De-implementation of Low-Value Practices for Autism Spectrum Disorder

Area of Science:

• Clinical Psychology
• Implementation Science
• Neurodevelopmental Disorders

Background:

• Autism Spectrum Disorder (ASD) is disproportionately associated with low-value practices (LVP) compared to other neurodevelopmental conditions.
• Despite increased availability of empirically supported treatments (EST) for ASD, the use of LVP has not decreased.
• There is a critical need to not only promote EST but also to de-implement ineffective or harmful practices.

Approach:

• This review outlines a data-driven methodology for identifying LVP in ASD services.
• The approach integrates established criteria for evidence-based treatments (e.g., APA Division 12, SAMHSA) with considerations like social validity, cost, and parsimony.
• A framework from implementation science is used to identify facilitators of LVP persistence.

Key Points:

• A systematic approach is proposed to identify LVP based on empirical evidence and practical considerations.
• Facilitators that contribute to the continued use of LVP in ASD care are identified.
• The review emphasizes the importance of social validity, cost-effectiveness, and parsimony in treatment evaluation.

Conclusions:

• Implementing a data-driven strategy is crucial for identifying and subsequently de-implementing LVP in ASD services.
• Understanding the factors that sustain LVP is essential for developing effective de-implementation strategies.
• The ultimate goal is to improve the quality of care and service access for autistic individuals by prioritizing evidence-based interventions.