Autism: Treatments & Assistance

When the disorder was first described almost 60 years ago, few if any treatment options were available, and parents were left with little hope of cognitive or behavioral advancement for their child. It was common for autistic children of this era to be placed in institutions, largely ignored, grouped together with children with other special needs (e.g., general mental retardation and blindness). Although there is still no cure for autism, modern-day treatment of this disorder affords several possibilities and research has shown that significant advances in cognitive and behavioral domains can be made. In fact, today, most children receive intervention on a daily basis, some as early as age 2. Furthermore, many school-aged children with autism are “mainstreamed” or are placed in classrooms with typically developing children for some or all of their school day. The reasons for this dramatic metamorphosis in thinking about the treatment of autism come from several sources. First, the 1940s through the 1970s was a time when autism was thought of as “psychogenic” in originFa disorder resulting primarily from poor parenting, particularly on the part of the mother. The late 1960s and early 1970s, however, brought new scientific information, such as elevated serotonin levels, the presence of seizure activity, and increased rates in monozygotic twins compared to dizygotic twins in autism. Such information presented clear evidence that this disorder was of biological, likely genetic, origin. This belief is still true today. Increased sophistication of diagnostic tools, heightened media attention of the disorder, federal laws mandating specialized education for children with disorders, and a growing knowledge of biological principles have all contributed to a new understanding of the treatment of autism.

Although intervention in autism is multimodal and typically includes several treatment types (e.g., language therapy and occupational therapy), takes place in several locations (e.g., the home and school), and is implemented by several treatment providers, (e.g., parents, teachers, and speech therapists), by far the most common treatment approach is one that relies on a behavioral model. The behavior analytic view is that autism is a syndrome of behavioral deficits that are amenable to change in response to specific, carefully programmed, constructive interactions with the environment. Within this framework, both global approaches, such as discrete trial training, or specific approaches, such as video modeling, have been used. Behavior analytic treatment focuses on teaching small, measurable units of behavior systematically. Every skill absent in the child's repertoire beginning from simple responses such as looking at an object to complex ones such as verbally describing an objectfis broken down into small steps. Each step is taught to the child by providing consistent prompts or instructions followed by consistent reward for accurate and/ or other appropriate behavior. Inappropriate behavior is often ignored or redirected. Teaching trials are repeated many times, often in rapid succession, until the child performs the target behavior in the absence of adult prompting. For example, a child may practice the association between the word “car” and a picture of a car dozens, perhaps even hundreds of times per day. It is this repetition along with gradual increases in demands in skill complexity that characterize behavioral treatment for children with autism.

Based on review of the treatment literature in autism, three general themes emerge: (i) Interventions based on a behavioral model are successful in increasing some functional behaviors (e.g., eye contact or language) as well as decreasing some nonfunctional behaviors (e.g., repetitive motor movements); (ii) the same intervention does not affect all children in the same way, even when factors such as IQ are controlled for; and (iii) the earlier the intervention is provided, the more efficacious for the child. These points raise larger questions regarding the biological mechanisms that may support their conclusions...