Research Unearths New Treatments for Autism

Research unearths new treatments for autism

Several treatments, and combinations
of treatments, are under intense study.

By Hugh McIntosh

Although still limited, the prospects for a child diagnosed with autism today are far better than for a child born several decades ago, according to experts in the field.

Several comprehensive behavioral treatment programs show promise in helping children with autism learn the skills they need to develop and interact with the world.

And many new approaches are being designed and tested. Some are focused on reshaping a child's learning environment. Others seek to match treatment to a child's individual needs.

Much of the research on these studies is still in the early phases, and researchers have yet to develop a common approach for evaluating outcomes. But they are continuing to collect data on treatments that combine parts of long-standing programs with new techniques.

Some of the most interesting include the following:

Many researchers have begun testing to see whether combinations of treatments from different programs can benefit children more than any one treatment program alone. A recent study by researchers at the University of Utah, for example, has tried combining methods from two widely used programs developed in the early 1970s: Treatment and Education of Autistic and Communication Handicapped Children (TEACCH), developed in 1971 by developmental psychologist Eric Schopler at the University of North Carolina, and the Young Autism Project, launched in 1970 by behavioral psychologist Ivar Lovaas, PhD, at the University of California, Los Angeles. The latter program relies exclusively on discrete trial training, which involves teaching autistic children thousands of individual behaviors, such as tying a shoe or eating with a fork, one at a time (see accompanying article). TEACCH emphasizes structuring the environment, using one-on-one teaching and classrooms that provide visual cues on how to complete tasks (a red ball, for example, goes through a red circle). It also encourages children to be more independent by teaching them to use newly mastered skills in less-structured environments, such as mainstream classrooms.

The Utah researchers found that children receiving a combination of the two treatments (Lovaas-type training at school and TEACCH methods at home) showed three to four times greater progress on all outcome tests than did children who received only the school-based treatment. That study was reported in the Journal of Autism and Developmental Disorders (Vol. 28, No. 1, p. 2532).

"Many of us in the field feel like all the approaches have some brilliant things about them and that perhaps taking pieces from each approach...is the way to go," says psychologist Sally Ozonoff, PhD, an investigator on the Utah study.

Researchers in Washington, D.C., are comparing a discrete trial training approach with a "developmental, individual-difference, relationship based" (DIR) approach, says child psychiatrist Stanley Greenspan, MD, professor of psychiatry at George Washington University Medical School. DIR focuses on the child's developmental needs, individual differences in nervous-system capacities and relationships with trainers. In this approach, a private practitioner who assesses the child also coordinates treatment. Following assessment, the practitioner forms an individualized treatment program using community resources such as speech and occupational therapists, counselors, parental support groups, school aides and special needs classes.

An initial retrospective study is comparing two groups of 20 children initially diagnosed with autism who were functioning well after two or more years of treatment, either with a discrete trial training approach or the DIR approach. The study aims to determine if treatment differences lead to subtle differences in outcome, for example, in terms of flexibility, emotional range, creativity and richness of the child's inner life. Investigators are planning to follow this research with a prospective, randomized, more rigorous study of the two approaches.

Several groups of researchers have begun examining the idea of matching treatments to a child's individual needs. "An individual child's needs [must] drive the intervention," says developmental psychologist Sally J. Rogers, PhD, of the University of Colorado in Denver. "If we can understand how different treatment approaches mesh with different kinds of symptoms or different severities, then we'll be able to have a more sophisticated approach to intervention in general."

Psychologist Robert Koegel, PhD, at the University of California, Santa Barbara, and his colleagues are attempting to tailor a standard treatment to the specific needs of an autistic child and family. The standard treatment is called pivotal response training. Rather than teaching thousands of behaviors one at a time, this approach concentrates on pivotal behaviors such as motivation and self-initiation that, when altered through one-on-one teaching, would produce widespread changes in many other behaviors. The study involves teaching parents in 60 families how to use pivotal response training with their autistic children. Thirty families will be taught standard pivotal response training. For the 30 other families, the researchers will develop an individualized treatment that might include more visual training if the child is having difficulty with verbal instruction. Or it might include more training in the clinic rather than home while the parents go through a particularly stressful experience, such as unemployment or divorce.

"In our previous studies we found out that it looks like you can't just deliver a standard treatment to autistic kids, that there's so much variability among the children that what works for one child doesn't work for another child," he says. "Our hypothesis is that...unless you individualize treatment, you're not going to get the best effect."

Researchers at the University of Maryland are testing an intervention to trigger children's "social engagement system," which includes behaviors such as listening, looking, facial expressions and vocalizations that support social interaction, says psychologist Stephen Porges, PhD. The treatment is designed to improve autistic children's ability to interact with others, thereby making them more receptive to traditional therapies.

The intervention is based on the theory that tensing the middle ear muscles enables people to pick out the human voice from lower frequency sounds in the environment, Porges says. Treatment involves exercising middle ear muscles by playing music that has been altered to include only frequencies associated with the human voice, which improves one's ability to listen to human voices.

This, in turn, stimulates the entire social engagement system, Porges says. About 80 percent of 50 children with autism or other behavioral problems receiving this treatment via five 45-minute sessions in a double blind, randomized controlled study showed marked improvements in listening, language and other communication skills.

Along with examining which treatments work best, some researchers want to know how much treatment is enough. In a report last year in the Journal of Autism and Developmental Disorders (Vol. 28, No. 1, p. 15-23) evaluating an intensive home-based discrete trial training intervention, Stephen Sheinkopf, PhD, of the University of Miami and Bryna Siegel, PhD, of the University of California, San Francisco, noted that children receiving an average of only 21 hours per week of treatment showed gains in IQ comparable to those achieved by children receiving 32 hours per week.

The intensity question remains an issue of importance for the autism community.

"If we need 40 hours a week, fine," says psychologist Geraldine Dawson, PhD, of the University of Washington. "But if you only need 25, you have to realize that 40 hours is a tremendous burden not only financially, but on families and on the child."

Hugh McIntosh is a writer in Chicago.

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