Controversies in autism: Encyclopedia II - Controversies in autism - Treatment choices

Controversies in autism - Treatment choices

It follows that there are a number of issues about the right way to deal with autism. These issues complicate the choices that confront parents with children who have developmental delays and/or diagnosed as being on the 'spectrum'.

It is particularly problematic that almost all approaches tried by parents have not been validated by double-blind studies. Scientific rigor is of particular significance in studying a disorder such as autism given that its diagnosis is based on the subjective observation of certain behaviors, not on objective metrics such as genetic tests.

In many cases any long-term consequences and risks are unknown or have not been studied in depth. It is also believed that no approach will work equally well for all autistic children.

Controversies in autism - Discredited approaches

The Bruno Bettelheim hypothesis that autistic children are the product of emotional abuse -- specifically, unsympathetic, emotionally distant "refrigerator mothers" -- has been discredited. There is no evidence to support the idea that autistic children - as a group - have shut themselves in because their parents didn't give them enough love and attention. Bettelheim prescribed "parendectomy", i.e. removal of the parents. Given how sensitive and easily frustrated autistic children are, the potential damage caused by this approach cannot be understated.

Controversies in autism - Behavioral interventions

Several schools of thought exist about behavioral interventions to treat autism. The most prominent is Lovaas/Applied Behavioral Analysis (ABA), which involves training autistic children through intensive trials (40 hours a week is often recommended) and reinforcement of limited tasks that grow more complex over time. A common method of conditioning used in ABA is that of offering some food or a drink after successful completion of a request. While this is a proven method for developing specific skills in children who do not respond to conventional reinforcement (e.g., parental approval), it is often criticized for being harsh, stringent, and not conducive to general skill-building. Its long-term outcome is questioned, and it has been suggested that full-time pressure of this kind can lead to posttraumatic stress disorder, anxiety and depression.

There is also some controversy about its effectiveness. Original ABA studies looked promising, but subsequent ones have not replicated their success fully. Furthermore, no double-blind ABA studies have been conducted. Studies on ABA are often conducted by ABA advocates.

The Greenspan/DIR approach seeks to stabilize the child's environment and then taking his/her lead to create learning opportunities through "floor time" and related approaches. While this has proven effective for children with strong sensory needs, the approach is often criticized for catering to the child's limitations rather than building strengths.

Other approaches pioneered by Marion Blank, Barry Kaufman, Arnold Miller, and others are less popular and known but have similar supporters and detractors.

Controversies in autism - Drug therapy

The benefits of drugs is widely disputed. While anti-seizure medication is indicated for some children with seizures, many parents are opposed to using psychopharmacology to treat their children. They point out that autistic people are not necessarily psychotic, particularly anxious, or depressed. Many autistic people themselves are against the overprescription of neuroleptic drugs in autistic people to control behavior. They have formed an organization called Autistic People Against Neuroleptic Abuse to counter this phenomenon.

Controversies in autism - Occupational auditory visual therapy

Developmental neurologists have noted that autistic children tend to be hyposensitive and/or hypersensitive to one or several sensory impressions, and that their gross and fine motor skills are usually impaired to varying degrees. These are symptoms consistent with Sensory Integration Dysfunction.

Pediatric occupational therapy has proven successful in helping autistic children deal more effectively with sensory impressions, use their senses more productively, and become more aware of their bodies.

Auditory therapies include the Tomatis and Berard schools and focus on training the child to use his/her sense of hearing more effectively.

Visual therapy, pioneered by Melvin Kaplan and others, employs prism lenses that distort the child's vision, forcing him/her to use his/her focal vision more productively.

Controversies in autism - Biomedical intervention

Some parents and medical professionals report improvements in the behavior of autistic children enrolled in restrictive diets, detoxification therapies, and a range of treatments, collectively known as biomedical intervention for autism. These claims are hotly contested by most specialists doctors, some of whom believe that the failure of conventional medicine to address parental concerns, and the meager resources committed to scientific research, has led to autism becoming a magnet for quacks and charlatans.

The premise for biomedical intervention is that certain neurological disorders are caused by environmental shocks that in turn compromise the children's gastrointestinal, immunological and neurological systems. Based on this premise, what is often diagnosed as autism or PDD is a physiological syndrome that can and should be treated.

This point of view is consistent with wider evidence that diet and nutrition can affect behavior generally, but there is no medical literature evidencing claims that autism can be cured. Some of the most prominent advocates of various therapies have autistic children who manifestly display serious behavioral difficulties.

There is plenty of anecdotal evidence to support biomedical intervention - most parents who try one or several therapies report some progress, and there are stories of children who have undergone these programs and become seemingly completely neurotypical, able to return to mainstream education. However, this evidence may be confounded by the dramatic improvements often seen in autistic children as they grow up, with or without such interventions. Hence the need for double-blind studies regarding treatments.

The use of high doses of vitamin B6 with or without magnesium is very popular among parents. Some studies do validate its effectiveness; including some double-blind ones.[7] However, there appear to be some significant risks associated with high doses of vitamin B6, including peripheral neuropathy. Some people argue that vitamin B6 only helps children in the following groups:

• Those with nutritional deficiencies, which can benefit from multivitamins in general; autistic children are notoriously fussy eaters.

• Those with vitamin B6 deficiency (related to seizures.)

Controversies in autism - Non-coercive approaches

The autism rights movement has been criticized for promoting 'doing nothing' about autism. While clearly anti-cure, autistic advocates have pointed out that not forcing children to be something they are not is not equivalent to 'letting them do whatever they want', or not educating them at all.

Given how much autistic individuals appear to be prone to stress, anxiety, nervousness and self-doubt, a number of non-coercive approaches have been proposed.

The Son-Rise program falls into this category, but it has a number of retractors. For one, there is no scientific evidence to validate it, and it is promoted in a way that seems to give a lot of unsubstantiated hope to parents. For example, proponents of the Son-Rise program claim that children will 'decide' to become non-autistic after accepting them for who they are and engaging them in play. The program was started by the parents of Raun Kaufman, who is claimed to have gone from being autistic to totally non-autistic. There are questions as to whether it is true that Raun Kaufman was autistic as a child, and also about the claim that "there is no trace" of his autism now. Overall, the goals of the Son-Rise program (i.e., removing the autism completely) are questioned, as well as the use of locked doors in order to keep children in the play area.

Economist Thomas Sowell, author of The Einstein Syndrome, is a major opponent of any form of "early intervention" for children with certain characteristics (whom he considers wrongly labeled autistic), i.e. those who appear to be intelligent, are able to understand spoken language, and have several engineers or musicians as close family members. His observations are based on experiences with his own son (a late talker) and various anecdotal accounts. Sowell has been criticized for providing false hope, and there are cases he himself documents in his book of parents who followed his advise only to later find out that their children were not simply late talkers.

An approach for dealing with autism which involves reducing stressful sitations, and not trying to force the autistic child to change into someone he is not, is proposed in The Self-Help Guide for Special Kids and Their Parents by Joan Matthews and James Williams. James Williams is an autistic child who, with his mother's help, recounts much of his experiences through examples of possible problems encountered by parents of autistic children. The approach recommends, for example, not forcing the child into a mainstreamed schooling situation too early; trying to understand the problems caused by hypersensitivity and adapting to them; allowing the child to cope with stress by stimming; helping the child develop left-brain thinking; and so on. Joan Matthews is also very much opposed to ABA therapy. This approach is close to something that would be acceptable to autistic advocates. But it also has the danger of giving false hope to parents. What worked well for James Williams may not work equally well for everyone.

Adapted from the Wikipedia article "Treatment choices", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki