| There are many types of interventions available today for autistic
individuals, including nutritional, biomedical, educational, sensory,
and behavioral. When beginning a new inter-vention, it is important
to be as objective as possible to determine whether the treatment
truly helped the person. If the treatment is not helping, then it
does not make sense to continue it especially if it involves a great
deal of time, money, or effort.
When deciding to try a new treatment, whether ‘proven’
or not, here are a few tips to help determine whether the person
may have improved from the specific treatment:
When a parent begins to learn about all of the various treatments
given to autistic children, he/she sometimes tries many at once
in order to see improvement as soon as possible. However, if the
child improves after receiving several treatments, it will be impossible
to determine which one(s) really made a difference. A general rule
is to try a treatment for about two months before beginning a new
one, to determine whether or not the treatment was helpful. However,
if it is quite clear that the child improved from a treatment, even
after a week or two, then another treatment can be started.
Parents should consider completing the Autism Treatment Evaluation
Checklist (ATEC) monthly for a few months prior to the intervention
and then monthly following the intervention. The ATEC was designed
specially to evaluate treatment effectiveness. If improvement occurs
due to maturation, then one typically sees gradual improvement over
time. However, if there is a sharp improvement after the intervention
is started, then the treatment may be helping. There is no charge
for use of the ATEC. You can complete the checklist on the Internet
at: www.autism.com/atec or obtain a hardcopy of the checklist by
writing to the Autism Research Institute (4182 Adams Ave., San Diego,
CA 92116; fax: 619-563-6840).
If at all possible, tell no one when a child starts a new treatment.
This includes teachers, friends, neighbors, and relatives. If there
is a noteworthy change in the child, it is likely that the people
who come in contact with the child will say something about the
improvement. It is also a good idea not to ask “Have you noticed
any changes in my child?” In this way, any spontaneous statements
regarding the child’s improvement will be credible.
People who do know that the child received a specific treatment
can, independently, compile a list of what changes they have noticed
in the child. After a month or two, you can compare their observations.
If similar changes are observed by different people, then there
is a reasonable chance that these changes are real. It is important
they these observations be written down; otherwise, when appropriate
behaviors replace inappropriate ones, you may not remember what
the child’s behavior was like before the treatment, especially
if the behavior was an undesirable one.
Parents and others should note in writing when the child’s
behavior ‘surprises’ them. Basically, parents usually
know how their child will respond in various situations; and once
in a while, their child may do something that is unexpected. If
a child improves soon after an intervention is begun, one can assume
that the child will act differently than before; and his/her behavior
will likely lead to more ‘surprises’ than usual-hopefully
good ones!
Some people suggest that parents should give their children only
treatments for which there is ample research evidence to support
their effectiveness. However, when a relatively new treatment is
introduced, there will likely be a limited amount of research, if
any, on its effectiveness. It takes, on average, 5 to 10 years to
complete enough research to support or refute an intervention’s
efficacy. Additionally, chances are fairly good that even after
10 years, the results will be mixed, because researchers often use
different populations and assess changes using different measures.
Be leery of any treatment if it has been around for ten or more
years, and there are no research studies to support its effectiveness.
For example, Ritalin is one of the most frequently prescribed treatments
for autism, but we are not aware of any published studies supporting
its effectiveness with this population. Before trying a new treatment,
learn as much as possible about the treatment. Rather than just
focusing on positive reports, it is also important to seek out criticisms
of the treatment. When evaluating conflicting claims, look to the
nature of the studies and their methodologies--poorly conducted
studies should not be given the same credence as methodologically
sound research.
It is important to keep in mind that no treatment will help everyone
with autism. Although one child may have improved dramatically from
a certain treatment, another child, even with similar characteristics,
may not benefit from the same treatment. Careful observation along
with a critical perspective will allow parents and others to decide
whether or not a treatment is truly beneficial.
*****
I would like to thank Dr. Bernard Rimland for his constructive comments
on an earlier draft of this article.
Author
Stephen M. Edelson, Ph.D.
Center for the Study of Autism, Salem, Oregon
Copyright Autism.org |
