Review of Evidence-based practice and research conducted on effective treatments with patients with Autism Spectrum Disorder (ASD) in patients residing in psychiatric facilities.

1. Running head: ARTICLE REVIEW ABILITY
Jacob Ryan Stotler
CO 506-93
July 31, 2020
Dr. Hollingsworth
The University of West Alabama

2. ARTICLE REVIEW ABILITIES 2
Article Review
Disability of Emotional disturbance according to IDEA
According to the Individual’s with Disabilities Education Act (IDEA), there are 13 areas of an
individual’s functioning that are recognized by the IDEA. Those thirteen areas are:
1. Autism.
2. Deaf-blindness.
3. Deafness.
4. Emotional disturbance.
5. Hearing impairment.
6. Intellectual disabilities.
7. Multiple Disabilities.
8. Orthopedic impairment.
9. Other Health Impairment (OHI).
10. Specific learning disability.
11. Speech or language impairment.
12. Traumatic brain injury.
13. Visual impairment including blindness (IDEA, 2006, p.1).
Some of the above disabilities or conditions could be comorbid with one or any other of the listed
areas of functioning. In counseling and in the clinical mental health clinic, we see that severe emotional
disturbances and relevant intellectual disabilities, or Autism can be societal problems, but also problems
within a person’s close family and continuously a major struggle for the individual. Autism often links
with emotional and behavioral disturbances, this combination is sometimes hazardous, obscure and as a
whole, the complications of these individuals’ symptoms are rarely diminished by the widely accepted
modern-day treatments and treatment plans that we are trained to implement.

3. ARTICLE REVIEW ABILITIES 3
The spectrum of Autism recognized by IDEA is considered as “a developmental disability
significantly affecting verbal and nonverbal communication and social interaction, generally evident
before age three, that adversely affects a child’s educational performance [and as defined with criteria in
the Diagnostic Statistical Manual of Mental Disorders Ed. 5.]” (Center for Parent Information &
Resources, 2017, p.1; IDEA, 2006, p.1). This disorder is often comorbid with one or many other
conditions recognized by the Individuals with Disabilities Educational Act.
We then recognize that such disorders recognized by the Individual’s with Disabilities Education
Act, that are often associated or intermingle with a person with Autism, and symptoms may include such
that of extreme externalizing behaviors, behaviors that could be dangerous and are most disturbing to the
community or milieu, and may be most connected to psychiatric, psychological, and behavioral distress
and extremities, to the individual and within the milieu/society. Often behavioral and emotional disorders
are too relevant conditions that are the target of treatment within a case involving a person with Autism.
We also recognize that emotional and behavioral disturbances are commonly recognized to be a set of
conditions that are most associated as being psychological and less neurodevelopmental, genetic, or
pathological, than other disabilities that are recognized in IDEA, and sometimes it is hard for caregivers
to accept that such presentations are not psychological but may be relevant to a primary diagnosis.
The article reviewed, describes modern psychiatric hospitalization and treatment of children with
Autism and serious behavioral disturbance. The article provides an extravagant amount of facts, statistics
and underpinning statements, limning a picture for the reader to better understand the severity of a high
number of cases of people with Autism, seeking or needing inpatient treatment, with and involving too,
emotional disturbances concomitant.
Interventions

4. ARTICLE REVIEW ABILITIES 4
Siegel & Gabriels’ (2014) article implies the metanalysis and investigation of evidence-based
treatments for individuals with Autism that involve behavioral or emotional disturbances as major
presentations of Autism. There were several major interventions covered in the article.
The major topics of treatment intervention described as evidence-based treatments in the article
cannot be clearly presented without identifying that two major elements in the intake process. In inpatient
or psychiatric treatment of individuals with Autism it was acknowledged that the institution and
practitioners should always “gather development history about the patient from caregivers and
standardized measures,” and “use standardized observational assessment of patients to better evaluate the
patients presenting difficulties and any identify any other disorders or psychiatric or psychological
presentations (p.129).
In essence, we can make it a point to understand that the two most important factors of treatment,
before implementing evidence-based treatments are to clearly evaluate the person for any and all
presenting conditions, and to clearly understand the presentations involved. This is important as some
conditions, behaviors and presentations are linked to other disorders and/or could involve or direct the
purpose of treatment. Not investigating the entire spectrum of relevant conditions puts the treatment
planning and treatment planners and practitioners at a disadvantage when applying a treatment strategy.
In this study the evidence-based treatments involved in treating Autism and comorbid
presentations such as intellectual disabilities, emotional or behavioral disorders was identified in this case
as a primarily inpatient treatment, but identified as a modern advancement in the treatment of Autism,
where the hospital implements a “specialized psychiatric hospital treatment model.” The “specialized
psychiatric hospital treatment model” was constructed as an isolated treatment unit specifically for those
with Autism. (Siegel & Gabriels, 2014, p.134).
The treatment was described as an “intensive multidisciplinary diagnostic assessment and
included the removal of psychotropic medications while the doctors re-prescribed pharmaceuticals. The

5. ARTICLE REVIEW ABILITIES 5
treatment modalities include behavioral treatment based on principles of applied behavior analysis and
positive reinforcement, treatment of acute medical issues, speech/language and occupational therapy,
milieu therapy, special education, family therapy, and parent behavioral management training” (p.136).
The inpatient “specialized treatment model,” also includes individualizing the treatment plan to
address the concerns and take customized approaches to treating relevant symptomology, or emotional,
behavioral, or other symptomologies that are unique intensive presentations of the individual’s main
deficits or needs. For example, a child with a major presentation of self-injury would have a treatment
including a therapeutic focus, inpatient, focusing on educating and teaching about incompatible
behaviors, while they are provided support for these behaviors specifically. The goals for this treatment
model include four major goals: “decrease behavioral problems..., decrease need for high staff ratios…,
increase patients involvement…, and increase caregiver sense of competence…” (Siegel & Gabriels,
2014, p.138).
Outcomes
Sieglel & Gabriels (2014) state in the research paper that there is evidence that these specialized
inpatient treatment programs “deliver positive behavioral outcomes for this population that endure for two
months after discharge” (p.141). The researchers state that the demand of inpatient psychiatric services
seems to be on the rise, and may increase, therefore, the need for investigation into the effectiveness of
these treatments is important and must evolve with the findings that we have already, that exploration into
treatments raises the standard and this raising standard is what we should be offering people that seek
treatment.
Finally, in one case study and single subject analysis stated that this “specialized treatment
model” was found to increase effectiveness, with the increase of delivery and patient skill implementation
[of skills taught in skill training]. The single subject investigation described that self-injurious behaviors,
and minutes spent in modes of “tantrum,” decreased with the patients learned implementation of

6. ARTICLE REVIEW ABILITIES 6
“exchange of Picture Exchange Communication System [PECS].” The specialized treatment model
focused on teaching PECS especially for this individual [a 12 year-old girl with Autism and presenting
issues in behavior and communication], in which was effective and allowed the child to give pictures to
staff in which signified what she wanted or what she would like to communicate, taking the place of her
ineffective techniques of making demands and being emotionally dysregulated if the demands were not
met .
Siegel & Gabriels’ defined in this study that the use of the PECS system increased by about
258%, and this was correlated with the 98% decrease in self injurious behaviors (in minutes), and 66%
decrease in daily minutes of “tantrum” or emotional dysregulation (p.142).
This gives us belief in further investigating individualizing programs and discovering with
research, and in clinic, how to accommodate for the specific needs of every child/person we work with.
We also learn from the incremental validity of this research, that we should be attending to an
individualized, multidisciplinary approach to all treatments including in treatments with those that have a
primary presenting disorder such as Autism or intellectual disability. We learn that it may be most
clinically effective, long-term, to be looking for the exact approach and treatment scheme that “works”
for the each child or person that seeks help with us. This doesn’t involve us mitigating the application of
standard treatment approaches, but using standardized treatment approaches [in counseling] to discover
and apply individualized approaches that all recognize fits with the individual client and brings the most
positive impact to the person’s life, long-term.

7. ARTICLE REVIEW ABILITIES 7
References
Center for Parent Information & Resources. (2017). Emotional disturbances. Retrieved July 31,
2020 from https://www.parentcenterhub.org/emotionaldisturbance/.
Hollingsworth, M.A. (2018) Theories of lifespan Development. New York: NY, Linus Learning.
Acton, MA: XanEdu
IDEA (2006). Sec, 300.8 Child with a disability. Retrieved July 31, 2020 from
https://sites.ed.gov/idea/regs/b/a/300.8.
Siegel, M. & Gabriel, R. (2014). Psychiatric hospital treatment of children with Autism and serious
behavioral disturbance. Child and adolescent psychiatric clinics of North America, 23(1), 125-
142. Retrieved August 1, 2020 from https://doi.org/10.1016/j.chc.2013.07.004.