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 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)^[2].

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 controlled 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.^[3]. 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. ^{[4] [5]}

The use of early techniques of ABA are documented in the book Let Me Hear Your Voice.

Computer use

Studies have suggested that computer use can help to calm children on the autistic spectrum, while stimulating their ability to communicate.^[6] 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^[7], 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 as well. However, there is currently little evidence that the benefits of computer use do extend to other mediums.

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 [8]).

Neurofeedback

Neurofeedback may alleviate some of autism symptoms, according to a pilot study on eight children.[9] 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

Craniosacral therapy is a form of osteopathy claimed to relieve uneven soft-tissue pressure around the base of the skull in order to balance the flow of cerebrospinal fluid to the brain. Improving the flow and balance of the supply of this fluid to the brain is believed by practitioners 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 refusing to force children to perform unnatural behaviors (for them) is not equivalent to 'letting them do whatever they want", or failing to educate them at all. Non-coercive approaches attempt to promote the development of autistic individuals while recognizing the high levels of stress, anxiety, nervousness and self-doubt they are prone to, and avoiding approaches that will increase these stresses.

Relationship Development Intervention

Relationship Development Intervention (RDI) is a treatment program developed by Dr. Steven E. Gutstein. Whereas ABA and other typical interventions aim to teach specific skills that are seen as lacking, RDI focuses primarily on building a general "dynamic intelligence" believed to underlie 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 Kaufman, who founded the Option Institute to promulgate the 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. 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.^[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.

Thomas Sowell

Economist Thomas Sowell, author of The Einstein Syndrome, is a major opponent of any form of 'early intervention' for children who are wrongly labeled autistic but appear to be intelligent, 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.

James Wiliams

The Self-Help Guide for Special Kids and Their Parents proposes reducing stressful situations, and not forcing the autistic child to change into someone he or she is not. James Williams, one of the authors, is an autistic child who recounts much of his experiences through examples of possible problems encountered by parents of autistic children. Some recommendations made by Williams include not forcing the child into a mainstreamed schooling situation too early, adapting to problems caused by hypersensitivity, and allowing stimming as a means of dealing with Stress. The book promotes the idea that certain symptoms exhibited by individuals with autism are normal human responses to stress, and blocking these responses removes the individual's ability to deal with this stress. The authors also stress the importance of a primary bond between autistic children and parents, and building social interest and learning from that bond, while criticizing ABA for turning parents and children into adversaries or pushing them into dominant and submissive roles.

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:

• 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.)

Chelation therapy

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. Currently there is no data that supports the theory that mercury and thimerosal cause autism.

The death of a five year old boy in August 2005 has been linked to this practice. This case has been attributed to the accidental administration of an incorrect chelation agent.

Drug therapy

The benefits of drugs is widely disputed. While anti-seizure medication is indicated for some children with seizures, other 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, 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

Main article: Gluten-free, casein-free diet

In the 1990's, Dr. Kalle 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. [13]. 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 and 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 found a significant proportion of people with autism were salicylate intolerant and unable to properly metabolise the chemical (a natural plant compound common in many foods that is toxic at high doses). This was found to be associated with deficiencies in the phenolsulphurtransferase enzyme, the lack of which could lead to suppressed immunity and detoxification functions.

Lutein-free diet

Waring's work was taken up by other researchers and led to alternative dietary approaches such as the lutein-free diet, known as Sara's Diet, to treat autism. This dietary approach was developed by nutrition researcher Sandra Desorgher, founder of World Community Autism Program and involves the total elimination of dietary lutein, artificial food dyes and Aspartame (also known as Nutrasweet and Canderel). This approach aims to provide all known and suspected essential nutrients, taking into account that optimal nutrition is individual and varies particularly in the autism population. Other elements of the diet might include: removal or reduction in intake of gluten and/or casein, soy protein, carotene pigments, high purine foods, active dry yeast, MSG, excessive supplementation and the return of some dairy fats or grains.

Feingold Diet

The Feingold Diet involves eliminating artificial colorings, flavourings, preservatives and nitrates, as well as salicylates. Salicylate intolerance has been linked to attentional problems, hyperactivity, mood and anxiety disturbances.

Thiamine supplementation

Derrick Lonsdale lead a pilot study on the treatment of autistic children with thiamine. This work is controversial linking diet with autism.

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 thiomersal 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[14] 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.

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.[15]

Other Therapy

The Ayurvedic herb bacopa has been used in several cases of autism.

Formal academic study, college level

Christopher Marsh, a 36-year-old American diagnosed with Asperger syndrome, who had pursued academic study of psychology, social psychology, and sociology to the Master's level, found certain courses of the social sciences extremely helpful in understanding the workings of the neurotypical world.

Primarily, one graduate course in Social Psychology focused two thirds of its attention to attribution (psychology) and conflict resolution, how anyone could learn to prevent and manage interpersonal conflict. If a neurotypical observer does not know that a person has Asperger, he or she may attribute unwelcome behavior as willful misconduct, and may, for example, decide to take no further action after a job interview. Or on the other hand, after knowing about the person's disability and skills, might hire that person.

Also of great importance, Emile Durkheim and the Rules of Sociological Method described how society, the invisible force that controls most of human behavior, organizes people to punish deviant behavior from small faux pas to immoral conduct and crime, and describes how anomie, a condition of alienation not very different from Asperger syndrome, can cause one to have emotional disorders like clinical depression and even commit suicide. Is it any accident that people with Asperger tend to receive negative treatment because of poorly coordinating an alien social world, have corresponding levels of depression, and sometimes commit suicide?

Undergraduate and graduate courses in sociological theory covered symbolic interactionism, notably the mind, self (sociology), and society focus of George Herbert Mead, Erving Goffman and impression management described in The Presentation of Self in Everyday Life, and other theories of how neurotypicals might perceive Asperger and how all people try to act in a social setting. A student with Asperger would intimately understand how conscious human communication takes place, but would still need to consider that non-verbal communication constitutes most of human communication. The theories should consider it. He or she would also learn the minute details of how neurotypicals strategize their behavior to maximize gains from social interaction.

Further examination of the relevant theories could include a review of related present-day research studies, with a careful assessment of what does and does not constitute sound research.

College students with autism and Asperger syndrome could benefit from two or three three-credit-hour courses in the above subjects to learn consciously about how society works, how neurotypicals manage in day-to-day life, and attempt to apply them for themselves. Indeed, many college students with Asperger, like Marsh, might be so overwhelmingly curious about the human (neurotypical) world ("other planet") that they will choose at least some electives from, if not a major in, the social sciences.

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 (actually parents of patients) resist therapies that have been scientifically validated
• even scientifically validated therapies are not universally effective for all individuals with autism

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

• Causes of autism

External links

• Healing Thresholds - daily summaries of scientific research on autism therapies
• Autism Network for Dietary Intervention
• Autism Treatment Info - Parents share their experience.
• Neurodiversity.com - 'Unchelated Autistics "Just Lost"???' (December 30, 2005)
• ScienceDaily.com - 'The Age of Autism: Gold salts to be tested', Dan Olmsted, United Press International (UPI) (August 29, 2005)
• UPI.com - 'The Age of Autism: Gold standards', Dan Olmsted, UPI (December 30, 2005)
• Washington.edu - 'About gold treatment: What is it? Gold treatment includes different forms of gold salts used to treat arthritis', University of Washington (December 30, 2004)
• Autism Treatment Search Engine - A community powered autism therapies search engine
• The Brain Engineering Laboratories HomePage