Autism Treatments

Autism treatments are a very intensive, comprehensive undertaking that involves the child's entire family and a team of professionals. Some programs may take place in the child's home with professionals and trained therapists and may include Parent Training for the child under supervision of a professional. Some programs are delivered in a specialized center, classroom or preschool. Autism treatments for the Core Symptoms of Autism Most families use one type of intensive intervention that best meets the needs of their child and their parenting style. The intensive interventions described here require multiple hours per week of therapy and address behavioral, developmental, and/or educational goals. They are developed specifically to treat autism.

Most parents would welcome a cure for their child, or a therapy that would alleviate all of the symptoms and challenges that make life difficult for them. Just as your child's challenges can't be summed up in one word, they can't be remedied with one therapy. Each challenge must be addressed with an appropriate therapy. No single therapy works for every child. What works for one child may not work for another. What works for one child for a period of time may stop working. Some autism treatments and therapies are supported by research showing their efficacy, while others are not. The skill, experience and style of the therapist are critical to the effectiveness of the intervention.

Before a family chooses any appropriate autism treatments or intervention, they will need to investigate the claims of each therapy so that they understand the possible risks and benefits for a child.

Applied Behavior Analysis (ABA)

Behavior analysis was originally described by B.F. Skinner in the 1930's. You may have learned about Skinner and ?operant conditioning? when you studied science in school. The principles and methods of behavior analysis have been applied effectively in many circumstances to develop a wide range of skills in learners with and without disabilities.

What is Applied Behavior Analysis?

Behavior analysis is a scientific approach to understanding behavior and how it is affected by the environment. "Behavior" refers to all kinds of actions and skills (not just misbehavior) and "environment" includes all sorts of physical and social events that might change or be changed by one's behavior. The science of behavior analysis focuses on principles (that is, general laws) about how behavior works, or how learning takes place. For example, one principle of behavior analysis is positive reinforcement. When a behavior is followed by something that is valued (a "reward"), that behavior is likely to be repeated. Through decades of research, the field of behavior analysis has developed many techniques for increasing useful behaviors and reducing those that may be harmful or that interfere with learning. Applied behavior analysis (ABA) is the use of those techniques and principles to address socially important problems, and to bring about meaningful behavior change.

Who Can Benefit from ABA?

ABA methods have been used successfully with many kinds of learners of all ages, with and without disabilities, in many different settings. In the early 1960s, behavior analysts began working with young children with autism and related disorders. Those pioneers used autism treatments and techniques in which adults directed most of the instruction, as well as some in which children took the lead. Since that time, a wide variety of ABA techniques have been developed for building useful skills in learners with autism of all ages. Those techniques are used in both structured situations (such as formal instruction in classrooms) and in more "natural" everyday situations (such as during play or mealtime at home), and in 1-to-1 as well as group instruction. They are used to develop basic skills like looking, listening and imitating, as well as complex skills like reading, conversing, and taking the perspective of others.

The use of ABA principles and techniques to help persons with autism live happy and productive lives has expanded rapidly in recent years. Today, ABA is widely recognized as a safe and effective use of autism treatment. It has been endorsed by a number of state and federal agencies, including the US Surgeon General and the New York State Department of Health.

For more general information about behavior analysis and ABA, see: [The Association of Professional Behavior Analysts] [The Association for Behavior Analysis International] [Behavior Analyst Certification Board] [American Psychological Association Archival Description of Behavioral Psychology] [Cambridge Center for Behavioral Studies]

What is the Research on ABA for Autism?

Hundreds of published studies have shown that specific ABA autism treatments and techniques can help individuals with autism learn specific skills, such as how to communicate, develop relationships, play, care for themselves, learn in school, succeed at work, and participate fully and productively in family and community activities, regardless of their age. A number of peer-reviewed studies have examined the effects of combining multiple ABA techniques into comprehensive, individualized, intensive early intervention programs for children with autism. "Comprehensive" refers to the fact that intervention addresses all kinds of skills: communication, social, self-care, play, motor, pre-academic, and so on. "Early" means that intervention began before the age of four for most children. "Intensive" means that ABA methods were used to arrange large numbers of learning opportunities for each child every day in both structured and unstructured situations, which amounted to 25-40 hours per week during which children actively learned and practiced skills. That was done so that young children with autism would have experiences like typical toddlers, who get thousands of chances every day to learn by interacting with their parents and others. These studies showed that many children with autism who received 1-3 years of this type of treatment had large improvements on tests of their cognitive, communication, and adaptive skills. Some who participated in early intensive ABA for at least 2 years acquired enough skills to participate in regular classrooms with little or no ongoing help. Other children in the studies learned many skills through intensive ABA, but not enough to function independently in regular classrooms full-time. Across studies, a small percentage of children improved relatively little. At this time, it is very difficult to predict in advance how far any individual child might go with this treatment. More research is needed to determine why some children with autism respond more favorably to early intensive ABA than others.

In some studies, intensive ABA was compared with less intensive ABA autism treatments, typical early intervention or special education, and "eclectic", mixed-method interventions done both intensively and non-intensively. The children with autism who received intensive ABA treatment made larger improvements in most skill areas than children who participated in the other interventions. Parents whose children received intensive ABA reported less stress than parents whose children received other treatments.

Does ABA Work with Older Learners with Autism?

Yes. Research documents that many ABA autism treatments and techniques are effective for building skills of all kinds in children, adolescents, and adults with autism and related disorders. Additionally, ABA methods are useful for helping individuals and families manage some of the difficult behaviors that may accompany autism, without the side effects of drugs or other treatments. A number of programs have been combining many ABA techniques into comprehensive treatment programs for youths and adults with autism for many years. Many of those individuals have learned to work and live successfully in their communities thanks to ABA treatment. However, so far, there have been no studies of intensive ABA with older individuals with autism comparable to those that have been done with young children.

For more information about research supporting ABA as autism treatments see: [The Cambridge Center for Behavioral Studies Autism Page] [US Surgeon General's Report on Mental Health] [Clinical Practice Guideline, New York State Department of Health Early Intervention Program] [Journal of Applied Behavior Analysis]

What Does ABA Intervention Involve?

Done correctly, ABA autism treatments and interventions are not a "one size fits all" approach consisting of a "canned" set of programs or drills. On the contrary, every aspect of intervention is customized to each learner's skills, needs, interests, preferences, and family situation. For those reasons, an ABA program for one learner might look somewhat different than a program for another learner. But genuine, comprehensive ABA programs for learners with autism have certain thing sin common:

-Intervention designed and overseen directly by qualified, well-trained professional behavior analysts

Detailed assessment of each learner's skills as well as learner and family preferences to determine initial treatment goals

Selection of goals that are meaningful for the learner and the family

Ongoing objective measurement of learner progress

Frequent review of progress data by the behavior analyst so that goals and procedures can be "fine tuned" as needed

Instruction on developmentally appropriate goals in skill areas (e.g. communication, social, self-care, play and leisure, motor, and academic skills)

Skills broken down into small parts or steps that are manageable for the learner, and taught from simple (such as imitating single sounds) to complex (e.g. carrying on conversations)

An emphasis on skills that will enable learners to be independent and successful in both the short and the long run

Use of multiple behavior analytic procedures - both adult-directed and learner-initiated - to promote learning in a variety of ways

Many opportunities - specifically planned and naturally occurring - for each learner to acquire and practice skills every day, in structured and unstructured situations

Intervention provided consistently for many hours each week

Abundant positive reinforcement for useful skills and socially appropriate behaviors

An emphasis on positive social interactions, and on making learning fun!

No reinforcement for behaviors that are harmful or prevent learning

Use of techniques to help trained skills carry over to various places, people, and times, and to enable learners to acquire new skills in a variety of settings

Parent training so family members can teach and support skills during typical family activities

Regular meetings between family members and program staff to plan, review progress, and make adjustments

What Kind of Improvements Can Be Expected From ABA autism treatments?

Competently delivered ABA autism treatments and interventions can help learners with autism make meaningful changes in many areas. But most learners require a great deal of carefully planned instruction and practice on most skills, so changes do not occur quickly. As mentioned earlier, quality ABA programs address a wide range of skill areas, but the focus is always on the individual learner, so goals vary from learner to learner, depending on age, level of functioning, family needs and interests, and other factors. The rate of progress also varies from one learner to the next. Some acquire skills quickly, others more slowly. In fact, an individual learner may make rapid progress in one skill area - such as reading - and need much more instruction and practice to master another, such as interacting with peers.

Who Can Provide ABA Autism Treatments and Intervention?

Because of the huge demand for ABA autism treatments and interventions, many individuals and programs now claim to "do ABA." Some are private practitioners or agencies that offer to provide services by periodically coming into a family's home; others operate private schools, and still others provide consultation services to public schools. Not all of them have the education and practical experience that the field of behavior analysis considers minimum requirements for practicing ABA. Family members and concerned professional are urged to be cautious when enlisting anyone to "do ABA" with a child, youth, or adult with autism.

Whether assembling or choosing an ABA autism treatments program, keep in mind the following:

Just as a medical treatment program should be directed by a qualified medical professional, ABA programs for learners with autism should be designed and supervised by qualified behavior analysts, preferably individuals who are Board Certified Behavior Analysts (R) with supervised experience providing ABA treatment for autism, or who can clearly document that they have equivalent training and experience. Always check credentials of those who claim to be qualified in behavior analysis. An ABA program should have the components and features listed above Monitor the autism treatments program by observing sessions and participating in training sessions and consultations

Pivotal Response Treatment

Pivotal Response Treatment, or PRT, was developed by Dr. Robert L. Koegel, Dr. Lynn Kern Koegel and Dr. Laura Shreibman, at the University of California, Santa Barbara. Pivotal Response Treatment was previously called the Natural Language Paradigm (NLP), which has been in development since the 1970s. It is a behavioral intervention model based on the principles of ABA.

What is PRT?

PRT autism treatments are used to teach language, decrease disruptive/self-stimulatory behaviors, and increase social, communication, and academic skills by focusing on critical, or ?pivotal,? behaviors that affect a wide range of behaviors. The primary pivotal behaviors are motivation and child's initiations of communications with others.

The goal of PRT autism treatments are to produce positive changes in the pivotal behaviors, leading to improvement in communication skills, play skills, social behaviors and the child's ability to monitor his own behavior. Unlike the Discrete Trial Teaching (DTT) method of teaching, which targets individual behaviors, based on an established curriculum, PRT is child directed. Motivational strategies are used throughout the autism treatments and interventions as often as possible. These include the variation of tasks, revisiting mastered tasks to ensure the child retains acquired skills, rewarding attempts, and the use of direct and natural reinforcement. The child plays a crucial role in determining the activities and objects that will be used in the PRT exchange. For example, a child's purposeful attempts at functional communication are rewarded with reinforcement related to their effort to communicate (for example, if a child attempts a request for a stuffed animal, the child receives the animal).

Who provides PRT autism treatments?

Psychologists, special education teachers, speech therapists and other providers specifically trained in PRT. The KoegCertification program.

What is a typical PRT autism treatments or therapy session like?

Each program is tailored to meet the goals and needs of the child as well as family routines. A session typically involves six segments during which language, play and social skills are targeted in structured and unstructured formats. Sessions change to accommodate more advanced goals and the changing needs as the child develops.

What is the intensity of a PRT program?

PRT autism treatments programs usually involve 25 or more hours per week. Everyone involved in the child's life is encouraged to use PRT methods consistently in every part of the child's life. PRT has been described as a lifestyle adopted by the affected family.

Verbal Behavior Therapy

Another behavioral (based on the principles of ABA) therapy and autism treatments method with a different approach to the acquisition and function of language is Verbal Behavior (VB) therapy.

What is VB?

In his 1957 book, ?Verbal Behavior,? B.F. Skinner (see previous section on ABA) detailed a functional analysis of language. He described all of the parts of language as a system. Verbal Behavior uses Skinner's analysis as a basis for teaching language and shaping behavior. Skinner theorized that all language could be grouped into a set of units, which he called operants. Each operant identified by Skinner serves a different function. The most important of these operants, or units, he named echoics, mands, tacts and intraverbals: The function of a ?mand? is to request or obtain what is wanted. For example, the child learns to say the word ?cookie? when he is interested in obtaining a cookie. When given the cookie, the word is reinforced and will be used again in the same context. In a VB program the child is taught to ask for the cookie anyway he can (vocally, sign language, etc.). If the child can echo the work he will be motivated to do so to obtain the desired object.

The operant for labeling an object is called a ?tact.? For example, the child says the word ?cookie? when seeing a picture and is thus labeling the item. In VB, more importance is placed on the mand than on the tact, theorizing that ?using language? is different from ?knowing language.?

An ?intraverbal? describes conversational or social, language. Intraverbals allow children to discuss something that isn't present. For example, the child finishes the sentence, ?I'm baking?? with the intraverbal fill-in ?Cookies.? Intraverbals also include responses to questions from another person, usually answers to ?wh-? questions (Who? What? When? Where? Why?). Intraverbals are strengthened with social reinforcement.

VB and classic ABA autism treatments use similar behavioral formats to work with children. VB is designed to motivate a child to learn language by developing a connection between a word and its value. VB may be used as an extension of the communication section of an ABA program.

Who provides VB autism treatments?

VB is provided by VB-trained psychologists, special education teachers, speech therapists and other providers.

What is the intensity of most VB programs?

VB autism treatments and programs usually involve 30 or more hours per week of scheduled therapy. Families are encouraged to use VB principals in their daily lives.

Floortime (DIR)

Floortime is a specific therapeutic technique based on the Developmental Individual Difference Relationship Model (DIR) developed in the 1980s by Dr. Stanley Greenspan. The premise of Floortime is that an adult can help a child expand his circles of communication by meeting him at his developmental level and building on his strengths. Therapy is often incorporated into play activities ? on the floor.

The goal of Floortime is to help the child reach six developmental milestones that contribute to emotional and intellectual growth:

Self-regulation and interest in the world

Intimacy or a special love for the world of human relations

Two-way communication

Complex communication

Emotional ideas

Emotional thinking

In Floortime, the therapist or parent engages the child at a level the child currently enjoys, enters the child's activities, and follows the child's lead. From a mutually shared engagement, the parent is instructed how to move the child toward more increasingly complex interactions, a process known as ?opening and closing circles of communication.? Floortime does not separate and focus on speech, motor, or cognitive skills but rather addresses these areas through a synthesized emphasis on emotional development. The intervention is called Floortime because the parent gets down on the floor with the child to engage him at his level. Floortime is considered an alternative to and is sometimes delivered in combination with behavioral therapies.

Who provides Floortime?

Parents and caregivers are trained to implement the approach. Floortime-trained psychologists, special education teachers, speech therapists, occupational therapists may also use Floortime techniques.

What is a typical Floortime therapy session like?

In Floortime, the parent or provider joins in the child's activities and follows the child's lead. The parent or provider then engages the child in increasingly complex interactions. During the preschool program, Floortime includes integration with typically developing peers.

What is the intensity of most Floortime programs?

Floortime is usually delivered in a low stimulus environment, ranging from two to five hours a day. Families are encouraged to use the principals of Floortime in their day-to-day lifestyle.

Relationship Development Intervention (RDI)

Like other therapies described here, RDI is a system of behavior modification through positive reinforcement. RDI was developed by Dr. Steven Gutstein as a parent-based treatment using dynamic intelligence. The goal of RDI is to improve the individual's long-term quality of life by helping them improve their social skills, adaptability and self-awareness. The six objectives of RDI are:

Emotional Referencing: The ability to use an emotional feedback system to learn from the subjective experiences of others.

Social Coordination: The ability to observe and continually regulate one's behavior in order to participate in spontaneous relationships involving collaboration and exchange of emotions.

Declarative Language: Using language and non-verbal communication to express curiosity, invite others to interact, share perceptions and feelings and coordinate your actions with others.

Flexible thinking: The ability to rapidly adapt, change strategies and alter plans based upon changing circumstances.

Relational Information Processing: The ability to obtain meaning based upon the larger context; Solving problems that have no ?right-and- wrong? solutions.

Foresight and Hindsight: The ability to reflect on past experiences and anticipate potential future scenarios in a productive manner.

The program involves a systematic approach to working on building motivation and teaching skills, focusing on the child's current developmental level of functioning. Children begin work in a one-on-one setting with a parent. When they are ready, they are matched with a peer at a similar level of relationship development to form a ?dyad.? Gradually additional children are added to the group and the number of settings in which children practice in order to help the child form and maintain relationships in different contexts.

Who provides RDI?

Parents, teachers and other professionals can be trained to provide RDI. Parents may choose to work together with an RDI-certified consultant. RDI is somewhat unique because it is designed to be implemented by parents. Parents learn the program through training seminars, books and other materials and can collaborate with an RDI-certified consultant. Some specialized schools offer RDI in a private school setting.

What is a typical RDI therapy session like?

In RDI, the parent or provider uses a comprehensive set of step-by-step, developmentally appropriate objectives in everyday life situations, based on different levels, or stages, of ability. Spoken language may be limited in order to encourage eye contact and non-verbal communication. RDI may also be delivered in a specialized school setting.

What is the intensity of most RDI programs?

Families use the principles of RDI in their day-to-day lifestyle.

Training and Education of Autistic and Related Communication Handicapped Children (TEACCH)

TEACCH is are special autism treatments and education programs, developed by Eric Schopler, Ph.D. and colleagues at the University of North Carolina, in the early 1970s. TEACCH's intervention approach is called ?Structured Teaching.?

Structured Teaching is based on what TEACCH calls the ?Culture of Autism.? The Culture of Autism refers to the relative strengths and difficulties shared by people with autism that are relevant to how they learn. Structured Teaching is designed to capitalize on the relative strength and preference for processing information visually, while taking into account the recognized difficulties.

Children with autism are assessed to identify emerging skills and work then focuses on these to enhance them. In Structured Teaching, individualized autism treatments are developed for each student rather than using a standard curriculum. The plan creates a highly structured environment to help the individual map out activities. The physical and social environment is organized using visual supports so that the child can more easily predict and understand daily activities and respond in appropriate ways. Visual supports are also used to make individual tasks understandable.

What does TEACCH look like?

TEACCH autism treatments and programs are usually conducted in a classroom setting. TEACCH-based home programs are also available and are sometimes used in conjunction with a TEACCH-based classroom program. Parents work with professionals as co-therapists for their children so that techniques can be continued at home.

Who provides TEACCH autism treatments?

TEACCH autism treatments are available at the TEACCH centers in North Carolina and by TEACCH-trained psychologists, special education teachers, speech therapists and TEACCH providers in other areas of the country.

Social Communication/ Emotional Regulation/ Transactional Support (SCERTS) Social Communication/ Emotional Regulation/ Transactional Support (SCERTS)

SCERTS is an educational autism treatments model developed by Barry Prizant, PhD, Amy Wetherby, PhD, Emily Rubin and Amy Laurant. SCERTS uses practices from other approaches including ABA (in the form of PRT), TEACCH, Floortime and RDI. The SCERTS Model differs most notably from the focus of ?traditional? ABA, by promoting child-initiated communication in everyday activities. SCERTS is most concerned with helping children with autism to achieve ?Authentic Progress,? which is defined as the ability to learn and spontaneously apply functional and relevant skills in a variety of settings and with a variety of partners.

The acronym SCERTS refers to the focus on:

SC: Social Communication - Development of spontaneous, functional communication, emotional expression and secure and trusting relationships with children and adults.

ER: Emotional Regulation - Development of the ability to maintain a well-regulated emotional state to cope with everyday stress, and to be most available for learning and interacting.

TS: Transactional Support - Development and implementation of supports to help partners respond to the child's needs and interests, modify and adapt the environment, and provide tools to enhance learning (e.g., picture communication, written schedules, and sensory supports).

Specific plans are also developed to provide educational and emotional support to families, and to foster teamwork among professionals.

What does a SCERTS autism treatments session look like?

The SCERTS Model favors having children learn with and from children who provide good social and language models in inclusive settings as much as possible. SCERTS is implemented using transactional supports implemented by a team, such as environmental accommodations, learning supports (schedules or visual organizers).

Who provides SCERTS autism treatments?

SCERTS autism treatments are usually provided in a school setting by SCERTS-trained special education teachers, speech therapist.

Treatment for Biological & Medical Conditions Associated with Autism

These autism treatments and services are therapies that address symptoms commonly associated with autism, but not specific to the disorder. These are called ?related services?.

Speech-Language Therapy (SLT)

Speech-Language Therapy (SLT) autism treatments encompass a variety of techniques and addresses a range of challenges for children with autism. For instance, some individuals are unable to speak. Others seem to love to talk. They may have difficulty understanding information or they may struggle to express themselves.

SLT autism treatments are designed to coordinate the mechanics of speech and the meaning and social value of language. An SLT autism treatments begins with an individual evaluation by a speech-language pathologist. The therapy may then be conducted one-on-one, in a small group or in a classroom setting.

The autism treatments therapy may have different goals for different children. Depending on the verbal aptitude of the individual, the goal might be to master spoken language or it might be to learn signs or gestures to communicate. In each case, the aim is to help the individual learn useful and functional communication.

Speech-language autism treatments therapy is provided by Speech-Language Pathologists who specialize in children with autism. Most intensive therapy programs address speech-language therapy as well.

Occupational Therapy (OT)

Occupational Therapy (OT) autism treatments brings together cognitive, physical and motor skills. The aim of OT is to enable the individual to gain independence and participate more fully in life. For a child with autism, the focus may be on appropriate play, learning and basic life skills.

An occupational therapist will evaluate the child's development as well as the psychological, social and environmental factors that may be involved. The therapist will then prepare autism treatments strategy and tactics for learning key tasks to practice at home, in school and other settings. Occupational therapy is usually delivered in a half hour to one hour session with the frequency determined by the needs of the child.

Goals of an OT autism treatments program might include independent dressing, feeding, grooming and use of the toilet and improved social, fine motor and visual perceptual skills. OT is provided by Certified Occupational Therapists.

Sensory Integration Therapy (SI)

Sensory Integration (SI) autism treatments and therapy is designed to identify disruptions in the way the individual's brain processes movement, touch, smell, sight and sound and help them process these senses in a more productive way. It is sometimes used alone, but is often part of an occupational therapy program. It is believed that SI does not teach higher-level skills, but enhances sensory processing abilities, allowing the child to be more available to acquire higher-level skills. Sensory Integration therapy might be used to help calm your child, reinforce a desired behavior or to help with transitions between activities.

Therapists begin with an individual evaluation to determine what your child's sensitivities are. The therapist then plans an individualized autism treatments program for the child matching sensory stimulation with physical movement to improve how the brain processes and organizes sensory information. The therapy often includes equipment such as swings, trampolines and slides.

Certified Occupational and Physical Therapists provide Sensory Integration Therapy.

Physical Therapy (PT)

Physical Therapy (PT) autism treatments focuses on any problems with movement that cause functional limitations. Children with autism frequently have challenges with motor skills such as sitting, walking, running and jumping. PT can also address poor muscle tone, balance and coordination. A physical therapist will start by evaluating the abilities and developmental level of the child. Once they identify where the individual's challenges are, they design activities that target those areas. PT might include assisted movement, various forms of exercise and orthopedic equipment.

Physical therapy is usually delivered in a half hour to one-hour session by a Certified Physical Therapist, with the frequency determined by the needs of the child.

Picture Exchange Communication System (PECS)

Picture Exchange Communication System (PECS) autism treatments are a learning system that allows children with little or not verbal ability to communicate using pictures. PECS can be used at home, in the classroom or a variety of settings. A therapist, teacher or parent helps the child build a vocabulary and articulate desires, observations or feelings by using pictures consistently.

The PECS autism treatments program starts by teaching the child how to exchange a picture for an object. Eventually, the individual is shown how to distinguish between pictures and symbols and use them to form sentences. Although PECS is based on visual tools, verbal reinforcement is a major component and verbal communication is encouraged.

Standard PECS pictures can be purchased as a part of a manual or pictures can be gathered from photos, newspapers, magazines or other books.

Auditory Integration Therapy

Auditory Integration Therapy (AIT), sometimes called Sound Therapy, is sometimes used to treat children with difficulties in auditory processing or sound sensitivity.

Treatment with AIT involves the patient listening to electronically modified music through headphones during multiple sessions. There are different methods of AIT, including Tomatis and Berard.

While some individuals have reported improvements in auditory processing resulting from AIT, there are no credible studies that demonstrate its effectiveness or support its use.

Gluten Free, Casein Free Diet (GFCF)

Many families of children with autism are interested in dietary and nutritional interventions that might help some of their children's symptoms. Removal of gluten (a protein found in barley, rye, and wheat, and in oats through cross contamination) and casein (a protein found in dairy products), is a popular dietary treatment for symptoms of autism.

The theory behind this diet is that proteins are absorbed differently in some children. Rather than having an allergic reaction, children who benefit from the GFCF diet experience physical and behavioral symptoms. While there have not yet been sufficient scientific studies to support this theory, many families report that dietary elimination of gluten and casein has helped regulate bowel habits, sleep activity, habitual behaviors and contributed to the overall progress in their individual child.

Because no specific laboratory tests can predict which children will benefit from dietary intervention, many families choose to try the diet with careful observation by the family and intervention team.

Families choosing a trial of dietary restriction should make sure their child is receiving adequate nutrition. Dairy products are the most common source of calcium and vitamin D in young children in the U.S. Many young children depend on dairy products for a balanced protein intake. Alternative sources of these nutrients require the substitution of other food and beverage products with attention to the nutritional content.

Substitution of gluten free products requires attention to the overall fiber and vitamin content of a child's diet. Vitamin supplement use may have both positive effects and side effects. Consultation with a dietician or physician should by considered and can be helpful to families in the determination of healthy application of a GFCF diet. This may be especially true for children who are picky eaters.

What about other medical interventions?

Many families are eager to try new treatments, even those that have not yet been scientifically proven to be effective. A family's hopes for a cure for their child may make them more vulnerable to the lure of untested treatments.

It's important to remember that just as each child with autism presents differently, so is their response to treatments. It may be helpful to collect information about a therapy that you are interested in trying and speak with a pediatrician as well as other team members, so that a discussion of the potential risks/benefits and measurable outcomes are addressed.

Parents of older children with autism can provide a history of therapies and biomedical interventions that have been promised as a cure for autism over the years. Some of them may have been meaningful for a small number of children. Upon further study, none of them, so far, has turned out to be a cure for many.

We do know that many children get better with intensive behavioral therapy. There is a large body of scientific evidence to support it. For this reason, it makes sense to engage a child in an intensive behavioral program before looking at other interventions.

Is there a cure? Is recovery possible?

You may have heard about children who have recovered from autism. Experts disagree about whether or not this is possible.

Growing evidence suggests that a small minority of children with autism have progressed to the point where they no longer meet the criteria for a diagnosis. The theories behind the recovery of some children range from the assertion that the child was misdiagnosed to the belief that the child had a form of autism that may resolve as he matures to the opinion that the child benefited from successful treatment. You may also hear about children who reach ?best outcome? status, which means they score normally on tests for IQ, language, adaptive functioning, school placement, and personality, but have mild symptoms on some personality and diagnostic tests.

Some children who no longer meet the criteria for an autism diagnosis are later diagnosed as having ADHD, Anxiety or even Asperger Syndrome.

We don't yet know what percentage of children with autism will recover, or what genetic, physiological or developmental factors can predict which ones will. Recovery from autism is usually reported in connection with intensive early intervention, but we do not know how much or which type of intervention works best, or whether the recovery can be fully credited to the intervention. Presently, there is no way of predicting which children will have the best outcomes.

In the absence of a cure or even an accurate prognosis of a child's future, do not be afraid to believe in a child's potential. Most children with autism will benefit from intervention. Many, if not most, will make very significant, meaningful progress.

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