Center for Autism Spectrum Disorders

There is no substitute for knowledge when confronting a complex problem. The information available about Autism Spectrum Disorders is vast, but most of it is simply opinion, often presented as if it were fact. Using an objective, evidenced-based approach provides a powerful method to help us address important human needs. Caring and compassion are the basis for helping others, with knowledge as the essential partner.
The purpose of CASD is to provide assistance using evidence-based approaches, those that have been put to rigorous scientific analysis to provide the consumer with a method to identify useful and proven procedures. We will not provide information nor training on the hundreds of treatments that claim to be effective but do not have methodologically rigorous evidence to support them.

Concept of Evidence-Based Treatment
Only 10 years after the coining of the term ‘evidence-based medicine’ (1), the publication of the American Psychological Association Division 12 Task Force’s report on Empirically Supported Therapies, Division 16 and the National Association of School Psychologists position on evidence-based interventions, and the establishment of the AHCPR guidelines (2), the federal No Child Left Behind (NCLB) Act was enacted into law in 2002. NCLB was enacted in part to require standards for effective educational interventions through the use of Evidence Based Education (EBE). EBE must utilize “research that applies rigorous, systematic and objective procedures to obtain relevant knowledge” (NCLB, 20 USC, 1208(6)).

Historical Perspective
As early as the third century, B.C., consumers were seeking assurance of the quality of goods and services. A classic example is the request made to Archimedes, the philosopher/scientist, by Hiero II, the king of Syracuse in Sicily, to ascertain if a gold crown was indeed all gold as claimed by the goldsmith. The king suspected it had been adulterated with ‘base’ metals, and the deception would thus increase the goldsmith’s profit. By using an analytical approach based in objective research, Archimedes was able to prove that the crown was not of the quality claimed by the goldsmith.
Because of the universal problem of inaccuracy in representation, typified by the warning ‘caveat emptor’ (let the buyer beware), complex moral and legal systems have developed around this issue. Historically, a quality control approach was adopted that designated certified purveyors to the czar or the queen, whose responsibility was to recognize proven quality and provide clear lines of consequence should quality falter. Over time designated hallmarks became more elaborate to include the smith's trademark, standard mark, town mark, date mark and duty mark. This provided the consumer with expanding information regarding the quality and value of consumable goods .
With the rapid growth of communication early in the 20th century, the abuses and dangers of contaminated food products, harmful metals, and chemicals in ‘remedies’, created an atmosphere of further doubt regarding product quality. With the publication of Upton Sinclair's The Jungle in 1906, the unsanitary practices of the meat-packing industry were revealed and resulted in public outcry. Public concern appears to have directly influenced President Teddy Roosevelt to urge Congress to pass the Pure Food and Drug Act of 1906, as well as the Meat Inspection Act of 1906. What followed were efforts to insure accurate labeling of product ingredients as well as some attempts to prohibit sale of products under fraudulent claims.
The 1906 Act directly influenced the creation of the Food and Drug Administration (FDA). Harvey W. Wiley, MD, regarded as the "Father" of the FDA was a scientist dedicated to consumer safety and food purity (3), who pioneered the establishment of a scientific protocol to evaluate the effects of chemicals and additives upon humans.

Current Status
In recent years, guidelines for clinical practice have come from educators, researchers, clinicians, government regulators, insurance companies, and consumers. However, evidence based practice guidelines are relatively new. In 1997, The Agency for Health Care Policy and Research (AHCPR) was established, currently designated as the Agency for Healthcare Research and Quality (AHRQ), as part of the United States Public Health Service and the primary federal agency involved with health services research. In order to promote evidence-based practice, AHRQ established Evidence-based Practice Centers (EPCs). These Centers “… develop evidence reports and technology assessments on topics relevant to clinical, social science/behavioral, economic, and other health care organization and delivery issues—specifically those that are common, expensive, and/or significant” (2).
The AHCPR clinical practice guideline methodology uses principles for developing practice guidelines recommended by the U.S. Institute of Medicine (1992) considered to be the standard for developing evidence-based clinical practice guidelines (4). Also, AHQR has recently provided guidance on judging the strength of evidence to support use of a given intervention or practice (5,6).

References
1. Evidence-Based Medicine Working Group (1992), Evidence-based medicine: A new approach to teaching the practice of medicine. Journal of the American Medical Association, 268, 2420-2425
2. Agency for Healthcare Research and Quality. http://www.ahrq.gov/clinic/epcix.htm
3. FDA. http://www.fda.gov/fdac/features/2006/106_wiley.html
4. Eddy, 1995; Holland, 1995; Schriger, 1995; Woolf, 1991; Woolf, 1995
5. West, King, Carey, Lohr, McKoy, Sutton, & Lux, 2002
6. Systems to rate the strength of scientific evidence (AHQR Publication No. 02-E016. Rockville, MD: Agency for Healthcare Research and Quality).