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Sorting Through Autism Treatments
 There is no one-size-fits-all treatment for autism spectrum disorders (ASD).
Reason: Scientists have yet to pinpoint the exact cause, or causes, of autism, even though evidence mounts that it is largely a genetic disorder. Thus far, no clear-cut evidence exists that shows environmental toxins or vaccines trigger autism spectrum disorders.
The symptoms that characterize ASD vary widely, even though they revolve around a common axis of impairments in the way children relate to others, communicate and behave.
For example, if your child struggles with saying consonant and vowel sounds — the precursors to talking — your child might benefit from a more structured intervention strategy than a child who can say words but has difficulty asking for things.
Considering the individual needs of your child is the torch you should carry to lead your way through an ever-growing maze of treatments.
According to one study, families try as many as nine and use between four and six different treatments, mainly speech and occupational therapy, a picture exchange program, sensory integration therapy, ABA, social skills training, Floortime and music therapy. And, they are constantly on the lookout for anything else that might help their child.
There are no quick fixes. Also, be on guard for treatments that promise a cure. There is no cure for autism, but that doesn’t mean that your child cannot “recover” and attend a regular school, have friends and be empathetic.
Children progress at different rates. While some children “lose” the diagnosis, others may require support in school. For example, it is not uncommon for children to receive special education services for reading and writing. Still others may need help with basic living skills, such as preparing a meal, or they may need lifelong care and support, despite your best efforts.
As you learn more about how various treatments can potentially help your child, try these treatments first before turning down the path of alternative treatments, which the medical community characterizes as complimentary and alternative medicines, or CAM.
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| As you explore treatments beyond those we cover, we encourage you to understand how treatments put — or pretend to put — research into practice. The best resource for evaluating the scientific efficacy, or effectiveness, of autism treatments is A Parent's Guide to Research by the Organization of Autism Research. Download this free booklet or fill in the request form and a print copy will be sent to you. Although this booklet is written in plain English, understanding whether a treatment has good science behind it can still be confusing. Even autism experts disagree over the validity of treatments. |
But there are treatments with more scientifically proven strengths. We call them “The Big Three” and selected them based on the books, The Science and Fiction of Autism, by Dr. Laura Schriebman, and Educating Children with Autism, a product of a federal panel that was convened to evaluate the strengths and weaknesses of ten major intervention models. You can read for free the full-text of Educating Children with Autism (National Academies Press, 2001) by visiting the publisher’s website. It is an excellent resource but a tedious read. Dr. Schriebman’s book is much easier to understand but only its introduction is available at no-cost from its publisher, Harvard University Press.
Shelfari displays The Early Intervention Network’s bookshelf that will take you directly to the order button on Amazon. [Your purchase through our Shelfari bookshelf generates proceeds to benefit the mission of The Early Intervention Network. There is no markup.]
The Early Intervention Network puts research into practice by educating you about your options and enabling you to take advantage of them. Click on one the three icons to reveal the treatments that are categorized under The Big Three. We encourage you to read through each treatment option in the order that we present them because that is order in which they evolved over time.
The Big Three
 Applied Behavior Analysis
Floortime
TEACCH
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Applied Behavior Analysis
What is it? ABA is an educational strategy for changing behaviors through positive reinforcement. Nowadays, you'll hear ABA referred to as Intensive Behavioral Intervention (IBI), or Early Intensive Behavioral Intervention (EIBI). IBI or EIBI is the new euphemism for applied behavior analysis because it has less of a negative connotation than ABA, which is often misunderstood to mean DTT, or discrete trial training. DTT is a form of ABA and takes a skill, such as waving hello, and breaks it down into its individual components. The idea is to teach each component individually and then combine the skills in sequence to achieve mastery of the overall skill.
The newest spin on ABA is AVB (Applied Verbal Behavior), which is a language and communications program. It was developed by Drs. James Partington and Mark Sundberg, not Dr. Vincent Carbone who seems to get all the credit because he’s better at marketing AVB parent-training seminars. ABA takes its cue from behaviorism, and the pioneer in that area was B.F. Skinner, who is best-known for a contraption he developed in the 1930s that showed how good behavior is rewarded. AVB relies less on repetition than DTT, for example. Again, the method that you choose will depend on the needs of your child.
Who developed it? Psychologist Dr. O. Ivar Lovaas and a team of researchers at the University of California in Los Angeles back in the mid-1960s.
How much does it cost? Generally, an ABA program consisting of at least 25 hours a week, can cost upwards of $25,000 a year. The cost depends on your child’s needs — your child may need more than 25 hours per week — and the hourly rate you’re paying a therapist, which varies depending on experience and your geographic location. For example, a therapist with no experience may earn $12 to $15 an hour, while a therapist certified in a major metropolitan area might earn about $40 an hour.
Why is it recommended? ABA is said to have the best science behind it, although that evidence is sometimes hotly debated and criticized by other experts. The famous 1987 study by Dr. Lovaas cemented that belief. In that study, Lovaas compared three groups of children. The first group received 40 hours of ABA a week, the second one received only 10 hours of behavioral treatment along with a variety of other therapies, and the third group received no behavioral intervention. Dr. Lovaas published results showing that about half of the children who received intensive ABA therapy wound up in regular first grade classes, and their IQs jumped 30 points.
The National Institute of Mental Health, the American Academy of Pediatrics, the U.S. Surgeon General and the National Research Council back ABA.
Where is it available? Typically, two options exist for parents creating home-based programs. They can:
Special education schools. Some schools based their curriculum on ABA strategies. A model ABA program is the STARS (Strategic Teaching and Reinforcement Systems) School in Walnut Creek, Calif. You also can search using the key phrase "ABA schools" (keep the quotes around the key phrase: it forces some search engines to search for the exact phrase) plus the name of your city or geographic area to find a program in your area.
Recruit and train college students under the supervision of a licensed psychologist with a BCBA (Board Certified Behavior Analyst) certification. To find students, contact either the psychology or speech and language department of your nearest university. Find out from the assistant to the department head if there is a listserv (email discussion list) for posting your ad. If not, ask the professor if he will make an announcement in class for you.
Find a practice that will provide you with a supervisor and trained therapists.
Floortime
What is it? Floortime is the opposite of Applied Behavior Analysis and is often seen as a competing treatment. It is a specific technique that involves following your child's natural emotional interests and challenging her toward greater mastery of six developmental milestones. The technique is to get on the floor with a child and create opportunities for the child to master these milestones through interactive play. A tenet is to follow a child's lead, not dominate it. In ABA, you — the adult — tell your child what to do. Floortime is not a language program. It involves five to six 20-minute sessions spread out over a day.
Don't confuse the DIR (its full name is Developmental, Individual-Difference, Relationship-Based) model with Floortime and lump them together as the same. They are different, even though they are expressed as the DIR/Floortime model. Think of the DIR as the axis around which to organize your thoughts, looking at your child's unique challenges and strengths and then knowing which specific interventions to select as part of a comprehensive program. In other words, the DIR model provides the framework for determining which interventions are right for your child. Floortime is the technique.
Who developed it? Drs. Stanley Greenspan and Serena Wieder are the co-creators of Floortime. In 1992, Dr. Greenspan's book. Infancy and Early Childhood: The Practice of Clinical Assessment, brought Floortime to the fore, though Greenspan and Wieder began using it on children with autism spectrum disorders in the mid-1980s.
How much does it cost? To get started, you're likely to seek the expertise of a psychologist trained in Floortime, or a certified therapist. Depending on your geographic location, the cost of 50-minute session with a psychologist runs from about $90 an hour to well over $200 an hour. A psychologist will train you in specific techniques. You also might find a workshop in your area for under $500. Floortime, as with ABA, can be grueling because of the intensive demands it places on you to constantly interact with your child who may not pay attention or stick with an activity for very long. You might want to consider finding a therapist.
Why is it recommended? Floortime emphasizes a child's emotional, social and imaginative abilities — autism's core deficits — and was developed from brain research that shows human development hinges on interactions and the relationships that develop from there. It is now the fastest growing intervention in the field, though ABA still dominates. Initial studies suggest its effectiveness.
Where is it available? Visit the website of Interdisciplinary Council on Developmental and Learning Disorders and choose U.S. Programs from its left-hand navigation bar to find a list of options for programs and schools that embrace the DIR/Floortime model.
TEACCH
What is it? TEACCH stands for Treatment and Education of Autistic and related Communication-handicapped CHildren. The long-term goal of TEACCH is to help children develop as many key life skills as possible for independent living. The method, another spin on behaviorism, emphasizes instruction that teaches to the strengths of most children with autism — their visual skills. Classroom and home environments are arranged with clear, concrete visual information. In the classroom, trained teachers keep children focused and interacting through pictures, schedules, and visual cues. For example, if a child is told to "wait," the child could be taught to go to a "blue" carpet square and sit. Providing a visual cue is likely to make more sense to a child with autism than the abstract concept of waiting.
Who developed it? In the 1970s, Dr. Eric Schopler (1927-2006), a professor of psychiatry and psychology at University of North Carolina at Chapel Hill, and colleagues developed TEACCH.
Why is it recommended? According to the National Research Council's report, TEACCH offers some supporting evidence. It also is the most widely used program in North Carolina schools, though it is not exclusive to North Carolina; other schools across the nation have adopted its techniques.
Where is it available? The TEACCH website lists regional centers throughout North Carolina that offer services. You also should visit the Family Services section of the Autism Speaks' website. Here you can search by state to find TEACCH services as well as a myriad of other services, including Floortime and ABA.
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