Heart & Soul of Treatment
While some medications might be needed at times for maladaptive behaviors in the course of treating autism, the “heart and soul” of treatment is one-to-one, in person, supportive, child-centered care (person-centered care), and a whole team of skilled clinicians is involved in making this care work for the child/person with autism. That said, no therapy approach yet developed can reliably, consistently, and effectively attack the core symptoms of autism.
Dozens of Therapies
Here is a consistent current and historical fact about medical care and medical treatment. When a medical condition has multiple variations in clinical presentation and no well-defined and researched targeted treatments, chaos ensues. Everyone, reputable researchers and clinicians and money-grubbing charlatans, claim to have “THE magic bullet” treatment. If anything, those with the loudest voices typically have the least respectable treatments. How does one decide? We hope the information below will help. As discussed more below, Applied Behavioral Analysis has been and remains the “gold standard” for effectively treating autism.
More Emphasis on One-to-One
This concept is important and too often overlook amidst the anxiety, anguish, and crisis feeling of parents of children with autism. It is similarly overlooked because of resource constraints for those from whom the parents seek help and treatment. The only true measure of whether an approach works is whether it works for one child, the one in front of you. Try different approaches and keep careful records, such as a diary, of which interventions worked and which did not. Both the parents and the treatment team members need to build this database to develop “evidence-based” help for a child, for this specific child, with autism.
The judgment call and decisions go beyond which types of therapies to pursue. A high-quality and conscientious therapist using a mediocre treatment protocol might likely produce good progress in the child’s well-being and progress. On the other hand, a poor-quality, lackadaisical therapist providing even the gold-standard of care might deliver no progress.
Does One Wait First To Set What Happens?
The sooner treatment is started after a firm diagnosis of autism is made the better everything will go for the child for years to come. So, the sooner a person that might have autism can get professional confirmation of the diagnosis, the better.
What Treatment Can Do
Treatment can make all the difference in the world. The first step will be an exploration to discover the current clinical picture. What is the child able to do? What can the child do really well, that is, what are his/her strengths, strengths upon which a therapist can build? In what areas does he not do well? That is, define areas that are not as strong. The information from this initial extensive evaluation gives the therapy team the ability to praise and confirm strengths. And, to work gently on less strong areas to gradually build a more balanced personal skill set over time.
Meet the Treatment Team
- First and foremost, one or two experienced, highly-trained, top-level health care professionals. Perhaps a psychiatrist or a neurologist, maybe a pediatrician or an internist.
- An occupational therapist. This individual knows play behavior, social skills, and daily living skills (like eating and personal hygiene).
- Speech therapist. Some people with autism are not great at speaking, at conversation, at getting their ideas across. A person who cannot explain what he needs or wants to others will not do well in life. Speech therapists train and improve language use, practice on communication with others, and improve a child’s ability to learn.
- A counselor or therapist-type clinician needs to be on the team. School psychologists can do this. As well as trained and experienced mental health specialists.
- Care manager. A central, super-necessary person. The care manager or case manager follows the treatment plan and keeps track of everything and everyone. The case manager functions like a coach on a sports team. The person with autism, the members of the treatment team, and the friends, relatives, and other helpers for the person with autism. The case manager is like the center hub a wheel holding the spokes of the wheel in place.
Comments on a few Behavioral Therapies
Applied Behavioral Analysis
Some refer to Applied Behavioral Analysis as the “gold standard” for effectively treating autism. Applied Behavioral Analysis is, no surprise, based on behavioral analysis and treatment principles in psychology. Behaviors that one wants to encourage are rewarded (reinforced) while those that one wants to extinguish elicit “consequences” such as being ignored. For example, behaviors to be rewarded might include school skills like reading and arithmetic, social experience such as play with others and communication, and living skills such as understanding schedules and being adaptable.
Cognitive Behavioral Therapies
These are more learning or cognition based approaches. The attempt here is teaching and it assumes the autistic child’s ability to understand and to work with the teacher/therapist. Some children can, some cannot, and with therapy in other areas this ability might well improve over time. Changing how one thinks and paying attention to how one behaves in a way that allows one to truly think differently and change behavior is hard for anyone. (Most mature and accomplished adults can’t do it!)
This approach is one that most parents use with most children. It can help some autistic children. It starts with involving the child in some form of exercise. If the child can do it, it helps with motor skills, coordination, and general physical fitness. Time spent in a productive, organized exercise pursuit leaves less time for problematic behaviors to emerge.
Other Therapy Approaches
These approaches are classroom-style educational approaches but with a fairly firm behavioral structure. The curriculum for a child must be designed for that one child. As one might imagine, pursuing this path with even a few students requires a team of trained professionals to provide an overall classroom environment but with individual attention to each child. Daycare and kindergarten age children who can be involved in this approach can show good progress and be better prepared for attempting the elementary grades. A term for a specific approach to this concept is Early Intensive Behavioral Intervention, or EIBI.
Parent Skills Training
Parents often are hit with several grief-like reactions as they discover the diagnosis of autism. Their internal struggle can cycle through all the stages, early denial, realization anger, hopeful bargaining, and upsetting depression. Finally the acceptance and desire to move forward sets in, but not usually with calm clear-mindedness. There’s still anxiety, perhaps some anguish, and maybe a feeling of crisis. Thus, it is little wonder that working with the parents is helpful and needed. How to play with their child, how to interact, in a way that promotes progress and growth in socialization and interpersonal interaction skills. And teach parents how to negotiate the troubled waters of any emerging problem behaviors.
No Evidence for CAM Therapies
The acronym CAM stands for Complementary and Alternative Medicine. For reasons that are not clear except the trendiness of the label, CAM therapies are popular for autism and autism spectrum disorders. CAM treatment includes herbal supplements, vitamin supplements, probiotics, “chelation” therapies, acupuncture, message therapies, yoga, hyperbaric oxygen, and dietary manipulations. Lumped under the CAM approaches are music therapies and other auditory training, drama therapies, dance therapies, pet therapy, and “sensory integration” therapies. Even chiropractic treatment is listed in this mix. Unfortunately, based on an remarkably extensive review by N Brondino et al. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439475/), there is no conclusive evidence that CAM therapies work for autism or autism spectrum disorder. When nothing works and a child is in distress, everything is tried based on hope.
National Library of Medicine (United States), PubMed Central
Centers for Disease Control and Prevention