Community Psychiatric Centers
Monroeville, Greensburg, Monessen, and Wilkinsburg Pittsburgh

April 12, 2011

Autism: What works; What Doesn’t; and What Causes It

Written by Dr. Carosso

Every so often we get a review of research that tries to shed some light. Three government funded studies, published in Pediatrics, is the latest in that regard. Lets take a look:

Three targets
The researchers looked at meds, behavioral interventions and, for some reason, Secretin (it’s long been recognized that Secretin doesn’t work, not sure why they wasted time with that).

It’s long-since been established that meds don’t “cure” autism but treat symptoms, which can be helpful for some children. For example, the study indicates that Ability and Risperdal can decrease irritability, crying, hyperactivity, and noncompliance.  However, side effects, especially with long-term use, can be troubling.

Behavioral Interventions
Behavioral strategies are undoubtedly effective for all kids with autism. There is a host of studies suggesting that discrete trial and other interventions, relying on Applied Behavioral Analysis (ABA), improve children’s IQ, language, and social skills. The question, however, is how much any given child benefits?  In fact, it’s disheartening to note how much we don’t know about the traditional interventions based in ABA, early intervention programs, and parent-training models. Upon the researcher’s analysis of the years of past research, they found the results biased and flawed. Moreover, generalizing any finding is challenging given the wide range of functioning demonstrated by kids on the spectrum, i.e. two children may both be diagnosed with PDD, but present very differently.  Not to mention factoring-in the cost-benefit ratio; Lovaas found his discrete trial methods were very effective, but at 30 hours per week of individualized attention, which can cost tens of thousands of dollars per year. These days, trying to persuade any insurance company to pay for that is an uphill battle.

We are what we eat?
In a separate set of analyses, there is more evidence that we can “let food to be thy medicine” (Hippocrates). It only stands to reason; what we put in our bodies affects every aspect of our functioning. Would you put water in your car’s gas tank? It’s well known that children with autism tend to have nutritional deficiencies, gut problems, and food allergies. Upwards of 69% of parents report positive outcomes from dietary regimens including going gluten and casein free. Yes, these surveys can be quite biased, but my own clinical experience suggests they’re not far off.  

Just when you thought it was safe to vaccinate…
To vaccinate or not to vaccinate? I wonder if this debate will ever end?  I think it continues because it is difficult  for parents, and practitioners, to not have some intuitive inclination that putting a bunch of chemicals in an infant can possibly cause some problems. We first hear that it’s harmless, then later that it does cause problems, then an onslaught from the medical community that it does not. Helen Ratajczak now tells us, in the Journal of Immunotoxicology (“Theoretical Aspects of Autism: Causes – A Review”) that “documented causes of autism include genetic mutations and/or deletions, viral infections, and encephalitis (brain damage) following vaccination” especially due to an ever-increasing number of vaccines given to an infant over a short period of time. Of course, critics suggest that her review is of theories, not science, so the saga continues.  However, as I have blogged before, it’s encouraging that pediatricians are more prone to space-out the vaccinations.

Where does that leave us?
It leaves us where we usually find ourselves especially with any research related to social “science” or psychology; in the dark. Consequently, we have to rely on clinical experience and anecdotal evidence, which leads to a multi-faceted approach using strategies based in applied behavioral analysis including discrete trial and verbal behavior; social-based interventions including floor-time; psycho-educational pursuits whereby parents are taught how to intervene; beginning treatment with children as young as possible; modifying diet accordingly, and closely assessing the child’s response. That’s why data collection is vital; how else are we to know if the intervention is working? Fortunately, in spite of the ‘darkness’, with a diverse approach focused primarily on the fundamentals of ABA, and an open mind to trying new things, daily I see children’s improved eye contact, communication, play, and social interactions, and the accompanying smiles and happiness from parents and kids alike. So, hang in there, keep fighting the good fight, pay close attention to results (i.e. your child’s improvement) and then you can rest-assured that what you’re doing is effective, and that your child is benefiting. God bless. 

Feel free to comment, and forward to a friend. Thanks.

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