Treatment

Deciding on Treatment

When finding out their child has Autism, many parents do not know what to do. And yet when they find out what they may do from the many professional interpretations and suggestions, anecdotal reports from other parents, and the dazzling array of treatments all claiming to cure autism, many parents still result in total confusion.

It is critical that parents carefully decide on an effective treatment that does not waste their money and the precious learning time of their child and most important of all, a treatment that brings in result and progress. The first step in this process is to look at what really works.

Choosing an effective treatment for your child requires the same careful judgment as a doctor prescribes medication. Any legal practitioners would only prescribe medications that have been approved by the FDA and scientifically proven to improve your condition. As a parent, it is your duty to choose the most scientifically reliable and effective treatment approach to improve conditions of your child.

Unfortunately, many treatment approaches that claim itself to be effective lack scientific evidence to support its claim. Some treatments have claimed to be very effective but have later been shown not to have any effect in treating autism, for example, secretin. Some treatments have been later shown to be very harmful to the body when taken over a period of time, for example, fenfloramine. Therefore, it is essential that parents are at all times well-informed and objective when deciding on a treatment for their child.

Parents should be fully informed on ALL the treatment options available for their child. While it is important to learn more about how the treatment can help your child, parents should also evaluate its claimed scientific effectiveness and locate its research history. Whether a treatment has been widely tested, adopted, and proven in scientific research and history is extremely crucial in determining the treatment outcome. After you have found out about your options, prepare a list of questions to aid you in structuring your evaluation of the provider. Then, you should visit all treatment providers to get a full picture of what services each provides.

Applied Behavior Analysis (ABA) has been shown to be the most researched and scientifically proven treatment of history today. There is no other treatment has shown to be more effective or has the same amount of scientific evidence to support it. As a result, intensive early intervention programs based upon the principles of ABA have become the gold standard of treatment in the USA.

“Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior.”

Mental Health: A Report of the Surgeon General (1999)

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Applied Behavior Analysis

Applied Behavior Analysis is based on Learning Theory, which was formulated almost 100 years ago by the founding fathers of Behaviorism: John B. Watson and Ivan Pavlov. The foundations of ABA are: socially and emotionally inappropriate behavior Therefore, behaviors can be unlearned. Skills are taught through systematic and positive teaching methods. Reliance on scientific methodology. ABA is a methodology used to decrease problematic behaviors and to teach skills to children, adolescents and adults of ALL functioning levels. It is a very individualized approach. ABA is sometimes only recognized as an approach to get autistic children to behave or sit in a chair. This is simply not the case.

ABA is used to assist companies and organizations to evaluate their performance and efficiency. It is also used to look at a myriad of problems faced by adults e.g. Dr Phil. It can help with fears and phobias and couples facing problems in their relationships. It is a very wide-ranging approach!

When treating a child with ASD, we would assess all their strengths and weaknesses in all areas. We then come up with a treatment plan to address their needs. Often this focuses on behavioral skills, communication and language, play and social skills. The programs are highly individualized in terms of the teaching method, curriculum and settings.

The priority or the targets for individuals is different for different age groups and also for different level of functioning. While the focus of programming for a 5-year-old with adequate verbal and intellectual abilities might be adapting and adjusting to a mainstream school placement, the focus of programming for another 5-year-old who has no language skills or play skills might be to develop more means to communicate functionally with people around him and to develop play skills appropriate to his age. On the other hand, the focus of a 15-year-old teenager in a mainstream school setting might be more relating to social-emotional and introspective skills while another 15-year-old teenager in a special school setting might have programs focusing more on community living skills and functional life skills.

ABA is a scientific approach to learning. We take lots of data to show that what we are doing is working or not working. If the teaching is not helping the student to learn skills then we modify our teaching program. By constantly reviewing and adjusting our treatment programs the program will always be working at the most optimal level for the child.

Contemporary Behavioral Therapy
One would think that all applications of ABA would be quite similar.  However, there is tremendous diversity!  Although our foundations are the same, there are extraordinary differences in how ABA is applied.  There is a broad continuum of applied styles and approaches. In the extremes, approaches range from those that are dogmatic and rigid to those that are loosely, inexactly and unsystematically applied.  Additionally, many claim to provide ABA, when in fact they only implement a single procedure of the field (e.g. Discrete Trial Teaching). 

Behaviorists are often pigeonholed as rigid, narrow, and punitive.  The fact is that many behaviorists employ methodology of ABA (including DTT) with much flexibility and are quite natural in its application.  Perhaps because of the stereotype of ABA, many professionals seem to have distanced themselves from ABA and have come up with other names and variations of teaching strategies that would aptly be conceptualized as ABA!

Prizant and Wetherby (1998) suggested that more “contemporary” behavioral treatment differed from “traditional” approaches in that teaching occurs in more natural learning environments, that there is more emphasis on individualization of curriculum and “the use of more natural and balanced social transactions in which learning opportunities are initiated by the child”.  They specifically, identified the methodology and strategies utilized by Autism Partnership as an example of a contemporary approach.

We concur that Autism Partnership’s approach to ABA treatment of autism greatly differs in many fundamental ways from those who have a more rigid application of ABA. Further, our model incorporates a variety of ABA methodologies (e.g. DTT, Token Economies, Systematic Desensitization, Teaching Interactions) appropriate for the treatment of persons with autism. Therefore, to distinguish our approach we identify ours it as “Contemporary Behavior Therapy”.

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Eclectric Treatment

One of the most common treatment approaches is to adopt an eclectic approach. This approach involves running around all over town to see a multitude of different professionals, usually for one-hour sessions, to try to do all the different kinds of treatments. The hope is that by doing everything that something will stick. By doing this kind of approach, it also alleviates feelings of guilt that you are not doing a particular kind of treatment that might be the “magic bullet”.

However, there are many problems with this kind of approach.

• By seeing so many different people, it is unlikely that the intervention will be very consistent. Everyone will be doing different things, which may result in confusion on the part of the parent and the child. With no team meetings and little communication, it is nearly impossible to formulate a comprehensive plan that everyone is following.
  
• It is also impossible to evaluate which of the treatments is really helping your child. Many treatments that are ineffective may be continued because progress has been made that might have been wrongly attributed. This does not only waste the child’s learning time but also the parent’s money. In addition, the ineffective treatments also take time away from the interventions that are helping your child. In other words, you may be giving less time to the treatment that helps your child progress.
  
• Different approaches have very different underlying philosophies about autism and its treatment. Some of these approaches are in direct contradiction of each other. One approach may see the intervention as harmful and the other may see it as necessary and beneficial. Often parents may be told that the different approaches are used to individualize to the needs of different children, without understanding that some underlying philosophies are quite different. Just like going on a diet, you could try an eclectic approach too with a diet. Having heard that good results can be gained from a low fat diet and the Atkins diet, you decide to do both to cover all your basics. Clearly, this would not work as they are in direct contradiction of each other.
  
• The research shows clearly that adopting an eclectic approach does not result in the best outcome. Three recent comparative studies in California showed that doing ABA on its own was far superior in treatment gains than children doing the same number of hours of a mixture of approaches.
  
•  It is unlikely that practitioners who adopt a whole host of different approaches are masters of all interventions just as the old saying goes, “Jack of all trades, master of none”. It often rings true in this regard. To be able to design a curriculum and implement effective ABA programming often takes more than 5 years of ongoing training and hard work in just this area. If it is also necessary to be trained in the use of TEEACH, Floortime and other approaches, it is unlikely that staff will be able to receive the necessary focus and training necessary to implement all programs with the right level of treatment integrity. This often leads to a hodge podge of different ideas and interventions without a true depth of understanding of any of them. It is often not uncommon for people to attend 2-day workshops on different interventions and then proclaim that they are now adopting that approach without any real training in that area.

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