Autism therapies

There is a broad array of autism therapies, but the efficacy of each varies dramatically from person to person. Progress toward development of medical and behavior modification remedies, for the more debilitating affects of autism, has been hindered significantly by widespread disagreements over such things as the nature and causes of autistic spectrum disorders, and by a relative paucity of efficacious therapies thus far recognized by medical authorities.

With advances in psychosocial and pharmacological interventions, the behavioral and cognitive functioning of individuals affected by autistic disorders might improve. Intensive, sustained special education programs and behavior therapy early in life might increase the ability of children with autism to acquire language and the ability to learn. In adults with autism, some studies have found beneficial effects of the antidepressant medications clomipramine and fluoxetine, and the antipsychotic medication haloperidol. In many cases, several medications will be tried unsuccessfully, and palliative drug treatments may lose much of their effectiveness for mitigating symptoms later in life. Distinguishing between beneficial, palliative and detrimental treatments is not always straightforward.

Applied Behavior Analysis
A treatment and education of children with autism came through the application of the principles and techniques of Applied Behavior Analysis (ABA). O. Ivar Lovaas's name is widely associated with ABA-based treatment, as he was one of the first psychologists to demonstrate that children with autism could learn language, play, social, self-help, and academic skills. The ABA method is highly disputed by many autistics, and is regarded useless by many others.


 * ABA'-based approaches&mdash;often referred to as Discrete Trial, Intensive Behavior Intervention, and ABA&mdash;are some of the best known and most widely used in the field, and focus on the development of attention, imitation, receptive and expressive language, play, social, and pre-academic, and self-help skills. Using a one-to-one therapist-child ratio and the "antecedent-behavior-consequence" (ABC) model, interventions based on this work involve trials or tasks.  Each consists of (a) an antecedent, which is a directive or request for the child to perform an action; (b) a behavior, or response from the child, which may be categorized as successful performance, noncompliance, or no response; and (c) a consequence, defined as the reaction from the therapist, which ranges from strong positive reinforcement to a strong negative response, "No!"(Autism Society of America, 2001).

Lovaas' ABA methods are widely regarded as the first scientifically validated therapy for autism. Early intervention, generally before school-age, seems to be critical to achieving optimal outcomes. The New York State Department of Health worked with a multi-disciplinary panel of autism experts to publish Clinical Practice Guidelines for young children diagnosed with autism. The panel reviewed research on a variety of treatment methodologies and cited ABA as a critical element in any intervention program for young children with autism. That same year, in the Surgeon General of the United States’ first report on mental health, intensive ABA based treatment was cited as an effective intervention for children with autism.

ABA techniques based on B. F. Skinner's Verbal Behavior claim to have succeeded in helping nonverbal children start to talk, typically going from zero words to several dozen. By allowing children to express their needs, even rudimentary speech can alleviate frustration and tantrums.

The scientific validity of Lovaas's methods has been questioned by many professionals, by parents, and by those diagnosed as autistics themselves. Lovaas's initial studies looked promising, but there are no double-blind studies that compare the Lovaas approach against a control group not receiving ABA. Sallows and Graupner's 2005 study, which compared groups treated by professionals vs. parents, replicated the results of Lovaas, but found little difference in outcome between the groups. This study represents the most comprehensive and rigorous replication to date, and their findings nearly mirror Lovaas's.

Many also feel that there are serious ethical challenges to autism treatment, and point out that early ABA was based around the use of aversives which are confusing and painful..

ABA has come into widespread use in the 1990s, and the demand is outstripping the supply of committed and experienced service providers. As a result, parents of children need to be extra vigilant in choosing appropriate treatments for their children; this is especially so with regard to choosing providers, who may be inexperienced, use questionable methods or even deceive parents about their competency with ABA or any other program. Such problems have led to horror stories from some parents.

Computer use
Studies have suggested that computer use can help to calm children on the autistic spectrum, while stimulating their ability to communicate. Autistic children may prefer interaction with a computer interface because they can actively control it, and therefore communication through this medium may be less threatening than face-to-face conversation.

Non-profit group Autism and Computing, have proposed that monotropism, or very focussed attention with a limited scope, is a primary feature in autistic spectrum disorders. It has been suggested that this attentional difficulty can be alleviated by the use of computers because the medium helps the user to combine different focusses of attention successfully, therefore helping the user in other areas also. Currently, there is little evidence that the benefits of computer use do extend to other mediums though.

Multisensory stimulation
Controlled multisensory stimulation, or snoezelen, is a therapeutic regime for people with severe mental disabilities involving exposure to soothing and/or stimulating light, color, scents and music in carefully controlled environments. Such sensory integration therapies have been used in the therapy of patients with autism diagnoses since the 1970s. They were developed in the Netherlands and are particularly popular in Germany.

Neurofeedback
Neurofeedback may alleviate some of autism symptoms, according to a pilot study on eight children. The therapy involves the placement of electrodes on the scalp and the training of individuals to control their own brain waves. After ten weeks of therapy, five of the children performed better on tasks involving imitation. Individuals with autism are thought to have mu wave dysfunction, associated with mirror neurons. These brain cells play a critical role in mimicking the behaviors of others and in development of the capacity for empathy and understanding of others.

Non-coercive approaches
The autism rights movement has been criticized for promoting 'doing nothing' about autism. While clearly anti-cure, autistic advocates have pointed out that not forcing children to be something they are not is not equivalent to 'letting them do whatever they want', or not educating them at all. Given how much autistic individuals appear to be prone to stress, anxiety, nervousness and self-doubt, a number of non-coercive approaches have been proposed.

The Son-Rise program falls into this category, but it has a number of retractors. For one, there is no scientific evidence to validate it, and it is promoted in a way that seems to give a lot of unsubstantiated hope to parents. For example, proponents of the Son-Rise program claim that children will 'decide' to become non-autistic after parents accept them for who they are and engage them in play. The program was started by the parents of Raun Kaufman, who is claimed to have gone from being autistic to totally non-autistic. There are questions as to whether it is true that Raun Kaufman was autistic as a child, and also about the claim that "there is no trace" of his autism now. Overall, the goals of the Son-Rise program (i.e., removing the autism completely) are questioned, as well as the use of locked doors in order to keep children in the play area.

Economist Thomas Sowell, author of The Einstein Syndrome, is a major opponent of any form of 'early intervention' for children with certain characteristics (whom he considers wrongly labeled autistic), i.e. those who appear to be intelligent, are able to understand spoken language, and have several engineers or musicians as close family members. His observations are based on experiences with his own son (a late talker) and various anecdotal accounts. Sowell has been criticized for providing false hope, and there are cases he himself documents in his book of parents who followed his advice only to later find out that their children were not simply late talkers.

An approach for dealing with autism which involves reducing stressful sitations, and not trying to force the autistic child to change into someone he is not, is proposed in The Self-Help Guide for Special Kids and Their Parents by Joan Matthews and James Williams. James Williams is an autistic child who, with his mother's help, recounts much of his experiences through examples of possible problems encountered by parents of autistic children. The approach recommends, for example, not forcing the child into a mainstreamed schooling situation too early; trying to understand the problems caused by hypersensitivity and adapting to them; allowing the child to cope with stress by stimming; helping the child develop left-brain thinking; and so on. Matthews is also very much opposed to ABA therapy. This approach is close to something that would be acceptable to autistic advocates. But it also has the danger of giving false hope to parents. What worked well for Williams may not work equally well for everyone.

Relationship Development Intervention
Relationship Development Intervention (RDI) is a treatment program developed by Dr. Steven E. Gutstein. Whereas ABA aims to teach social skills directly, RDI focuses on building the "dynamic intelligence" that underlies the acquisition of those social skills in neurotypical children. It also focuses on the building blocks of motivation by developing episodic memory (seen as impaired in autism) and filling it with the child's own personal stories of competence and mastery. RDI emphasizes declarative (as opposed to imperative) communication, and aims for an appropriate balance of verbal and nonverbal communication.

Dr. Gutstein claims that 70% of his patients improved their ADOS score within 18 months and that a similar proportion are able to enter school without a shadow teacher or other personal assistant.

Son-Rise
The Son-Rise program was developed by Samahria & Barry Neil Kaufman, who founded the Option Institute to promulgate their more general philosophy upon which the Son-Rise program is partially based, and to provide training in this treatment approach. It is a home-based program with emphasis on eye contact, accepting the child without judgment, and engaging the child in a noncoercive way. The Association for Science in Autism Treatment (ASAT) maintains a description of the Son-Rise Program.

Criticism about the Son-Rise program revolves around the fact that there are no scientific studies that validate its claims. Critics have also pointed out that it may provide "false hope" to desperate parents.

The Institutes for The Achievement of Human Potential
The Institutes for The Achievement of Human Potential, established in 1955, is a nonprofit organization dedicated to improving the health and development of children who have some form of brain injury, including children diagnosed with autism. The IAHP claims that many children show improvement with a home program consisting of a healthy diet, clean air, and respiratory programs, without the need for medication. The IAHP publishes the results of its treatment for over 1700 children on its website.

Biomedical interventions
Some parents and medical professionals report improvements in the behavior of autistic children enrolled in restrictive diets, detoxification therapies, and a range of treatments, collectively known as biomedical intervention for autism. Some of these claims are contested by specialist doctors, who fear that the failure of conventional medicine to address parental concerns, and the meager resources committed to scientific research, has led to autism becoming a magnet for quacks and charlatans.

The premise for biomedical intervention is that certain neurological disorders are caused by environmental shocks that in turn compromise the children's gastrointestinal, immunological and neurological systems. Based on this premise, what is often diagnosed as autism or PDD is a physiological syndrome that can and should be treated as a physiological disorder.

This point of view is consistent with wider evidence that diet and nutrition can affect behavior generally, but there is no medical literature evidencing claims that autism can be fully cured. Some of the most prominent advocates of various therapies have autistic children who manifestly display serious behavioral difficulties.

There is plenty of anecdotal evidence to support biomedical intervention - most parents who try one or several therapies report some progress, and there are stories of children who have undergone these programs and become seemingly completely neurotypical, able to return to mainstream education. However, this evidence may be confounded by the dramatic improvements often seen in autistic children as they grow up, with or without such interventions. There are calls for double-blind studies regarding various treatment approaches.

As an example, the use of high doses of vitamin B6 with or without magnesium is gaining popularity among parents. Some studies do validate its effectiveness; including some double-blind ones. However, there appear to be some significant risks associated with high doses of vitamin B6, including peripheral neuropathy. Some people argue that vitamin B6 only helps children in the following groups:


 * Those with nutritional deficiencies, which can benefit from multivitamins in general; autistic children are notoriously fussy eaters.
 * Those with vitamin B6 deficiency (related to seizures.)

Detoxification
Based on the speculation that heavy metal poisoning may trigger the symptoms of autism, particularly in small subsets of individuals who cannot excrete toxins effectively, some parents have turned to alternative medicine practitioners who provide detoxification treatments, via chelation therapy, as a treatment method. However, evidence to support this practice has been anecdotal and not rigorous. Furthermore, there is strong epidemiological evidence that refutes links between environmental triggers, in particular thimerosal containing vaccines, and the onset of autistic symptoms.

The death of a five year old boy in August 2005 has been linked to this practice ; however, the isolated case has been attributed to the accidental administration of an incorrect agent. In this instance, the death was due to the administration of disodium EDTA instead of calcium disodium EDTA.

Drug therapy
The benefits of drugs is widely disputed. While anti-seizure medication is indicated for some children with seizures, many parents are opposed to using psychopharmacology to treat their children. They point out that autistic people are not necessarily psychotic, particularly anxious, or depressed. Many autistic people themselves are against the overprescription of neuroleptic drugs in autistic people to control behavior. They have formed an organization called Autistic People Against Neuroleptic Abuse to counter this phenomenon.

Gluten-free, casein-free diet
Dr. Karl Ludwig Reichelt claims to have found peptides from casein and gluten that worsen the symptoms of autistic children, many of whom have digestive disorders. These peptides are casomorphines and gluten exorphins, which influence the brain. The primary proponent of the possible link between digestive disorders and autism is Dr. Andrew Wakefield, a United Kingdom gastroenterologist who has described the disputed condition as autistic enterocolitis. According to Dr. Reichelt, significant improvement has been seen in the symptoms of some of his patients with autism who had been put on a diet that omits these peptides. The diet is called the gluten-free, casein-free diet. Some physicians see diet as a central part of the treatment, but in addition to many other treatments at the same time.

Gold salts
Gold salts have recently come into focus as a potential treatment for autism. Boyd Haley, a University of Kentucky professor and leading proponent of the mercury-autism hypothesis (see also Thimerosal controversy), has suggested that gold salts may reverse conditions attributed to mercury administration in the form of thimerosal that was used as a preservative in vaccinations until recently. Currently, Dr. Mady Hornig of Columbia University is testing gold salts on mice specially bred to be susceptible to thimerosal. Dan Olmsted reported a 1947 case of a 12 year old patient, the first person ever diagnosed with autism, who was treated for arthritis using gold salts at the Campbell Clinic in Memphis, Tennessee. According to the patient's brother, the "extreme nervousness" and excitability that had afflicted him cleared up as well as the arthritis. However, Haley cautions " [p] lease note that I am not recommending using gold salts to treat autistics, but it would certainly be worth a project if carefully monitored by a physician in a good clinic".

Occupational, auditory, visual therapy
Developmental neurologists have noted that autistic children tend to be hyposensitive and/or hypersensitive to one or several sensory impressions, and that their gross and fine motor skills are usually impaired to varying degrees. These are symptoms consistent with Sensory Integration Dysfunction.

Pediatric occupational therapy has proven successful in helping autistic children deal more effectively with sensory impressions, use their senses more productively, and become more aware of their bodies.

Auditory therapies include the Tomatis and Berard schools and focus on training the child to use his/her sense of hearing more effectively. Visual therapy, pioneered by Melvin Kaplan and others, employs prism lenses that distort the child's vision, forcing him/her to use his/her focal vision more productively.

Other Therapy
The Ayurvedic herb bacopa has been used in several cases of autism with promising effect. Bacopa is used medicinally in India for memory enhancement, epilepsy, insomnia, and as a mild sedative. This herb commonly grows in marsh areas throughtout India. Some studies have shown that Bacopa has antioxidant effects specific to the cerebral tissue.