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Special Needs Awareness

The Science Behind Autism Treatment & Therapy

January 01, 2011
In life, there's a natural order to things. First you walk, then you run. You learn your letters, then you read. You receive a medical diagnosis, then you receive a treatment plan. Unless, that is, if your child is diagnosed with autism. Parents who receive a diagnosis of autism for their child often get the news and are left to discern the best course of treatment for themselves. It can understandably be overwhelming. Thanks to the National Autism Center and others, however, there is some help for parents wading in the sea of touted treatments.

"There are so many treatments that are suggested to parents that it's hard to know which ones are likely to produce benefit. That's one of the reasons we did the National Standards Project," says Susan Wilczynski, Ph.D., B.C.B.A., executive director of the National Autism Center.

The National Standards Project offers families a comprehensive analysis of treatments that have been shown to be effective for children and adolescents with autism. Published in September 2009, Wilczynski says the center does its best to update the information every three to four years. Currently the report, which can be found at www.nationalautismcenter.org, points to 11 treatments field experts consider to be established interventions and to produce beneficial outcomes for people on the autism spectrum. Most of these established treatments fall within the realm of behavioral therapy. This concurs with the U.S. Surgeon General's support of applied behavior analysis as an effective autism therapy as well.

Defining Behavioral Therapy Laura Grant, M.A., B.C.B.A., behavior analyst with the Applied Behavior Center for Autism, describes applied behavior analysis as the applied science of human behavior. She says there are more than 70 years worth of research that supports the science. Therapists are trained to observe behavior, measure it and analyze the data following specific environmental changes so they can make decisions based on those data to ensure the most progress is being made in the least amount of time.

"Our goal is to teach behaviors that are going to increase each individual's quality of life and eliminate behaviors that decrease quality of life," says Grant.

She advises parents to look for a therapist who is truly versed in behavior analysis and behavior psychology. It's also a good idea to get an understanding of their experience and education.

In addition to applied behavior analysis, other common interventions for children with autism include speech therapy, occupational therapy and social skills therapy, which are all behavioral interventions that use core behavior principals to shape their learner's behavior. They often go hand-in-hand with applied behavior analysis.

A Balancing Act While behavioral therapy is well regarded, it is not the only treatment option available for autism. Not by a long shot. Area families can find treatments ranging from sensory integration to hippotherapy to specialized diets, even interventions involving bottles of energy. Albeit none of these appear under the established category of treatments according to the National Standards Project.

One new type of intervention has made its way to the area. Called Brain Balance, it is a national program of learning centers. Brad Ralston, D.C. D.A.C.B.N., executive director of the Brain Balance in Indianapolis, says it is a brain-based learning center that provides a treatment, not a therapy, for various kids with Special Needs, including those with high-functioning autism. Patients come in for three one-hour sessions per week for 12 weeks.

Ralston explains the theory behind Brain Balance, or more generically hemisphere integration therapy, is that behavioral problems are caused by imbalances on the right side of the brain and learning problems are caused by imbalances on the left side. The treatment focuses on the child's weaknesses to essentially bring the identified weak skills up to par with typical peers.

"Our core mission statement is optimal function for the child in the physical, cognitive and social realms. We aren't saying eliminate autism, but take the child and make them function at their maximum in these three areas by balancing their weaknesses," he says. Brain Balance isolates its patient's weaknesses and works intensively on those things. At this time, no research is published on the efficacy of hemisphere integration therapy, though the center can provide anecdotal evidence.

Tread Lightly into Treatments Tim Courtney, M.S., B.C.B.A., clinical director at Little Star Center, says he is seeing an increase in alternative therapies being offered to autism patients. "There are more and more treatments and a lot are hypothesized interventions that are not yet proven to be effective," he says.

Carl Sundberg, Ph.D., B.C.B.A.-D., executive director at the Behavior Analysis Center for Autism, has also seen his fair share of alternative therapies come and go throughout his years as a behavioral therapist. His advice? If somebody stands to make a lot of money and there is no peer reviewed research that is published to back up its science, parents should likely stay away from it.

Rather, it is his experience that the main treatment is teaching. "As of now, there's no magic pill," he says. Proven interventions are all therapies that involve teaching something, he points out. Social skills need to be taught, occupational therapy and speech therapy teach things, and so on.

Both Courtney and Sundberg recommend families look at the website for the Association for Science and Autism (www.asatonline.org) for further research into autism interventions. "That [website] covers just about every treatment out there and the science that backs it. So you don't have to make up your own mind," says Sundberg.

In other words, tread lightly before buying into a treatment.

Emerging Treatments While applied behavior analysis and related therapies identified in the National Standards Project are currently considered the established forms of intervention, Wilczynski says there are other promising treatments around the corner. Specifically she calls attention to picture exchange communication system (PECS) and augmentative and alternative communication devices (AAC), both of which are available through speech language pathologists in school or healthcare settings. While AAC has been around awhile, PECS is a newer treatment largely developed through the Delaware Autism Program. "Our goal is to identify treatments that are effective so families can have as many choices as possible," Wilczynski says.

Options, undeniably, will also help families make better decisions on their child's course of treatment. For instance, many of the treatments that are shown to be effective are time intensive so making that treatment work within a family's lifestyle can be challenging. As such, some might choose treatments that have little or no effect but work more conveniently for the family. "It's important to remember that if there isn't scientific evidence supporting the treatment, it may work, it may be neutral or it could even produce harm," Wilczynski says.

World-Class Autism Research in Indy's Backyard In addition to reviewing the National Standards Project, Wilczynski, who spoke last month at the eighth annual Christian Sarkine Autsm Treatment Center conference, recommends families in Indianapolis contact the Department of Psychiatry at the Indiana University School of Medicine. She says they are among the top researchers in the world for the treatment of autism and have published what she describes as some of the most relevant literature on biomedical treatments.

"When working with people who are the top researchers in the world, they are going to help facilitate a conversation on the topic so families can make the best decisions for themselves," says Wilczynski.

Among the best is Craig Erickson, M.D., chief of the Christian Sarkine Autism Treatment Center at Riley Hospital for Children, who confirms the Christian Sarkine Autism Treatment Center at the IU School of Medicine Department of Psychiatry is a cutting edge research center for new medical treatments. Several studies are currently underway. One federally funded project involves an investigational study medication, social skills training, and clinic visits with a child psychiatrist and research staff. Another project is a 24-week parent training research study. Families interested in participating in these or other research programs need simply call the center directly.

Beyond its research, however, the center offers medication management services, behavioral services, community-based therapy, supportive counseling, traditional diagnostic interviews and co-treatment therapy models. It's a resource the community is proud of and families with children who have autism can look to for top-notch help and information.

Prioritizing Data-Driven Therapies As parents research the best interventions for their child with autism and family as a whole, many experts agree it's important to look for evidence-based treatments that collect data that will track change in symptoms. Data will not only help pinpoint and fine tune interventions that are working, it will help prevent a patient from spinning wheels on an ineffective treatment.

"Irrespective of the treatment you select, in the end you should have data that are showing that it is this and only this treatment that is making the difference," Wilczynski says.

Carrie Bishop is a freelance writer and mother of two young sons whose daily antics inspire her work and her life. Contact her at freelancewritercarrie@gmail.com.

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The 11 Established Treatments According to the National Standards Project: According to the National Standards Project, established treatments "produce beneficial outcomes and are known to be effective for individuals on the autism spectrum. The overwhelming majority of these interventions were developed in the behavioral literature."

• Antecedent Package

• Behavioral Package

• Comprehensive Behavioral Treatment for Young Children

• Joint Attention Intervention

• Modeling

• Naturalistic Teaching Strategies

• Peer Training Package

• Pivotal Response Treatment

• Schedules

• Self-management

• Story- based Intervention Package

The report considers emerging treatments to "have some evidence of effectiveness." Identified emerging treatments include:

• Augmentative and Alternative Communication Device

• Cognitive Behavioral Intervention Package

• Developmental Relationship-based Treatment

• Exercise

• Exposure Package

• Imitation-based Interaction

• Initiation Training

• Language Training

• Massage/Touch Therapy

• Multi-component Package

• Music Therapy

• Peer-mediated Instructional Arrangement

• Picture Exchange Communication System

• Reductive Package

• Scripting

• Sign Instruction

• Social Communication Intervention

• Social Skills Package

• Structured Teaching

• Technology-based Treatment

• Theory of Mind Training

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