Transcript Evidence-based and Fad Treatments for Autism

Evaluating Treatments for
Autism:
Current Status of the Science
Rachel Hoffman, M. A.
Anne Shroyer, B.S.
Overview

Conflicts in Treatment Selection

Why Science Matters

Evidence-Based vs. Alternative Treatments
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Being an Advocate
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More In-Depth Look at Autism Treatments

General Recommendations for Treatment Selection
The Dilemma
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Search for an effective treatment starts at
diagnosis
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Many available treatments
◦ Sheer number overwhelming
◦ Effectiveness not always clear
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Which one to choose??
One Mother’s Story
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“Can you give me a little background about
your son?”
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“What was it like receiving a diagnosis, and
what came next?”
The Importance of Science
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Teachers and Science
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Why Science Matters Video
What Is Science?
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Systematic method
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Rules out other variables
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Conclusions supported with high degree of
confidence

Replication of results
Science and Autism Treatment
Science effectively demonstrates:
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Which treatments are effective

To what extent they’re effective
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In what cases they’re effective
Objective Evidence

Uninfluenced by personal biases

Data dependent
◦ “How much?”
◦ E.g., amount of hand raising in class, before
and after intervention
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Causal relationships
Subjective Evidence

Open to personal biases

Opinion dependent
◦ “How good?”
◦ E.g., someone’s feelings about a treatment’s
efficacy

Correlational relationships
Correlation ≠ Causation

Important to distinguish between the two
terms

Correlation
◦ Degree to which two events are related
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Causation
◦ When one event results in a subsequent event
Correlations – Example 1

Ice cream consumption and drowning
◦ When rate of one increases, so does the
other

Does eating ice cream cause drowning?

What else might cause increases in both?
◦ Increases tend to occur in hot summer
months
Correlations – Example 2

Why an increase in autism diagnoses?
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Proposed reasons
◦ More chemicals in the environment
◦ Increase in Rx drug use
◦ Broadening of diagnostic criteria
◦ Increased awareness of symptoms
Evidence-Based Practice
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Backed by scientific evidence
◦ Lots of research on specifics of treatment

Demonstrated effectiveness
◦ Objective data

Most likely to result in improvements
Alternative Treatments
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“Pseudoscientific”
◦ Effectiveness generally unevaluated
◦ Subjective data - testimonials and case studies

Popular - but, risky
◦ Safety may be unclear
Alternative Treatments –
What’s the Harm?

Can lead to waste of
◦ Time
◦ Money
◦ Opportunities
◦ Effort

Can result in crushing disappointment
◦ No measurable improvements
Eclectic Treatment Approach
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Using components from multiple treatments

So what’s the harm
in trying a little of
everything?
Alternative Treatments – An Analogy
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Weight loss
◦ Diet and exercise vs. over-the-counter pill
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Which is more likely to improve your quality of life?

Relate this to selection of autism treatment
◦ Consider long-term quality of life and
independence
◦ Time wasted in treatment can not be returned
Red Flags in Treatment Claims
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“Cure” claim
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Little training provided to
caregivers

Non-individualized treatments

Effectiveness based on testimonials / case
studies
INTERMISSION
Making an Informed Choice
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One child in every 110 is classified as having
ASD (Rice, 2006)
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Therapies began claiming astonishing results

Difficult to choose which therapy is best

Parents have sought the recommendations of
professionals
Professional Recommendations
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Medical:
◦ Chelation, sensory diet, GFCF diet, chiropractic,
Hyperbaric Chamber, drug therapy, etc.

Non-medical:
◦ Applied Behavior Analysis (ABA), TEACCH,
sensory integration, music therapy, etc.
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Treatments range in effectiveness and safety

Physicians may lack knowledge on effectiveness
(Golnik & Ireland, 2009)
A Few Types of Autism Therapies
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Facilitated Communication
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Sensory Integration Therapy
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Chelation
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Applied Behavior Analysis
Facilitated Communication
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Created in the 1970’s
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Claims to provide a form of communication for
non-verbal individuals

Large anecdotal claims of effectiveness (Finn,
Bothe, & Bramlett, 2005)
Facilitated Communication Video
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FC Frontline Clips.MP4
Facilitated Communication

Objective research found FC ineffective (Finn,
Bothe, & Bramlett, 2005; Kezuka, 1997; Jacobson, Mulick, &
Schwartz,1995)

Learners’ response dependent on the facilitator
(Kezuka, 1997)
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Harmful
◦ Wrongful accusations and disappointments
(Jacobson, Mulick, & Schwartz,1995)
Facilitated Communication Video

FC Frontline Clips.MP4
Sensory Integration Therapy

Began to be used for autism in the late 1970’s
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Claims to be effective in improving sensory
processing in the brain
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Involves activities such as:
◦ Swinging
◦ Rocking
◦ Massages
◦ Pressure/weighted vests
Sensory Integration Video
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What it is based on
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Sensory room
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Video short clip of swinging
Sensory Integration Therapy
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1-10 hours, 1-3 times a week, 3-6 months
◦ $30-120 per session

Parent training: Some

Does it work?
◦ Not enough objective research available
(Maurice, Green, & Luce, 1996)
◦ Found ineffective in the reduction of
stereotypy (Hodgetts, Magill-Evans, & Misiaszek, 2011;
Reichow, Barton, Good, & Wolery, 2009)
Chelation

Began to be used for autism in the early 1980’s

Claims to stop further damage caused by
mercury poisoning

Complex, time consuming, and distressing

Removal of heavy metals through IV or oral
medication
Chelation

1-10 hours a week, 1month to a year
◦ $30-120 per session

Parent training: None

Does it work?
◦ 2008 stopped research due to dangers
associated
◦ Reserved for the treatment of children only
with heavy-metal poisoning (Van der Linde, Pillen,
Gerrits & Bouwes Bavinck, 2008)
Wick & Smith 2009
Applied Behavior Analysis
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Behavioral psychology emerged in the early
1900’s
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Measure objective observable events
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Systematically manipulate events in the
immediate environment to improve behavior
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Rule out other explanations
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Replicate the results
ABA Video
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Video
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Video PECS
Applied Behavior Analysis


Therapy may include:
◦ One-on-one instruction using prompts and
reinforcement
◦ Teaching in natural environment
◦ Facilitated peer play
◦ Individualized interventions to reduce problem
behavior
Interventions based on ABA include
◦ Pivotal Response Training
◦ Verbal Behavior Therapy
◦ Picture Exchange Communication System (PECS)
◦ Early Start Denver Model
Applied Behavior Analysis

15-40 hours, 3-5 days a week, 1-3 years
◦ Costs vary: average $50-120 per session
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Parent training: Yes
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Does it work?
◦ Research demonstrates ABA as the most
effective approach to the treatment of autism
(Maurice, Green, & Luce, 1996)
General Recommendations
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Who claims the treatment will help?
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Be skeptical
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Financial benefits
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Research the information closely
General Recommendations Cont.
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Ask others for help in deciphering difficult
topics
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Be cautious of new treatments with little
reviews
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Be sure to request objective measures
Scientifically Proven Treatments
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Additional Resources:
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Texas Autism Research and Resource Center:
http://www.dads.state.tx.us/tarrc/research/treatment.ht
ml
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National Standards Project:
http://www.nationalautismcenter.org/about/national.php
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National Professional Development Standards on
Autism Spectrum Disorders:
http://autismpdc.fpg.unc.edu/content/briefs
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Institute of Education Services- What Works
Clearinghouse: http://ies.ed.gov/ncee/wwc/reports/
Where is Trevor now?

Trevor with his mother making a pizza
Thank You!
Questions
References

Finn, P., Bothe, A. K., & Bramlett, R. E. (2005). Science and pseudoscience
in communication disorders: criteria and applications. American
Journal of Speech-Language Pathology, 14(3), 172-186.
doi:10.1044/10580360(2005/018)

Golnik, A., & Ireland, M. (2009). Complementary alternative medicine
for children with autism: a physician survey. Journal Of Autism And
Developmental Disorders, 39(7), 996-1005.

Hodgetts, S., Magill-Evans, J., & Misiaszek, J. E. (2011). Weighted vests,
stereotyped behaviors and arousal in children with autism. Journal
of Autism Developemntal Disorders, 41, 805–814. doi:
10.1007/s10803-010-1104-x
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Jacobson, J. W., Mulick, J. A., & Schwartz, A. A. (1995). A history of
facilitated communication: Science, pseudoscience, and
antiscience science working group on facilitated communication.
American Psychologist, 50, 9, 750-765. doi: 10.1037/0003066X.50.9.750
References Cont.
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Kezuka, E. (1997). The role of touch in facilitated communication.
Journal of Autism and Developmental Disorders, 27, 5, 571-593.
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Leaf, R., McEachin, J., &Taubman, M. (2008). Sense and nonsense in the
behavioral treatment of autsim: It has to be said. NY, NY. DRL
Books, Inc.
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Luiselli, J. K., Russo, D. C., Christian, W. P., & Wilczynski, S. M. (2008).
Effective practices for children with autism: Educational and
behavioral support interventions that work. NY, NY. Oxford
University Press.
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Maurice, C., Green, G., & Luce, S. (1996) Behavioral Intervention for
young children with autism. Austin, TX: PRO-ED.

Reichow, B., Barton E. E., Good, L., & Wolery, M. (2009). Brief report:
effects of pressure vest usage on engagement and problem
behaviors of a young child with developmental delays. Journal of
Autism and Developmental Disorder, 39, 1218–1221. doi:
10.1007/s10803-009-0726-3.
References Cont.
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Rice, C. (2006). Prevalence of autism spectrum disorders . Autism and
Developmental Disabilities Monitoring Network, 58, 1-20.
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Schreck, K. A. & Mazur, A. (2008). Behavior analyst use of and beliefs in
treatments for people with autism. Behavioral Interventions, 23,
201-212. doi: 10.1002/bin.264
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Todd, J.T. (1987). The great power of steady misrepresentation:
Behaviorism's presumed denial of instinct. Behavior Analyst, 10,
117-118.
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Van der Linde, A., Pillen, S., Gerrits, G., & Bouwes Bavinck, J. (2008).
Stevens-johnson syndrome in a child with chronic mercury
exposure and 2,3-dimercaptopropane-1-sulfonate (DMPS)
therapy. Clinical Toxicology (Philadelphia, Pa.), 46, 5, 479-481.
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Weiss, M. J. & Ferraioli, S. (2009). Identifying evidence based treatments.
ABA Special Interest Group Newsletter. 25(1): 1-4.
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Wick, J., & Smith, T. (2009). Controversial treatments for children with
autism in the popular media. ABA Special Interest Group Newsletter.
25(1): 5-11.
References Cont.
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whyscience.co.uk
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sciencepunk.com
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raisingchildren.net
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http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5810a1.htm