Treatment Options
No single treatment approach can take away all the traits of autism for everyone, but many behaviors can be positively changed with appropriate intervention.
Sometimes the resulting changes are so significant the person appears to no longer have autism. However, the majority of children and adults will continue to
show some characteristics of the disorder to some degree throughout their lives.
While some students with autism attend regular school classes, most need training in vocational skills and community living skills at the earliest possible age.
Learning to cross a street safely, shop and make change, or ask for assistance are critical skills that may be difficult even for individuals with average
intelligence. Skills should be taught that would enhance the person's independence, give more opportunity for personal choice and allow more freedom in the
community.
To be effective, any approach should be flexible in nature, rely on positive strategies, be re-evaluated on a regular basis, and provide a smooth transition
from home to school to community environments. A good program will also incorporate training and support systems for caregivers as well. Rarely can a family,
classroom teacher or other caregiver provide effective habilitation for a person with autism unless offered consultation or in-service training by a knowledgeable
specialist.
A generation ago, most people with autism were eventually placed in institutions. Today, as a result of appropriate and individualized services and programs,
even the more severely disabled can be taught skills that will allow them to develop to their fullest potential.
Effective Treatment Approaches
Several treatment approaches have consistently been demonstrated to benefit people with autism. These approaches are described below.
The South Carolina Department of Disabilities and Special Needs and the South Carolina Autism Society do not endorse nor promote any particular treatment or
therapy. For additional information about Treatment and Therapies for autism go the South Carolina Services Information System (SCSIS) website:
www.state.sc.us/ddsn/pubs/scsis/scsis.htm.
Behavior Technology (Applied Behavior Analysis)Principles and techniques from the field of applied behavior analysis (ABA) are very effective in the treatment of people with autism. Behavior principles help
family members and professionals to be clearer in how they teach and give directions to children and adults with autism. Behavior principles are also useful in
helping people to respond productively to the unusual behaviors of some autistic individuals. Strategies based on ABA are particularly useful in evaluating
inappropriate (and even bizarre) behaviors to understand what the person is communicating through the behaviors.
Refer to Section 2. Glossary of Terms to read the definition of Applied Behavior Analysis.
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Discrete Trial Training
One form of ABA is discrete trial training. Discrete trial training is an intensive, one-on-one teaching session in which small parts of behaviors or skills
are taught in short, repeated “trials.” As the skills are learned, new skills are added in a carefully planned sequence. There is evidence that Discrete
Trial Training can be effective for some children with autism from birth through six years. The success of discrete trials depends upon the following: (1)
individual child; (2) number of hours of therapy; and (3) the curriculum or content of the training sessions. Lovaas therapy is a widely known type of discrete trial training. Professor O. Ivar Lovaas of the
University of California at Los Angeles published a landmark study of discrete trial training. He has developed a curriculum for preschool children using
discrete trials. Not all discrete trial training is the same, nor is all of it the same as the Lovaas method.
Setting up a discrete trial training program that utilizes applied behavior analysis requires a professional trained in ABA.
Communication TrainingBecause one of the main areas affected by autism is the ability to communicate, treatment programs should include methods to increase communication skills.
Depending on the individual's needs, speech therapy may focus on acquiring language skills or teaching sign language. Electronic devices or picture boards
may be used to help the person communicate more effectively. Teaching programs based on behavioral principles can be written specifically for the person’s
individual communication needs. Communication therapy can include a combination of methods. To determine your child’s communication needs, it is recommended
that you have your child evaluated by a speech/language pathologist who is knowledgeable about autism.
Social Skills TrainingAnother major area associated with autism is a lack of social ability or the understanding of social cues. Individuals with autism may spend time alone
instead of with others, show little apparent interest in making friends and be less responsive than others to social cues such as eye contact or facial
expressions. Social skills programming may include techniques such as helping the individual to (1) learn to recognize facial expressions and other
indicators of emotions (as expressed by others); (2) communicate in social situations; or (3) wait calmly in line at the grocery store. Social skills
programs need to be based on behavior principles. As with other autism treatments, social skills programming will vary depending upon individual needs.
Other Helpful Approaches
Visual Supports
Visual supports are symbols or pictures that help to signal to the person with autism what to do (the appropriate behavior) or what not to do (the
inappropriate behavior). They have been demonstrated to be helpful to many people who have autism. One of the most commonly used and effective types
of visual supports is the visual schedule.
Social Stories
Social stories help people with autism to deal with specific situations that are difficult for them to handle. In simple terms, the written (and sometimes
illustrated) story outlines the situation. The person may tend to have inappropriate behaviors in the situation or lack the skills needed to appropriately
deal with the situation. The story goes on to describe what the person should do. When written correctly and presented correctly, social stories have been
shown to be very helpful to some people with autism.
Circle of Friends
A circle of friends is a group of peers who support the person with autism. The method was first used in school settings, where children were invited (but not
pressured) to be in the “ circle&edquo;for the student with autism. An adult facilitator explains autism to the group, at the children’s level of comprehension,
providing information specific to the particular child. The facilitator encourages and guides the children as they express their concerns about the child and
come up with solutions to difficulties he or she is having. When done for adults, the method may be called a Circle of Supports and usually addresses broader
life issues.
Other Treatment Options
What follows is an overview of other treatment options available to individuals with autism. This is not an exhaustive list, and it is intended to provide a
general overview of available options as opposed to specific treatment recommendations. Some of the therapies and treatments listed in this next section are
not viewed as credible approaches by some medical and professional associations.
Auditory Integration Training
The technique of auditory integration training may help some individuals who are oversensitive (hypersensitive) to sounds. The individual listens to a
variety of sound frequencies, coordinated to his or her level of impairment. Auditory training is performed by an audiologist trained in this method.
Diet/Vitamins
Some individuals with autism exhibit low tolerance for and/or allergies to a variety of substances, such as yeast and gluten. Although no rigorous scientific
studies support the idea that dietary modifications reduce or eliminate symptoms of autism, some professionals and parents have reported positive changes in
behavior following the modifications. Vitamin supplements have been reported by some parents to affect particular behaviors, such as increasing attention spans.
Facilitated Communication
Facilitated communication is a technique by which a trained professional, the "facilitator," supports the hand, arm or shoulder of the individual who has
communication impairments. This method helps the individual to point to or press the keys of a communication device to spell out words.
Medications
There is no single medication to treat autism, but a wide variety of them have been prescribed to alleviate symptoms such as aggression, seizures, inattention,
hyperactivity, anxiety or obsessive/compulsive behaviors. For information on the use of medications, consult a physician who has experience in treating the
symptoms of autism.
Music
When used in a structured setting, music can be incorporated into the teaching of cognitive, motor and daily living skills. Effective for some individuals
with autism, music therapy may be provided in a private setting or included in a child's school program.
Sensory Integration
Difficulty integrating sensory messages may not be an obvious problem for people with autism, but it appears to occur quite often. Some people have unusual
sensory reactions, such as being overly sensitive to touch or less than normally responsive to pain. Sight, hearing, touch, smell and taste may be affected to a
lesser or greater degree. Noises may sound too loud or too soft; colors may appear to be too bright or possibly even painful to see. Different treatments exist,
depending upon the area that is affected. One approach is sensory integration therapy, which is usually provided by an occupational therapist trained in the method.
Vision
Some individuals with autism experience vision difficulties, such as poor eye contact, difficulty with visual attending, visual fixation and hyper- or
hyposensitivity to light and/or color. Developmental or behavioral optometrists may be able to treat them. They believe that some of the unusual behaviors
associated with autism may be related to visual-perceptual problems. Treatments include specialized colored or prism lenses and vision exercises.
Other Treatments
The treatments mentioned above are not a comprehensive list of all options available to individuals with autism. There are a variety of others, including
therapy using animals, treatments to reduce yeast in the body and cranial-sacral therapy.
To help parents or other caregivers as they consider possible treatments, Dr. B. J. Freeman developed the following list of guidelines.
Principles for Evaluating Treatment of Autism
- Approach any new treatment with hopeful skepticism. Remember that the goal of any treatment should be to help the person with autism become a fully
functioning member of society.
- Beware of any program or technique that is touted as effective or desirable for every person with autism.
- Beware of any program that thwarts individualization and potentially results in harmful program decisions.
- Be aware that any treatment represents one of several options for a person with autism.
- Be aware that treatment should always depend on individual assessment information that points to it as an appropriate choice for a particular child.>
- Be aware that no new treatment should be implemented until its proponents can specify assessment procedures necessary to determine whether it will be appropriate
for an individual with autism.
- Be aware that debate over use of various techniques are often reduced to superficial arguments over who is right, moral and ethical and who is a true advocate
for the children. This can lead to results that are directly opposite to those intended.
- Be aware that new treatments often have not been validated scientifically.
Questions to Ask Regarding Specific Treatments
- Will the treatment result in harm to the child?
- How will failure of the treatment affect my child and family?
- Has the treatment been validated scientifically?
- Do specified assessment procedures exist?
- How will the treatment be integrated into the child's current program?
Try to avoid becoming so infatuated with a given treatment that functional curriculum, vocational life and social skills are ignored.
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