it depends on the child's abilities... if child can speak, then he/she can be treated by behavior therapy... but if he/she can not speak, used other method such as PECS ...

so, parent training can be effective for help and education to their child.

Dear Maryam

How successful do you find biological therapies in treating autism? When do you find them relevant for treatment?

biological therapies are secondary treatments... they are expensive... they can be effective some extent...

but I think that involving parent to help their child by behavioral method is better...

so. if child is with ADHD too, he / she have to use medical treatment

There is no biological treatment for autism as their is no fixed identifiable biological cause behind that. And behavioral treatments take a loong time to show any effect, but there may be exceptions too depending on the child's state of illness. And along with therapist's efforts and dedication, parental involvement is highly required.

But isn't lack of parental education, knowledge and their unwillingness a major barrier to effective treatment, which is a reality and one of the chief causes why autism is highly difficult to manage. And moreover the fact that success rates are less so parental stress and frustration are definitely bound to make treatment more difficult. How to tackle the parental frustration when even the therapist keeps telling them that treatment would take time and there would be very less change in child in long run? One can't deny the parental frustration and their condition which is significantly equally distressful as their child's (and therapist's too) and this becomes more meaningful as the only possible treatment is behavioral.

@ Nafja,

Research in autism is in a state of infancy or may be fetal. :D. Many researches have identified certain biological agents that cause autism like genes, enzymes etc. Autism is a hetero-genous disease/disorder which has multiple causes and hence syndrome can occur with multiple clusters of symptoms. What scientists are confused about is whether there is any polygene or a biomarker that can easily help to predict the autism in a child that is believed to be present in all possible forms of autism. Because certain features are there that are characteristic of autism only. Or there may be diagnostic limitations to that as some scientists believe autism should be classified into subtypes to cover some relevant types of autisms atleast.

So unless any success is achieved in identifying any biological cause or any biomarker or any other enzyme or biochemical whose imbalance would result in autistic features, treatment would focus on behavioral techniques only. Quite unfortunate reality this seems to be!

This is a topic that I have pondered every day for the last ten years. I am both a clinician and scientist specializing in autism spectrum disorders. Sally Rogers at the university of California at Davis has done one of the few systematic reviews of the efficacy of treatments in ASD. Basically, those methods that utilized operant conditioning principles (ABA, pivotal response) demonstrated the greatest treatment effects. While I am not a behaviorist by training (I have a background in speech-language pathology and developmental neuropsychology), I think that behavioral treatments tap into something that is fairly unbiquitous in mammals; reinforcement.

It is interesting to note that Rhea Paul at Yale is engaging in a longitudnal study looking into the efficacy of two common methods of teaching speech, language and communication in ASD. She compared behavioral methods (discrete trial) and an "eclectic" child centered approach. Her preliminary data showed that both treatment approach produced similar results. As a colleague of mine (Jose Ortiz, a gifted speech-language pathologist) once said, "sometimes the most improtant thing is to just do something."

For me as a clinician, I take a page from my mentor Marcel Kinsbourne. When looking into a program for a child, it is important to consider ones that tap these elements:

1) Make social stimuli reinforcing. So many times I have worked with an older child that has years of "treatment" with an ill educated, ill tempered instructor whereby the child developed a healthy aversion to other human beings. I have spent too much time "re-socializing" these kids. Whether deficits of social cognition are inherent in ASD is still a lively area of research, but experience and often drive the autistic person away from the fold. Good clinical practices help to keep them in the fold.

2) Some degree of mass teaching of weak skills.

3) Take ethological variables into account. It is important to understand how the basic biology of behavior affects the child. In other words, there has to be a reason for the ASD person's behavior other than being irrelevant. Repetitive behaviors are most likely manifestations of arousal, much like we see in other mammals. Much of what we can learn about even the non-verbal child/adult (my specialty) if we look to homologues in nature.

4) An understanding that ASD is far more complicated than any one treatment paradigm can explain or address. Being to stiff necked can get you stuck, to the detriment of the patient.

This is my opinion. Thanks for reading

Hello Brian,

Thanks for the unique perspective on autism. Long time ago I watched the movie Instinct, starring Anthony Hopkins, where he developed a relation with gorillas in a jungle while working on his research project. The movie was a good example of how non-verbal communication can be developed in a relationship with some creature who can't speak or understand a language that we speak. I have found similarities while working with children with autism too.

One can think of an analogy between an animal and an autistic child, both of whom are 'inhuman' in the sense that they can't comprehend the human language [readers are requested not to take this as an attempt to de-humanize the mentally ill, this is discussed solely for scientific purposes]. One can say that autistic children are primitive as they lack the basic feature of human evolutionary sign i.e. language. In all of PDDs the higher cortical functions are poorly developed. Though I have not read such literature linking human evolution to developmental disorders but one can find many similarities between a developmental disorder and lack of appropriate human evolution. Due to this such children are usually found as instinctive, reacting mainly to their basic drives and instincts and the learnings that they have attained during the course of development.

No wonder that their treatment should also approach from the way of their manner of relating to the environment. If they are instinctual and easily drawn to their biological mechanisms of excitation and arousal, then their treatment should target at how much they are able to have awareness of the social environment around them, to which they can react for the purpose of learning and developing.

Being ‘autistic’ means being busy in self (autos means self). So much of their relation is with the self, and in a non-developed state their self constitutes drives and need for their fulfillment, with no social aspects to it. And developing their social relationships is like making them more civilized and humane, letting them control their primitive reactions or putting it better - ‘discovering a relation of self with others by internalizing others as part of his/her self, hence perceiving his/her self in a new context’. This would always be a tiresome goal to achieve and with every child would pose many challenges for all the care givers, including therapist.

A therapist must know how to manage the instincts of an autistic child, his un-social behaviors like aggressiveness, tantrums, hyperactivity, non-reciprocity, repetitive behaviors and mannerisms, banging and beating, hitting; which the child has urges to perform. Once he knows the pattern of child’s reactions he can know how and when to intervene with the child to make him/her follow what is instructed. Changes are brought under the presence of a ‘complex’ of child’s primitive behaviors (the state where he/she is at any time) and a constant conflict that he/she faces during the changing relations of self with environment.

Thanks for reading with patience.

I think it is a mistake to as, which therapy is "best". Autism is a broad-spectrum label, and there is a saying in the autism community that, "if you have met one person with autism, you have met one person with autism, then you have met one person with autism." That is because each individual is so very different, with very different needs.

So the better question is, "which therapies are effective to treat which autism-related problems?" and "how do we best determine whether a given therapy is likely to be effective for this individual?" We need to focus and developing good protocols for evaluation of various treatments, while at the same time recognizing that something that "works" in one case might be wholly ineffective in another. So what is needed is better data collection overall, as well as an awareness that empirical research will tend to obscure the results for some treatment approaches which may be highly effective for a small fraction of individuals, but not helpful to the majority. That is, if there is a treatment that is certain to help 5% of the autistic population, it should not be rejected because 95% do not benefit; rather, what is needed is a way to better determine how to identify the 5% who can be helped by that approach, while continuing to study alternatives for the other 95%.

I have just finished writing a book about a fairly new educational therapy geared to older, moderately to high functioning autistic individuals, to help them gain insight and skills needed for independent living and social integration. In the course of writing that book, I interviewed many practitioners parents and assembled some case studies. There are many, many success stories -- children who no longer need specialized services at school, who are able to make friends and function with peers; adults who are now able to hold down jobs and become active community participants. Because this is an intensive and relatively short term therapy, it is possible to clearly see results and to draw clear correlations between what has happened with the program and the changes experienced in the autistic individual's life. But it would be a huge mistake to label this is a "best" therapy, because there are also autistic children who resist the program from the outset, meaning that the program is discontinued early on.

I do think that it is still premature to expect empirical evidence for most therapies because of this mixed results issues -- we need to do a better job of accumulating data about the separate programs through more objective protocols for case studies before we are ready to move to the next step. Further, it is simply not possible or ethical to expect a controlled study model. The complexity of individual needs means that each autistic person is likely to be receiving or exposed to multiple treatments and therapies over time, so there will rarely be opportunities to study a treatment in a controlled setting -- that is, where a target group receives only a single therapy for a sustained period, while treatment is deferred for a matched control group. But we probably can and should develop better methods for evaluating the efficacy of individual treatments on a case-by-case basis, so we can avoid hype and misleading information. I mean, we can't be sending kids off to ride horses in Mongolia or swim with dolphins because of individual success stories - but at the same time we could recognize that animal therapy seems to be helpful for some, and improve our ability to collect information and data about that broad category of therapy.

Tarun,

I could not agree more with your insights. Over the years, I have gained a great deal of insight into the children I work with starting with the assumptions:

1) They are mammals

2) They are primates

As you wisely noted, I am in no way trying to dehumanize or denigrate autistic individuals. They are as human as I. But, I am also a mammal, primate and great ape. To deny that in the autist is to deny a vital link to the rest of us and inhibits our ability to make sense of them in a broader sense.

That said, it is interesting that you mentioned gestural communication. It is something. I have used with the non-verbal children I have worked with. Michael Tomasello found in his research that chimps used gestures far more flexibly than vocalizations. In fact, he noted that individual chimps would use a single gesture for different reasons function with different individuals in the troop. The gestures were also not phylogentically driven, but culturally derived and unique to a troop. In practice, what I have dome is take many of the extant gestures the non-verbal child has and expand on them. The key is that they are agreed upon by the group and "forces" the child to pay attention to what a person might know. Not quite Theory of Mind, but an awareness of the intents of others, something chimps and gorillas do routinely.

It is also interesting that you mentioned the focus on the Self in ASD. Again taking a page from Dr. Kinsbourne, autism can be viewed as an internalizing disorder. A researcher by the name of Williams found that in high functioning individuals, there is greater cerebral activation in the temporal-parietal junction areas associated with self-reflection.

I think that for the low-functioning, it is a far more primal phenomenon. You are right, their reactions to their environment are primitive and encompass what I consider to be the core elements of behavior: approach and withdraw. Getting back to treatment, the goal is to engender trust and increase the liklihood of an approach. Communication itself is an act of approach. An organism will approach for a variety of reasons (hunger, curiosity, territoriality, aggression etc...). The common thread is that the organism is able to maintain some sort of homeostatasis. Otherwise, withdrawal occurs. Simply focusing communication therapy on discriminitive stimuli without accounting for the factors inhibiting communicative approach I feel is counterproductive.

More than anything else, I have become passionate about using primate homologues to explain behavior in low-functioning individuals because it forces us not to trivialize their behavior and provides the first steps towards clinical improvement. For example, I have worked with many children who engage in "verbal sterotypies." Their parents and clinicians called them "stims" which I felt trivialized this response to the environment. What I have often noted is that the recitations stopped when the television was on, and started immediately (along with staring off into space), when the television was turned off and instruction began again. This always struck me as an avoidance response or flight, something that keeps people away even when physical flight is impossible. When viewed from this stance, the question should be, why is the individual trying to avoid contact. It could be as simple as the person does not want to work, or it could be that my use of language exceeded his cognitive capabilities. It could be a bad habit that has worked in the past to escape, or anxiety due to years of being to forced to make eye contact (which is a primate threat display and always pained me to see people cupping their hands around a child's eyes in order to "promote" eye contact). But, if we simply deem the behavior irrelevant, we never see the bigger biological picture and look at the factors that are affecting performance. At some point, I feel that it is important to speak their language as we are attempting to get them to speak ours.

I do appreciate your patience reading this and the accepting forum with which to share my views.

Brian Roper

Compassion

I've written three books commissioned by a Dutch autism center, the Dr Leo Kannerhuis. One (2003) about how they developed their treatment system, starting in 1974 at a time when ‘treatment’ as we know it today hardly existed; TEACCH had just started in North-Carolina. In the Netherlands autism enjoyed great interest in the academic world. The phenomenon of the ‘refrigerator mother’ or other forms of blaming the parents hardly occurred. The second book (2007) is about the treatment of a chronic treatment facility (30 people of around 50). The third one (2010) is an extensive treatment of the developments of the last 10 years: methods developed to treat people at home, prepare them for jobs and independent living among others. Moreover plans for the future in which the center is expanding all over the country. Recently I’ve been working on a book about architecture for autistic people. [Unfortunately entering these publications and my own CV proved very difficult. My texts mysteriously disappear before they are published. I didn’t get around this a third or fourth time. I’ve found no way of contacting the moderators of this site about this.]

One can say that a considerable proportion of autism treatment is aimed at reaching the best “fit” between people with autism and their varying characteristics on the one hand and their environment on the other. Of course this means different things for people with more and less severe forms of autism (and comorbidity). Mostly ‘environment’ means ‘social environment, but by extension, providing a physical environment which takes autistic limitations and various (sometimes very severe) sensory difficulties into account comes close to ‘treatment’. This very promising development is presently in its infancy. I’ve found no books about it, but there are some very worthwhile articles. Most work so far has been done in and around schools and classroom-design. The best place to look is http://www.ud-da.eu/information_nav.htm. (All but two or three are excellent reading, in my opinion.)

There’s very little effect-research done on architectural adaptations. Most is speculative either by professionals (such as the book by Olga Bodhashina, mentioned by Steven Michaelis, which, for that reason I don’t use) or by autistic writers such as Donna Williams (which I try to use). On the other hand there’s a lot of experience with such measures but almost none of these have been scientifically tested.

I am presently working on a Dutch/English website which will make the experiences of the Dr Leo Kannerhuis and quite a few others available. It will be up in about two months time. The most informative articles, such as just mentioned, will be reviewed as well. Putting all this into an semi-interactive website seems a better idea for disseminating this expanding body of (experiential) knowledge than publishing the 160 page book which exists now as a manuscript. A website gives more opportunity to search for specific contexts (home alone or in a family, schools, treatment facilities of various degree of intensity) and specific types of autistic difficulties (such as various sensory ones and varying degrees of central coherence problems), along with specific aspects of architecture (such as kitchens, floors, windows, installations, etcetera).

Hi,

We - a research group from Bergen (Norway) - think that improvisational music therapy might be an effective early intervention for children with ASD. There is promising research that music therapy has an effect on core symptoms in Autism, since music therapy is directly addressing problem areas such as joint attention, affect attunement, reciprocity, turn-taking. In contrast to behavioral approaches, improvisational music therapy does not use rewarding strategies for desired behavior, but aims to support a selv-motivated learning and developing through the experience of synchronised moments (Schumacher, 2008). Our research group is currently conducting the largest clinical trial (N=300) examining the effects of improvisational music therapy (Geretsegger et al. 2012). This trial is taking place in 7 countries world wide. For more information you can check out our proejct website: www.uni.no/helse/timea.

Best, Karin

https://www.researchgate.net/publication/280997107_ASSESSMENT_OF_A_LONG-TERM_DEVELOPMENTAL_RELATIONSHIP-BASED_APPROACH_IN_CHILDREN_WITH_AUTISM_SPECTRUM_DISORDER_%28.%29

Article Assessment of a Long-Term Developmental Relationship-Based A...

I hope can be a good answer to your question

Article From the Emotional Integration to the Cognitive Construction...