Thursday, March 12, 2009

Inside the autism treatment maze

No single approach is best for every child

Every child who receives the diagnosis of autism may be different, but the families of those children face the same overwhelming challenge — finding the best treatment for the complex condition.

While there has been significant progress in easing symptoms of autism and educating children diagnosed with the disorder, there is little agreement among doctors, parents and researchers over which type of treatment most effectively helps an affected child grow into an independent adult.

Parents can find themselves confronted with a confusing maze of often expensive strategies and methods, some of them promising miracle cures but backed by little or no medical evidence.

"With autism, the variation in treatments is huge," says Laura Schreibman, an autism researcher and professor of psychology at the University of California at San Diego. "Parents not only have to deal with the emotional impact of the devastating diagnosis, [but] there’s no clear course of where to go. The amount of garbage that's out there and what parents have to sift through is truly astounding."

For many kids, autism treatment involves some combination of intensive behavioral therapy, speech and language therapy and special education in public schools. Anecdotal reports support newer forms of play-based behavioral therapies and alternative methods involving vitamins and dietary restrictions, although many autism experts vigorously disagree over whether these offer benefit.

'The beginning of this journey'
"We do have some important knowledge in treatment of autism, but we’re still very much at the beginning of this journey," says Geraldine Dawson, a professor of psychology at the Center on Human Development and Disability at the University of Washington in Seattle.

Since autism was first recognized in 1943, the search for an effective treatment has been frustrating for those involved. Once promising medical treatments have later been shown in tests to have no benefit. Research supporting newer or alternative treatments is lacking.

The causes of autism are unclear, and the wide range in the type and severity of a patient's disabilities can make it particularly challenging to select a specific therapy.

In 2001, a report from the National Academy of Sciences found that children with autism should receive at least 25 hours a week of intensive training beginning as young as age 2. Early diagnosis, now being given to children as young as 8 months, improves the chances of treatment success, experts say.

"We know that most children, but not all because we can’t guarantee, do well with early intervention," says Dr. Fred Volkmar, a professor of child psychiatry at Yale University and an expert on autism.

But the report stopped short of endorsing any particular treatment beyond education and support for parents, noting that the type of treatment might differ depending on the child.

"There is no one treatment that is going to work for all children or one treatment that is going to do everything for any given child over a long period of time," says Catherine Lord, director of the autism and communication disorders program at the University of Michigan in Ann Arbor and chairwoman of the National Academy of Sciences expert panel.

Many children with autism have additional problems such as gastrointestinal illnesses, sleeping difficulties or anxiety that can complicate treatment, researchers also note.

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Guide to treatment options

A treatment program called Applied Behavior Analysis (ABA), which is based upon a rewards system, is widely accepted by parents and doctors largely because it is the most researched and is supported by numerous anecdotal success stories. ABA is considered especially beneficial for children with more severe symptoms.

ABA calls for one-on-one interaction between a teacher and a child for up to 40 hours a week. In the highly structured program toddlers receive positive reinforcement for initially learning simple actions like identifying colors and then gradually working up to more advanced activities that target deficits in learning, language, play-interaction and attention.

Advocates of this behavioral therapy pioneered by Dr. O. Ivaar Lovaas, professor emeritus at the University of California at Los Angeles, point to a study published in 1987 that suggested that with a comprehensive ABA program of 40 hours a week, about half of kids with autism were indistinguishable from other kids at age 7. But even within the field, the research has been questioned.

"No one else has been able to replicate that," says Lord. "That finding was an anomaly."

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