Relationship-based Interventions

Social Communication Disorders in School-Age Children
Cognition/Language Treatment

Relationship-based Interventions



External Scientific Evidence

Evidence-Based Practice Guidelines
National Autism Center

National Standards Report
National Autism Center, 1-161.
Added: October 2012

This guideline provides recommendations for treatment of children and adolescents with autism spectrum disorders. The audience for this guideline includes parents, caregivers, educators, and service providers. Treatments have been evaluated and determined to be established, emerging, or unestablished. No treatments were determined to be ineffective or harmful.


  • The guideline authors stress that treatment selection should be made by a team of individuals and that this document should not dictate which treatments can or cannot be used for individuals with autism. However, the following suggestions are made to assist in decision making.

  • “Given the limited research support for Emerging Treatments, we generally do not recommend beginning with these treatments. However, Emerging Treatments should be considered promising and warrant serious consideration if Established Treatments are deemed inappropriate by the decision-making team” (p. 76).

  • Emerging treatments that have been shown to increase [social] communication skills include:

    • Augmentative and Alternative Communication Devices

    • Developmental Relationship-based Treatment

    • Language Training (Production)

    • Language Training (Production and Understanding)

    • Multi-component Package

    • Peer-mediated Instructional Arrangement

    • Picture Exchange Communication System

    • Scripting

    • Sign Instruction

    • Social Communication Intervention

    • Social Skills Package

    • Structured Teaching

    • Technology-based Treatment

    • Theory of Mind Training 

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Evidence-Based Systematic Reviews
Evidence-Based Review of Interventions for Autism Used in or of Relevance to Occupational Therapy
Case-Smith, J., & Arbesman, M. (2008).
American Journal of Occupational Therapy, 62(4), 416-429.
Added: October 2012

This is a review of Level I (i.e., randomized controlled trials, systematic reviews, meta-analyses), Level II (nonrandomized clinical trials, cohort studies), and Level III evidence (before-after studies and one group designs) that pertain to interventions conducted by occupational therapists for children and adolescents with autism. Although the intended audience is occupational therapists, the interventions target cognitive communication outcomes.


  • Relationship-based interventions (RBIs) had small but positive effects for improving social-emotional growth in children (p. 419). RBIs that incorporate adult imitation of the child’s actions, “implement high levels of positive responsiveness, apply prompting and cueing, facilitate peer interactions, establish environments that support social interaction, and demonstrate positive effects on social engagement in children with ASD” (p. 419).

  • Activities incorporating “cueing, prompting, and reinforcement, are effective interventions to enhance turn-taking, sharing, communication, and social interaction in children with ASD” (p. 420).

  • “Interventions emphasizing responsive, supportive relationships, and social-emotional development in young children can facilitate the child’s social-emotional growth and promote development of pivotal behaviors essential for learning” (p. 420).

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Autism Spectrum Disorders (ASDs) Services: Final Report on Environmental Scan
Young, J., Corea, C., et al. (2010).
Baltimore, MD: IMPAQ International, 112 pages.
Added: October 2012

This is an “environmental scan” of the empirical evidence regarding the efficacy, effectiveness, safety, and availability of behavioral and psychosocial interventions for individuals with autism spectrum disorders (ASD). The evidence, separated by children, transitioning youth, and adults and interventions, is rated as evidence-based, emerging evidence-based, or unestablished within each population.

  • Evidence-based: Interventions were considered evidence-based if they were supported with multiple high quality randomized, quasi-experimental or single-subject design studies with no critical design flaws to create confounders to the studies.

  • Emerging evidence-based: Emerging evidence-based interventions were those supported with evidence of mixed quality and mixed effects.

  • Unestablished: An intervention was considered unestablished based on the poor quality of the studies or the lack of studies showing a positive result.

Emerging evidence-based social communication interventions include developmental relationship-based treatment, initiation training, and pivotal response training (pp. 29-30). "Overall, the studies reviewed for the interventions included in this group had positive outcomes" (p. 28).

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Clinical Expertise/Expert Opinion

Consensus Guidelines
No consensus guidelines were found.

Client/Patient/Caregiver Perspectives

No information was found pertaining to client/patient/caregiver perspectives.

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