Center for Autism Spectrum Disorders

There is no substitute for knowledge when confronting a complex problem. The information available about Autism Spectrum Disorders is enormous, 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’, (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) 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, (Agency for Healthcare Research and Quality. http://www.ahrq.gov/clinic/epcix.htm), 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
Seeking and insuring quality of goods and services has a very long and colorful history. A classic example of a consumer seeking corroboration of a provider’s claim of quality comes from the 3rd century BC. A request was 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 indeed the crown was not of the quality claimed.
Because of a universal problem of determining accuracy 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 by designating certified providers, such as purveyors to the czar, or purveyors to the queen. This designation recognized proven quality as well as provided clear lines of responsibility if quality should falter.
At the more individual provider level, the hallmark was developed by gold and silver smiths to provide proof of quality and source of production. Consumers were then able to seek out goods that had specific hallmarks that could be used for acquisition decisions. Over time these designations 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 as to quality and value.
With the growth of rapid and widespread communication early in the 20th century, the abuses and dangers of contaminated food products, harmful metals and chemicals in ‘remedies’, created an atmosphere that challenged caveat emptor. The publishing of The Jungle in 1906 by Upton Sinclair, the American author, is often credited as providing a strong impetus for the Pure Food and Drug Act of 1906. The novel portrayed the unsanitary and fraudulent practices in the meat packing industry at the time, and as a quasi investigational journalism piece, it resulted in great public outcry. This 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 making fraudulent claims.
An important figure, Harvey W. Wiley, MD, was a scientist dedicated to consumer safety, prominent in his role beginning in the early 1880’s as a chemist who focused on food purity. The 1906 Act directly influenced the creation of the Food and Drug Administration (FDA), Dr Wiley is regarded as the “Father” of the FDA (http://www.fda.gov/fdac/features/2006/106_wiley.html). He 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 come from many sources: educators, researchers, clinicians, government regulators, insurance companies, and of course consumers. But evidence based practice guidelines are relatively new. The Agency for Health Care Policy and Research (AHCPR) was established in 1997, and is currently designated as the Agency for Healthcare Research and Quality (AHRQ). The AHRQ, is part of the United States Public Health Service and is the primary federal agency involved with health services research. In order to promote evidence-based practice, Evidence-based Practice Centers (EPCs) were established. 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.” (http://www.ahrq.gov/clinic/epc/)
The AHCPR clinical practice guideline methodology uses principles for developing practice guidelines recommended by the U.S. Institute of Medicine (IOM, 1992). This AHCPR methodology is considered to be the standard for developing evidence-based clinical practice guidelines (Eddy, 1995; Holland, 1995; Schriger, 1995; Woolf, 1991; Woolf, 1995). More recently, AHQR has provided guide on judging strength of evidence (West, S., King, V., Carey, T.S., Lohr, K.N., McKoy, N., Sutton, S.F., & Lux, L. (2002). Systems to rate the strength of scientific evidence (AHQR Publication No. 02-E016). Rockville, MD: Agency for Healthcare Research and Quality).