Evidenced-Based Practice: Autism Management in Children Qualitative Research

Introduction

Sackett et al (1996) defined Evidenced-based practice (EBP) based on medicine as, “the conscientious, explicit, and judicious use of current best evidence based in making decisions about the care of individual patience, furthermore EBP involves integrating individual clinical expertise with the best available external clinical evidence from systematic research” (cited in Social Work Resources, 2010).

Individual clinical expertise constitutes those adeptness and judgmental aspects a professional clinician builds over time as a result of field experience and practice.

While on the other hand, external clinical evidence constitutes precise research built from the sciences of medicine but reflecting patient-focus clinical research that largely involves, “correct and meticulous diagnostic tests, the power of prognostic markers and the efficacy and safety of therapeutic rehabilitative and preventive regimens” (Social Work Resources, 2010, p.1; Curtin, 2008).

Autism is a disorder that affects a child’s social and communication skills. In many instances, these children have a problem in interpreting the usual messages and signals, experience difficulty in social relationships, have problems in development of play and imagination, always appear resistance to change in routine, and lastly, these children normally demonstrate to possess unique skills and talents in art, music and even science (Autism Reality, 2007).

Demonstrating numerous social problems and with no particular specific medicine available to treat the disorder, this paper tries to answer a question that arises as to how well can Autism children be clinically and ‘socially’ treated based on a communication intervention program in an effort to integrated them properly in the society.

Treating disability based on Evidence-based practice

Debate has persisted for a long time about how mental health problems have manifested themselves in those individuals with different degrees of disability. Broad consensus is that individuals who manifest mild learning disability can be diagnosed by adopting criteria usually used for the general population.

These criteria include, International Classification of Disease-10, adopted by World Health Organization in 1993 and the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) adopted by the American Psychiatrist Association in 1994 (Raghavan and Patel, 2005). These treatments have been a challenge to victims who demonstrate severe to profound learning disabilities.

Individuals with such disabilities have problems that are more individualized in form manifested as behavioral disorder, and for them to have better forms of treatment, there is need for assessment that is qualitative in nature, case study approach using person-centered planning models and behavioral approaches such as functional analysis.

When there is no adequate recognition of the mental health problems specifically to those with learning disabilities, the victims experience major effect on their general well being, personal independence, productivity, and quality of life. At the same time, the family of the victim gets affected together with other caregivers.

When learning disabilities combine with mental ill health, victims may always experience stigmatization and prejudices that sometimes lead to social exclusion. Treatment for the victims has generally involved differential diagnosis of challenging behavior and mental health disorder which in turn has resulted in numerous and serious consequences with regard to understanding the therapeutic needs of these people with disabilities.

Dual diagnosis has become complex and sometimes confusing in nature whereby, various practitioners have not understood the form and types of needs of people with learning disabilities and sometimes who experience mental health disorders (Raghavan and Patel, 2005).

Evidence shows that people with dual diagnosis have intricate needs, which in most cases are poorly identified, and in most cases, these people receive fruitless therapeutic services.

Providing therapeutic care in addressing mental health problems and learning disabilities requires in-depth understanding of the biopsychosocial dimensions of learning disability (Raghavan and Patel, 2005).

This has led to search and identification of a systematic process of identifying needs and providing appropriate interventions to meet the needs. Further, providing care for these people needs to be undertaken with professional integrity, respecting the individuality, rights, and choices of the people.

More so, there is a need for thorough assessment of the problems and needs of the people, and this calls for the use of structured assessment processes using standardized screening tools, interview schedules, rating scales and checklists.

Treating Autism using evidence-based practice

Autism victims demonstrate greater disability with regard to communication skills. They tend to have problem in communication skills, which in general affect their associative social world (Glicken, 2009; Gordon, 2010, p.1). Practitioners adopting and utilizing the broad definition of the EBP have integrated it into communication assessment and intervention for the Autism victims.

In general, EBP process takes place based on the following steps: asks a well-built question; search for research evidence; appraise the evidence; apply the evidence; and evaluate the effectiveness of the application (Matson, 2009; Neville and Horbatt, 2008).

At the same time, to effectively carry out this evidence-based practice process, the practitioner requires to: assess and incorporate stakeholder perspectives into the communication assessments and interventions;

identify and select the most relevant, adequate and effective empirically validated procedures and adapt the procedures to suit the unique elements of individual children; and gain and apply the requisite clinical expertise to effectively apply and evaluate assessment and treatment procedures (Matson 2009; Olszyk 2005).

Evidence-based practice puts much emphasis on incorporating stakeholders’ perspectives in the implementation of assessment and intervention.

Stakeholders in this context include direct stakeholders, who are recipient of the intervention; indirect stakeholders, who may involve family members of the child; immediate stakeholders, comprising peers and teachers; and extended stakeholders, the various people the child may interact with (Matson, 2009).

Incorporating stakeholders plays a significant role in communication intervention since these are the people who constitute the child’s frequent communicative partners. At the same time, inclusion of stakeholders will result into a collaborative interaction between the stakeholders and practitioners in implementing the intervention.

When the participation and commitment of stakeholders is effective, then there is likelihood of experiencing successful treatment outcomes and maintaining treatment gains. Moreover, evidence-based practice advocate for incorporation of stakeholders from the beginning when the intervention process is initiated.

Selection of appropriate target behaviors and negotiation of stakeholders’ involvement during the initial stages of designing communication intervention programs for Autism children is important. Critical decisions to make during this stage include the methods and modes of communication that the child will be taught to use and the initial communicative skills to target for acquisition (Matson, 2009).

In addition, stakeholders need to be taught the full range of speech and non-speech communication modes that include speech, gestures, manual sign, picture communication, and a range of communicative functions that largely involve verbal behavior (Matson, 2009).

Evidence-based practice further requires practitioners to utilize procedures that have precise establishment or that are empirically supported. To do this, the practitioner will need to evaluate the nature of the encountered problem; the time constraints; and the level of expertise. In a communication intervention program of Autism children, EBP postulate that there should be flexible use of well-established techniques.

In selecting the best empirical procedures for the communication intervention program, practitioners are required to select procedures that: suit the child’s unique attributes and characteristics; practitioners should also collect and use learner-generated performance data to determine if the intervention is fruitful; then the practitioner is further required to understand the fundamental principles that underlie the empirically validated procedures(Matson, 2009).

The third aspect of evidence-based practice is that practitioners should utilize relevant educational and clinical expertise in generating and foster an assessment or intervention.

The overall requirement of this element is that practitioners should demonstrate exemplary skills in implementing empirically supported procedures and working within a high degree of treatment fidelity (Matson, 2009). At the same time, practitioners are required to constantly update themselves with the new and emerging evidence that characterize the evidence-based practice.

Conclusion

Autism largely is connected to communication abilities of a child, a situation that later results into the child experiencing disability problems in effectively encoding and decoding communicative messages.

These communicative disabilities further affect the quality of the child’s life. To effectively address this issue, evidence-based practice has come out as the intervention method that appears holistically to address the needs of the Autism children.

Evidence-based practice is seen to integrate the numerous available researches with relevant educational and clinical expertise (Boswell, Gatson, Baker and Vaughn, 2008) without forgetting the key stakeholders in generating effective assessment and intervention decisions that are efficient in treating Autism children.

Reference List

Autism Reality. 2007. AutismPro-“Somewhat” Evidence Based Internet Autism Intervention or Not Evidence Based At All? Web.

Boswell, C., Gatson, Z., Baker, D. and Vaughn, G., 2008. Application of Evidence-Based Practice through a Float Project. Nursing Forum, Vol. 43, No. 3. Web.

Curtin, L. J., 2008. The Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. The Journal of Continuing Education in Nursing, Vol. 39, No. 9. Web.

Glicken, M. D., 2009. Evidence-Based Practice with Emotionally Troubled Children and Adolescents. CA, Academic Press. Web.

Gordon, M., 2010. New program helps autistic students transition into ‘real world’ after high school. McClatchy-Tribune Business News, Washington. Web.

Matson, J. L., 2009. Applied Behavior Analysis for Children with Autism Spectrum Disorders. NY, Springer. Web.

Neville, K. and Horbatt, S., 2008. Evidence-Based Practice: Creating a Spirit of Inquiry to Solve Clinical Nursing Problems. Orthopaedic Nursing, Vol. 27, No. 6. Web.

Olszyk, R. K., 205. Change in symptomatology and functioning of preschoolers with autism in the context of the DIR model. Pace University. Web.

Raghavan, R. and, Patel, P., 2005. Learning disabilities and mental health: a nursing perspective. Wiley-Blackwell. Web.

Social Work Resources. (2010). Evidenced Based Practice. Web.