Issues and Trends in Treatment of Children with Autism Spectrum Disorders. (Autism)

Article excerpt

Autism and its associated spectrum of disorders are severe disorders of communication and social relatedness. It is estimated that more than two out of every 1,000 children in the United States are affected by autism or autism spectrum disorders (ASD), and, according to a recent study by the Centers for Disease Control and Prevention (CDC), that number may be as high as six per 1,000. This means there are at least 1.5 million children and adults with autism in America, making it one of the country's most common developmental disabilities.

Our understanding of these disorders has changed radically over the past few years and has attracted media attention. The changes include a redefinition of the disorder, a measurable rise in prevalence and breakthroughs in treatment. There is a new emphasis on early diagnosis and intensive intervention, both of which can markedly change outcomes. Other recent issues include the availability of qualified therapists and the scrutiny of treatment cost and concentration.

Despite the increase in media interest and the expansion of treatment options, there are few information resources for families needing help with the ASD treatment process. Parents and children navigating treatment decisions are faced with conflicting information, sometimes controversial therapies, and the lack of specialized therapists and support networks. When these hurdles are overcome, however, and appropriate therapy is carried out, treatment is more likely to have a positive outcome.

Earlier diagnosis

Treatment options for ASD have evolved significantly in a relatively short amount of time. Only 20 years ago, the vast majority of people with autism were eventually institutionalized. For decades, autism was treated with psychoanalysis. Today, ASD is commonly regarded as a neurobiological disorder and treatment is based on behavioral, cognitive-developmental and medical research findings.

Diagnosing children at younger ages is an important factor in the proliferation of treatment options. In the past, children with autism spectrum disorders were diagnosed when they were between 5 and 10 years of age; treatment programs were less refined and less effective. Reaching these children earlier, at 24 to 36 months old, increases treatment effectiveness.

In July 2001, the Committee on Educational Interventions for Children with Autism (CEICA) issued a report outlining an inter disciplinary approach to education for children with autism called Educating Children with Autism (ECA), which can be read at http://www.nap.edu. Catherine Lord, PhD, professor of psychology at the University of Michigan and director of the university's Autism and Communication Disorders Center, heads CEICA. "Autism affects very basic aspects of social development and communication," says Lord. "Therefore, early intervention may help prevent the development of more severe problems, a common occurrence which begins when a child participates in early and minimal social relations. Consequently, the press for early recognition and intervention can be likened to the need for early screening for visual or hearing impairments--but instead of getting a child glasses or a hearing aid, what we're trying to do is give children with ASD intense, positive social and communicative experiences that allow them to learn and develop as well as possible. It wouldn't be accurate to say that there's a true critical period or one correct treatment. We're trying to provide kids with `social scaffolding' to learn as other children do."

Which approach to use?

Of the numerous treatment approaches currently practiced, some of the most well known include: applied behavioral analysis (ABA); treatment and education of autistic and related communication handicapped children (TEACCH); and the developmental, individual-difference, relationship-based (DIR) approach, often described as Floortime or the Greenspan approach. …