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Autism therapies attempt to lessen the deficits and family distress associated with autism and other autism spectrum disorders (ASD), and to increase the quality of life and functional independence of autistic individuals, especially children. No single treatment is best, and treatment is typically tailored to the child's needs. Treatments fall into two major categories: educational interventions and medical management. Training and support are also given to families of those with ASD.
Studies of interventions have methodological problems that prevent definitive conclusions about efficacy. Although many psychosocial interventions have some positive evidence, suggesting that some form of treatment is preferable to no treatment, the methodological quality of systematic reviews of these studies has generally been poor, their clinical results are mostly tentative, and there is little evidence for the relative effectiveness of treatment options. Intensive, sustained special education programs and behavior therapy early in life can help children with ASD acquire self-care, social, and job skills, and often can improve functioning, and decrease symptom severity and maladaptive behaviors; claims that intervention by around age three years is crucial are not substantiated. Available approaches include applied behavior analysis (ABA), developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy. Educational interventions have some effectiveness in children: intensive ABA treatment has demonstrated effectiveness in enhancing global functioning in preschool children, and is well-established for improving intellectual performance of young children. Neuropsychological reports are often poorly communicated to educators, resulting in a gap between what a report recommends and what education is provided. The limited research on the effectiveness of adult residential programs shows mixed results.
Many medications are used to treat problems associated with ASD. More than half of U.S. children diagnosed with ASD are prescribed psychoactive drugs or anticonvulsants, with the most common drug classes being antidepressants, stimulants, and antipsychotics. Aside from antipsychotics, there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD. A person with ASD may respond atypically to medications, the medications can have adverse effects, and no known medication relieves autism's core symptoms of social and communication impairments.
Many alternative therapies and interventions are available, ranging from elimination diets to chelation therapy. Few are supported by scientific studies. Treatment approaches lack empirical support in quality-of-life contexts, and many programs focus on success measures that lack predictive validity and real-world relevance. Scientific evidence appears to matter less to service providers than program marketing, training availability, and parent requests. Even if they do not help, conservative treatments such as changes in diet are expected to be harmless aside from their bother and cost. Dubious invasive treatments are a much more serious matter: for example, in 2005, botched chelation therapy killed a five-year-old autistic boy.
Treatment is expensive; indirect costs are more so. For someone born in 2000, a U.S. study estimated an average discounted lifetime cost of $Template:Formatprice (2021 dollars, inflation-adjusted from 2003 estimateTemplate:Inflation-fn), with about 10% medical care, 30% extra education and other care, and 60% lost economic productivity. A UK study estimated discounted lifetime costs at ₤Template:Formatprice and ₤Template:Formatprice for an autistic person with and without intellectual disability, respectively (2021 pounds, inflation-adjusted from 2005/06 estimateTemplate:Inflation-fn). Legal rights to treatment are complex, vary with location and age, and require advocacy by caregivers. Publicly supported programs are often inadequate or inappropriate for a given child, and unreimbursed out-of-pocket medical or therapy expenses are associated with likelihood of family financial problems; one 2008 U.S. study found a 14% average loss of annual income in families of children with ASD, and a related study found that ASD is associated with higher probability that child care problems will greatly affect parental employment. After childhood, key treatment issues include residential care, job training and placement, sexuality, social skills, and estate planning.
- 1 Educational interventions
- 2 Parent mediated interventions
- 3 Medical management
- 4 Religious interventions
- 5 References
- 6 Further reading
- 7 External links
Educational interventions attempt to help children not only to learn academic subjects and gain traditional readiness skills, but also to improve functional communication and spontaneity, enhance social skills such as joint attention, gain cognitive skills such as symbolic play, reduce disruptive behavior, and generalize learned skills by applying them to new situations. Several model programs have been developed, which in practice often overlap and share many features, including:
- early intervention that does not wait for a definitive diagnosis;
- intense intervention, at least 25 hours/week, 12 months/year;
- low student/teacher ratio;
- family involvement, including training of parents;
- interaction with neurotypical peers;
- structure that includes predictable routine and clear physical boundaries to lessen distraction; and
- ongoing measurement of a systematically planned intervention, resulting in adjustments as needed.
Several educational intervention methods are available, as discussed below. They can take place at home, at school, or at a center devoted to autism treatment; they can be done by parents, teachers, speech and language therapists, and occupational therapists. A 2007 study found that augmenting a center-based program with weekly home visits by a special education teacher improved cognitive development and behavior.
Studies of interventions have methodological problems that prevent definitive conclusions about efficacy. Although many psychosocial interventions have some positive evidence, suggesting that some form of treatment is preferable to no treatment, the methodological quality of systematic reviews of these studies has generally been poor, their clinical results are mostly tentative, and there is little evidence for the relative effectiveness of treatment options. Concerns about outcome measures, such as their inconsistent use, most greatly affect how the results of scientific studies are interpreted. A 2009 Minnesota study found that parents follow behavioral treatment recommendations significantly less often than they follow medical recommendations, and that they adhere more often to reinforcement than to punishment recommendations. Intensive, sustained special education programs and behavior therapy early in life can help children acquire self-care, social, and job skills, and often improve functioning and decrease symptom severity and maladaptive behaviors; claims that intervention by around age three years is crucial are not substantiated.
Applied behavior analysis
- Further information: Applied behavior analysis
Applied behavior analysis (ABA) is the applied research field of the science of behavior analysis, and it underpins a wide range of techniques used to treat autism and many other behaviors and diagnoses. ABA-based interventions focus on teaching tasks one-on-one using the behaviorist principles of stimulus, response and reward, and on reliable measurement and objective evaluation of observed behavior. There is wide variation in the professional practice of behavior analysis and among the assessments and interventions used in school-based ABA programs. Many interventions rely heavily on discrete trial teaching (DTT) methods, which use stimulus-response-reward techniques to teach foundational skills such as attention, compliance, and imitation. However, children have problems using DTT-taught skills in natural environments. In functional assessment, a common technique, a teacher formulates a clear description of a problem behavior, identifies antecedents, consequents, and other environmental factors that influence and maintain the behavior, develops hypotheses about what occasions and maintains the behavior, and collects observations to support the hypotheses. A few more-comprehensive ABA programs use multiple assessment and intervention methods individually and dynamically.
ABA-based techniques have demonstrated effectiveness in several controlled studies: children have been shown to make sustained gains in academic performance, adaptive behavior, and language, with outcomes significantly better than control groups. A 2009 review of educational interventions for children, whose mean age was six years or less at intake, found that the higher-quality studies all assessed ABA, that ABA is well-established and no other educational treatment is considered probably-efficacious, and that intensive ABA treatment, carried out by trained therapists, is demonstrated effective in enhancing global functioning in pre-school children. A 2008 evidence-based review of comprehensive treatment approaches found that ABA is well-established for improving intellectual performance of young children with ASD. A 2009 comprehensive synthesis of early intensive behavioral intervention (EIBI), a form of ABA treatment, found that EIBI produces strong effects, suggesting that it can be effective for some children with autism; it also found that the large effects might be an artifact of comparison groups with treatments that have yet to be empirically validated, and that no comparisons between EIBI and other widely recognized treatment programs have been published. A 2009 systematic review came to the same principal conclusion that EIBI is effective for some but not all children, with wide variability in response to treatment; it also suggested that any gains are likely to be greatest in the first year of intervention. A 2009 meta-analysis concluded that EIBI has a large effect on full-scale intelligence and a moderate effect on adaptive behavior. However, a 2009 systematic review and meta-analysis found that applied behavior intervention (ABI), another name for EIBI, did not significantly improve outcomes compared with standard care of preschool children with ASD in the areas of cognitive outcome, expressive language, receptive language, and adaptive behavior.
Pivotal response therapy
- Main article: Pivotal response therapy
Pivotal response therapy or treatment (PRT) is a naturalistic intervention derived from ABA principles. Instead of individual behaviors, it targets pivotal areas of a child's development, such as motivation, responsivity to multiple cues, self-management, and social initiations; it aims for widespread improvements in areas that are not specifically targeted. The child determines activities and objects that will be used in a PRT exchange. Intended attempts at the target behavior are rewarded with a natural reinforcer: for example, if a child attempts a request for a stuffed animal, the child receives the animal, not a piece of candy or other unrelated reinforcer.
Treatment and education of autistic and related communication handicapped children (TEACCH), which has come to be called "structured teaching", emphasizes structure by using organized physical environments, predictably sequenced activities, visual schedules and visually structured activities, and structured work/activity systems where each child can practice various tasks. Parents are taught to implement the treatment at home. A 1998 controlled trial found that children treated with a TEACCH-based home program improved significantly more than a control group.
Communication interventions fall into two major categories. First, many autistic children do not speak, or have little speech, or have difficulties in effective use of language. Interventions that attempt to improve communication are commonly conducted by speech and language therapists, and work on joint attention, communicative intent, and alternative or augmentative and alternative communication (AAC) methods such as visual methods. Little solid research supports the efficacy of speech therapy for autism; AAC methods do not appear to impede speech and may result in modest gains. A 2006 study reported benefits both for joint attention intervention and for symbolic play intervention, and a 2007 study found that joint attention intervention is more likely than symbolic play intervention to cause children to engage later in shared interactions.
Second, social skills treatment attempts to increase social and communicative skills of autistic individuals, addressing a core deficit of autism. A wide range of intervention approaches is available, including modeling and reinforcement, adult and peer mediation strategies, peer tutoring, social games and stories, self-management, pivotal response therapy, video modeling, direct instruction, visual cuing, circle of friends, and social-skills groups. A 2007 meta-analysis of 55 studies of school-based social skills intervention found that they were minimally effective for children and adolescents with ASD, and a 2007 review found that social skills training has minimal empirical support for children with Asperger syndrome or high-functioning autism.
Unusual responses to sensory stimuli are more common and prominent in children with autism, although there is not good evidence that sensory symptoms differentiate autism from other developmental disorders. Several therapies have been developed to treat Sensory Integration Dysfunction. Some of these treatments (for example, sensorimotor handling) have a questionable rationale and have no empirical evidence. Other treatments have been studied, with small positive outcomes, but few conclusions can be drawn due to methodological problems with the studies. These treatments include prism lenses, physical exercise, auditory integration training, and sensory stimulation or inhibition techniques such as "deep pressure"—firm touch pressure applied either manually or via an apparatus such as a hug machine or a pressure garment. Weighted vests, a popular deep-pressure therapy, have only a limited amount of scientific research available, which on balance indicates that the therapy is ineffective. Although replicable treatments have been described and valid outcome measures are known, gaps exist in knowledge related to sensory integration dysfunction and therapy. Because empirical support is limited, systematic evaluation is needed if these interventions are used.
Music therapy uses the elements of music to let people express their feelings and communicate. Two small studies have reported short-term improvement in verbal and gestural communication skills of autistic children from a week's work of daily sessions; no significant effects on behavior problems were observed.
Animal-assisted therapy, where an animal such as a dog or a horse becomes a basic part of a person's treatment, is a controversial treatment for some symptoms. A 2007 meta-analysis found that animal-assisted therapy is associated with a moderate improvement in autism spectrum symptoms. Reviews of published dolphin-assisted therapy (DAT) studies have found important methodological flaws and have concluded that there is no compelling scientific evidence that DAT is a legitimate therapy or that it affords any more than fleeting improvements in mood.
Neurofeedback has been hypothesized to improve focusing and decrease anxiety in individuals with ASD. One pilot study investigated this hypothesis in ten adolescent boys diagnosed with Asperger syndrome. Five boys dropped out during the study; results on the remaining boys were positive but were not statistically significant.
- Main article: Son-Rise
Son-Rise is a home-based program that emphasizes eye contact, accepting the child without judgment, and joining in with the child's repetitive and restricted behaviors. Proponents claim that children will decide to become non-autistic after parents accept them for who they are and engage them in play. Initially, parents and their child go to live at the Autism Treatment Center of America—which is based at the Option Institute—for a week and sometimes longer. Staff from the center help parents with their personal problems in order to teach them how to drop their judgements and beliefs. Staff also request to families to be hopeful for their child's future.
The program was started by the parents of Raun Kaufman, who is claimed to have gone from being autistic to normal via the treatment in the early 1970s. No independent study has tested the efficacy of the program, but a 2003 study found that involvement with the program led to more drawbacks than benefits for the involved families over time, and a 2006 study found that the program is not always implemented as it is typically described in the literature, which suggests it will be difficult to evaluate its efficacy.
In packing, children are wrapped tightly for up to an hour in wet sheets that have been refrigerated, with only their heads left free. The treatment is repeated several times a week, and can continue for years. It is intended as treatment for autistic children who harm themselves; most of these children cannot speak. Similar envelopment techniques have been used for centuries, such as to calm violent patients in Germany in the 19th century; its modern use in France began in the 1960s, based on psychoanalytic theories such as the theory of the refrigerator mother. Packing is currently used in hundreds of French clinics. There is no scientific evidence for the effectiveness of packing, and some concern about risk of adverse health effects.
The Judge Rotenberg Educational Center uses aversion therapy, notably contingent shock (electric shock delivered to the skin for a few seconds), to control the behavior of its patients, many of which are autistic. The practice is controversial.
Patterning is a set of exercises that attempts to improve the organization of a child's neurologic impairments. It has been used for decades to treat children with several unrelated neurologic disorders, including autism. The method, taught at the The Institutes for the Achievement of Human Potential, is based on oversimplified theories and is not supported by carefully designed research studies.
Parent mediated interventions
Parent mediated interventions offer support and practical advice to parents of autistic children. Randomized and controlled studies suggest that parent training leads to reduced maternal depression, improved maternal knowledge of autism and communication style, and improved child communicative behavior. A 2006 randomized controlled trial (RCT) found that a twenty-week parent education and behavior management (PEBM) program provided significant improvements in parental mental health and well-being, particularly for parents with preexisting mental health problems. A 2008 pilot trial of Parent-Child Interaction Therapy, a parent coaching intervention model, for boys aged 5–12 with high-functioning ASD and behavioral problems, found increases in child adaptability and reductions in parent perceptions of child problem behaviors.
Drugs, supplements, or diets are often used to alter physiology in an attempt to relieve common autistic symptoms such as seizures, sleep disturbances, irritability, and hyperactivity that can interfere with education or social adaptation or (more rarely) cause autistic individuals to harm themselves or others. There is plenty of anecdotal evidence to support medical treatment; many parents who try one or more therapies report some progress, and there are a few well-publicized reports of children who are able to return to mainstream education after treatment, with dramatic improvements in health and well-being. However, this evidence may be confounded by improvements seen in autistic children who grow up without treatment, by the difficulty of verifying reports of improvements, and by the lack of reporting of treatments' negative outcomes. Only a very few medical treatments are well supported by scientific evidence using controlled experiments.
Many medications are used to treat problems associated with ASD. More than half of U.S. children diagnosed with ASD are prescribed psychoactive drugs or anticonvulsants, with the most common drug classes being antidepressants, stimulants, and antipsychotics. Only the antipsychotics have clearly demonstrated efficacy.
Research has focused on atypical antipsychotics, especially risperidone, which has the largest amount of evidence that consistently shows improvements in irritability, self-injury, aggression, and tantrums associated with ASD. Risperidone is approved by the Food and Drug Administration (FDA) for treating symptomatic irritability in autistic children and adolescents. In short-term trials (up to six months) most adverse events were mild to moderate, with weight gain, drowsiness, and high blood sugar requiring monitoring; long term efficacy and safety have not been fully determined. It is unclear whether risperidone improves autism's core social and communication deficits. The FDA's decision was based in part on a study of autistic children with severe and enduring problems of tantrums, aggression, and self-injury; risperidone is not recommended for autistic children with mild aggression and explosive behavior without an enduring pattern.
Other drugs are prescribed off-label in the U.S., which means they have not been approved for treating ASD. Large placebo-controlled studies of olanzapine and aripiprazole were underway in early 2008. Some selective serotonin reuptake inhibitors (SSRIs) and dopamine blockers can reduce some maladaptive behaviors associated with ASD. Although SSRIs reduce levels of repetitive behavior in autistic adults, a 2009 multisite randomized controlled study found no benefit and some adverse effects in children from the SSRI citalopram, raising doubts whether SSRIs are effective for treating repetitive behavior in autistic children. One study found that the psychostimulant methylphenidate was efficacious against hyperactivity associated with ASD, though with less response than in neurotypical children with ADHD. Of the many medications studied for treatment of aggressive and self-injurious behavior in children and adolescents with autism, only risperidone and methylphenidate demonstrate results that have been replicated. A 1998 study of the hormone secretin reported improved symptoms and generated tremendous interest, but several controlled studies since have found no benefit.
Oxytocin may play a role in autism and may be an effective treatment for repetitive and affiliative behaviors; two related studies in adults found that oxytocin decreased repetitive behaviors and improved interpretation of emotions, but these preliminary results do not necessarily apply to children. An experimental drug STX107 has stopped overproduction of metabotropic glutamate receptor 5 in rodents, and it has been hypothesized that this may help in about 5% of autism cases, but this hypothesis has not been tested in humans.
Aside from antipsychotics, there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD. Results of the handful of randomized control trials that have been performed suggest that risperidone, the SSRI fluvoxamine, and the typical antipsychotic haloperidol may be effective in reducing some behaviors, that haloperidol may be more effective than the tricyclic antidepressant clomipramine, and that the opiate antagonist naltrexone hydrochloride is not effective. A person with ASD may respond atypically to medications, the medications can have adverse side effects, and no known medication relieves autism's core symptoms of social and communication impairments.
Many parents give their children vitamin and other nutritional supplements in an attempt to treat autism or to alleviate its symptoms. The range of supplements given is wide; few are supported by scientific data, but most have relatively mild side effects.
Proponents of orthomolecular psychiatry have claimed that nutritional supplementation with high dose pyridoxine (vitamin B6) and magnesium (HPDM) alleviate the symptoms of autism; this is one of the most popular complementary and alternative medicine choices for autism. Three small randomized controlled trials have studied this therapy; the smallest one (with 8 individuals) found improved verbal IQ in the treatment group and the other two (with ten and fifteen individuals, respectively) found no significant difference. Due to the limited data it is difficult to tell whether this treatment approach has effects greater than placebo. The short-term side effects seem to be mild, but there may be significant long-term side effects, as high doses of pyridoxine cause peripheral neuropathy in adults, high doses of magnesium can cause reduced heart rate and weakened reflexes, and high magnesium concentrations are associated with seizures. High dose pyridoxine can cause side effects such as irritability and sensitivity to sound, which can be managed through the use of magnesium.
Dimethylglycine (DMG) is hypothesized to improve speech and reduce autistic behaviors, and is a commonly used supplement. Two double-blind, placebo-controlled studies found no statistically significant effect on autistic behaviors, and reported few side effects. No peer-reviewed studies have addressed treatment with the related compound trimethylglycine.
Vitamin C decreased stereotyped behavior in a small 1993 study. The study has not been replicated, and vitamin C has limited popularity as an autism treatment. High doses might cause kidney stones or gastrointestinal upset such as diarrhea.
Probiotics containing potentially beneficial bacteria are hypothesized to relieve some symptoms of autism by minimizing yeast overgrowth in the colon. The hypothesized yeast overgrowth has not been confirmed by endoscopy, the mechanism connecting yeast overgrowth to autism is only hypothetical, and no clinical trials to date have been published in the peer-reviewed literature. No negative side effects have been reported.
Melatonin is sometimes used to manage sleep problems in developmental disorders. Adverse effects are generally reported to be mild, including drowsiness, headache, dizziness, and nausea; however, an increase in seizure frequency is reported among susceptible children. A 2008 open trial found that melatonin appears to be a safe and well-tolerated treatment for insomnia in children with ASD. and suggested controlled trials to determine efficacy; a small 2009 retrospective study had similar results for adults.
Although omega-3 fatty acids, which are polyunsaturated fatty acids (PUFA), are a popular treatment for children with ASD, there is very little scientific evidence supporting their effectiveness, and further research is needed.
Several other supplements have been hypothesized to relieve autism symptoms, including carnosine, cholesterol, cyproheptadine, D-cycloserine, folic acid, glutathione, metallothionein promoters, other PUFA such as omega-6 fatty acids, tryptophan, tyrosine, thiamine (see Chelation therapy), vitamin B12, and zinc. These lack reliable scientific evidence of efficacy or safety in treatment of autism.
- Further information: Gluten-free, casein-free diet
Atypical eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur; this does not appear to result in malnutrition. Although some children with autism also have gastrointestinal (GI) symptoms, there is a lack of published rigorous data to support the theory that autistic children have more or different GI symptoms than usual; studies report conflicting results, and the relationship between GI problems and ASD is unclear.
In the early 1990s, it was hypothesized that autism can be caused or aggravated by opioid peptides like casomorphine that are metabolic products of gluten and casein. Based on this hypothesis, diets that eliminate foods containing either gluten or casein, or both, are widely promoted, and many testimonials can be found describing benefits in autism-related symptoms, notably social engagement and verbal skills. Studies supporting these claims have had significant flaws, so the data are inadequate to guide treatment recommendations.
Other elimination diets have also been proposed, targeting salicylates, food dyes, yeast, and simple sugars. No scientific evidence has established the efficacy of such diets in treating autism in children. An elimination diet may create nutritional deficiencies that harm overall health unless care is taken to assure proper nutrition. For example, a 2008 study found that autistic boys on casein-free diets have significantly thinner bones than usual, presumably because the diets contribute to calcium and vitamin D deficiencies.
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. However, evidence to support this practice has been anecdotal and not rigorous. Strong epidemiological evidence refutes links between environmental triggers, in particular thimerosal containing vaccines, and the onset of autistic symptoms. No scientific data supports the claim that the mercury in the vaccine preservative thiomersal causes autism or its symptoms, and there is no scientific support for chelation therapy as a treatment for autism.
Intravenous EDTA (using the drug edetate calcium disodium) chelation has been used safely for over 40 years for treating lead-poisoned children. It is approaved by the FDA for this purpose. The FDA has received reports of 11 deaths associated with the use of edetate disodium (instead of the edetate calcium disodium form). These deaths were reported over the time period from 1971 through 2007. Most recently, two reports were received in 2003, two reports in 2005 and one report was received in 2007. Nine of the deaths were reported following the administration of edetate disodium (by its specific name). A specific EDTA drug was not identified in two cases. Instead, these two death reports simply referred to use of "EDTA." http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm113738.htm
Thiamine tetrahydrofurfuryl disulfide (TTFD) is hypothesized to act as a chelating agent in children with autism. A 2002 pilot study administered TTFD rectally to ten autism spectrum children, and found beneficial clinical effect. This study has not been replicated, and a 2006 review of thiamine by the same author did not mention thiamine's possible effect on autism. There is not sufficient evidence to support the use of thiamine (vitamin B1) to treat autism.
Chiropractic is an alternative medical practice whose main hypothesis is that mechanical disorders of the spine affect general health via the nervous system, and whose main treatment is spinal manipulation. A significant portion of the profession rejects vaccination, as traditional chiropractic philosophy equates vaccines to poison. Most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous, ineffective, and unnecessary, and in some cases suggesting that vaccination causes autism or that chiropractors should be the primary contact for treatment of autism and other neurodevelopmental disorders. Chiropractic treatment has not been shown to be effective for medical conditions other than back pain, and there is insufficient scientific evidence to make conclusions about chiropractic care for autism.
Craniosacral therapy is based on the theory that restrictions at cranial sutures of the skull affect rhythmic impulses conveyed via cerebrospinal fluid, and that gentle pressure on external areas can improve the flow and balance of the supply of this fluid to the brain, relieving symptoms of many conditions. There is no scientific support for major elements of the underlying model, there is little scientific evidence to support the therapy, and research methods that could conclusively evaluate the therapy's effectiveness have not been applied.
Studies indicate that 12–17% of adolescents and young adults with autism satisfy diagnostic criteria for catatonia, which is loss of or hyperactive motor activity. Electroconvulsive therapy (ECT) has been used to treat cases of catatonia and related conditions in people with autism. However, no controlled trials have been performed of ECT in autism, and there are serious ethical and legal obstacles to its use.
Hyperbaric oxygen therapy
Hyperbaric oxygen therapy (HBOT) can compensate for decreased blood flow by increasing the oxygen content in the body. It has been postulated that HBOT might relieve some of the core symptoms of autism. A small 2009 double-blind study of autistic children found that 40 hourly treatments of 24% oxygen at 1.3 atmospheres provided significant improvement in the children's behavior immediately after treatment sessions. The study has not been independently confirmed; further studies are planned or in progress.
Unlike conventional neuromotor prostheses, neurocognitive prostheses would sense or modulate neural function in order to physically reconstitute cognitive processes such as executive function and language. No neurocognitive prostheses are currently available but the development of implantable neurocognitive brain-computer interfaces has been proposed to help treat conditions such as autism.
Affective computing devices, typically with image or voice recognition capabilities, have been proposed to help autistic individuals improve their social communication skills. These devices are still under development. Robots have also been proposed as educational aids for autistic children.
Stem cell therapy
Mesenchymal stem cells and cord blood CD34+ cells have been proposed to treat autism, but this proposal has not been tested.
The Table Talk of Martin Luther contains the story of a 12-year-old boy who may have been severely autistic. According to Luther's notetaker Mathesius, Luther thought the boy was a soulless mass of flesh possessed by the devil, and suggested that he be suffocated. In 2003 an autistic boy in Wisconsin suffocated during an exorcism in which he was wrapped in sheets.
Ultraorthodox Jewish parents sometimes use spiritual and mystical interventions such as prayers, blessings, recitations of religious text, holy water, amulets, changing the child's name, and exorcism.
One study has suggested that spirituality and not religious activities involving the mothers of autistic children were associated with better outcomes for the child. Religion has also been studied by Pargament as an assist in helping families cope with autism.
- Powell K (2004). Opening a window to the autistic brain. PLoS Biol 2 (8): E267.
- Myers SM, Johnson CP, Council on Children with Disabilities (2007). Management of children with autism spectrum disorders. Pediatrics 120 (5): 1162–82.
- Ospina MB, Krebs Seida J, Clark B et al. (2008). Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review. PLoS ONE 3 (11): e3755.
- Krebs Seida J, Ospina MB, Karkhaneh M, Hartling L, Smith V, Clark B (2009). Systematic reviews of psychosocial interventions for autism: an umbrella review. Dev Med Child Neurol 51 (2): 95–104.
- Rogers SJ, Vismara LA (2008). Evidence-based comprehensive treatments for early autism. J Clin Child Adolesc Psychol 37 (1): 8–38.
- Howlin P, Magiati I, Charman T (2009). Systematic review of early intensive behavioral interventions for children with autism. Am J Intellect Dev Disabil 114 (1): 23–41.
- Eikeseth S (2009). Outcome of comprehensive psycho-educational interventions for young children with autism. Res Dev Disabil 30 (1): 158–78.
- Kanne SM, Randolph JK, Farmer JE (2008). Diagnostic and assessment findings: a bridge to academic planning for children with autism spectrum disorders. Neuropsychol Rev 18 (4): 367–84.
- Van Bourgondien ME, Reichle NC, Schopler E (2003). Effects of a model treatment approach on adults with autism. J Autism Dev Disord 33 (2): 131–40.
- Leskovec TJ, Rowles BM, Findling RL (2008). Pharmacological treatment options for autism spectrum disorders in children and adolescents. Harv Rev Psychiatry 16 (2): 97–112.
- Medications for U.S. children with ASD:
- Oswald DP, Sonenklar NA (2007). Medication use among children with autism spectrum disorders. J Child Adolesc Psychopharmacol 17 (3): 348–55.
- Mandell DS, Morales KH, Marcus SC, Stahmer AC, Doshi J, Polsky DE (2008). Psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders. Pediatrics 121 (3): e441–8.
- Posey DJ, Stigler KA, Erickson CA, McDougle CJ (2008). Antipsychotics in the treatment of autism. J Clin Invest 118 (1): 6–14.
- Angley M, Young R, Ellis D, Chan W, McKinnon R (2007). Children and autism—part 1—recognition and pharmacological management. Aust Fam Physician 36 (9): 741–4.
- Broadstock M, Doughty C, Eggleston M (2007). Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder. Autism 11 (4): 335–48.
- Buitelaar JK (2003). Why have drug treatments been so disappointing?. Novartis Found Symp 251: 235–44; discussion 245–9, 281–97.
- Angley M, Semple S, Hewton C, Paterson F, McKinnon R (2007). Children and autism—part 2—management with complementary medicines and dietary interventions. Aust Fam Physician 36 (10): 827–30.
- Francis K (2005). Autism interventions: a critical update. Dev Med Child Neurol 47 (7): 493–9.
- Herbert JD, Sharp IR, Gaudiano BA (2002). Separating fact from fiction in the etiology and treatment of autism: a scientific review of the evidence. S ci Rev Ment Health Pract 1 (1): 23–43.
- Rao PA, Beidel DC, Murray MJ (2008). Social skills interventions for children with Asperger's syndrome or high-functioning autism: a review and recommendations. J Autism Dev Disord 38 (2): 353–61.
- Schechtman MA (2007). Scientifically unsupported therapies in the treatment of young children with autism spectrum disorders. Pediatr Ann 36 (8): 497–8, 500–2, 504–5.
- Lack of support for interventions:
- Howlin P (2005). "The effectiveness of interventions for children with autism" Fleischhacker WW, Brooks DJ Neurodevelopmental Disorders, 101–19, Springer.PMID 16355605.
- Sigman M, Spence SJ, Wang AT (2006). Autism from developmental and neuropsychological perspectives. Annu Rev Clin Psychol 2: 327–55.
- Williams White S, Keonig K, Scahill L (2007). Social skills development in children with autism spectrum disorders: a review of the intervention research. J Autism Dev Disord 37 (10): 1858–68.
- Burgess AF, Gutstein SE (2007). Quality of life for people with autism: raising the standard for evaluating successful outcomes. Child Adolesc Ment Health 12 (2): 80–6.
- Stahmer AC, Collings NM, Palinkas LA (2005). Early intervention practices for children with autism: descriptions from community providers. Focus Autism Other Dev Disabl 20 (2): 66–79.
- Christison GW, Ivany K (2006). Elimination diets in autism spectrum disorders: any wheat amidst the chaff?. J Dev Behav Pediatr 27 (2 Suppl 2): S162–71.
- Hazards of chelation therapy:
- Brown MJ, Willis T, Omalu B, Leiker R (2006). Deaths resulting from hypocalcemia after administration of edetate disodium: 2003–2005. Pediatrics 118 (2): e534–6.
- Baxter AJ, Krenzelok EP (2008). Pediatric fatality secondary to EDTA chelation. Clin Toxicol 46 (10): 1083–4.
- Shimabukuro TT, Grosse SD, Rice C (2008). Medical expenditures for children with an autism spectrum disorder in a privately insured population. J Autism Dev Disord 38 (3): 546–52.
- Ganz ML (2007). The lifetime distribution of the incremental societal costs of autism. Arch Pediatr Adolesc Med 161 (4): 343–9.
- Knapp M, Romeo R, Beecham J (2009). Economic cost of autism in the UK. Autism 13 (3): 317–36.
- Aman MG (2005). Treatment planning for patients with autism spectrum disorders. J Clin Psychiatry 66 (Suppl 10): 38–45.
- Sharpe DL, Baker DL (2007). Financial issues associated with having a child with autism. J Fam Econ Iss 28 (2): 247–64.
- Montes G, Halterman JS (2008). Association of childhood autism spectrum disorders and loss of family income. Pediatrics 121 (4): e821–6.
- Montes G, Halterman JS (2008). Child care problems and employment among families with preschool-aged children with autism in the United States. Pediatrics 122 (1): e202–8.
- Case-Smith J, Arbesman M (2008). Evidence-based review of interventions for autism used in or of relevance to occupational therapy. Am J Occup Ther 62 (4): 416–29.
- Rickards AL, Walstab JE, Wright-Rossi RA, Simpson J, Reddihough DS (2007). A randomized, controlled trial of a home-based intervention program for children with autism and developmental delay. J Dev Behav Pediatr 28 (4): 308–16.
- Wheeler D, Williams K, Seida J, Ospina M (2008). The Cochrane Library and Autism Spectrum Disorder: an overview of reviews. Evid Based Child Health 3 (1): 3–15.
- Moore TR, Symons FJ (2009). Adherence to behavioral and medical treatment recommendations by parents of children with autism spectrum disorders. J Autism Dev Disord.
- Dillenburger K, Keenan M (2009). None of the As in ABA stand for autism: dispelling the myths. J Intellect Dev Disabil 34 (2): 193–5.
- Howard JS, Sparkman CR, Cohen HG, Green G, Stanislaw H (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Res Dev Disabil 26 (4): 359–83.
- Steege MW, Mace FC, Perry L, Longenecker H (2007). Applied behavior analysis: beyond discrete trial teaching. Psychol Schools 44 (1): 91–9.
- Reichow B, Wolery M (2009). Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA Young Autism Project model. J Autism Dev Disord 31 (1): 23–41.
- Eldevik S, Hastings RP, Hughes JC, Jahr E, Eikeseth S, Cross S (2009). Meta-analysis of Early Intensive Behavioral Intervention for children with autism. J Clin Child Adolesc Psychol 38 (3): 439–50.
- Spreckley M, Boyd R (2009). Efficacy of applied behavioral intervention in preschool children with autism for improving cognitive, language, and adaptive behavior: a systematic review and meta-analysis. J Pediatr 154 (3): 338–44.
- Pivotal response therapy:
- Koegel RL, Koegel LK (2006). Pivotal Response Treatments for Autism: Communication, Social, & Academic Development, Brookes.
- Koegel LK, Koegel RL, Harrower JK, Carter CM (1999). Pivotal response intervention I: overview of approach. J Assoc Pers Sev Handicaps 24 (3): 174–85.
- Ozonoff S, Cathcart K (1998). Effectiveness of a home program intervention for young children with autism. J Autism Dev Disord 28 (1): 25–32.
- Scottish Intercollegiate Guidelines Network (SIGN) (2007). "Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders" (PDF). SIGN publication no. 98. Retrieved on 2008-04-02. Lay summary (PDF) — SIGN (2008).
- Weber W, Newmark S (2007). Complementary and alternative medical therapies for attention-deficit/hyperactivity disorder and autism. Pediatr Clin North Am 54 (6): 983–1006.
- Schlosser RW, Wendt O (2008). Effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review. Am J Speech Lang Pathol 17 (3): 212–30.
- Kasari C, Freeman S, Paparella T (2006). Joint attention and symbolic play in young children with autism: a randomized controlled intervention study. J Child Psychol Psychiatry 47 (6): 611–20. (2007) Erratum. J Child Psychol Psychiatry 48 (5): 523.
- Gulsrud AC, Kasari C, Freeman S, Paparella T (2007). Children with autism's response to novel stimuli while participating in interventions targeting joint attention or symbolic play skills. Autism 11 (6): 535–46.
- Matson JL, Matson ML, Rivet TT (2007). Social-skills treatments for children with autism spectrum disorders: an overview. Behav Modif 31 (5): 682–707.
- Bellini S, Peters JK, Benner L, Hopf A (2007). A meta-analysis of school-based social skills interventions for children with autism spectrum disorders. Remedial Spec Educ 28 (3): 153–62.
- Rogers SJ, Ozonoff S (2005). Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence. J Child Psychol Psychiatry 46 (12): 1255–68.
- Sensory integrative therapy. Research Autism. URL accessed on 2007-10-08.
- Baranek GT (2002). Efficacy of sensory and motor interventions for children with autism. J Autism Dev Disord 32 (5): 397–422.
- Stephenson J, Carter M (2009). The use of weighted vests with children with autism spectrum disorders and other disabilities. J Autism Dev Disord 39 (1): 105–14.
- Schaaf RC, Miller LJ (2005). Occupational therapy using a sensory integrative approach for children with developmental disabilities. Ment Retard Dev Disabil Res Rev 11 (2): 143–8.
- Hodgetts S, Hodgetts W (2007). Somatosensory stimulation interventions for children with autism: literature review and clinical considerations. Can J Occup Ther 74 (5): 393–400.
- Gold C, Wigram T, Elefant C (2006). Music therapy for autistic spectrum disorder. Cochrane Database Syst Rev (2): CD004381.
- Nimer J, Lundahl B (2007). Animal-assisted therapy: a meta-analysis. Anthrozoos 20 (3): 225–38.
- Marino L, Lilienfeld SO (2007). Dolphin-Assisted Therapy: more flawed data and more flawed conclusions. Anthrozoos 20 (3): 239–49.
- Scolnick B (2005). Effects of electroencephalogram biofeedback with Asperger's syndrome. Int J Rehabil Res 28 (2): 159–63.
- redirect Template:Cite web
- Kaufman BN (1995). Son-Rise: the Miracle Continues, HJ Kramer.
- Williams KR, Wishart JG (2003). The Son-Rise Program intervention for autism: an investigation into family experiences. J Intellect Disabil Res 47 (4–5): 291–9.
- Williams KR (2006). The Son-Rise Program intervention for autism: prerequisites for evaluation. Autism 10 (1): 86–102.
- Spinney L (2007). Therapy for autistic children causes outcry in France. Lancet 370 (9588): 645–6.
- Gonnerman J (2007). School of shock. Mother Jones 32 (5).
- American Academy of Pediatrics. Committee on Children with Disabilities (1999). The treatment of neurologically impaired children using patterning. Pediatrics 104 (5): 1149–51.
- McConachie H, Diggle T (2007). Parent implemented early intervention for young children with autism spectrum disorder: a systematic review. J Eval Clin Pract 13 (1): 120–9.
- Tonge B, Brereton A, Kiomall M, Mackinnon A, King N, Rinehart N (2006). Effects on parental mental health of an education and skills training program for parents of young children with autism: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 45 (5): 561–9.
- Solomon M, Ono M, Timmer S, Goodlin-Jones B (2008). The effectiveness of Parent-Child Interaction Therapy for families of children on the autism spectrum. J Autism Dev Disord 38 (9): 1767–76.
- Levy SE, Hyman SL (2005). Novel treatments for autistic spectrum disorders. Ment Retard Dev Disabil Res Rev 11 (2): 131–42.
- Schreibman L (2005). "Critical evaluation of issues in autism" The Science and Fiction of Autism, Harvard University Press.
- Chavez B, Chavez-Brown M, Sopko MA Jr, Rey JA (2007). Atypical antipsychotics in children with pervasive developmental disorders. Pediatr Drugs 9 (4): 249–66.
- Scott LJ, Dhillon S (2007). Risperidone: a review of its use in the treatment of irritability associated with autistic disorder in children and adolescents. Pediatr Drugs 9 (5): 343–54.
- Scahill L (2008). How do I decide whether or not to use medication for my child with autism? should I try behavior therapy first?. J Autism Dev Disord 38 (6): 1197–8.
- Myers SM (2007). The status of pharmacotherapy for autism spectrum disorders. Expert Opin Pharmacother 8 (11): 1579–603.
- Volkmar FR (2009). Citalopram treatment in children with autism spectrum disorders and high levels of repetitive behavior. Arch Gen Psychiatry 66 (6): 581–2.
- King BH, Hollander E, Sikich L et al. (2009). Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Arch Gen Psychiatry 66 (6): 583–90.
- Parikh MS, Kolevzon A, Hollander E (2008). Psychopharmacology of aggression in children and adolescents with autism: a critical review of efficacy and tolerability. J Child Adolesc Psychopharmacol 18 (2): 157–78.
- Bartz JA, Hollander E (2008). Oxytocin and experimental therapeutics in autism spectrum disorders. Prog Brain Res 170 (451–62): 451.
- Opar A (2008). Search for potential autism treatments turns to 'trust hormone'. Nat Med 14 (4): 353.
- Strock M (2007). "Autism spectrum disorders (pervasive developmental disorders)". National Institute of Mental Health. Retrieved on 2007-10-05.
- Tsai LY (1999). Psychopharmacology in autism. Psychosom Med 61 (5): 651–65.
- Andersen IM, Kaczmarska J, McGrew SG, Malow BA (2008). Melatonin for insomnia in children with autism spectrum disorders. J Child Neurol 23 (5): 482–5.
- Galli-Carminati G, Deriaz N, Bertschy G (2009). Melatonin in treatment of chronic sleep disorders in adults with autism: a retrospective study. Swiss Med Wkly 139 (19-20): 293–6.
- Bent S, Bertoglio K, Hendren RL (2009). Omega-3 fatty acids for autistic spectrum disorder: a systematic review. J Autism Dev Disord.
- Aneja A, Tierney E (2008). Autism: The role of cholesterol in treatment. Int Rev Psychiatry 20 (2): 165–70.
- Dominick KC, Davis NO, Lainhart J, Tager-Flusberg H, Folstein S (2007). Atypical behaviors in children with autism and children with a history of language impairment. Res Dev Disabil 28 (2): 145–62.
- Erickson CA, Stigler KA, Corkins MR, Posey DJ, Fitzgerald JF, McDougle CJ (2005). Gastrointestinal factors in autistic disorder: a critical review. J Autism Dev Disord 35 (6): 713–27.
- Reichelt KL, Knivsberg A-M, Lind G, Nødland M (1991). Probable etiology and possible treatment of childhood autism. Brain Dysfunct 4: 308–19.
- Millward C, Ferriter M, Calver S, Connell-Jones G (2008). Gluten- and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev (2): CD003498.
- Hediger ML, England LJ, Molloy CA, Yu KF, Manning-Courtney P, Mills JL (2008). Reduced bone cortical thickness in boys with autism or autism spectrum disorder. J Autism Dev Disord 38 (5): 848–56.
- Doja A, Roberts W (2006). Immunizations and autism: a review of the literature. Can J Neurol Sci 33 (4): 341–6.
- Thompson WW, Price C, Goodson B et al. (2007). Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years. N Engl J Med 357 (13): 1281–92.
- Lonsdale D, Shamberger RJ, Audhya T (2002). Treatment of autism spectrum children with thiamine tetrahydrofurfuryl disulfide: a pilot study. Neuro Endocrinol Lett 23 (4): 303–8.
- Lonsdale D (2006). A review of the biochemistry, metabolism and clinical benefits of thiamin(e) and its derivatives. Evid Based Complement Alternat Med 3 (1): 49–59.
- Campbell JB, Busse JW, Injeyan HS (2000). Chiropractors and vaccination: a historical perspective. Pediatrics 105 (4): e43.
- Busse JW, Morgan L, Campbell JB (2005). Chiropractic antivaccination arguments. J Manipulative Physiol Ther 28 (5): 367–73.
- Ferrance RJ (2003). Autism—another topic often lacking facts when discussed within the chiropractic profession. J Can Chiropr Assoc 47 (1): 4–7.
- Ernst E (2008). Chiropractic: a critical evaluation. J Pain Symptom Manage 35 (5): 544–62.
- Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW (2007). Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research. J Altern Complement Med 13 (5): 491–512.
- Green C, Martin CW, Bassett K, Kazanjian A (1999). A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness. Complement Ther Med 7 (4): 201–7. An earlier version of the paper is available without a subscription: Green C, Martin CW, Bassett K, Kazanjian A (1999). "A systematic review and critical appraisal of the scientific evidence on craniosacral therapy" (PDF). BCOHTA 99:1J. British Columbia Office of Health Technology Assessment. Retrieved on 2007-10-08.
- Hartman SE, Norton JM (2002). Interexaminer reliability and cranial osteopathy. Sci Rev Alt Med 6 (1): 23–34.
- Dhossche DM, Reti IM, Wachtel LE (2009). Catatonia and autism: a historical review, with implications for electroconvulsive therapy. J ECT.
- Rossignol DA, Rossignol LW, Smith S et al. (2009). Hyperbaric treatment for children with autism: a multicenter, randomized, double-blind, controlled trial. BMC Pediatrics 9.
- Serruya MD, Kahana MJ (2008). Techniques and devices to restore cognition. Behav Brain Res 192 (2): 149–65.
- Bishop J (2003). The Internet for educating individuals with social impairments. Journal of Computer Assisted Learning 19 (4): 546–56.
- el Kaliouby R, Picard R, Baron-Cohen S (2006). Affective computing and autism. Ann N Y Acad Sci 1093: 228–48.
- Ichim TE, Solano F, Glenn E et al. (2007). Stem cell therapy for autism. J Transl Med 5 (30): 30.
- Wing L (1997). The history of ideas on autism: legends, myths and reality. Autism 1 (1): 13–23.
- Miles M (2005). Martin Luther and childhood disability in 16th century Germany: what did he write? what did he say?. Independent Living Institute. URL accessed on 2008-12-23.
- includeonly>Collins D. "Autistic boy dies during exorcism", CBS News, 2003-08-25.
- Shaked M, Bilu Y (2006). Grappling with affliction: autism in the Jewish ultraorthodox community in Israel. Cult Med Psychiatry 30 (1): 1–27.
- Ekas, NV, Whitman TL, Shivers C. (2009 May). Religiosity, spirituality, and socioemotional functioning in mothers of children with autism spectrum disorder. J Autism Dev Disord. 39 (5): 706–19..
- Tarakeshwar, Nalini, Kenneth I. Pargament (2001). Religious Coping in Families of Children with Autism. Focus on Autism and Other Developmental Disabilities 16 (4): 247–260.
- Ministries of Health and Education (2008). New Zealand Autism Spectrum Disorder Guideline (PDF), Wellington: Ministry of Health.
- Fitzpatrick M (2008). Defeating Autism: A Damaging Delusion, London: Routledge. Reviewed in: Guldberg H. 'Autistic children are now seen as a burden'. spiked.
- Posey DJ, McDougle CJ (2008). Preface. Child Adolesc Psychiatr Clin N Am 17 (4): xv–xviii. This describes a special issue of the journal Child and Adolescent Psychiatric Clinics of North America, titled "Treating Autism Spectrum Disorders" (volume 17, issue 4, pages 713–932) and dated October 2008.
- Bryson SE, Rogers SJ, Fombonne E (2003). Autism spectrum disorders: early detection, intervention, education, and psychopharmacological management. Can J Psychiatry 48 (8): 506–16.
- Erickson CA, Posey DJ, Stigler KA, McDougle CJ (2007). Pharmacologic treatment of autism and related disorders. Pediatr Ann 36 (9): 575–85.
Pervasive developmental disorders / Autism spectrum
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