity and diversity of autism, the responsibility of selecting appropriate interventions should not fall solely on families, who are often vulnerable to misleading or ineffective treatments. This underscores the need for clear, evidence-based guidelines that empower families and professionals to make informed decisions, safeguarding individuals with autism from therapies that offer false promises while prioritizing those that provide real, lasting benefits.

1.4 Classification according to evidence evaluation systems, such as GRADE or SIGN

Grading therapies for autism using evidence assessment systems such as GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) and SIGN (Scottish Intercollegiate Guidelines Network) allows for an objective determination of the scientific support behind each intervention. These frameworks provide a structured approach to evaluating the quality of evidence and the strength of clinical recommendations, helping health professionals make informed decisions based on reliable data rather than trends or unverified approaches.

The GRADE System

Widely used in medical research and clinical guideline development, the GRADE system categorizes the quality of evidence into four levels:

High: Derived from well-conducted randomized controlled trials (RCTs) with minimal bias, providing strong confidence in the results.
Moderate: Findings are credible, but new studies may influence conclusions.
Low: Based primarily on observational studies, with a higher likelihood of bias.
Very Low: Evidence is of poor methodological quality or lacks reliability.

Additionally, GRADE classifies the strength of recommendations into two categories:

Strong: The benefits of the intervention clearly outweigh the risks, and the evidence is robust.
Weak: The balance of benefits and risks is uncertain, the evidence is limited, or patient preferences vary significantly.

The SIGN System

The SIGN system focuses on methodological rigor, organizing evidence hierarchically:

1++ and 1+: High-quality meta-analyses and RCTs with minimal bias.
2-, 3, and 4: Observational studies with limitations or expert opinions, which are considered the weakest forms of evidence.

Based on this classification, SIGN assigns grades of recommendation:

Grade A: Based on high-quality evidence (e.g., well-designed RCTs).
Grade D: Based on lower-quality studies or expert consensus, with limited scientific backing.

Application to autism´s therapies

Applying these evidence-based grading systems to autism interventions helps differentiate therapies with strong scientific support from those lacking proven efficacy.

Evidence-based therapies:
- Applied Behavior Analysis (ABA) and the Early Start Denver Model (ESDM) hold SIGN 1++ evidence and high GRADE ratings, demonstrating strong efficacy in improving social, communicative, and adaptive skills in children with autism.
Therapies with insufficient or weak evidence:
- Approaches such as sensory integration therapy and hyperbaric oxygen therapy lack robust scientific validation. In many cases, these interventions have been classified as low-quality or non-recommended by GRADE and SIGN due to inconsistent findings or methodological weaknesses.

The Importance of Evidence-Based Decision Making

Using GRADE and SIGN ensures that clinical decisions in autism treatment are grounded in rigorous scientific evaluation rather than anecdotal success stories or emerging trends without proven validity. These frameworks empower professionals and families to prioritize therapies that offer meaningful benefits while avoiding ineffective or potentially harmful interventions. By relying on objective, high-quality evidence, healthcare providers can enhance the long-term well-being of individuals with autism and support the development of best practices in autism care (Hume et al., 2021).

The World Health Organization (WHO, 2023) reinforces the importance of evidence-based rehabilitation for individuals with neurodevelopmental disorders, including autism. In its 2023 report, "Package of Interventions for Rehabilitation: Module 5. Neurodevelopmental Disorders," the WHO emphasizes a multidisciplinary approach, integrating behavioral, educational, and medical strategies to enhance adaptive functioning. This framework aligns with GRADE and SIGN recommendations, advocating for interventions with strong empirical support while discouraging unproven or potentially harmful treatments. By prioritizing accessibility and sustainability, the WHO underscores the need for globally adaptable interventions that promote the well-being and inclusion of individuals with autism in diverse social and cultural contexts.

1.5 AUTHERAPIES classification system

The AUTHERAPIES project is an initiative dedicated to promoting the use of evidence-based interventions for individuals with autism. To ensure accessibility for professionals, individuals with autism, families, and students, AUTHERAPIES presents its information in a simple and visual format, making complex scientific concepts easier to understand. The platform integrates intuitive visual elements, pictograms, and structured layouts, allowing users to quickly identify the level of scientific support behind each therapy.

To build its comprehensive database, an intensive bibliographic review was conducted, analyzing the most important evidence-based guidelines from around the world. This rigorous process ensures that the therapies included are backed by high-quality scientific research, providing users with reliable, up-to-date, and accessible information. By combining scientific rigor with an intuitive format, Autherapies facilitates informed decision-making and bridges the gap between research and practical application, ensuring that validated therapies are available to everyone. The online database of the AUTHERAPIES project is available at:
www.autherapies.eu/en/evidence-therapies

To organize the information and facilitate decision-making, therapies have been classified into five categories of level of evidence, according to the degree of scientific support and the sources reviewed:

1. High: Therapies that have robust scientific studies, such as randomized controlled clinical trials, meta-analyses or systematic reviews. These practices have been shown to be effective and safe in multiple settings and populations with autism.

2. Medium: Therapies for austism that show positive results, but have a less solid scientific basis or lack larger or more rigorous studies. They may be useful in certain cases, but more research is needed to confirm their effectiveness.

3. Low level of evidence: Therapies for autism that have little or no scientific studies to support their efficacy, meaning that there is insufficient evidence to recommend their widespread use. They may lack scientific validity or may not have been adequately evaluated.

4. Dangerous: Therapies that present clear risks or adverse effects to persons with autism and their families, making them unsafe to apply. These practices should be avoided because of their potential negative consequences.

5. Not recommended: Therapies that not only lack solid scientific evidence, but may also be associated with fraudulent practices, are based on myths or pseudoscience, or are considered ineffective and potentially harmful for persons with autism and their families.

This classification has been made after an exhaustive review of scientific and professional sources, in order to provide an informative and reliable approach for people interested in the therapy and treatment of autism.

2. Criteria for evaluating evidence-based interventions

In the search for effective interventions for autism, it is essential to establish a rigorous evaluation framework that distinguishes between evidence-based therapies and those whose effectiveness remains unproven. Implementing treatments without scientific support may not only be ineffective but, as previously mentioned, could also pose risks to the health and well-being of individuals with autism while placing a financial burden on their families.

This chapter outlines the fundamental criteria for assessing therapies used in the treatment of autism, ensuring that only those with strong scientific backing are selected. It will also explore the importance of adequately training professionals responsible for implementing these therapies and analyzing the cost-benefit ratio to ensure interventions are both sustainable and accessible.

Throughout this chapter, an evidence-based approach will be presented to enable professionals, families, and caregivers to make informed decisions regarding the most appropriate therapies for individuals with autism. Evaluating interventions through rigorous scientific criteria is a crucial step in ensuring that autism treatment adheres to principles of quality, safety, and efficacy.

2.1 Pre-Treatment Assessment and Foundations of Intervention

For any family with a child with autism, early support is essential in fostering parental confidence and competence while also helping to mitigate the exacerbation of future challenges. Therefore, while families should await a formal autism diagnosis, comprehensive assessments of the child's strengths and difficulties across multiple domains can serve as a foundation for tailoring general approaches based on the individual profile of the child’s abilities and challenges.

Objective assessments, even simple ones, are crucial for contextualizing observed behaviors within a developmental framework, thereby providing a reference point for planning interventions and tracking progress over time.

For adults with autism, having a formal diagnosis is just one part of understanding their needs, as the spectrum is highly diverse. Each individual presents a unique combination of strengths and challenges, making it essential to conduct thorough evaluations across different areas of functioning. These assessments provide a clear picture of the specific difficulties an individual faces and serve as a foundation for designing tailored interventions.

By aligning support strategies with an individual’s actual needs, rather than relying solely on a general diagnosis, interventions can be more effective in enhancing quality of life, promoting independence, and addressing challenges in daily life. A precise and personalized approach ensures better outcomes and more meaningful support for autistic adults.

Autism varies widely among individuals. Therefore, effective intervention must combine standardized assessments with personalized approaches. While evidence-based practices are foundational, the application of therapeutic recommendations must consider the unique profile of strengths, weaknesses, and needs of the individual, as well as their familial and social context. Effective intervention requires a functional analysis of behavior, identifying environmental factors that influence quality of life and designing personalized interventions. Therapeutic planning should prioritize the optimization of learning opportunities within the individual's natural environment, with a central role for caregivers and professionals as facilitators. Social inclusion and respect for individual rights are paramount objectives, requiring intersectoral coordination and the adaptation of environments to promote full participation

It is crucial to consider the following guidelines when selecting evidence-based treatments, as they are essential for ensuring the chosen treatment's effectiveness.

Each individual and each family are unique. Acknowledging the inherent variability among individuals with autism and families is paramount in psychological practice. Diagnosis and assessment of autism should be grounded in reliable and valid instruments, and evidence-based interventions should be prioritized. However, the interpretation of assessment findings and the application of standardized treatment protocols must be tempered by a thorough understanding of the individual's unique strengths, difficulties, and needs, as well as their socio-familial context. Furthermore, the developmental trajectory of individuals with autism and families requires a flexible approach, wherein intervention and support strategies are continuously adapted to reflect evolving needs and circumstances.

Focus on individual strengths, not just limitations. A strength-based approach is crucial in autism intervention, shifting the focus from solely addressing limitations to leveraging individual strengths. Autism often presents with a heterogeneous profile of abilities, where strengths can be strategically utilized to foster a more positive environment for both the individual and their family. Identifying and cultivating these strengths allows for the development of compensatory strategies, effectively circumventing or mitigating areas of relative weakness. For instance, individuals with strong visual processing skills may benefit significantly from visual communication strategies when verbal skills are limited. Furthermore, special interests, such as those related to numerical data or technology, can be harnessed to enhance academic or practical skills and to facilitate social engagement.

Intervention should be based on a ‘functional analysis’ of behavior, meaning that before implementing any strategy, it is essential to understand why a behavior occurs. Functional analysis involves identifying the triggers (antecedents) and consequences that maintain a behavior, allowing for more effective and individualized intervention.

For example, consider a child with autism who frequently engages in self-injurious behavior, such as hitting their head. A functional analysis might reveal that this behavior occurs most often in noisy environments and decreases when the child is given access to noise-canceling headphones or a quiet space. This suggests that the behavior is an attempt to escape sensory overload. Based on this understanding, an intervention could include modifying the environment, teaching alternative coping strategies, or gradually increasing tolerance to noise in a controlled manner.

By applying functional analysis, interventions become more precise, reducing the likelihood of misinterpretation and ineffective responses while promoting positive and lasting behavioral changes.

Focus on making the environment more “autism friendly”. Optimizing the environment to be more conducive to the needs of individuals with autism is a critical component of effective intervention. Functional analysis should extend to the identification of environmental variables—including social, sensory, cognitive, and physical factors—that may impede progress or diminish quality of life. Promoting an empathic understanding of the environment from the perspective of the individual with autism is essential for stakeholders. This necessitates the development of strategies aimed at mitigating environmental stressors. Notably, even subtle modifications to the environment can yield significant positive effects on behavior and overall well-being.

Effective treatment is not determined by a fixed number of hours or intervention sessions. The efficacy of intervention is not contingent upon a predetermined number of therapy hours or sessions. Individuals with core deficits in social relatedness, communication, and imaginative capacity encounter substantial challenges. Therefore, therapeutic approaches should not be constrained by rigid, time-based protocols. Instead, the focus should be on maximizing opportunities for therapeutic intervention within the individual's daily life, thereby facilitating continuous progress and mitigating personal challenges.

Reassess the role of professionals. A reevaluation of professional roles is warranted. The clinician or therapist's function transcends that of primary interventionist; their role is more effectively conceptualized as a coach or consultant to key stakeholders directly involved in the individual's life, including parents, educators, family members, support personnel, and employers. In accordance with NICE Guidance and other relevant guidelines, the assignment of a professional case manager, often referred to as a 'key facilitator' or 'care coordinator,' is recommended. This individual, drawn from any child and adolescent mental health discipline, assumes responsibility for the integration of intervention recommendations, the continuous monitoring of progress, and the facilitation of future planning.

Provide access to effective participation and full inclusion in society. Facilitating effective participation and full societal inclusion is a fundamental objective. The World Health Organization (WHO) has recognized the capacity of non-specialist providers within educational and community contexts to deliver successful psychosocial interventions, encompassing behavioral and parent-mediated approaches, for children with autism spectrum disorder and/or intellectual disabilities. Furthermore, the WHO emphasizes that interventions for individuals with autism should be integrated with comprehensive strategies aimed at enhancing the accessibility, inclusivity, and supportiveness of physical and social environments. Provision of appropriate support across diverse settings—including family homes, educational institutions, employment settings, residential facilities, local health services, community recreation centers, and cultural or religious organizations—is essential for achieving these goals (WHO, 2014).

Respecting individual rights. Upholding the rights of individuals with disabilities is paramount. In 2016, the tenth anniversary of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) was commemorated. Over the preceding decade, significant strides have been made, and the CRPD continues to guide Member States in the development and implementation of legislation, strategies, policies, and programs that foster equality, inclusion, and empowerment for individuals with disabilities at global, regional, national, and local levels. These principles have served as a foundational framework for European autism organizations, which advocate for clinicians to empower individuals with autism and their families or caregivers to assert their rights, actively contribute to policy formulation, and achieve full societal participation.

Establish mechanisms for referral and coordination of key agencies. The establishment of robust referral and coordination mechanisms among key agencies is essential for comprehensive support across the lifespan of individuals with autism spectrum disorder. Multiple governmental departments, local authorities, and community agencies play critical roles, traditionally encompassing health, education, social welfare, family support, housing, employment, taxation, pensions, equal rights legislation, and the justice system. However, a broader spectrum of services, including those related to scientific research, technology, sports, culture, transportation, and immigration, also contributes significantly. Therefore, individuals with autism require multidimensional and intersectoral coordination that surpasses traditional national and regional/local policy boundaries. While the implementation of such comprehensive frameworks remains limited globally, the increasing recognition of autism's heterogeneity and its associated personal and economic impact has prompted numerous European nations, including the United Kingdom, Wales, Denmark, Hungary, France, Spain, and Malta, to adopt or consider parliamentary proposals for national autism strategies, a trend observed in other countries worldwide (Fuentes et al., 2021).

Understanding the hierarchy of evidence is essential for evaluating autism interventions, but knowing which studies hold the most weight is only the first step. To make informed decisions, it is equally important to develop the skills to critically read and interpret scientific studies. The following section provides key strategies for analyzing research, ensuring that professionals, families, and individuals with autism can confidently assess the reliability and relevance of scientific findings.

2.2 How to evaluate the scientific evidence of proposed interventions

The selection of evidence-based treatments, rigorously validated through scientific research, is paramount for optimizing outcomes in autism spectrum disorder. These interventions, demonstrating efficacy in areas such as communication, social interaction, and behavior among others, provide families with confidence in their treatment choices, mitigating the risk of relying on ineffective methods (Altogether Autism, 2022; Autism Science Foundation, 2023).

Methodological rigor is essential in studies validating autism interventions, particularly concerning sample size, replication, control groups, randomization, and blinding. Larger sample sizes improve generalizability by reducing outlier influence. Replication across diverse settings strengthens evidence. Control groups establish baselines, mitigating placebo effects. Randomization and double-blinding minimize bias in participant assignment and outcome assessment.

Furthermore, cautious interpretation of single studies is crucial, as scientific consensus typically requires replication and validation across multiple investigations. It is also essential to distinguish between correlation and causation. For instance, the observed correlation between vaccination rates and autism diagnoses does not imply a causal link; rather, the increase in diagnoses reflects changes in diagnostic criteria and heightened awareness.

Given the heterogeneity of autism spectrum disorder, individualized guidance from qualified health professionals—such as physicians, psychologists, or therapists—is indispensable. These professionals possess the expertise to critically evaluate scientific evidence and determine its relevance to individual needs, considering factors such as age, developmental stage, and comorbidities. This collaborative approach ensures that treatment decisions are both evidence-based and tailored to the unique profile of each individual. Individualized treatment planning will be further discussed in Module 4 (Rychetnik, 2002).

2.3 Evidence versus anecdote

Anecdotal evidence, derived from personal narratives and observations, contrasts sharply with empirical evidence, which stems from systematic research and statistical analysis. While anecdotal accounts can offer valuable insights into individual experiences and generate hypotheses, they lack the rigor and reliability of empirical data.

In research, anecdotes may serve as preliminary indicators, highlighting areas warranting further investigation. However, their inherent subjectivity, susceptibility to bias, and lack of control groups and randomization limit their generalizability.

Personal stories are influenced by individual circumstances and emotional factors, rendering them unreliable for drawing broader conclusions.

Empirical evidence, grounded in systematic observation and experimentation, is prioritized in academic and professional settings due to its robustness and replicability. Researchers utilize empirical data to mitigate bias and ensure findings are applicable across diverse populations and contexts.

Examples of anecdotal evidence include patient testimonials, social media narratives, and casual conversations. While these accounts can be compelling, they often lack empirical validation. Reliance on anecdotes, particularly in healthcare and policy-making, can lead to misinterpretations and biased decision-making, as individuals may mistakenly assume their experiences are representative of larger trends.

Anecdotal evidence can be judiciously employed to illustrate points or humanize complex concepts, but it should not be presented as definitive proof. Ethical considerations mandate transparency regarding the limitations of anecdotal evidence, preventing its misuse for manipulation or misrepresentation.

The integration of anecdotal and quantitative data, facilitated by advancements in data collection and analysis, offers the potential for a more nuanced understanding of complex phenomena. By combining personal narratives with statistical trends, researchers can enrich their analyses and provide a more comprehensive perspective (Mlodinow, 2008).

2.4 The hierarchy of evidence

Building upon previous discussions of therapeutic classifications, this section delineates the hierarchy of evidence, enabling informed decision-making regarding autism interventions for professionals, families, and individuals. This hierarchy prioritizes interventions based on the strength of supporting research, ensuring appropriateness, safety, and evidence-based practice.

The hierarchy commences with expert opinions and case studies, which, while informative, lack robust scientific validation and exhibit limited generalizability. Observational studies, such as cohort and cross-sectional designs, offer insights into associations but cannot establish causality.

Randomized controlled trials (RCTs) occupy the next tier, considered the gold standard in clinical research. RCTs minimize bias and enhance validity through randomized comparisons of intervention and control groups. Within this category, randomized controlled clinical trials (RCTs) are particularly salient, providing strong evidence of efficacy under specified conditions.

Systematic reviews and meta-analyses represent a higher level of evidence, rigorously synthesizing results from multiple RCTs. Meta-analyses, by combining data from various trials, offer robust and generalizable conclusions, addressing inter-study variability and establishing consensus on therapeutic efficacy. These are among the most reliable sources of scientific evidence.

At the apex of the hierarchy are evidence-based clinical practice guidelines, which integrate meta-analyses, RCTs, and other pertinent evidence. Developed by expert committees, these guidelines provide recommendations based on the synthesis of the best available scientific literature.

Autism treatment should adhere to this hierarchical approach, prioritizing interventions supported by systematic reviews and meta-analyses, followed by RCTs. However, it is acknowledged that emerging therapies may initially rely on preliminary evidence from observational or expert studies.

By applying this hierarchy, healthcare professionals can select optimal and safe interventions for individuals with autism, ensuring treatment aligns with current scientific knowledge (Leaf, 2022).

2.5 How to read and understand scientific studies

Comprehending scientific literature requires practice and strategic engagement. Utilizing scholarly databases such as PubMed, Google Scholar, or Scopus facilitates the selection of relevant studies within one's area of interest.

Initiate the reading process by reviewing the abstract to gain an overview of the study's objectives, methodology, findings, and conclusions. This initial assessment aids in determining the study's suitability. Subsequently, examine the introduction to contextualize the research, understanding its rationale and the existing literature it builds upon.

A critical evaluation of the methodology is essential for assessing the study's validity and reliability. Scrutinize the participant selection process, experimental design, and data collection and analysis procedures.

The results section presents the study's findings, which should be examined closely through the lens of presented statistics, figures, and tables. Following this, analyze the discussion and conclusion sections to understand the researchers' interpretation of the results and their implications.

Critically appraise the study's strengths and limitations. All studies possess inherent limitations, and their consideration is crucial for evaluating the study's overall validity and relevance.

Supplement understanding by consulting supplementary resources, such as textbooks, review articles, and online educational materials.

Critical reading is a developmental skill, honed through consistent practice. As familiarity with scientific literature increases, the ability to assess study validity, relevance, and methodological rigor improves.

Understanding scientific studies is an iterative process. Continuous learning and improvement are encouraged. Do not hesitate to seek clarification by engaging in discussions with colleagues, mentors, or experts in the field (Green & Kreuter, 2009).

If you are not familiar with scientific research or you are not a health or education professional, the best idea is to seek for reliable information sources.

Consult healthcare professionals: Obtain information from doctors, psychologists, or therapists with experience in autism.
Seek information from recognized organizations: Consult websites of organizations such as the World Health Organization (WHO) or Autism Speaks.
Use scientific databases: Search for studies in databases such as PubMed or Google Scholar, but with the help of a professional for proper interpretation.
Consult healthcare professionals: Libraries that are from reputable sources that contain documentation with scientific evidence about autism.

It is important to remember that interpreting scientific studies can be complex. Therefore, it is recommended to seek the support of trained health professionals to help individuals with autism and their families understand the information and make informed treatment decisions.

2.6 Key questions for evaluating an intervention

To ensure the methodological rigor and validity of evidence-based interventions, critical evaluation is essential. The following questions provide a framework for this process (Green & Glasgow, 2006):

What is the strength of the scientific evidence supporting the intervention? Examine relevant literature, including randomized controlled trials (RCTs), meta-analyses, and systematic reviews.
How was the supporting study designed and implemented? Analyze the study's methodology, including participant selection and assignment, and follow-up procedures.
What were the study's results and their interpretation? Evaluate the statistical and clinical significance of the findings and their interpretation.
Has the intervention's efficacy been replicated? Assess evidence of replication across diverse contexts and populations.
Are there potential conflicts of interest that could introduce bias? Identify any conflicts of interest that may have influenced the study's results.
What is the quality of the available evidence? Evaluate the level of evidence, risk of bias, and consistency of findings.
What is the magnitude of the intervention's effect? Determine the clinical and practical relevance of the intervention's effect size, considering benefits, risks, and costs.
Is the intervention generalizable? Assess the intervention's applicability to diverse populations and settings.
What are the limitations of the evidence? Identify potential biases, methodological flaws, and areas of uncertainty.
What are the recommendations from health authorities and professional organizations? Consult guidelines and recommendations from reputable sources.

3. Evidence-based and non-evidence-based interventions for autism.

The therapeutic landscape for autism has undergone substantial transformation in recent decades, marked by a growing emphasis on evidence-based interventions validated through rigorous scientific inquiry. Concurrently, non-evidence-based approaches continue to be promoted, often lacking substantiation from controlled studies. This chapter delineates the critical distinctions between these intervention modalities, underscoring the imperative of selecting treatments supported by robust scientific evidence to safeguard the well-being of individuals with autism. By examining diverse therapeutic approaches, their underlying rationales, documented outcomes, and the potential ramifications of utilizing interventions devoid of scientific validation, this chapter aims to provide clinicians, families, and individuals with autism with clear guidance for informed treatment decision-making.

3.1 How evidence-based interventions improve quality of life for people with autism

Therapeutic interventions for autism significantly enhance the quality of life for affected individuals, fostering personal development and socio-familial integration. By targeting core domains such as communication, social interaction, self-regulation, and adaptive behaviors, these interventions equip individuals with essential skills for daily functioning.

A primary impact of autism therapies lies in the development of communication proficiency. Evidence-based approaches, including Applied Behavior Analysis (ABA) and the Early Start Denver Model (ESDM), have demonstrated efficacy in facilitating clearer and more functional communication, thereby mitigating frustration and improving social interactions. Augmentative and alternative communication (AAC) strategies, such as pictograms or Picture Exchange Communication Systems (PECS), further support the expression of needs and desires, promoting autonomy and emotional well-being (further details in Module 3).

Furthermore, these therapies address emotional regulation and cognitive flexibility, critical skills for navigating daily challenges and transitions. By providing individuals with autism with strategies to manage anxiety, unexpected changes, and social interaction difficulties, therapies enhance adaptive capacity. This, in turn, improves behavioral outcomes and facilitates participation in social, educational, and vocational activities.

Another key benefit is the enhancement of daily living skills, encompassing self-care, decision-making, and time management. Structured interventions, incorporating routines and visual supports, foster independence in everyday tasks, resulting in increased self-esteem and improved community integration.

In summary, therapies for autism empower individuals by developing crucial skills in communication, self-regulation, social adaptation, and independence. With appropriate support, individuals with autism can achieve their full potential and lead fulfilling, independent lives (Hume, 2021; Fuentes, 2021).

3.2 Common elements of effective intervention programs

Effective treatment for autism requires an individualized approach. Given the heterogeneity of autism, encompassing variations in severity, comorbidities, age, and environmental contexts, a standardized intervention is inappropriate. Tailoring treatment to individual interests and motivations is paramount. Therefore, the initial phase of any intervention should involve a comprehensive assessment to determine its appropriateness for each individual. Aligning with contemporary disability paradigms, individual challenges should be translated into specific levels of intensity and required support.

Structured intervention is fundamental. Organized and structured teaching, incorporating environmental adaptations that promote predictability and stability, alongside pre-defined objectives and activities, is essential. A pre-planned, multidisciplinary program facilitates reliable evaluation of agreed-upon objectives, established in collaboration with the individual with autism or their representatives.

Intensive and contextually extensive intervention is crucial. To ensure generalization of skills, key stakeholders—families and professionals—must capitalize on or create natural opportunities to implement individualized plans. Adherence to established international guidelines, recommending a minimum of 20-25 hours of intervention per week, including naturalistic settings, is vital for skill acquisition and symptom reduction.

Parental involvement is a critical determinant of treatment success. Collaborative partnerships between families, educators, and support professionals are essential for defining objectives and implementing strategies, such as augmentative communication, visual aids, technology, and social stories. Furthermore, families require comprehensive support, including guidance, information, financial assistance, respite care, and crisis intervention, to effectively participate as co-therapists while maintaining their own well-being. Contemporary family-centered care models emphasize the family's pivotal role in enhancing the quality of life for individuals with autism, within a collaborative framework with professionals (Association for Behavioral and Cognitive Therapies, 2023).

3.3 Strategies and Adaptations for the Comprehensive Support of Persons with Autism

To optimize the development and well-being of individuals with autism, environmental adaptation is paramount. This includes proactive environmental structuring through visual supports, such as graphic organizers, schedules, and agendas, to enhance organizational skills. Sensory modulation, involving stimulus control and sensory protection, is also crucial for minimizing distractions and fostering a sense of security. Establishing predictable routines further reduces anxiety and facilitates adaptation.

Strategies implemented by caregivers and support personnel should prioritize effective learning and well-being. Errorless learning, utilizing graduated prompts to ensure task success and promote autonomy, enhances motivation and mitigates frustration-related behaviors. Positive reinforcement, emphasizing effort and attempts rather than solely achievements, fosters confidence. Constructive communication, replacing negative directives with alternative solutions, and promoting generalization of skills across contexts are essential.

Targeted interventions should focus on developing competencies in communication, social interaction, cognitive flexibility, and emotional regulation. This necessitates the implementation of evidence-based strategies to enhance these domains, enabling individuals to function with greater autonomy and confidence.

A comprehensive functional behavior assessment is crucial for addressing associated difficulties, including emotional and behavioral dysregulation, anxiety, mood alterations, sleep disturbances, and feeding challenges. This assessment facilitates the development of individualized interventions tailored to the function of specific behaviors within their context.

Transitional support is essential across the lifespan, encompassing transitions from childhood to adolescence, primary to secondary education, and adolescence to adulthood. Support during adulthood should address evolving roles, responsibilities, and care service needs. The development of daily living skills should be aligned with the individual's developmental stage and capabilities, maximizing independence.

Lifelong support, extending beyond childhood and adolescence into working life and old age, is critical for promoting sustained well-being and quality of life (Cruz, 2025).

4. Identification of interventions that lack scientific support

Identifying therapies lacking scientific substantiation necessitates vigilance for specific indicators. Primarily, the absence of peer-reviewed scientific studies is a critical warning sign. Evidence-based therapies are characterized by rigorous controlled research and scientific validation. Furthermore, claims of rapid or miraculous outcomes, unsupported by robust data, are often indicative of misleading practices. Evaluating the credentials and expertise of therapy proponents is also essential, as reputable professionals typically advocate for evidence-based interventions. Maintaining a critical perspective and scrutinizing objective evidence is paramount before adopting any therapeutic approach.

4.1 Risk associated with these interventions

The utilization of interventions for autism lacking scientific validation poses several significant risks. Firstly, these interventions often exhibit limited or no efficacy. Without robust empirical support, the likelihood of achieving desired outcomes is substantially diminished, resulting in wasted time and resources.

Secondly, certain unsupported interventions can be detrimental to health. Unregulated products or alternative treatments administered without medical supervision may induce adverse side effects or medical complications in persons with autism. Furthermore, such practices can delay the pursuit of appropriate medical care, potentially exacerbating underlying conditions.

Financial implications constitute another critical concern. Individuals may incur substantial expenses on interventions lacking demonstrable benefits, leading to significant financial losses when expectations are unmet.

Beyond physical and financial risks, the use of non-evidence-based interventions can negatively impact the emotional well-being of the person with autism and their families. Unfulfilled expectations and subsequent frustration can erode confidence in legitimate medical treatments and interventions.

Finally, individuals may be exposed to deceptive or fraudulent practices. Some pseudoscientific interventions are designed to exploit vulnerable populations, promoting hazardous therapies, costly but ineffective treatments, or counterfeit products (Higgins & Green, 2011).

4.2 Strategies to avoid being misled by unfounded claims

Navigating the complex landscape of autism interventions necessitates vigilance and informed decision-making. Several indicators suggest a treatment may lack credible evidence and potentially constitute a scam or ineffective practice (NHS, 2022).

Check whether the treatment has been approved by the relevant regulatory authorities. Regulatory approval by authorities such as the FDA or EMA, while not a guarantee of efficacy, provides a baseline assurance of safety and quality. Conversely, pressure to make rapid purchases should raise suspicion, as fraudulent schemes often employ aggressive sales tactics and artificial urgency (Pluye et al., 2004)

Be wary of pressure to buy quickly. If you are pressured to make a quick purchase, resist the pressure and do additional research. Scams often use aggressive sales tactics and a false sense of urgency to persuade people to make hasty decisions (Pluye et al, 2004).

Claims of "cure" or "recovery" from autism are significant red flags. Autism is a lifelong neurodevelopmental condition; while interventions can enhance skills and quality of life, a scientifically validated cure does not exist. Such claims often exploit familial desires for their loved ones to conform to societal norms.

Another red flag is the assertion that a treatment can cure multiple conditions simultaneously. Treatments purporting to address multiple unrelated conditions simultaneously (autism, chronic pain, HIV, etc.) lack specificity and empirical support. Similarly, claims of universal efficacy and rapid results should be met with skepticism. Effective interventions typically require personalized, longitudinal approaches.

Reliance on anecdotal evidence, rather than peer-reviewed research, is another key indicator of dubious practices. While personal narratives can offer insights, they do not constitute scientific validation. Language employing terms like "miracle," "faith," and "trust" often appeals to emotion rather than logic.

Interventions that can be administered without formal training raise safety and efficacy concerns. Professional interventions necessitate specialized expertise. High costs, lack of national health system coverage, and absence of recognition from reputable medical organizations further suggest a lack of scientific foundation.

Source credibility is paramount. Information disseminated through social media platforms should be scrutinized, as these sources may lack professional oversight. Verifying information through qualified professionals and credible research is essential. Be wary of treatments promoted by influencers, content creators, social media, etc., that are not endorsed by qualified professionals.

Active engagement in consultations with healthcare providers is advisable, as they can facilitate the clarification of misconceptions and offer evidence-based recommendations tailored to individual patient profiles. Seeking supplementary professional opinions or engaging in multidisciplinary consultations can further enhance the comprehensiveness of treatment perspectives.

Vigilance regarding misinformation and the application of critical evaluation tools are essential for individuals with autism spectrum disorder and their families to effectively navigate intervention options. The identification of unreliable claims safeguards against harmful or ineffective treatments, promoting reliance on evidence-based approaches that support well-being and development. This empowered approach enhances treatment efficacy and fosters confidence in decision-making, leading to improved care. Informed and discerning families can effectively advocate for their loved ones, ensuring judicious allocation of time and resources to evidence-based interventions.

5. Resources and tools for decision-making

In the realm of autism intervention, the ability to make informed and effective decisions is paramount for individuals, families, and professionals. Just as in any complex domain, this necessitates access to and proficiency in utilizing appropriate resources and tools. However, the unique challenges posed by autism, including its heterogeneity and the proliferation of both evidence-based and unsubstantiated treatments, demand a specialized approach to decision-making

5.1 Guides and databases of scientifically evaluated interventions

The following are the main resources for EBP (evidence-based practices), classified according to the “5S Knowledge Pyramid” by Haynes et al:

Computerized systems
BMJ Best Practice	BMJ Best Practice is an evidence-based, clinical decision support tool that provides healthcare professionals with continually updated, reliable information on the diagnosis, treatment, and management of medical conditions.
BestBETs	BestBETs is a quick access tool to the best available evidence in response to clinical questions on common clinical interventions. Evidence is critically analyzed.

Summaries
RNAO (Registered Nurses Association of Ontario)	The Registered Nurses’ Association of Ontario (RNAO) is a world-renowned leader in guideline development, evidence-informed practice uptake, sustainability and evaluation.
AHRQ (Agency for Healthcare Research and Quality)	Database of Clinical Practice Guidelines and other related documents, supported by the American Agency for Healthcare Quality (AHRQ) of the United States. It is a compendium of multiple resources: guidelines, toolkits, articles, patient resources, etc.
SIGN (Scottish Intercollegiate Guidelines Network)	Clinical practice guidelines developed and disseminated for the National Health System in Scotland with the aim of increasing the quality of care for patients. Contains other evidence products.
NICE (National Institute for Clinical Excellence, United Kingdom)	Quality standards for health, public health, and social work professionals, as well as disease prevention and healthy lifestyle guidelines, are developed within the UK National Health System. These are supported by additional evidence-based products.
Guidelines International Network (GIN)	Repository of clinical practice guidelines and methodological resources, with tools for their adaptation and implementation developed by the member organizations of this international collaborative network.

Synopsis of synthesis
Evidence Based Nursing	Evidence-Based Nursing systematically searches a wide range of international healthcare journals applying strict criteria for the validity of research and relevance to best nursing practice. Content is critically appraised and the most relevant articles are summarised into succinct expert commentaries, focusing on the papers` key findings and implications for nursing practice.
Evidence Based Mental Health	BMJ Mental Health (formerly Evidence-Based Mental Health) is an open access, peer reviewed journal publishing evidence-based, innovative research, systematic reviews, and methodological papers in the area of mental health. It facilitates multidisciplinary collaboration among psychiatrists, psychologists and other mental health professionals, encourages debate on clinically relevant topics, and informs real world practice to improve patient and carer outcomes.
Effectiveness Matters	Effectiveness Matters is a summary of reliable research evidence about the effects of important interventions for practitioners and decision makers in the NHS and public health. It is produced by the NIHR Centre for Reviews and Dissemination at the University of York in collaboration with subject area experts. Effectiveness Matters is extensively peer reviewed.

Synthesis
Cochrane Library	Systematic reviews mainly focused on effectiveness and diagnosis. Based on networking, which is grouped in different thematic nodes. Includes other resources, such as RCT registry, manuals, tools, special collections, or systematic review software.
PEDro (the Physiotherapy Evidence Database)	Evidence-Based Physical Therapy database, created by the Center for Evidence-Based Physical Therapy at the George Institute for Global Health. Contains randomized controlled trials, systematic reviews and clinical practice guidelines for Physical Therapy. It incorporates quality assessment of the trials.
Health Services/Technology Assessment Text (HSTAT)	On-line resource of full-text documents that provide health information and decision support in health care. Some of the documents contain evaluation indicators. It refers to different organizations, such as AHRQ or the U.S. Preventive Services Task Force.

Studies (databases)
PubMed	Medline database search engine, which allows simultaneous searches in several sources specialized in systematic reviews. It has applications for Android and IOS.
CINHAL	CINAHL Complete (Cumulative Index to Nursing and Allied Health Literature Complete) is a comprehensive bibliographic database specifically designed for healthcare professionals, researchers, and students in the fields of nursing and allied health disciplines. It covers a wide range of topics related to nursing, physical therapy, occupational therapy, nutrition, public health, alternative and complementary medicine, and many other health-related disciplines.
SciELO	SciELO (Scientific Electronic Library Online) is an electronic library that covers a selected collection of scientific journals from Latin America, the Caribbean, Spain, and Portugal. Its main objective is to provide open access to high-quality scientific literature, promoting the visibility and impact of research produced in these regions.
Health and Psychosocial Instruments (HaPY)	HaPI is a bibliographic database that contains over 240,000 records providing detailed, comprehensive information about behavioral and psychosocial measurement tools for researchers across diverse disciplines and professions. For nearly four decades, HaPI has been the premier instrument database for health and psychological measurement instruments in the fields of medicine, nursing, psychology, public health, social work, communication, and sociology.

Information on search engines, working groups and other interesting resources
Biblioteca Virtual en Salud (OPS – OMS)	Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information (BIREME). It organizes information in a structure that integrates and interconnects databases, directories, decision support resources, full text collections, etc.
The Turning Research into Practice (TRIP) Database	Search engine for quality research evidence. It facilitates the search for other content, such as images, videos, patient information and brochures, training and news. It can include filters by quality, according to the evidence pyramid.
Epistemonikos	Collaborative database to support clinical or health policy decision makers, based primarily on systematic reviews. Epistemonikos is a collaborative, multilingual database of health evidence. It is the largest source of systematic reviews relevant for health-decision making, and a large source of other types of scientific evidence.
Essential Evidence Plus	Comprehensive, evidence-based clinical decision support tool designed primarily for primary care clinicians, hospitalists, and emergency and urgent care physicians. It provides overviews of diseases and symptoms, evidence-graded recommendations, and links to research summaries, Cochrane reviews, diagnostic calculators, and clinical decision support tools. Essentially, it's a resource to help medical professionals make informed decisions at the point of care.
Evidence Alerts	EvidenceAlerts is an Internet service that notifies physicians and researchers about newly-published clinical studies. Researchers at the McMaster Health Information Unit find the highest quality studies, reviews, and evidence-based clinical practice guidelines from 125 premier clinical journals and these articles are rated by practicing physicians for clinical relevance and interest. Alerts are curated to your own clinical interests.
Centre for Evidence Based Medicine (CEBM)	Training, research and evidence implementation resources. It includes its own classification of levels of evidence and degrees of recommendation for different types of questions and training pills, among others on how to formulate a question for a systematic review
GRADE Working Group	The Grading of Recommendations Assessment, Development and Evaluation (short GRADE) working group began in the year 2000 as an informal collaboration of people with an interest in addressing the shortcomings of grading systems in health care. The working group has developed a common, sensible and transparent approach to grading quality (or certainty) of evidence and strength of recommendations. Many international organizations have provided input into the development of the GRADE approach which is now considered the standard in guideline development.
JBI COnNECT+	JBI COnNECT+ (Clinical Online Network of Evidence for Care and Therapeutics) provides you with easy access to evidence-based resources, making it easy for you to find and use evidence to inform your clinical decision-making.
Evidence-Based Medicine	BMJ Evidence-Based Medicine (BMJ EBM) publishes original evidence-based research, insights and opinions on what matters for health care. We focus on the tools, methods, and concepts that are basic and central to practising evidence-based medicine and deliver relevant, trustworthy and impactful evidence. You can also access us on X, Facebook, and on The BMJ's Talk Evidence podcast.

5.2 Keeping up to date with research

Staying up to date with research is essential for accessing the latest advancements, improving decision-making, and ensuring the relevance of knowledge in a constantly changing world. It enables innovation, enhances academic credibility, and allows adaptation to new needs and challenges in various fields. Continuous updates not only improve the quality of work but also contribute to the generation of ideas and solutions based on the latest evidence (Universidad de Alicante, 2021).

The primary vehicle for the dissemination of scientific advancements is journal articles, making them one of the main sources of information for staying current. Nowadays, many articles can be accessed online before their official publication in a journal, with two types of articles being particularly relevant:

Preprints: Articles that are pending review and have not yet been published in a journal but are available for online consultation.
OnlineFirst: Articles that have already been reviewed and are awaiting formal publication in a journal. These can also be accessed online.

5.2.1 RSS (Really Simple Syndication)

RSS (Really Simple Syndication) is a technology that allows users to subscribe to information resources of interest and view the content of subscribed channels centrally through an RSS reader.

To receive content updates via RSS, two things are required:

Desktop programs installed on your device.
Web browser integrations (e.g., Microsoft Edge, Mozilla Firefox).
Online readers such as Netvibes, Feedly, and Feeder.

Once you have an RSS reader, follow these steps to receive updates:

1. Look for the RSS feed link on the resource’s website (often represented by an RSS icon) and click on it.

2. Copy the RSS feed URL.

3. Paste the URL into your chosen RSS reader. 4. The RSS reader will detect the feed. Click on it and then select "Follow" to subscribe.

From then on, every time you access the RSS reader, you will see the latest updates from the journal without needing to visit its website.

5.2.2 Alerts and subscriptions

Alerts are personalized services that notify users of new content that meets predefined criteria. These notifications are typically sent via email or RSS.

Common types of alerts include:

Journal alerts: Notify users when a new issue of a selected journal is indexed. These are also called subscriptions or table of contents alerts, as they often include the table of contents of the published issue.
Search alerts: Allow users to track specific searches. A predefined search strategy is automatically executed at regular intervals, and new results since the last search are sent to the user.
Citation alerts: Also known as document alerts or cited article alerts, these notify users whenever a particular document receives a new citation.
Author alerts: Notify users when a specific author publishes a new document. This feature is also called author tracking.
Cited author alerts: Notify users when an author’s work is cited by other publications.
Topic or subject alerts: Notify users about new publications in a general field of interest. These alerts are generally discouraged, as they tend to return an overwhelming number of irrelevant results.

5.2.3 Webs, blogs, wikis.

In addition to traditional academic sources such as databases and electronic journal portals, other resources—such as websites, blogs, and wikis—offer more open and collaborative participation.

These sources are usually open access and free. They belong to the so-called Web 2.0 and allow for collective content creation, including posting comments, rating, recommending, and contributing knowledge. While they may be less rigorous than academic sources, they are often more dynamic and versatile.

5.2.4 Academic social networks

Academic social networks are digital platforms designed to connect researchers, increase the visibility of scientific work, and foster collaboration and knowledge exchange.

These platforms allow users to:

Create a personal profile to share publications.
Connect with professionals working on similar projects.
Access and follow specialists in their field.

The two most widely used academic social networks are:

ResearchGate

Academia.edu

To stay up to date with new publications, users can activate email notifications:

ResearchGate: Navigate to Settings > Emails > Network and enable "Notify me when someone from my network adds research to their profile."
Academia.edu: Go to Account Settings > Email notifications > Your Network and enable "Someone you follow adds a new paper or video."

Academic social networks also feature search engines to locate publications, authors, and institutions. Users can follow specialists by clicking the "Follow" button next to their names, ensuring that their latest work appears in the user's news feed.

5.2.5 Keeping up to date

Scientific news services

Science 2.0. A science news portal with social media features, allowing interaction between registered authors.
ScienceDaily. A scientific information site that aggregates and references scientific news from various sources. Users can subscribe via email or RSS for updates on specific topics.

Appointment alerts

Google Scholar. A search engine for academic publications and citations. It allows users to track citations and receive alerts when their work is cited.
Web of Science. A specialized database that tracks citation counts for research publications. Users can create citation alerts after registering.
Scopus. A multidisciplinary database that indexes citations from 1996 onwards. It allows users to set up alerts for when a work or author is cited.

Publication alerts

ScienceDirect. Elsevier's journal portal that allows users to subscribe to publication alerts via RSS or email. Summaries of new journal issues are available without visiting individual journal websites.
Wiley. An example of a publisher that offers newsletter subscriptions via RSS. Most academic publishers offer similar services, allowing users to receive alerts about newly published articles.

Conferences

Conal Conference Alerts. A website listing upcoming conferences categorized by subject, country, and city. Users can set up alerts for conferences in their field of interest.

Keeping up to date with the latest scientific advances is essential for researchers, clinicians, professionals interested in autism, and families alike. Access to updated knowledge not only improves decision-making and academic credibility but also enhances intervention strategies, fosters innovation, and strengthens collaboration within the scientific and professional community. By utilizing tools such as journal alerts, academic social networks, and RSS feeds, it is possible to stay informed efficiently and reliably, ensuring that the most recent evidence informs both research and practice.

Summary of the module

Self-assessment

Question text

Further resources and references

Altogether Autism. (2022). Spotting Bad Science – Warning signs of fake autism therapies. Altogether Autism. https://www.altogetherautism.org.nz/spotting-bad-science-warning-signs-of-pseudoscientific-autism-therapies/

Association for Behavioral and Cognitive Therapies. (2023). What is Evidence-Based Practice? – Get Help. Association for Behavioral and Cognitive Therapies (ABTC). https://www.abct.org/get-help/what-is-evidence-based-practice/

Autism Science Foundation. (2023). Beware of Non-Evidence-Based Treatments. Autism Science Foundation. https://autismsciencefoundation.org/beware-of-non-evidence-based-treatments/

Cruz, E. (2025). Estrategias para apoyar a estudiantes con trastorno del espectro autista y mejorar su experiencia educativa. Apoyar a estudiantes con trastorno del espectro autista 2025

Fuentes, J., Hervás, A., Howlin, P. et al. (2021). ESCAP practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment. Eur Child Adolesc Psychiatry, 30, 961–984.

Green, L. W., & Glasgow, R. E. (2006). Evaluating the Relevance, Generalization, and Applicability of Research: Issues in External Validation and Translation Methodology. Evaluation & the Health Professions, 29(1), 126-153.

Green L. W, Kreuter MW. (2005). Health Promotion Planning: An Educational and Environmental Approach. 4th edition. McGraw-Hill Education.

Haynes RB, Haines A. (2002). Barriers and bridges to evidence-based health care practice. BMJ;317:273–276.

Higgins, J. P., & Green, S. (Eds.). (2011). Cochrane Handbook for Systematic Reviews of Interventions (Vol. 4). John Wiley & Sons.

Hume, K., Steinbrenner, J.R., Odom, S.L. et al. (2021) Evidence-Based Practices for Children, Youth, and Young Adults with Autism: Third Generation Review. J Autism Dev Disord 51, 4013–4032 https://link.springer.com/article/10.1007/s10803-020-04844-2

Lai, M. C., Lombardo, M. V., & Baron-Cohen, S. (2014). Autism. Lancet, 383(9920), 896–910. https://doi.org/10.1016/S0140-6736(13)61539-1 Leaf, J. B. (Ed.). (2023). Handbook of Evidence-Based Practices in Autism Spectrum Disorder. Springer. https://link.springer.com/book/10.1007/978-3-031-78143-8

Lyra Health. (2022). What is evidence-based therapy? https://www.lyrahealth.com/blog/what-is-evidence-based-practice-and-why-is-it-important/

Mlodinow, L. (2008). The drunkard’s walk: How randomness rules our lives. Pantheon Books.

NHS. (2022). Treatments that are not recommended for autism. National Health Service England (NHS). https://www.nhs.uk/conditions/autism/autism-and-everyday-life/treatments-that-are-not-recommended-for-autism/

Pinos López, M. L., & Merinero Santos, M. (2023). Importancia de la evidencia científica en las prácticas aplicadas en el abordaje del autismo. Centro Español sobre Trastorno del Espectro del Autismo. https://centroautismo.es/wp-content/uploads/2024/01/InformeTecnico_ImportanciaEvidenciaCientifica_CentroAutismo.pdf

Pluye P., Potvin L., Denis J.L. (2004) Making Public Health Programs Last: Conceptualizing Sustainability. Eval Program Plann,27(2): 121-133.

Reichow, B., Barton, E. E., Boyd, B. A., & Hume, K. (2012). Early Intensive Behavioral Intervention (EIBI) for Young Children with Autism Spectrum Disorders (ASD). Cochrane Database of Systematic Reviews, 10.

Rychetnik, L., Frommer, M., Hawe, P., & Shiell, A. (2002). Criteria for Evaluating Evidence on Public Health Interventions. Journal of Epidemiology & Community Health, 56(2), 119-127.

Ratnani I, Fatima S, Abid MM, Surani Z, Surani S. Evidence-Based Medicine: History, Review, Criticisms, and Pitfalls. Cureus. 2023 Feb 21;15(2):e35266. doi: 10.7759/cureus.35266. PMID: 36968905; PMCID: PMC10035760.

Universidad de Alicante. (2021). Mantenerse al día en información científica. https://rua.ua.es/dspace/bitstream/10045/113497/10/Mantenerse_actualizado_Investigacion_Educativa_Doctorado_2020_21.pdf

Warren, Z., McPheeters, M. L., Sathe, N., Foss-Feig, J. H., Glasser, A., & Veenstra-VanderWeele, J. (2011). A Systematic Review of Early Intensive Intervention for Autism Spectrum Disorders. Pediatrics, 127(5), e1303-e1311.

Extra resources:

National Institute for Health and Care Excellence (NICE). (2014). Developing NICE Guidelines: The Manual. National Institute for Health and Care Excellence (NICE).

World Health Organization. (2014). Handbook for Guideline Development. World Health Organization.

Package of interventions for rehabilitation. Module 5. Neurodevelopmental disorders. Geneva: World Health Organization; 2023 (Package of interventions for rehabilitation). Licence: CC BY-NC-SA 3.0 IGO.

Glossary of terms

1. Academic Social Networks: Digital platforms that facilitate connection and collaboration among researchers, helping to disseminate their publications and exchange knowledge. Examples include ResearchGate and Academia.edu.

2. Adaptive Behavior: Skills necessary for daily life, such as communication, self-care, and problem-solving, that allow autistic individuals to function independently. Improving adaptive behaviors is a primary focus of therapeutic interventions.

3. Alerts: Personalized services that send notifications periodically about new publications that meet pre-selected criteria.

4. Analysis of evidence: The process of reviewing and evaluating scientific data to determine the effectiveness of an intervention.

5. Author Alerts: Notifications sent when a specific author publishes a new paper.

6. Blinding: A research method in which participants and/or investigators do not know which treatment is being administered to avoid bias in study results.

7. Case Studies: Research methods involving in-depth examination of a single subject or a small group to explore specific phenomena.

8. Cited Author Alerts: Notifications that inform you about citations of an author's work by other researchers.

9. Citation Alerts: Notifications sent when a document is cited by other research papers.

10. Clinical Practice Guidelines: Evidence-based recommendations developed by expert committees to guide the treatment and management of medical conditions.

11. Clinical protocols: A set of evidence-based guidelines designed to standardize and optimize medical care.

12. Control Group: A group in a study that does not receive the intervention being tested, used as a baseline for comparison.

13. Correlation vs. Causation: The distinction between two variables appearing related (correlation) and one directly causing the other (causation).

14. Cost-Benefit Ratio: The assessment of whether the benefits of an intervention outweigh its financial and resource costs.

15. Daily Living Skills: Essential skills needed for independence, such as self-care, decision-making, and time management. Interventions aim to enhance these skills to improve the individual’s quality of life and ability to function independently.

16. Developmental Framework: A reference system used to assess and understand an individual's skills and behaviors in relation to typical developmental stages.

17. Double-Blinding: A research method where neither the participants nor the researchers know who is receiving the actual treatment, preventing bias.

18. Early Support: Interventions provided at an early stage to enhance parental confidence and child development while minimizing future difficulties.

19. Empirical Evidence: Information obtained through systematic observation, experimentation, and data collection, considered more reliable than anecdotal evidence.

20. Empirical evidence: Information obtained through rigorous observation and experimentation in scientific studies.

21. Efficacy: The ability of an intervention to produce the desired outcome under controlled conditions.

22. Efficiency: The relationship between the benefits obtained from an intervention and the resources used for its implementation.

23. Evidence-based intervention: A practice or treatment supported by rigorous scientific studies that demonstrate its effectiveness.

24. Evidence-based therapies: Treatments supported by scientific research that have been proven effective and safe through rigorous studies.

25. Evidence-Based Interventions: Therapeutic approaches and treatments that have been validated through rigorous scientific studies, showing positive outcomes for autistic individuals.

26. Evidence-Based Practices: Therapies and interventions that have been rigorously evaluated and proven effective through peer-reviewed research and clinical trials. These practices are considered the gold standard in treatment for autism.

27. Expert Opinions: Insights provided by specialists in a field, often based on experience rather than empirical research.

28. Functional Assessment of Behavior: A systematic process used to understand the purpose and context of specific behaviors, enabling the development of effective intervention strategies tailored to the individual’s needs.

29. Functional Analysis: An approach to understanding behavior by identifying its underlying causes and finding effective ways to address them.

30. Generalization of Learning: The ability to apply newly learned skills across different environments and contexts. Interventions focus on ensuring that individuals can use skills gained in therapy or structured settings in everyday life.

31. GRADE (Grading of Recommendations, Assessment, Development, and Evaluation): A system for grading the quality of evidence and the strength of recommendations in clinical practice.

32. High-quality evidence: Data from well-designed studies, such as randomized clinical trials or meta-analyses, with a low risk of bias.

33. Hierarchy of Evidence: A ranking system used to classify research studies based on their scientific rigor and reliability.

34. Intervention: A treatment or support strategy designed to improve the well-being and development of autistic individuals.

35. Inclusion and Accessibility: Strategies and practices aimed at ensuring full participation of individuals with autism in society by removing barriers.

36. Limited evidence: Scientific information that is inconclusive due to methodological limitations or a lack of high-quality studies.

37. Meta-Analysis: A statistical method that combines the results of multiple studies to derive a comprehensive conclusion about an intervention’s effectiveness.

38. Multidimensional and Coordinated Action: The integration of various sectors (health, education, social services) to provide comprehensive support for autistic individuals.

39. Multidisciplinary Program: A treatment approach that involves collaboration among various professionals (e.g., therapists, educators, medical experts) to provide comprehensive care for autistic individuals, addressing their unique needs from multiple perspectives.

40. Non-Evidence-Based Interventions: Approaches or therapies that lack scientific validation and have not been proven through controlled research to be effective. These methods may still be promoted for autism treatment but carry potential risks due to the absence of reliable evidence supporting their efficacy.

41. Onlinefirst: Articles that have been reviewed and accepted for publication but have not yet been formally published in a journal. These articles are also available online.

42. Parent Involvement: The active participation of family members in the therapeutic process. Research suggests that parent involvement enhances treatment outcomes by providing consistent support, reinforcing skills at home, and advocating for the individual’s needs.

43. Placebo Effect: A phenomenon where individuals perceive improvements due to their belief in a treatment, rather than the treatment’s actual effect.

44. Preprints: Scientific articles that are pending peer review and have not yet been published in a journal but are available for online consultation.

45. Pseudoscience: Claims or therapies that are presented as scientific but lack empirical evidence or proper testing. These interventions often lack credible research and may pose risks to individuals’ health and well-being.

46. Randomized Controlled Trial (RCT): A type of study where participants are randomly assigned to different groups to test the effectiveness of an intervention under controlled conditions.

47. Regulatory Authorities: Organizations such as the FDA (Food and Drug Administration) and EMA (European Medicines Agency) that evaluate and approve treatments, ensuring their safety and efficacy. Approval from these authorities provides some assurance about a treatment’s quality.

48. Replication: The process of repeating a study to verify its findings and ensure reliability across different populations and settings.

49. RSS (Really Simple Syndication): A technology that allows users to subscribe to information resources and receive updates through an RSS reader. Readers can be desktop programs or online services, such as Netvibes, Feedly, and Feeder.

50. RSS Readers: Programs that allow users to follow and manage RSS channels. These can be desktop applications, browser-integrated, or online services.

51. Sample Size: The number of participants in a study; larger samples generally provide more reliable results.

52. Scientific basis: A set of studies and verifiable proof that support the validity of an intervention or treatment.

53. Scientific evidence: Knowledge derived from empirical studies and systematic reviews that support a practice or treatment.

54. Scientific Validation: The process of proving a therapy or intervention's effectiveness through rigorous and controlled scientific research, ensuring that it produces consistent, reliable results.

55. Sensory Environment: The surroundings that impact an individual’s sensory experiences, such as noise, lighting, and spatial arrangement.

56. Sensory Protection: Strategies aimed at minimizing overwhelming or distracting stimuli for individuals with sensory sensitivities. This can include controlling noise, light, and other environmental factors to provide comfort and reduce anxiety.

57. SIGN (Scottish Intercollegiate Guidelines Network): A system that classifies the quality of evidence in medical studies and issues recommendations based on methodological robustness.

58. Social Inclusion: The practice of integrating autistic individuals into mainstream social, educational, and occupational settings.

59. Social Stories: Short, personalized narratives used to teach autistic individuals how to navigate social situations, helping them understand social cues, expectations, and appropriate behaviors.

60. Statistical Significance: A measure indicating whether study results are likely due to the tested intervention rather than random chance.

61. Strengths-Based Approach: A method that focuses on identifying and leveraging an individual’s abilities rather than solely addressing weaknesses.

62. Structured Learning Environment: An educational setting that provides clear expectations, routines, and visual support to help autistic individuals to understand and engage with the material. Structure can reduce anxiety and improve focus and learning.

63. Systematic analysis: A research method that collects and synthesizes existing studies on a specific topic to draw evidence-based conclusions.

64. Systematic review: A study that critically analyzes the scientific literature on a specific topic to synthesize findings in a structured manner.

65. Therapeutic approaches: Evidence-based treatments and interventions that have been proven effective for autistic individuals.

66. Topic or Subject Alerts: Notifications about new publications in a specific field of interest, though these can be too general at times.

67. Transition Support: The provision of assistance during significant life transitions, such as from childhood to adolescence, or from school to work, to ensure that autistic individuals receive the support needed to adapt and thrive in new environments.

68. Variability in treatments: Differences in the application and outcomes of an intervention due to individual, methodological, or contextual factors.

69. Visual Communication Strategies: Techniques that use images, symbols, or gestures to enhance communication, particularly for individuals with limited verbal skills.

70. Visual Supports: Tools such as charts, schedules, and graphic organizers used to help autistic individuals to understand tasks, routines, and expectations. These supports are essential in creating a predictable and organized environment.

71. Wiley: A publisher offering the option to subscribe to traditional newsletters via RSS channels. Most publishers provide this service to create profiles for subjects of interest and receive alerts for new titles.

MODULE 2: How to identify evidence-based interventions