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Autism therapies

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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 learning skills. In adults with autism, some studies have found beneficial effects of the antidepressant medications clomipramine and fluoxetine, and the newer antipsychotic medications such as Risperdal and, more traditionally, the much older drug haloperidol, possibly due to the preponderance of co-morbid disorders in those with autism significantly adding to behavioural and functional challenges more than the autism itself.

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.

Behavioral and sensory integration interventions

Applied Behavior Analysis

Main article: 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—often referred to as Discrete Trial, Intensive Behavior Intervention, and ABA—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)[1].

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.

Some people have made ethical challenges to autism treatment by pointing out that early ABA was based around the use of aversives and saying that these aversives can be confusing and/or painful.[2]. Aversives are not used in today's ABA therapy programs.

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. [3] [4]

Computer use

Studies have suggested that computer use can help to calm children on the autistic spectrum, while stimulating their ability to communicate.[5] 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[6], have proposed that monotropism, or very focused 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 focuses 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. Also in Italy applications of snoezelen are proving effective in geriatric hospital departments (see Parma General Hospital [7]).

Neurofeedback

Neurofeedback may alleviate some of autism symptoms, according to a pilot study on eight children.[8] 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.

Cranio Sacral Therapy

A form of Osteopathy used to relieve uneven soft-tissue pressure around the base of the scull in order to balance the flow of Cerebral Spinal Fluid to the brain. Cerebral Spinal Fluid feeds nutrition to the brain and assists in removal of toxins from the brain in the excretion process. Hence improving the flow and balance of the supply of this fluid to the brain is asserted to assist in information processing and other autism-associated challenges.

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 detractors. 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 situations, 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. This approach is close to something that would be acceptable to autistic advocates. Matthews and Williams believe that certain symptoms that are regarded as autistic are actually normal human responses to stress, and that programs that attempt to reduce these symptoms may make the autism worse by taking away the individual's ability to react in a normal fashion to discomfort. Matthews firmly believes in the importance of establishing a primary bond between an autistic child and his parent, and from that bond, social interest and learning can eventually occur. She feels that ABA and other behavioral interventions can possibly turn the parent and child into adversaries, or create a master-servant relationship in which the parent commands and the child learns to obey unthinkingly. This, she believes, makes intimacy much more difficult later in life, and can lead to the gullibility and passivity that autistic people are often noted for. Matthews allowed Williams to remain out of school after the fifth grade, and now eighteen, he has gone on to become a sought-after speaker at autism conferences and support groups. However, his outcome 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 appropriate replacement behaviors, self-help skills, verbal behavior, academic skills, fine motor, gross motor, and social skills, directly, RDI focuses primarily on building the "dynamic intelligence" that underlies the acquisition of social skills demonstrated 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. To date no peer-reviewed published research exists.

Son-Rise

Main article: 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)[9] maintains a description of the Son-Rise Program.[10]

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[11], 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

Many parents and medical professionals have reported improvements in the behavior of autistic children enrolled in special diets, detoxification therapies, and a range of treatments, collectively known as biomedical intervention for autism. In 1995, The Autism Research Institute brought together a group of about 30 physicians and scientists to share information and ideas toward defeating autism as quickly as possible. This became known as Defeat Autism Now!, which comprises a network of doctors whose goal is to educate parents and clinicians about biomedically-based research, appropriate testing and safe and effective interventions for autism.

Some of these claims are contested by other 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 including autism are caused by environmental shocks that compromise the gastrointestinal, immunological and neurological systems. Based on this premise, what is often diagnosed as autism or PDD is seen as 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. Many of the most prominent researchers and advocates of biomedical therapies in autism have autistic children of their own and have been driven by their own experience of seeing their own children improve to devote their time to helping others. These include Dr. Bernard Rimland, who is seen by many as the godfather of biological interventions in autism.

There is plenty of anecdotal evidence to support biomedical intervention - most parents who try one or several therapies report some progress, and there are many anecdotal stories of children who have undergone these programs and become seemingly completely neurotypical, able to return to mainstream education, and/or made dramatic improvements in health and well-being. 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 more research including double-blind studies to test the relative efficacy of the different treatment approaches, and the light they might shed on the nature of autism.

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.[12] 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:

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. This is not to say that mercury and thimerosal cannot cause autism, just that there is no data to support the connection[13]

The death of a five year old boy in August 2005 has been linked to this practice [14]; however, the isolated case has been attributed to the accidental administration of an incorrect agent [15]. 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 whilst a subset have been found to have co-morbid mood, anxiety and compulsive disorders, autistic people are not necessarily psychotic, particularly anxious, depressed or bipolar. Many autistic people themselves are against the overprescription of neuroleptic drugs in autistic people to control behavior whilst some of those with co-morbid disorders have been relieved to have medication to manage these and some psychiatrists are just now beginning to explore minimal doses of medication for this group. Those against the use of Neuroleptic abuse of people with autism have formed an organization called Autistic People Against Neuroleptic Abuse to counter this phenomenon.

Gluten-free, casein-free diet

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Main article: Gluten-free, casein-free diet

In the 1990's, Dr. Karl Ludwig Reichelt MD, PhD, Institute of Pediatric Research at the University of Oslo reported that several laboratories found increases in urinary peptides in children with autism, including casomorphines and gluten exorphins. [16]. According to Dr. Reichelt and others, significant improvements have been seen in the symptoms of some patients with autism who had been put on a diet that omits casein nd gluten. The diet became known as the gluten-free, casein-free diet.

The possible link between digestive disorders and autism has also been raised by Dr. Andrew Wakefield, a United Kingdom gastroenterologist who has described the disputed condition as autistic enterocolitis.

Low Salicylate diet

Researchers such as Rosemary Waring (Birmingham University) found a significant proportion of people with autism were Salicylate Intolerant, meaning they were unable to properly metabolise Salicylates ; a natural plant toxin common in most stone fruits, berries, citrus fruits (with the exception of lemon), some vegetables and very high in honey, yeast extracts and almonds. This was found associated with deficiencies in an enzyme, Phenolsulphurtransferase, the lack of which lead to suppressed immunity and detoxification functions in Salicylate intolerant children. Waring's work was taken up by other researchers including Sandra Johnson-Desorgher whose daughter made dramatic recovery using a pigment-restricted diet that became known as Sara's Diet. She later formed World Community Autism Program together with her husband, Max Desorgher.

The low Salicylate diet is commonly known of in ADHD/ADD circles as the Feingold Diet and includes eliminating artificial colorings, flavourings, preservatives and nitrates. Salicylate intolerance has been particularly linked to attentional problems and hyperactivity but more recently to mood and anxiety disturbances.

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 (however, it is important to note that thimerosal has not yet been outlawed in all 50 states). Currently, Dr. Mady Hornig of Columbia University is testing gold salts on mice specially bred to be susceptible to thimerosal. Dan Olmsted[17] 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

Tinted Lenses

Tinted Lenses were popularised by autistic author Donna Williams in her book Like Colour To The Blind and went on to become widely used by people with autism for the visual perceptual disorder of Scotopic Sensitivity Syndrome. Scotopic Sensitivity Syndrome is asserted to underpin reading challenges and asserted to result in a visual fragmentation effect in which it is difficult to see a whole face or process objects or a room visually as a whole.

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 throughout India. Some studies have shown that Bacopa has antioxidant effects specific to the cerebral tissue.[citation needed]

Holistic Healing

Evidence exists which may explain why the individual therapies listed above do not necessarily work for all sufferers of autism. A more comprehensive approach may be required, in which the genetics of each individual autism sufferer is studied and understood, followed by a personalized therapy schedule which may include diet restrictions, heavy metal detoxification, vitamin supplementation, etc. Often referred to as Holistic Healing, an example of this approach can be seen by going to www.autismanswer.com.

Probiotic diets

Probiotics are dietary supplements containing potentially beneficial bacteria or yeast. The use of probiotic diets for children with autism has been reported to have improved the concentration and behavior of the study subjects so much that medical trials collapsed because parents refused to accept placebos. According to the researchers, the effectiveness of the treatment caused some of the parents involved in a blind trial to realize that their children were not taking a placebo. The parents then refused to switch to the placebo as scheduled, resulting in the collapse of the trial. As a result, it was difficult for researchers to draw firm conclusions. Further research is being planned.[18]

Non-medical views

Autism is not a disorder

There is a view that autism is not a disorder, but a normal, healthy variation in neurological hard-wiring, and therefore does not need to be cured. This "anti-cure perspective" supports the model of autism that claims that autism is a fundamental part of who the autistic person is and that autism is something that cannot be separated from the person. A cure is seen as destroying the original personality of the individual and is perceived similar to attempts to "cure" homosexuality, therefore this perspective considers the disease classification insulting. In line with this belief an autistic culture has begun to develop similar to deaf culture. This view is usually held by autistic people themselves (Autism rights movement), and is mostly criticized by parents of autistic children.

There is no one condition called autism

This view was put forward by autistic author Donna Williams in her 9th book in the autism field, The Jumbled Jigsaw based on her work as an autism consultant working with over 600 people on the spectrum over 8 years. Here she presented a holistic model called Autism as a fruit salad model and demonstrated how the severity of someone's autism could be linked to their degree of co-morbid communication, sensory-perceptual, gut/immune, neurological integration, mood, anxiety and compulsive disorders a person inherited or developed coupled with cognitive and learning style differences and unusual personality trait collections. She suggested these challenges came about via different combinations of pathways including genetic inheritance, toxic exposure and clashing socio/sensory environments. She suggested that treatment and management, therefore, depended on mapping out which collection of co-morbid challenges were underpinning the autistic presentation for different individuals and addressing each with the most appropriate approaches to each individual underlying issue to maximise each person's potential. She also acknowledged that within this framework, individuals would exist for whom their greatest challenge would be cultural clashes between themselves and the neurotypical world.

Research

There are approximately twelve research studies published each week on therapies for individuals with autism. A recent review article (Bodfish 2004) suggests that there are three major barriers in the transfer of this information from the laboratory to the child. They are:

  • treatment providers do not routinely turn to treatments that have been validated scientifically
  • a large minority of patients (acutally parents of patients) resist therapies that have been scientifically validated
  • even scientifically validated therapies are not universally effective for all individuals with autism

Derrick Lonsdale lead a successful study on the treatment of autism spectrum children with thiamine.[1] This work is controversial linking diet with autism.

The study, Lonsdale D and Shamberger R J (2000) "A clinical study of secretin in autism and pervasive developmental delay." Journal of Nutritional and Environmental Medicine, Vol 10 (4), pp 271-280, has been cited by the National Autistic Society.[2]

References

Footnotes

  1. ^ "Autism Society of America ABA study". Retrieved July 30. {{cite web}}: Check date values in: |accessdate= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  2. ^ "ABA and autistics controversy". Retrieved July 30. {{cite web}}: Check date values in: |accessdate= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  3. ^ "IAHP Online". Retrieved February 14. {{cite web}}: Check date values in: |accessdate= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  4. ^ "ASAT Online". Retrieved September 13. {{cite web}}: Check date values in: |accessdate= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  5. ^ "ASAT Online - Son-Rise". Retrieved September 13. {{cite web}}: Check date values in: |accessdate= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  6. ^ "Autism and Computers Department of Education study". Retrieved July 30. {{cite web}}: Check date values in: |accessdate= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  7. ^ "Autism and Computing". Retrieved July 30. {{cite web}}: Check date values in: |accessdate= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  8. ^ "Gluten and Casien-free diet with other treatments". Retrieved July 30. {{cite web}}: Check date values in: |accessdate= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  9. ^ "The Age of Autism: Gold standards". {{cite web}}: Unknown parameter |accessmonthday= ignored (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  • Bodfish, J.W., Mental Retardation and Developmental Disabilities Research Reviews, 2004, 10:318-326

See also

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