What Works to Treat Autism?
Studies Detail Evidence Behind Medication, Behavioral Therapies for Autism Spectrum Disorders
Early Intensive Behavioral Interventions
Intensive behavioral therapies, where a therapist or parent works one on one with an autistic child for more than 25 hours a week over several years, have made recent headlines as studies have shown that these approaches may yield substantial improvements in IQ, language, and interpersonal skills.
But when reviewers sat down to compare apples to apples in this range of different approaches, they found themselves looking at mixed fruit.
“When you start talking about interventions that are primarily behavioral or educational in nature that are delivered for many hours a week over the course of a year or two, there are so many factors that need to be brought into that comparison that it is very tricky,” Warren says.
“What we do see is a body of work that suggests that yes, in fact, young children with autism spectrum disorders who do receive early intensive intervention do show or tend to show benefit,” he says, “But there are some who show much more benefit than others. And there are some interventions where the effects are very modest, and some subgroups are showing tremendous gains.”
Researchers looked at three broad categories of therapies. The first was the so-called University of California at Los Angeles/Lovaas approach, where therapists work with children at least 25 hours a week to try to combat specific behaviors and deficits associated autism.
For example, if an autistic child shows interest in a toy, but not necessarily a person in the same room, a therapist might hold the toy and prompt the child to ask for it in an appropriate way, in an effort to develop communication skills.
The second category of interventions included programs that attempt to address autistic tendencies in very young children, who are under 2 years of age. In general, these are studies based on the Early Start Denver Model, which uses play-based therapy to encourage language and social skills.
The third kind of therapies reviewed were programs that train parents to help their kids at home.
“The mantra in the field has been that with early identification and early intervention, you can improve the long-term developmental trajectory of the illness,” says Eric Hollander, MD, director of the Compulsive, Impulsive and Autism Spectrum Disorders Program at Montefiore Medical Center in New York City.
Among 23 studies of the UCLA/Lovaas method and four studies of the Denver Early Start program that were included in the review, many showed gains in IQ, cognitive performance, language skills, and adaptive behaviors.
But those findings appeared to be biased from the get-go, experts say, because children who got the intensive interventions, as opposed to “eclectic” community-based programs, started out with milder symptoms.
“The early studies were flawed,” Hollander says. He was not involved in the reviews.