Treatment

Autism is a spectrum disorder that typically appears in childhood and involves challenges in communication and socialization, and rigid, inflexible patterns of behavior. (See our page on diagnostic criteria.) While having particular challenges, many individuals on the spectrum often have special talents that equal or even exceed those of other “neuro-typical” peers. While there is no cure for Autism Spectrum Disorder (ASD), individuals on the spectrum are lifelong learners and benefit greatly from treatments involving Applied Behavior Analysis (ABA), visual supports, and functional communication training. Individuals on the spectrum typically respond well to highly structured and predictable habilitative and educational programs designed to meet their individual needs and desires. It should be noted that individuals with ASD can be affected by the same issues as their peers (e.g., anxiety, depression, seizure disorders, diabetes, and so on); diagnosis of these additional issues, while often more difficult because of communication challenges, is important in developing effective treatments. With individualized treatment, education, and support, children and adults can learn to live and participate in their community.

Research has demonstrated that individuals with ASD benefit from early intervention and appropriate interventions throughout their lifespans. Applied Behavior Analysis (ABA) is an empirically based best practice that is available from appropriately trained behavior analysts. ABA has often been misinterpreted historically. It is a robust empirical approach to the study of human behavior, most often involving the identification of the functional properties of behaviors, strengthening desired behaviors through reinforcement and environmental manipulation, and weakening undesired behaviors through the strengthening of appropriate replacement behaviors. It is quite effective, not only in treating behavioral issues but also in identifying and teaching effective skills. Other treatments that have been demonstrated to be effective are functional communication training, structured teaching, and speech therapy. Recent research by the Frank Porter Graham Child Development Institute in conjunction with the National Professional Development Center on ASD identified 27 evidence-based practices; of these, 13 are traditional behavior analytic techniques, eight are naturalistic behavioral techniques, and the remaining six are from other theoretical influences.

As most of us in the field of ASD know only too well, many practices are promoted as “wonder-treatments,” and unfortunately, many of these claims are not based on solid evidence. As you choose which treatment would best serve your loved one or clients, it is important to know which ones have been clearly and empirically shown to be effective. Evidence-based practices are those interventions that researchers have shown to be safe and effective, based on clear scientific research. Efficacy, according to the National Professional Development Center on ASD, must be established through peer-reviewed research in scientific journals using accepted high standard methodologies.

 

The 27 evidence-based practices are (Click on the names to read more):

Antecedent-Based Intervention Cognitive Behavioral Intervention (CBI)
Differential Reinforcement Discrete Trial Teaching
Exercise Extinction
Functional Behavior Assessment Functional Communication Training
Modeling Naturalistic Intervention
Parent-Implemented Intervention Peer-Mediated Instruction and Intervention
Pivotal Response Training Picture Exchange Communication System (PECS)
Prompting Reinforcement
Response Interruption Scripting
Self-Management Social Narratives
Social Skills Training Structured Play Groups
Task Analysis Technology-Aided Instruction and Intervention
Time Delay Video Modeling
Visual Supports  

 

The study also reviewed comprehensive treatment models, which typically use a combination of techniques. Perhaps not surprisingly, those found to be evidence-based practices typically involve a protocol that incorporates, at least in part, some of the techniques listed above. Five program models received the highest scores in the four areas analyzed for evaluation:

Denver Model LEAP
Lovaas Institute May Institute
Princeton Child Development Institute  

 

It should be noted that studies on Comprehensive Treatment Models are ongoing, and it takes time to gather empirical results. A number of models have had stronger empirical studies published since this study’s review was conducted. While not yet labeled as EBP, these may be moving in that direction:

Early Start Denver Model TEACCH
Hanen Pivotal Response Training (PRT)
DIR/Floortime STAR

 

Finally, and perhaps equally important to families and professionals when selecting treatment approaches, the study identified unestablished interventions that have insufficient empirical evidence of effectiveness. These include:

Antifungal treatment Hyperbaric oxygen therapy **
Aquatic therapy Medical marijuana
Auditory Integration Therapy Neuroimmune dysfunction & antiviral therapy
Sensory Gym Chelation removal of toxic metals
Stem cell therapy Craniosacral and chiropractic therapy
Dietary interventions Traditional and indigenous healing
Transcranial Direct Current Stimulation  

**The Food and Drug Administration (FDA) has issued a warning on the use of hyperbaric oxygen therapy. In their words:
Patients receiving HBOT are at risk of suffering an injury that can be mild (such as sinus pain, ear pressure, painful joints) or serious (such as paralysis, air embolism). Since hyperbaric chambers are oxygen rich environments, there is also a risk of fire. If you're considering using HBOT, it's essential that you first discuss all possible options with your health care professional.

We endorse the position that quality programs seamlessly integrate evidence-based practices in the field of autism intervention. The Autism Society of North Carolina’s Clinical Services staff can provide private consultation services and more detailed information about treatment options in your area. If you would like information about other resources or providers in your local area, ASNC Autism Resource Specialists can help.