Upload
annabelle-peters
View
240
Download
1
Tags:
Embed Size (px)
Citation preview
Chapter 15
Autism: A Late 20th-Century Fad Magnet
Claudia PisanoCaldwell CollegeAssessing Autism Interventions
RATES OF AUTISM
Researchers estimated that across the US it was 10 to 20 children per 10,000 (Jacobson, Foxx, & Mulick, 2005)
Historically it was shown to be 4 to 5 children per 10,000 (Jacobson, Foxx, & Mulick, 2005)
As of 2012, it is 1 in 88 children will be diagnosed with Autism (http://www.cdc.gov/NCBDDD/autism/data.html)
Controversy, Fads, and Unsupported Treatments
Google Search
1 hour
Using the words “Autism” & “Treatment”
Search Yielded 65 distinct interventions
The Only Proven TreatmentInterventions that are based in
Applied Behavior Analysis (Jacobson, 2000)
Only intervention to produce comprehensive and lasting results.
The Nature of Fads
Nobody creates a fad. It just happens. People love going along with the idea of a beautiful pig. It’s like a conspiracy. – Jim Henson
What is a fad?Merriam- Webster – a practice or interest
followed for a time with exaggerated zeal
Aquirre, Quarantelli, and Mendoza (1988) defined specific characteristics of fads◦They are homogenous, novel, and odd
Bikhchandani, Hirschleifer, and Welch (1998)◦Used social learning theory to describe fads
Types of Fads According to Kozloff Ordinary Fads
◦Inexpensive and harmless
Pernicious Innovations In Education◦Passing Fads◦Chronic Malignancies
The ParentsParents are part of the reason for
the continuation of fads due to: ◦Nature of the disorder
Shotgun approach
◦Lack of knowledge ◦Inconsistencies among professionals
The Nature of Evidence Based Intervention
A lot of studies do not meet our scientific standards for evidence based practice.
The suggestion is that they should be categorized as unproven and not implemented until they are established.
National Autism CenterTreatment National Standards Report
Results
Biomedical Treatments Not Directly Reported
Gluten Casein Free Diet Unestablished
Facilitated Communication Unestablished
Auditory and Sensory Integration
Unestablished
Floortime Emerging
TEACHH Emerging
ABA Established
www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf
The Nature of Controversy Interventions are controversial if
◦ Presented as efficacious in the absence of confirming studies ◦ When pilot studies supporting them have not been replicated ◦ When treatments go farther than the data that do support them ◦ When treatment is used in an isolated fashion when multimodal
approaches are needed◦ They are packaged with so many potentially active elements
that the effects of some of them are obscured or even counteracted
Controversy can be an essential part to helping medicine grow
The legal proceedings in which parents are fighting to have effective autism treatments provided by school and health services has been instrumental in the search for the best treatment
Areas of AgreementKabot, Masi, & Segal (2003)6 Guidelines for Effective Treatment
1. Intervention should be started at the earliest possible age
2. Must be intensive3. Parent training & support is critical4. Social & Communication domains should be
the foci of the intervention 5. Treatment should be systematic, built on
individualized goals and objectives tailored to the child
6. An emphasis on generalization is critical to the effective intervention.
Biomedical Fad InterventionsResearchers generally agree that
autism develops as a result of some abnormality or insult to the nervous system of developing children. ◦Multiple developmental processes
are involved◦Evidence does implicate several
different neurochemical systems Still preliminary and tentative
Biomedical Fad InterventionsSeveral biomedical interventions
with little empirical support experience popularity◦Pharmacologic Treatments◦Nutritional Fad Interventions◦Supplements◦Vaccine Link◦Pharmacologic Treatments
Pharmacologic TreatmentsDr. Fred Volkmar is a preeminent researcher
in the area of medical approaches to autism. ◦ He cautions that medication treatment studies are
complicated by the complexity of ASD, uncertain etiology, and methodological problems.
◦ Robust animal models of autism are lacking Current animal models tap into some aspects of autism
but do not mimic the complex expression of autism in humans
Animal models of disease are the foundation needed to develop efficacious and safe medications.
◦ Conclusions about medication efficacy should be approached with caution.
Nutritional Fad TreatmentsRestriction in diet plays a role in the
management of many medical disorders (Diabetes, seizures, phenylketonuria)
It is reasonable that doctors and parents would consider and try nutritional interventions.
Chief among dietary manipulations is the Gluten-free, Casein-Free diet, based on the “leaky gut” theory.
The “Leaky Gut” HypothesisSome children with autism have gut membranes
damaged by inflammation◦ Makes the gut “leaky”◦ Gut cannot fully process gluten and casein
Glutomophine and casomorphine cross a “leaky” gut membrane, enter the body, and cross the blood-brain barrier◦ Interfere with neurotransmitter activity and result in
increased opioid activity
Incomplete breakdown of gluten and casein turns into opioid peptides ◦ Could be caused by
Yeast overgrowth Immunological abnormalities Gastroenterological disease secondary to Autism.
Dietary Treatments for “Leaky Guts”Aimed at restoring healthy gut flora, reducing
inflammation, and sealing the “leaky” Gut◦ GF/CF diet
No gluten, no casein
◦ Specific Carbohydrate Diet Only monosaccharides (simple sugars) Some types of cheese allowed
◦ Body Ecology Diet A combination approach
So far, no large scale, randomized trials of these dietary interventions, that control for confounding variables (especially maturation and diffusion of treatment)
Dr. Kenneth Bock on Dietary Intervention for Autism
Mechanical Fad InterventionsFacilitated Communication
Auditory Integration Training
Sensory Integration Training
Facilitated CommunicationFirst proposed by Crossley and
popularized by Biklen
A form of assisted typing
It was hypothesized that the technique allowed for revelation of previously untapped cognitive abilities and enabled quicker rates and more sophisticated types of learning, despite deficits in formal education.
Auditory Integration TrainingTechnique involves the use of
audiograms to identify auditory hypersensitivities. ◦Sounds are played at high, low, and
hypersensitive frequencies◦Approximately 20 half hour session over a
10 day period.
The goal is to normalize hearing and the manner in which the brain processes auditory information.
Sensory Integration TrainingSensory integration is a neurological process, the
way the brain organizes and interprets touch, movement, body awareness, sight, sound, and gravity.
Performed by an occupational or physical therapist
Child is given a “diet” of sensory stimulation
The “diet” consists of vestibular and tactile stimulation, purposeful movements, use of weighted vests, and brushing among other techniques.
Psychosocial Fad InterventionsFloortime: A Developmental,
Individual Differences, Relationship-Based Approach (DIR)
TEACCH (Treatment and Educational of Autistic and Communication Handicapped Children)
Floortime (DIR)Developed by Dr. Stanley Greenspan
◦Autism is an inability to relate to other affectionately in a reciprocal fashion in a variety of contexts.
So, he developed his form of play therapyIn the model he takes into account that
each child with autism has their own strengths and weaknesses.
He also states that these must be identified
The “Criterion”Each child must master six
foundational milestones in sequential order.
When they have mastered the milestones, they will have the basic capacity for communication, thinking, and emotional coping.
The Six Steps
1. Self-regulation and interest in the world
2. The formation of relationships, attachment, and engagement
3. Reciprocal communication4. Complex communication5. Representational capacity 6. Representational differentiation
The End “Result”Children whom have progressed through
these milestones can◦Develop a positive sense of self◦Engage in positive affective relationships◦Use language to express a variety of emotions◦Tolerate strong emotions without loss of
control◦Use imagination to create new ideas◦Use language to express a variety of emotions◦Tolerate change◦Be flexible in dealing with people and
situations
How does it work?The child's actions are assumed
to be purposeful.
It is the parent's or caregiver's role to follow the child's lead and help him develop social interaction and communication skills.
An ExampleA boy may frequently tap a toy car against
the floor. During a Floortime session, his mother may imitate the tapping action, or put her car in the way of the child's car. This will prompt the child to interact with her. From there, the mother encourages the child to develop more complex play schemes and incorporate words and language into play. Floortime is more child-directed than some teaching methods. Its goal is to increase back-and-forth interaction and communication between child and adult.
You can go through life with out being able to tie shoelaces (buy slip-ons), but who wants to go through life alone? - unknown
TEACCH (Treatment and Education of Autistic and Communication Handicapped Children)
Founded by Eric Schopler in the Early 1970’s
University of North Carolina Chapel Hill
First statewide, comprehensive, community programs aimed at improving services for children with autism.
TEACCH (cont.) Works with existing skills the child
has Priority is structured teaching
◦Organizing the physical environment ◦Using visual materials so that the child
can function as independently as possible without prompts from an adult
◦Cultivating strengths and interests instead of focusing on remediation of the deficits
TEACCH (cont.) Broad based and life long
approach Teaches communication Teaches leisure and social skillsPromotes independent works
skills
TEACCH also attempts to provide networks and integrate services over the lifespan.
Problem with TEACCHTEACCH has been embraced by
many school districts
The program that is implemented in North Carolina is mandated by the legislature
To the best of our knowledge, no other state has such a mandate
ABA Is It a Fad?Despite the flaws in some studies, there
is enough research to demonstrate the effectiveness of behavioral interventions.
NY State Department of Health (1999)◦“…ABA programs were the only form of
intervention that met the burden of demonstrating significantly positive outcomes under rigorous scientifically controlled circumstances, and constituted treatment of choice for young children with autism”
Based on what we know about fads, what do you think?
ABA Is It a Fad? (cont.)ABA does face problems with
fads and internal controversies◦Recommendations for high levels of
training and expertise that may be difficult to implement
◦“Branding” of ABA programs “We do Lovaas [or] discrete trial [or]
verbal behavior … therapy”
ConclusionNew ideas for intervention should
be encouraged. However, each new idea should
be rigorously tested and proven to work before it is labeled an effective treatment for children with autism.
ReferencesJacobson, J. W., Foxx, R. M., &
Mulick, J.A. (Eds). (2005). Controversial therapies for developmental disabilities: Fad, fashion, and science in professional practice. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
http://www.cdc.gov/NCBDDD/autism/data.html