Autism spectrum disorder (ASD) is one of the most common neurodevelopmental conditions. Recent estimates suggest as many as 1 out of every 50 youth in the United States may be affected (Blumberg et al., 2013 and Kogan et al., 2009). The core ASD symptoms are wide-ranging and can include social-cognitive impairments (e.g., limited theory-of-mind skills), pragmatic language deficits, and repetitive behaviors (e.g., insistence on nonfunctional routines). Youth with ASD often experience significant impairment in adaptive functioning throughout development as a result of the core ASD symptoms (e.g., Howlin, Goode, Hutton, & Rutter, 2004). Most youth with ASD also have comorbid mental health disorders that increase morbidity and stress (e.g., Mannion et al., 2013, Smith and Matson, 2010 and Wood and Gadow, 2010). If untreated, ASD rarely remits over time (Matson and Horovitz, 2010, Matson et al., 2010 and Moss et al., 2008). The great majority of youth diagnosed with ASD in childhood have substantial morbidity in adulthood, such as limited employment, failure to attend or complete postsecondary education, failure to date or marry, and no close friends (Barnhill, 2007, Eaves and Ho, 2008 and Marriage et al., 2009).
Given the impairment caused by ASD, a fundamental goal in the field is identifying interventions that substantially mitigate the morbidity associated with ASD. Progress toward achieving this goal is mixed. The intervention literature for ASD has lagged behind that for emotional and behavioral disorders (McLeod, Southam-Gerow, Christon, Archer, & Rodríguez, 2013). Presently, several promising intervention programs exist; however, there are few interventions for ASD that meet American Psychological Association criteria for efficacy or possible efficacy (Danial & Wood, 2013). Moreover, the intervention literature is characterized by methodological limitations that make it difficult to interpret findings (e.g., lack of random assignment, reliance on unblinded rater assessments of outcome; see Rogers & Vismara, 2008). Given the substantial increase in the number of youth identified with ASD over the past decade, an important issue facing the field is how to develop and evaluate effective interventions for youth with ASD (Odom et al., 2010 and Reichow et al., 2008). Whereas many youth with ASD receive a relatively high dose of treatment in community settings (Ganz, 2006 and Ganz, 2007), descriptive studies document that relatively few of the provided interventions could be classified as evidence based (Bowker et al., 2011, Goin-Kochel et al., 2007, Green et al., 2006, Heflin and Simpson, 1998, Simpson, 2005 and Stahmer et al., 2005), likely limiting their effectiveness.
In moving forward toward more effective intervention for youth with ASD, we believe that researchers will need to address three key issues. These include efficiently measuring the most pressing clinical problems experienced by youth with ASD, given that ASD phenotypes are exceptionally heterogeneous; identifying interventions that are sufficiently promising to justify further development and evaluation; and determining which models of implementation are most likely to promote adoption and adherence to effective practice guidelines for treatment of youth with ASD in community settings. In this special series, we attempt to highlight some ways that these issues may be addressed. In this introductory paper, we discuss these three themes and how they are addressed in the articles in this special series.
