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

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Due to a variety of factors, Autism Spectrum Disorder (ASD) has long been tethered to use of low-value practice (LVP), arguably moreso than any other psychiatric or neurodevelopmental condition. Although dissemination of empirically supported treatments (EST) for autistic individuals has expanded markedly over the past decade, there has not been concomitant reduction in the use of LVP. It is critical that clinicians and scientists not only promote the implementation of EST, but also facilitate the de-implementation (abandonment and/or divestment) of ineffective or harmful practices. In this review, we describe a data-driven approach that can be used to identify LVP, drawing from established criteria for identification of evidence-based treatments (e.g., APA Division 12, National Clearinghouse on Autism Evidence and Practice; SAMHSA), as well as broader considerations such as social validity, cost, and parsimony. Herein, a data-based approach to LVP identification is proposed with a goal of improving quality of service access. Within an implementation science framework, we identify specific facilitators that sustain LVP use, and recommendations for subsequent de-implementation strategies are offered.

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  1. Many in the autistic community have advocated for the use of identity first language (Bottema-Beutel et al., 2021). While acknowledging that not all individuals agree with this sentiment, we use primarily identity first language.

  2. We recognize that this is not the experience of all parents, and that there has been a shift away from a curative approach in recent years; however, the intersection between caregiver distress and the development of treatments leveraging unproven etiological theories to promise a cure is critical to acknowledge here, as it is unique to ASD and has had substantial impact on the uptake and proliferation of LVP.


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R34MH131599 (White) and R21MH128467 (White).

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All authors contributed substantially to this work. NRF and SWW drafted the article with critical contributions and revisions from all co-authors.

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Correspondence to Susan W. White.

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Friedman, N.R., Watkins, L., Barnard-Brak, L. et al. De-implementation of Low-Value Practices for Autism Spectrum Disorder. Clin Child Fam Psychol Rev 26, 690–705 (2023).

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