How is autism treated?
There is no cure for autism. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that target the core symptoms of autism: impaired social interaction, problems with verbal and nonverbal communication, and obsessive or repetitive routines and interests. Most professionals agree that the earlier the intervention, the better.
Educational/behavioral interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills. Family counseling for the parents and siblings of children with autism often helps families cope with the particular challenges of living with an autistic child.
Medications: Doctors often prescribe an antidepressant medication to handle symptoms of anxiety, depression, or obsessive-compulsive disorder. Anti-psychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more of the anticonvulsant drugs. Stimulant drugs, such as those used for children with attention deficit disorder (ADD), are sometimes used effectively to help decrease impulsivity and hyperactivity.
Other therapies: There are a number of controversial therapies or interventions available for autistic children, but few, if any, are supported by scientific studies. Parents should use caution before adopting any of these treatments.
Applied Behavioral Analysis
ABA is a discipline devoted to the understanding and improvement of human behavior. It focuses on objectively defined, observable behavior of social significance; it seeks to improve specific behaviors while demonstrating a reliable relationship between the procedures used and the change in that specific behavior. ABA uses the method of science; description, quantification and analysis. In 1968 Baer, Montrose and Risley published a paper that outlined seven defining characteristics of ABA, this paper has become the most widely cited publication in ABA and serves as the standard description of ABA.
Applied: is determined by the social significance of the target behavior (what we teach a student). The behavior must have immediate importance to the student/family
Behavioral: the behavior chosen has to be a behavior in need of changing (teaching a 2 year old to tie shoes), and the behavior must be measured reliably and precisely.
Analytic: this simply means that we can demonstrate that the change in behavior is due to our teaching procedures. There has to be a functional relationship between the manipulated events and the behavior of interest.
Technological: Procedures are considered technological when all of the procedures used to teach are completely identified and precisely described; we often refer to this as “objectively defined.” Can someone else carry out your program/behavior plan without you there?
Conceptually systematic: behavior change procedures should be described in terms of the behavioral principle from which it was derived. There are many tactics we use to change a behavior (i.e. teach) however they all come from just a few principles of behavior.
Effective: did the behavior of interest change to a meaningful/practical degree? Did a physical prompt teach a student to touch her head?
Generality: does the behavior last over time? Can your student go to play group and sing “twinkle twinkle?” Once the teaching procedure is finished does the student really “know” his/her colors? Generality also occurs when a behavior that was not the focus of teaching changes as well. This is a good thing but not always automatic. We have to program for generality aka generalization.
Facilitated Communication (FC)
FC was developed in the 1970s in Australia by an aide who was trying to help a patient with cerebral palsy to communicate. It is based on the idea that the person is unable to communicate because of a movement disorder, not because of a lack of communication skills. FC involves a facilitator who, by supporting an individual’s hand or arm, helps the person communicate through the use of a computer or typewriter. It has not been scientifically validated; critics claim it is actually the ideas or thoughts of the facilitator that are being communicated. FC is very controversial and organizations such as the American Association of Mental Retardation, and the American Academy of Child & Adolescent Psychiatry, have adopted formal positions opposing the acceptance of FC.
Pivotal Response Treatment (PRT)
Regarded as one of the top state-of-the-art treatments for autism in the United States*, Pivotal Response Treatment (PRT) is a naturalistic intervention model producing positive changes in critical behaviors, leading to generalized improvement in communication, social, and behavioral areas. Rather than target individual behaviors one at a time, PRT targets pivotal areas of a child’s development, such as motivation, responsivity to multiple cues, self-management, and social initiations. By targeting these critical areas, PRT results in widespread, collateral improvements in other social, communicative, and behavioral areas.
The underlying motivational strategies of PRT are incorporated throughout intervention as often as possible, and they include child choice, task variation, interspersing maintenance tasks, rewarding attempts, and the use of direct and natural reinforcers. The child plays a crucial role in determining the activities and objects that will be used in the PRT exchange. For example, attempts at functional communication are rewarded with a natural reinforcer (e.g., if a child attempts a request for a stuffed animal, the child receives the animal, not a piece of candy or other unrelated reinforcer). Pivotal Response Treatment is used to teach language, decrease disruptive/self-stimulatory behaviors, and increase social, communication, and academic skills.
* National Research Council of the National Academy of Sciences, 2001
Relationship Development Intervention (RDI)
Relationship Development Intervention (RDI) is based on the work of psychologist Steven Gutstein. RDI focuses on improving the long term quality of life for all individuals on the spectrum. The RDI program is a parent- based treatment that focuses on the core problems of gaining friendships, feeling empathy, expressing love and being able to share experiences with others. Dr’s Gutstein program is said to be based on extensive research in typical development and translates research findings into a systematic clinical approach. His research found that individuals on the autism spectrum seemed to lack certain abilities necessary for success in managing the real life environments that are dynamic and changing. He calls these abilities dynamic intelligence and describes six aspects as follows:
- Emotional Referencing: The ability to use an emotional feedback system to learn from the subjective experiences of others.
- Social Coordination: The ability to observe and continually regulate one’s behavior in order to participate in spontaneous relationships involving collaboration and exchange of emotions.
- Declarative Language: Using language and non-verbal communication to express curiosity, invite others to interact, share perceptions and feelings and coordinate your actions with others.
- Flexible thinking: The ability to rapidly adapt, change strategies and alter plans based upon changing circumstances.
- Relational Information Processing: The ability to obtain meaning based upon the larger context. Solving problems that have no “right-and-wrong” solutions.
- Foresight and Hindsight: The ability to reflect on past experiences and anticipate potential future scenarios in a productive manner
Dr Gutstein who, along with Dr. Rachelle Sheely, formed the Connections Center For Family and Personal Development based in Houston Texas in 1995, states, ” We are challenging families and professionals to think beyond achieving mere functionality as a successful outcome for individuals with autism; our reference point for success in the RDI program is quality of life.” The goal is social improvement as well as change in flexible thinking, pragmatic communication, creative information processing, and self-development. The program offers training workshops for parents as well as several books that offer step-by step exercises building motivation so that skills will be utilized and generalized. The program can be started easily and implemented into regular, daily activities that enrich family life.
The communications problems of autistic children vary to some degree and may depend on the intellectual and social development of the individual. Some may be completely unable to speak whereas others have well-developed vocabularies and can speak at length on topics that interest them. Any attempt at therapy must begin with an individual assessment of the child’s language abilities by a trained speech and language pathologist.
Though some autistic children have little or no problem with the pronunciation of words, most have difficulty effectively using language. Even those children who have no articulation problems exhibit difficulties in the pragmatic use of language such as knowing what to say, how to say it, and when to say it as well as how to interact socially with people. Many who speak often say things that have no content or information. Others repeat verbatim what they have heard (echolalia) or repeat irrelevant scripts they have memorized. Some autistic children speak in a high-pitched voice or use robotic sounding speech.
Two pre skills for language development are joint attention and social initiation. Joint attention involves an eye gaze and referential gestures such as pointing, showing and giving. Children with autism lack social initiation such as questioning, make fewer utterance and fail to use language as a means of social initiation. Though no one treatment is found to successfully improve communication, the best treatment begins early during the preschool years, is individually tailored, and involves parents along with professionals. The goal is always to improve useful communication. For some verbal communication is realistic, for others gestured communication or communication through a symbol system such as picture boards can be attempted. Periodic evaluations must be made to find the best approaches and to reestablish goals for the individual child.
TEACCH (Training and Education of Autistic and Related Communication Handicapped Children) is a special education program that is tailored to the autistic child’s individual needs based on general guidelines. It dates back to the 1960s when doctors Eric Schopler, R.J. Reichler, and Margaret Lansing were working with children with autism and constructed a means to gain control of the teaching setup so that independence could be fostered in the children.
What makes the TEACCH approach unique is that the focus is on the design of the physical, social, and communicating environment. The environment is structured to accommodate the difficulties a child with autism has while training them to perform in acceptable and appropriate ways. Building on the fact that autistic children are often visual learners, TEACCH brings visual clarity to the learning process in order to build receptiveness, understanding, organization, and independence. The children work in a highly structured environment which may include physical organization of furniture, clearly delineated activity areas, picture-based schedules and work systems, and instructional clarity. The child is guided through a clear sequence of activities and thus aided to become more organized.It is believed that structure for autistic children provides a strong base and framework for learning. Though TEACCH does not specifically focus on social and communication skills as fully as other therapies it can be used along with such therapies to make them more effective.
While early educational intervention is key to improving the lives of individuals with autism, some parents and professionals believe that other treatment approaches may play an important role in improving communications skills and reducing behavioral symptoms associated with autism. These complementary therapies may include music, art, or animal therapy and may be done on an individual basis or integrated into an educational program. All of them can help by increasing communication skills, developing social interaction, and providing a sense of accomplishment. They can provide a non-threatening way for a child with autism to develop a positive relationship with a therapist in a safe environment.
Art and music are particularly useful in sensory integration, providing tactile, visual, and auditory stimulation. Music therapy is good for speech development and language comprehension. Songs can be used to teach language and increase the ability to put words together. Art therapy can provide a nonverbal, symbolic way for the child with autism to express him or herself. Animal therapy may include horseback riding or swimming with dolphins. Therapeutic riding programs provide both physical and emotional benefits, improving coordination, and motor development, while creating a sense of well-being and increasing self-confidence. Dolphin therapy was first used in the 1970s by psychologist David Nathanson. He believed that interactions with dolphins would increase a child’s attention, enhancing cognitive processes. In a number of studies, he found that children with disabilities learned faster and retained information longer when they were with dolphins, compared to children who learned in a classroom setting.
As with any therapy or treatment approach, it is important to gather information about the treatment and make an informed decision. Keep in mind however, as with most complementary approaches, there will be little scientific research that has been conducted to support the particular therapy.
If your child is younger than 3 years old, he or she is eligible for “early intervention” assistance. This federally-funded program is available in every state, but may be provided by different agencies.
This early education assistance may be available to you in two forms: home-based or school-based. Home-based programs generally assign members of an early intervention team to come to your home to train you and educate your child. School-based programs may be in a public school or a private organization. Both of these programs should be staffed by teachers and other professionals who have experience working with children with disabilities specifically autism. Related services should also be offered, such as speech, physical or occupational therapy, depending on the needs of each child. The program may be only for children with disabilities or it may also include non-challenged peers. Because no two children with autism have the exact same symptoms and behavioral patterns, a treatment approach that works for one child may not be successful with another. This makes evaluating different approaches difficult. There is little comparative research between treatment approaches. Primarily this is because there are too many variables that have to be controlled. So, it’s no wonder that as a parent you might be confused about what to do.
In an article titled “Behavioral and Educational Treatment for Autistic Spectrum Disorders” (Advocate, Volume 33, No. 6), Bryna Siegel Ph.D. suggests thinking about “each symptom as an autism specific learning disability . . . and a barrier to understanding.” Using this model, it is easier to evaluate what a child can and cannot do well. “Take stock of which autistic learning disabilities are present . . . then select treatments that address that particular child’s unique autism learning disability profile.” Understanding these learning differences is the first step in assessing whether a specific treatment approach may be helpful to your child. Understanding a child’s strengths is equally important. For example, some children are good visual learners, while another more advanced child may require written, rather than oral, learning tools.