Interventions for Students With Autism in Inclusive Settings: A Best-Evidence Synthesis and Meta-Analysis

Authors

• Laci Watkins: The University of Alabama

• Katherine Ledbetter-Cho: The University of Texas at Austin

• Mark O’Reilly: The University of Texas at Austin

• Lucy Barnard-Brak: The University of Alabama

• Pau Garcia-Grau: The University of Alabama

Introduction

• Context

  • Students with autism spectrum disorder (ASD) increasingly educated alongside typically developing peers in regular education environments.

  • Impairments hinder success in inclusive school settings necessitating individualized supports.

• Purpose of Meta-Analysis

  • Examine characteristics of interventions for students with ASD in inclusive settings.

  • Provide quantitative analysis of intervention effects.

  • Explore moderating variables that influence outcomes.

  • Analyze social validity of these interventions.

  • Provide practice and future research recommendations.

• Study Inclusion

  • 28 studies met What Works Clearinghouse standards for group and single-case design research.

Key Findings

1. Focus of Included Studies

   • Primarily on social communication skills.

   • Interventions produced moderate to large effects and were considered socially valid.

2. Types of Effective Interventions

   • Function-based interventions, visual supports, self-monitoring strategies, peer-mediated interventions.

   • Teacher-delivered interventions produced the largest overall effects.

3. Recommendations

   • High-quality studies needed for advancing evidence-based practice for students with ASD.

Public Significance Statement

• Implications

  • Strong results from targeted interventions for students with autism in inclusive classrooms.

  • Feasibility for implementation in inclusive settings.

  • Future studies should consider training teachers, targeting additional skills, and focusing on students with diverse characteristics.

Prevalence and Policy

• Prevalence Statistics

  • ASD diagnoses increasing worldwide.

  • In the U.S., 1 in 59 school-age children diagnosed with ASD (Baio et al., 2018).

  • Education mandated by the Individuals with Disabilities Education Act (IDEA) to educate students with ASD alongside typically developing peers.

• Support for Inclusion

  • Support from international frameworks (e.g., Salamanca Statement, World Declaration on Education for All).

  • Need to address barriers for students with ASD in inclusive settings and implement evidence-based interventions.

Theoretical Background

• Challenges for Students with ASD

  • Social communication deficits hinder interactions and participation.

  • Restricted and repetitive behaviors can negatively impact relationships and academic achievement.

  • Challenging behaviors (e.g., aggression, elopement) may limit successful inclusion.

Evidence-Based Practices Definition and Previous Reviews

• Evidence-Based Practices for ASD

  • Organizations recognized 27 evidence-based practices for ASD (Wong et al., 2015).

  • Previous reviews lacked focus on inclusive settings or quantitative analysis of interventions.

Meta-analysis Aims

• Aims

  • Characterize interventions used in inclusive settings.

  • Report effect sizes and analyze intervention outcomes.

  • Examine moderating variables influencing outcomes.

  • Analyze social validity indicators.

  • Provide future practice and research recommendations.

Method

• Protocol Registration

  • Registered with PROSPERO (Watkins & O’Reilly, 2016).

  • Conducted according to PRISMA guidelines (Moher et al., 2009).

• Search Procedures

  • Databases: PsycINFO, ERIC, Medline with terms searching for interventions for ASD in inclusive settings.

  • Inclusion criteria (published 1997-2017, peer-reviewed studies).

  • Initial record count: 1,585; 126 screened; 84 accessed; 28 included in meta-analysis.

Inclusion Criteria

• Studies must:

  • Conduct focused interventions in inclusive school settings.

  • Target skill-based or behavioral outcomes for diagnosed students with ASD (age 3-21).

  • Utilize experimental research design demonstrating methodological rigor.

Data Extraction

• Study Characteristics

  • Data collected on: research design, participant demographics, intervention agents, types, procedures, effectiveness, social validity.

Results

1. Participant Characteristics

   • 293 students with ASD: predominantly male (83%); most were elementary school age (83%).

   • Ethnic distribution: mainly Caucasian (49%), followed by Hispanic/Latino (17%), Asian (15%), African American (8%).

2. Settings and Intervention Dosage

   • Locations: classroom (n=18), playground/schoolyard (n=12), cafeteria (n=5).

   • Treatment intensity varied; most studies used 3-4 hours total.

3. Intervention Agents

   • Predominantly teachers (32%) or combinations of researchers and peers.

4. Effectiveness

   • Average effects across skill domains were noted; most intervention types generated large effects.

   • Function-based interventions showed superior outcomes.

Social Validity Indicators

• Majority of studies (89%) demonstrated social validity, supporting practical relevance and effectiveness of interventions used.

Conclusions

• Implications

  • Function-based interventions are highly effective; teacher delivery is essential.

  • More rigorous interventions needed that extend beyond social communication skills to academic and adaptive behaviors.

  • Highlighted need for diverse participant inclusion and for interventions to be perceived as socially valid.

Limitations

• Consider diversity in studies to prevent skewed results; issues regarding reliance on U.S.-based guidelines.

• Caution noted due to small study numbers and specific focus of included research.