Evaluating Treatments for Evaluating Treatments for Autism:  Autism: 

Current Status of the Current Status of the ScienceScience

Rachel Hoffman, M. A.Anne Shroyer, B.S.

OverviewOverviewConflicts in Treatment Selection

Why Science Matters

Evidence-Based vs. Alternative Treatments

Being an Advocate

More In-Depth Look at Autism Treatments

General Recommendations for Treatment Selection

The DilemmaThe DilemmaSearch for an effective treatment

starts at diagnosis

Many available treatments◦Sheer number overwhelming◦Effectiveness not always clear

Which one to choose??

One Mother’s StoryOne Mother’s Story“Can you give me a little background

about your son?”

“What was it like receiving a diagnosis, and what came next?”

The Importance of ScienceThe Importance of ScienceTeachers and Science

Why Science Matters Video

What Is Science?What Is Science?Systematic method

Rules out other variables

Conclusions supported with high degree of confidence

Replication of results

Science and Autism Science and Autism TreatmentTreatmentScience effectively demonstrates:

Which treatments are effective

To what extent they’re effective

In what cases they’re effective

Objective EvidenceObjective EvidenceUninfluenced by personal biases

Data dependent ◦“How much?”◦E.g., amount of hand raising in

class, before and after intervention

Causal relationships

Subjective EvidenceSubjective EvidenceOpen to personal biases

Opinion dependent◦“How good?”◦E.g., someone’s feelings about a

treatment’s efficacy

Correlational relationships

Correlation ≠ CausationCorrelation ≠ CausationImportant to distinguish between the

two terms

Correlation◦Degree to which two events are

related

Causation◦When one event results in a

subsequent event

Correlations – Example 1Correlations – Example 1Ice cream consumption and drowning

◦When rate of one increases, so does the other

Does eating ice cream cause drowning?

What else might cause increases in both?◦Increases tend to occur in hot

summer months

Correlations – Example 2Correlations – Example 2Why an increase in autism diagnoses?

Proposed reasons◦More chemicals in the environment◦Increase in Rx drug use◦Broadening of diagnostic criteria◦Increased awareness of symptoms

Evidence-Based PracticeEvidence-Based PracticeBacked by scientific evidence

◦Lots of research on specifics of treatment

Demonstrated effectiveness◦Objective data

Most likely to result in improvements

Alternative TreatmentsAlternative Treatments“Pseudoscientific”

◦Effectiveness generally unevaluated◦Subjective data - testimonials and

case studies

Popular - but, risky◦Safety may be unclear

Alternative Treatments – Alternative Treatments – What’s the Harm?What’s the Harm?Can lead to waste of

◦Time◦Money◦Opportunities◦Effort

Can result in crushing disappointment◦No measurable improvements

Eclectic Treatment Eclectic Treatment ApproachApproachUsing components from multiple

treatments

So what’s the harm in trying a little of everything?

Alternative Treatments – An Alternative Treatments – An AnalogyAnalogyWeight loss

◦Diet and exercise vs. over-the-counter pill

Which is more likely to improve your quality of life?

Relate this to selection of autism treatment◦Consider long-term quality of life and

independence ◦Time wasted in treatment can not be

returned

Red Flags in Treatment Red Flags in Treatment ClaimsClaims“Cure” claim

Little training provided to caregivers

Non-individualized treatments

Effectiveness based on testimonials / case studies

INTERMISSION

Making an Informed Making an Informed Choice Choice One child in every 110 is classified as

having ASD (Rice, 2006)

Therapies began claiming astonishing

results

Difficult to choose which therapy is best

Parents have sought the recommendations of professionals

Professional Professional RecommendationsRecommendationsMedical:

◦Chelation, sensory diet, GFCF diet, chiropractic, Hyperbaric Chamber, drug therapy, etc.

Non-medical:◦Applied Behavior Analysis (ABA), TEACCH,

sensory integration, music therapy, etc.

Treatments range in effectiveness and safety

Physicians may lack knowledge on effectiveness (Golnik & Ireland, 2009)

A Few Types of Autism A Few Types of Autism TherapiesTherapiesFacilitated Communication

Sensory Integration Therapy

Chelation

Applied Behavior Analysis

Facilitated CommunicationFacilitated CommunicationCreated in the 1970’s

Claims to provide a form of communication for non-verbal individuals

Large anecdotal claims of effectiveness (Finn, Bothe, & Bramlett, 2005)

Facilitated Communication Facilitated Communication VideoVideo

FC Frontline Clips.MP4

Facilitated CommunicationFacilitated CommunicationObjective research found FC

ineffective (Finn, Bothe, & Bramlett, 2005; Kezuka, 1997; Jacobson, Mulick, & Schwartz,1995)

Learners’ response dependent on the facilitator (Kezuka, 1997)

Harmful◦Wrongful accusations and

disappointments (Jacobson, Mulick, & Schwartz,1995)

Facilitated Communication Facilitated Communication VideoVideo

FC Frontline Clips.MP4

Sensory Integration Sensory Integration TherapyTherapyBegan to be used for autism in the

late 1970’s

Claims to be effective in improving sensory processing in the brain

Involves activities such as:◦Swinging◦Rocking◦Massages◦Pressure/weighted vests

Sensory Integration VideoSensory Integration VideoWhat it is based on

Sensory room

Video short clip of swinging

Sensory Integration Sensory Integration TherapyTherapy1-10 hours, 1-3 times a week, 3-6

months◦$30-120 per session

Parent training: Some

Does it work?◦Not enough objective research

available (Maurice, Green, & Luce, 1996)

◦Found ineffective in the reduction of stereotypy (Hodgetts, Magill-Evans, & Misiaszek, 2011; Reichow, Barton, Good, & Wolery, 2009)

ChelationChelationBegan to be used for autism in the early

1980’s

Claims to stop further damage caused by mercury poisoning

Complex, time consuming, and distressing

Removal of heavy metals through IV or oral medication

ChelationChelation1-10 hours a week, 1month to a year

◦$30-120 per session

Parent training: None

Does it work?◦2008 stopped research due to dangers

associated◦Reserved for the treatment of children

only with heavy-metal poisoning (Van der Linde, Pillen, Gerrits & Bouwes Bavinck, 2008)

Wick & Smith 2009

Applied Behavior AnalysisApplied Behavior AnalysisBehavioral psychology emerged in the

early 1900’s

Measure objective observable events

Systematically manipulate events in the immediate environment to improve behavior

Rule out other explanations

Replicate the results

ABA VideoABA VideoVideo

Video PECS

Applied Behavior AnalysisApplied Behavior AnalysisTherapy may include:

◦One-on-one instruction using prompts and reinforcement

◦Teaching in natural environment◦Facilitated peer play◦ Individualized interventions to reduce

problem behaviorInterventions based on ABA include

◦Pivotal Response Training◦Verbal Behavior Therapy◦Picture Exchange Communication System

(PECS)◦Early Start Denver Model

Applied Behavior AnalysisApplied Behavior Analysis15-40 hours, 3-5 days a week, 1-3 years ◦ Costs vary: average $50-120 per session

Parent training: Yes

Does it work?◦ Research demonstrates ABA as the most

effective approach to the treatment of autism (Maurice, Green, & Luce, 1996)

General General RecommendationsRecommendationsWho claims the treatment will help?

Be skeptical

Financial benefits

Research the information closely

General Recommendations General Recommendations Cont.Cont.Ask others for help in deciphering

difficult topics

Be cautious of new treatments with little reviews

Be sure to request objective measures

Scientifically Proven Scientifically Proven TreatmentsTreatmentsAdditional Resources:

Texas Autism Research and Resource Center: http://www.dads.state.tx.us/tarrc/research/treatment.html

National Standards Project: http://www.nationalautismcenter.org/about/national.php

National Professional Development Standards on Autism Spectrum Disorders: http://autismpdc.fpg.unc.edu/content/briefs

Institute of Education Services- What Works Clearinghouse: http://ies.ed.gov/ncee/wwc/reports/

Where is Trevor now?Where is Trevor now?Trevor with his mother making a pizza

Thank You!

Questions

ReferencesReferences Finn, P., Bothe, A. K., & Bramlett, R. E. (2005). Science and

pseudoscience in communication disorders: criteria and applications. American Journal of Speech-Language Pathology, 14(3), 172-186. doi:10.1044/10580360(2005/018)

Golnik, A., & Ireland, M. (2009). Complementary alternative medicine for children with autism: a physician survey. Journal Of Autism And Developmental Disorders, 39(7), 996-1005.

Hodgetts, S., Magill-Evans, J., & Misiaszek, J. E. (2011). Weighted vests, stereotyped behaviors and arousal in children with autism. Journal of Autism Developemntal Disorders, 41, 805–814. doi: 10.1007/s10803-010-1104-x

Jacobson, J. W., Mulick, J. A., & Schwartz, A. A. (1995). A history of facilitated communication: Science, pseudoscience, and antiscience science working group on facilitated communication. American Psychologist, 50, 9, 750-765. doi: 10.1037/0003- 066X.50.9.750

References Cont. References Cont. Kezuka, E. (1997). The role of touch in facilitated

communication. Journal of Autism and Developmental Disorders, 27, 5, 571-593.

Leaf, R., McEachin, J., &Taubman, M. (2008). Sense and nonsense in the behavioral treatment of autsim: It has to be said. NY, NY. DRL Books, Inc.

Luiselli, J. K., Russo, D. C., Christian, W. P., & Wilczynski, S. M. (2008). Effective practices for children with autism: Educational and behavioral support interventions that work. NY, NY. Oxford University Press.

Maurice, C., Green, G., & Luce, S. (1996) Behavioral Intervention for young children with autism. Austin, TX: PRO-ED.

Reichow, B., Barton E. E., Good, L., & Wolery, M. (2009). Brief report: effects of pressure vest usage on engagement and problem behaviors of a young child with developmental delays. Journal of Autism and Developmental Disorder, 39, 1218–1221. doi: 10.1007/s10803-009-0726-3.

References Cont.References Cont. Rice, C. (2006). Prevalence of autism spectrum disorders . Autism

and Developmental Disabilities Monitoring Network, 58, 1-20. Schreck, K. A. & Mazur, A. (2008). Behavior analyst use of and

beliefs in treatments for people with autism. Behavioral Interventions, 23, 201-212. doi: 10.1002/bin.264

Todd, J.T. (1987). The great power of steady misrepresentation: Behaviorism's presumed denial of instinct. Behavior

Analyst, 10, 117-118. Van der Linde, A., Pillen, S., Gerrits, G., & Bouwes Bavinck, J.

(2008). Stevens-johnson syndrome in a child with chronic mercury exposure and 2,3-dimercaptopropane-1-sulfonate (DMPS) therapy. Clinical Toxicology (Philadelphia, Pa.), 46, 5, 479-481.

Weiss, M. J. & Ferraioli, S. (2009). Identifying evidence based treatments. ABA Special Interest Group Newsletter. 25(1): 1-4.

Wick, J., & Smith, T. (2009). Controversial treatments for children with autism in the popular media. ABA Special Interest Group Newsletter. 25(1): 5-11.

References Cont.References Cont. whyscience.co.uk sciencepunk.com raisingchildren.net http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5810a1.htm