What Works to Treat Autism?
Studies Detail Evidence Behind Medication, Behavioral Therapies for Autism Spectrum Disorders
Early Intensive Behavioral Interventions continued...
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.
“There are some kids who get response to some treatments over a short period of time, but it’s kind of hard to figure out which of the kids respond best to which specific treatments and whether those treatments have a large impact over time,” he says.
It’s a critical question, too, considering what it costs to provide these therapies.
“There are high costs associated with these treatments, hundreds of thousands of dollars a year,” Hollander says.
Reviewers cited a lack of high-quality studies and a lack of confirmatory research, or studies that independently duplicate previous findings, as a reason to further question these approaches. They noted that one finding that was “powerfully replicated” across studies was that many kids who get these therapies “will not demonstrate dramatic gains ... .”
Among seven studies of parent-training programs, researchers said small sizes, failure to randomly assign participants to different treatments, wide variation in the symptoms of children enrolled in the studies, and a lack of objectively assessed outcomes limited the conclusions that could be drawn.