Unsubstantiated Interventions for Autism Spectrum Disorder

  • Yannick A. SchenkEmail author
  • Ryan J. Martin
  • Whitney L. Kleinert
  • Shawn P. Quigley
  • Serra R. Langone


Autism spectrum disorder (ASD) is characterized by deficits in communication and social interactions, as well as repetitive patterns of behavior (American Psychiatric Association [APA], Diagnostic and statistical manual of mental disorders (5th ed). American Psychiatric Association, Washington, DC, 2013). Much effort has been invested into identifying the etiology of, and effective treatments for, ASD. Although many treatments are available to individuals with ASD, only some are based on sufficient scientific research to be considered evidence-based (Offit, Autism’s false prophets: Bad science, risky medicine, and the search for a cure, Columbia University Press, New York, NY, 2008). Thus, there exists a need to make a distinction between evidence-based and unsubstantiated treatments. Unsubstantiated interventions for ASD are characterized by weak methodological rigor, and poorly defined procedures and measures, and generally have insufficient or no supporting evidence for their effectiveness. Many factors help explain why caregivers sometimes pursue unsubstantiated interventions, and it is our responsibility as health service providers and educators to advocate for caregivers and inform them of the benefits of selecting evidence-based interventions for their children. This chapter reviews the defining features of evidence-based practice and contrasts characteristics of unsubstantiated treatments. Additionally, we review factors that may lead caregivers to choose treatments that lack evidence, provide resources to help caregivers and practitioners recognize and select efficacious interventions, and describe three case reviews of common unsubstantiated treatments to illustrate key limitations that impact the believability of their efficacy.


Autism spectrum disorder Unsubstantiated interventions Evidence-based interventions 


  1. Aljadeff-Abergel, E., Schenk, Y., Walmsley, C., Peterson, S. M., Frieder, J. E., & Acker, N. (2015). The effectiveness of self-management interventions for children with autism—A literature review. Research in Autism Spectrum Disorders, 18, 34–50.Google Scholar
  2. Allen, K. D., & Warzak, W. J. (2000). The problem of parental nonadherence in clinical behavior analysis: Effective treatment is not enough. Journal of Applied Behavior Analysis, 33(3), 373–391.PubMedPubMedCentralGoogle Scholar
  3. Altiere, M. J., & von Kluge, S. (2009). Searching for acceptance: Challenges encountered while raising a child with autism. Journal of Intellectual and Developmental Disability, 34(2), 142–152.PubMedGoogle Scholar
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  5. Anderson, C. M., Martin, R. J., & Haynes, R. D. (2017). Supporting students with autism spectrum disorder in rural schools. In Handbook of rural school mental health (pp. 213–230). Basel, Switzerland: Springer International Publishing.Google Scholar
  6. Ayers, A. J. (1972a). Sensory integration and the child. Los Angeles: Western Psychological Services.Google Scholar
  7. Ayers, A. J. (1972b). Sensory integration and learning disorders. Los Angeles: Western Psychological Services.Google Scholar
  8. Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1(1), 91–97.PubMedPubMedCentralGoogle Scholar
  9. Bailey, J. S. (1992). Gentle teaching: Trying to win friends and influence people with euphemism, metaphor, smoke, and mirrors. Journal of Applied Behavior Analysis, 25, 879–883.PubMedPubMedCentralGoogle Scholar
  10. Barton, E. E., Reichow, B., Schnitz, A., Smith, I. C., & Sherlock, D. (2014). A systematic review of sensory-based treatment for children with disabilities. Research in Developmental Disabilities, 37, 64–80.PubMedGoogle Scholar
  11. Bauman, M. L. (2010). Medical comorbidities in autism: Challenges to diagnosis and treatment. Neurotherapeutics, 7(3), 320–327.PubMedPubMedCentralGoogle Scholar
  12. Behavior Analyst Certification Board [BACB]. (2014). Behavior analyst certification board guidelines for responsible conduct for behavior analysts. Retrieved from Google Scholar
  13. Borgi, M., Loliva, D., Cerino, S., Chiarotti, F., Venerosi, A., Bramini, M., & Cirulli, F. (2015). Effectiveness of a standardized equine-assisted therapy program for children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(1), 1–9. Google Scholar
  14. Bundy, A. C., Land, S. J., & Murray, E. A. (2002). Sensory integration: Theory and practice (2nd ed.). Philadelphia, PA: F. A. Davis Company.Google Scholar
  15. Carlon, S., Stephenson, J., & Carter, M. (2014). Parent reports of treatments and interventions used with children with Autism Spectrum Disorders (ASD): A review of the literature. Australian Journal of Special Education, 38(1), 63–90. Google Scholar
  16. Carr, J. E., & Briggs, A. M. (2010). Strategies for making regular contact with the scholarly literature. Behavior Analysis in Practice, 3(2), 13–18.PubMedPubMedCentralGoogle Scholar
  17. Case-Smith, J., Weaver, L. L., & Fristad, M. A. (2014). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism, 18, 1–16.Google Scholar
  18. Center for Disease Control and Prevention. (2016a). Autism Spectrum Disorder (ASD): Data and statistics. Retrieved from
  19. Center for Disease Control and Prevention. (2016b). Autism Spectrum Disorder (ASD): Facts about ASD. Retrieved from
  20. Center for Disease Control and Prevention. (2016c). Key findings from the ADDM Network: A snapshot of Autism Spectrum Disorder. Retrieved from
  21. Centers for Disease Control and Prevention [CDC]. (2018). Prevalence of autism spectrum disorder among children aged 8 years – Autism and developmental disabilities monitoring network, 11 sites, United States, 2014. Morbidity and Mortality Weekly Report Surveillance Summaries, 67(6), 1–23.Google Scholar
  22. Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Crits-Christoph, P., … Johnson, S. B. (1998). Update on empirically validated therapies, II. The Clinical Psychologist, 51(1), 3–16.Google Scholar
  23. Chandler, C. K. (2005). Animal assisted therapy in counseling. New York: Routledge.Google Scholar
  24. Christensen, D. L., Baio, J., Braun, K. V., Van Naarden Braum, K., Bilder, D., Charles, J., … Yeargin-Allsopp, M. (2016). Prevalence and characteristics of Autism Spectrum Disorder among children aged 8 years: Autism and developmental disabilities monitoring network, 11 Sites, United States, 2012. Morbidity and Mortality Weekly Report. Surveillance Summaries, 65, 1–23. PubMedGoogle Scholar
  25. Christon, L. M., Mackintosh, V. H., & Myers, B. J. (2010). Use of complementary and alternative medicine (CAM) treatments by parents of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 4(2), 249–259.Google Scholar
  26. Cochrane, A. L. (1972). Effectiveness and efficiency: Random reflections on health services. London: Nuffield Provincial Hospitals Trust.Google Scholar
  27. Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Pearson Education, Inc..Google Scholar
  28. Cullen, C., & Mudford, O. C. (2005). Gentle teaching. In J. W. Jacobson, R. M. Foxx, & J. A. Mulick (Eds.), Controversial therapies for developmental disabilities: Fad, fashion, and science in professional practice (pp. 423–432). New York: Routledge.Google Scholar
  29. Cuvo, A. J. (1992). Gentle teaching: On the one hand … but on the other hand. Journal of Applied Behavior Analysis, 25, 873–877.PubMedPubMedCentralGoogle Scholar
  30. Dardennes, R. M., Al Anbar, N. N., Prado-Netto, A., Kaye, K., Contejean, Y., & Al Anbar, N. N. (2011). Treating the cause of illness rather than the symptoms: Parental causal beliefs and treatment choices in autism spectrum disorder. Research in Developmental Disabilities, 32(3), 1137–1146.PubMedGoogle Scholar
  31. Doshi-Velez, F., Ge, Y., & Kohane, I. (2014). Comorbidity clusters in autism spectrum disorders: An electronic health record time-series analysis. Pediatrics, 133(1), 54–63.Google Scholar
  32. Duarte, C. S., Bordin, I. A., Yazigi, L., & Mooney, J. (2005). Factors associated with stress in mothers of children with autism. Autism, 9(4), 416–427.PubMedGoogle Scholar
  33. Engber, D., (2015, October 20). The strange case of Anna Stubblefield. The New York Times Magazine. Retrieved from
  34. Fung, S. C., & Leung, A. S.-M. (2014). Pilot study investigating the role of therapy dogs in facilitating social interaction among children with autism. Journal of Contemporary Psychotherapy, 44(4), 253–262. Google Scholar
  35. Gabriels, R. L., Zhaoxing, P., DeChant, B., Agnew, J. A., Brim, N., & Mesibov, G. (2015). Randomized controlled trial of therapeutic horseback riding in children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 55(7), 541–549. Google Scholar
  36. Goin-Kochel, R. P., Mackintosh, V. H., & Myers, B. J. (2009). Parental reports on the efficacy of treatments and therapies for their children with autism spectrum disorders. Research in Autism Spectrum Disorders, 3(2), 528–537.Google Scholar
  37. Green, G. (2011). Early intensive behavior analytic intervention for Autism Spectrum Disorder. In E. A. Mayville & J. A. Mulick (Eds.), Behavioral foundation of effective autism treatment. New York: Sloan Publishing.Google Scholar
  38. Green, V. A., Pituch, K. A., Itchon, J., Choi, A., O’Reilly, M., & Sigafoos, J. (2006). Internet survey of treatments used by parents of children with autism. Research in Developmental Disabilities, 27(1), 70–84.PubMedPubMedCentralGoogle Scholar
  39. Grigore, A. A., & Rusu, A. S. (2014). Interaction with a therapy dog enhances the effects of social story method in autistic children. Society & Animals, 2014, 241–261. Google Scholar
  40. Hall, S. E., & Riccio, C. A. (2012). Complementary and alternative treatment use for autism spectrum disorders. Complementary Therapies in Clinical Practice, 18(3), 159–163.PubMedGoogle Scholar
  41. Hess, K. L., Morrier, M. J., Heflin, L. J., & Ivey, M. L. (2008). Autism treatment survey: Services received by children with Autism Spectrum Disorders in public school classrooms. Journal of Autism and Developmental Disorders, 38, 961–971.PubMedGoogle Scholar
  42. Howard, J. S. (2014, November). Comparisons of intensive behavior analytic and eclectic interventions for young children with autism: Findings and implications. Presentation delivered during a colloquium at Western Michigan University, Kalamazoo, MI.Google Scholar
  43. Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359–383.PubMedPubMedCentralGoogle Scholar
  44. Howard, J. S., Stanislaw, H., Green, G., Sparkman, C. R., & Cohen, H. G. (2014). Comparison of behavior analytic and eclectic early interventions for young children with autism after three years. Research in Developmental Disabilities, 35(12), 3326–3344.PubMedGoogle Scholar
  45. Jacobson, J. W., Mulick, J. A., & Schwartz, A. A. (1995). A history of facilitated communication: Science, pseudoscience, and antiscience science working group on facilitated communication. American Psychologist, 50(9), 750.Google Scholar
  46. Johnson, R. A., Danis, M., & Hafner-Eaton, C. (2014). US state variation in autism insurance mandates: Balancing access and fairness. Autism, 18(7), 803–814.PubMedPubMedCentralGoogle Scholar
  47. Jones, R. S. P., & McCaughey, R. E. (1992). Gentle teaching and applied behavior analysis: A critical review. Journal of Applied Behavior Analysis, 25, 853–867.PubMedPubMedCentralGoogle Scholar
  48. Jones, R. S. P., McCaughey, R. E., & Connell, E. M. (1991). The philosophy and practice of gentle teaching: Implications for mental handicap services. The Irish Journal of Psychology, 12(1), 1–16.Google Scholar
  49. Karst, J. S., & Van Hecke, A. V. (2012). Parent and family impact of autism spectrum disorders: A review and proposed model for intervention evaluation. Clinical Child and Family Psychology Review, 15(3), 247–277.PubMedGoogle Scholar
  50. Kelly, B., & Stone, J. (1989). Gentle teaching in the classroom. Entourage, 4, 15–19.Google Scholar
  51. Kratochwill, T. R., Hitchcock, J., Horner, R. H., Levin, J. R., Odom, S. L., Rindskopf, D. M., & Shadish, W. R. (2010). Single-case designs technical documentation. In what works clearinghouse: Procedures and standards handbook (version 1.0). Retrieved from
  52. Krskova, L., Talarovicova, A., & Olexova, L. (2010). Guinea pigs: The “small great” therapist for autistic children, or do Guinea pigs have positive effects on autistic child social behavior? Society and Animals, 18, 139–151. Google Scholar
  53. Kruger, K. A., & Serpell, J. A. (2010). Animal-assisted interventions in mental health: Definitions and theoretical foundations. In A. H. Fine (Ed.), Handbook on animal-assisted therapy: Theoretical foundations and guidelines for practice (3rd ed., pp. 33–48). San Diego: Academic Press.Google Scholar
  54. Lang, R., O’Reilly, M., Healy, O., Rispoli, M., Lydon, H., Streusand, W., … Didden, R. (2012). Sensory integration therapy for autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders, 6(3), 1004–1018.Google Scholar
  55. Lilienfeld, S. O. (2005). Scientifically unsupported and supported interventions for childhood psychopathology: A summary. American Academy of Pediatrics, 115(3), 761–764.Google Scholar
  56. McGee, J. (1990). Gentle teaching: The basic tenet. Mental Handicap Nursing, 86, 68–72.Google Scholar
  57. McGee, J. (n.d.) Mending broken hearts. Retrieved from
  58. MdYusof, M. S. B., & Chia, N. K. H. (2012). Dolphin encounter for special children (DESC) program: Effectiveness of dolphin-assisted therapy for children with autism. International Journal of Special Education, 27(3), 54–67.Google Scholar
  59. Miller, V. A., Schreck, K. A., Mulick, J. A., & Butter, E. (2012). Factors related to parents’ choices of treatments for their children with autism spectrum disorders. Research in Autism Spectrum Disorders, 6(1), 87–95.Google Scholar
  60. National Autism Center [NAC]. (2009/2015). National standards report: The national standards project. Retrieved from
  61. National Autism Center [NAC]. (2011). A parent’s guide to evidence-based practice and autism. Retrieved from
  62. Nimer, J., & Lundahl, B. (2007). Animal-assisted therapy: A meta-analysis. Anthrozoös, 20(3), 225–238. Google Scholar
  63. O’Haire, M. E. (2013). Animal-assisted intervention for autism spectrum disorder: A systematic literature review. Journal of Autism and Developmental Disorders, 43, 1606–1622. PubMedGoogle Scholar
  64. O’Haire, M. E. (2017). Research on animal-assisted intervention and autism spectrum disorder, 2012–2015. Applied Developmental Science, 21(3), 1–17. Google Scholar
  65. Odom, S. L., Collet-Klingenberg, L., Rogers, S. J., & Hatton, D. D. (2010). Evidence-based practices in interventions for children and youth with autism spectrum disorders. Preventing School Failure: Alternative Education for Children and Youth, 54(4), 275–282.Google Scholar
  66. Offit, P. A. (2008). Autism’s false prophets: Bad science, risky medicine, and the search for a cure. New York, NY: Columbia University Press.Google Scholar
  67. Otte, L. F., Quigley, S. P., Field, S. P., Weiss, M. J., Zane, T. L., & Peterson, S. M. (in press). A review of gentle teaching as a therapeutic approach. Education and Treatment of Children.Google Scholar
  68. Parish, S. L., Thomas, K. C., Williams, C. S., & Crossman, M. K. (2015). Autism and families’ financial burden: The association with health insurance coverage. American Journal on Intellectual and Developmental Disabilities, 120(2), 166–175.PubMedGoogle Scholar
  69. Pituch, K. A., Green, V. A., Didden, R., Lang, R., O’Reilly, M. F., Lancioni, G. E., & Sigafoos, J. (2011). Parent reported treatment priorities for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 135–143.Google Scholar
  70. Quigley, S. P., Peterson, L. D., Frieder, J. E., & Peterson, S. M. (2009). Effects of a weighted vest on problem behaviors during functional analyses in children with pervasive developmental disorders. Research in Autism Spectrum Disorders, 5, 529–538.Google Scholar
  71. Rao, T. S. S., & Andrade, C. (2011). The MMR vaccine and autism: Sensation, refutation, retraction, and fraud. Indian Journal of Psychiatry, 53(2), 95–96. PubMedPubMedCentralGoogle Scholar
  72. Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence-based medicine: What it is and what it isn’t. British Medical Journal, 3(12), 71–72. Google Scholar
  73. Shermer, M. (2009, December). Baloney detection: How to draw boundaries between science and pseudoscience. Retrieved December 3, 2017 from
  74. Smith, T., & Iadarola, S. (2015). Evidence base update for Autism Spectrum Disorder. Journal of Clinical Child & Adolescent Psychology, 44(6), 897–922.Google Scholar
  75. Spring, B. (2007). Evidence-based practice in clinical psychology: What it is, why it matters; what you need to know. International Journal of Clinical Psychology, 63, 611–631.Google Scholar
  76. Stephenson, J., & Carter, M. (2009). The use of weighted vests with children with autism spectrum disorders and other disabilities. Journal of Autism and Developmental Disorders, 39, 105–114.PubMedGoogle Scholar
  77. Stevenson, K., Jarred, S., Hinchcliffe, V., & Roberts, K. (2015). Can a dog be used as a motivator to develop social interaction and engagement with teachers for students with autism? Support for Learning, 30(4), 341–363. Google Scholar
  78. Stock Kranowitz, C. (1998). The out of since child: Recognizing and coping with the nature of sensory integration with diverse populations. San Antonio, TX: Therapy Skill Builders.Google Scholar
  79. Tomaszewska, K., Bomert, I., & Wilkiewicz-Wawro, E. (2017). Feline-assisted therapy: Integrating contact with cats into treatment plans. Polish Animals of Medicine, 24, 283–286.Google Scholar
  80. van de Siepkamp, P. (2010). An introduction to gentle teaching. Learning Disability Practice, 13(6), 25–27.Google Scholar
  81. Van Houten, R., Axelrod, S., Bailey, J. S., Favell, J. E., Foxx, R. M., Iwata, B. A., & Lovaas, O. I. (1988). The right to effective behavioral treatment. Journal of Applied Behavior Analysis, 21(4), 381–384.PubMedPubMedCentralGoogle Scholar
  82. Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, D. M., Malik, M., … Valentine, A. (1998). RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, 351(9103), P637–P641.Google Scholar
  83. Watling, R., Deitz, J., Kanny, E. M., & McLaughlin, J. F. (1999). Current practice of occupational therapy for children with autism. American Journal of Occupational Therapy, 53, 489–497.Google Scholar
  84. Weinberger, D. (2012). Too big to know: Rethinking knowledge now that the facts aren’t the facts, experts are everywhere, and the smartest person in the room is the room. New York: Basic Books.Google Scholar
  85. What Works Clearinghouse. (n.d.). Children and youth with disabilities. Retrieved from,Children-Youth-with-Disabilities
  86. White, E. (2014). Science, pseudoscience, and the frontline practitioner: The vaccination/autism debate. Journal of Evidence-Based Social Work, 11(3), 269–274.PubMedGoogle Scholar
  87. Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., … Schultz, T. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951–1966. PubMedGoogle Scholar
  88. Wong, H. H., & Smith, R. G. (2006). Patterns of complementary and alternative medical therapy use in children diagnosed with autism spectrum disorders. Journal of Autism and Developmental Disorders, 36(7), 901–909.PubMedGoogle Scholar
  89. Woodgate, R. L., Ateah, C., & Secco, L. (2008). Living in a world of our own: The experience of parents who have a child with autism. Qualitative Health Research, 18(8), 1075–1083.PubMedGoogle Scholar
  90. Zafeiriou, D. I., Ververi, A., & Vargiami, E. (2007). Childhood autism and associated comorbidities. Brain and Development, 29(5), 257–272.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Yannick A. Schenk
    • 1
    Email author
  • Ryan J. Martin
    • 1
  • Whitney L. Kleinert
    • 1
  • Shawn P. Quigley
    • 2
  • Serra R. Langone
    • 1
  1. 1.May InstituteRandolphUSA
  2. 2.MelmarkBerwynUSA

Personalised recommendations