Remodeling the Autistic Child
The father of a 5-year-old autistic boy walks into Mifflin Elementary School in Pittsburgh, where the youngster is enrolled in a preschool program with both autistic and healthy children. The man throws his arms around program director Philip S. Strain. The smile on his face speaks volumes. "Thank you for giving me back my son," he tells Strain.
Later that day, Strain meets with the parents of another autistic child in the program, known as LEAP (Learning Experiences... An Alternative Program for Preschoolers and Parents). Instead of smiles, their faces convey despair. "What have we done wrong with our boy?" the mother asks. "What have you done wrong?"
Contrasting reactions exemplify the sometimes triumphant, sometimes disillusioning outcomes of programs such as Strain's, which specialize in "behavioral treatment" -- perhaps better known as behavior modification -- for autistics. Teachers use praise, rewards and other nonpunitive tactics to promote appropriate behaviors in the classroom, and parents use behavioral techniques at home with children as young as 3 years old.
Encouraging signs indicate that round-the-clock behavioral treatment relying on parents as "home therapists" substantially improves the social and academic performance of some autistic youngsters, according to researchers at the annual meeting of the American Psychological Association (APA), held in New Orleans this past August. However, not all parents can or will carry the heavy burden of being an amateur behavioral therapist. And the long-term effectiveness of behavioral therapy for autism remains much in question, at times sparking intense debate even among those investigators using it.
Controversy is no stranger to the field of autism research. Since first described in 1943, childhood autism had witnessed a number of treatments heralded as godsends by some and denounced as failures by others. The push for new remedies no doubt reflects the mystery that surrounds the causes of autism and the dismal outlook for those afflicted with it: Fewer than one in 20 autistics become independently functioning adults living outside institutions or custodial care.
In rare cases, an autistic adult--such as Dustin Hoffman's character in the movie "Rain Man" -- performs extraordinary intellectual or artistic feats.
Autism afflicts an estimated five of 10,000 persons, most of them male. The severity of the disorder becomes apparent early in life. Autistic children shrink from normal social relationships and never really connect emotionally and intellectually with the outside world. These youngsters avoid even the hugs of their parents. They often develop no language skills or mechanically repeat the words and phrases of others, a behavior called echolalia. Additional symptoms include repetitive behaviors such as rocking back and forth, prolonged tantrums, and in some cases head-banging or other forms of self-injury.
Psychoanalysts have suggested that emotionally disturbed, aloof parents produce autistic children. Psychoanalytically oriented treatment, which has fallen out of favor in the past 20 years, often removes autistics from their homes and attempts to create a healthy environment with clinicians taking on the role of supportive parents.
The prevailing view, however, regards autism as a biological disorder of unknown cause (SN: 9/6/86, p.154). Most behavioral researchers accept the biological hypothesis, but they attempt to treat autism by manipulating the child's environment with the parents' help.
The best-known behavioral treatment program for autistics began in the early 1960s at the University of California, Los Angeles, under the direction of O. Ivar Lovaas. In 1970, Lovaas and his co-workers admitted 38 autistics, all around 3 years of age, to a long-term study. They randomly assigned each child to one of two groups: 19 received intensive behavioral treatment, and 19 received minimal treatment. …