by Pat Blackwell, Ph.D.
Multiple Challenges, Multiple Treatments
In general, people on the spectrum have sensory sensitivity, speech and communication challenges, and social cognitive difficulties—including rigidity, restricted range of interests and social skill deficits. These deficits are severe enough to disrupt functioning in multiple environments. There is no one-treatment approach for autism, and no treatment cures it. Therapies are designed to target specific symptoms. Multi-disciplinary approaches including occupational and speech therapy, and applied behavior analysis (ABA therapy) are the cornerstones of early intervention, but are not the only treatments that may be helpful. Medicine to treat some of the symptoms of autism (including psychiatry and gastro intestinal medicine) may also be warranted.
In addition to professional intervention, parents must understand the unique behavior and learning needs of children on the spectrum. Holistic and healthy lifestyle approaches such as diet, sleep and exercise are important, as are a predictable schedule and consistent discipline. Allergies and gastro intestinal problems are sometimes part of the presentation of autism. Some parents have reported great success with eliminating casein and gluten from their child’s diet—even though there is limited clinical evidence supporting the effectiveness of these diets. This should be done under the guidance of a pediatrician or licensed dietitian.
Occupational therapists are effective at treating sensory sensitivities. This is important because behavioral difficulties and withdrawal seen in children on the spectrum may be due to avoiding overstimulation. Early and intensive speech therapy is indicated for most but not all people on the spectrum. Finally, educators are gradually adjusting their curriculum to accommodate kids on the spectrum—relieving them of overstimulation and working in groups.
Applied Behavior Analysis, or ABA therapy, as a treatment for autism that has garnered the most research evidence of effectiveness. ABA is an umbrella term for various types of intervention. (autismspeaks.org provides a resource of ABA therapists in New Orleans.) At its core, ABA is based on reinforcement schedules to increase desirable and decrease undesirable behaviors. While ABA is historically a strict behavioral approach, types of ABA interventions such as pivotal response treatment can be used as a component of more humanistic or relationship-based therapies (such as floor time, relationship development intervention, and affinity therapy). Pivotal response treatment uses a system of rewards to increase interaction, eye contact, and shared interest between a child and an adult (usually a therapist trained in ABA).
Better outcomes, but no miracles
An autism diagnosis is no longer a specter of doom. People with autism graduate from high school and many go to college, have rewarding careers and build families. Successful outcomes are becoming more common as early identification and treatment, along with understanding of the condition, advance. However, for individuals with more severe forms of autism, successful outcomes may be limited even with treatment. Long-term successful outcomes are best when symptoms are mild and treatment is comprehensive and provided early.
As autism diagnoses increase, understanding about treatment also improves. But some treatment approaches boasting miraculous outcomes are just the latest form of “snake oil.” Parents must research treatments carefully, expediently respond to their child’s needs, and assemble an effective multidisciplinary team including active collaboration with educators. With help, people with autism are thriving.
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