Monday, September 28, 2009
Dear Ms. Darula:
On behalf of the Association for Science in Autism Treatment (ASAT), we are writing to you in regard to your article, "Discover Autism – A Wide Range of Therapy Programs" (August 31, 2009). While we appreciate your efforts to raise awareness of treatment of the disorder, the article contains misleading information and suggests that all therapies are equally effective. Moreover, the inaccurate content may serve to perpetuate common myths and misconceptions, which has the potential to negatively impact decisions regarding service delivery. The latter may result in delays in the application of an effective evidence-based treatment or, even worse, cause harm to consumers of services. We would like to draw your attention to the statements in the story of most concern. They are listed below for your reference followed by specific comments.
QUOTE: Sometimes a combination of treatments and programs will yield the best results, but it should be known that the condition generally requires treatment for the life of the patient and the caregiver should maintain flexibility of approach.
ASAT COMMENT: There is research to suggest that a combination of approaches does not improve outcomes for individuals with autism. Although treatment may be life-long, there is no evidence to suggest that flexibility of approach yields better results. (1)
QUOTE: ...it is important to remember that there are a lot of avenues to explore as the chase for the definitive cure goes on.
ASAT: Significant efforts are being made to identify the cause and early signs of autism. At the present time, there is no definitive cure for autism. While hundreds of treatment options for parents and individuals with autism exist, a majority of these lack scientific evidence and are promoted via anecdotal claims by parents and non-professionals. Treatment procedures that fall within applied behavior analysis have been shown to have strong empirical support.
QUOTE: Behavioral therapies deal with modification techniques, to assist the patient to gain job skills and to enable them to function in their environment. For example, Applied Behavior Analysis, or ABA, entails the teaching of skill oriented activities. In this practice, patients are rewarded as they learn enjoyable skills, and as their behavioral skills continue to develop.
ASAT: The terminology in the above quote is somewhat outdated. Applied behavior analysis is a science with a wide array of treatment procedures to improve socially significant behavior. One of its principles includes reinforcement—rather than reward—to increase desired behaviors/skills.
QUOTE: Many critics still feel that the approach is overly "robotic" and that it doesn't really encourage the child to be spontaneous while they're trying to adapt to the world around them.
ASAT: As stated previously, research has shown that applied behavior analysis includes teaching techniques to facilitate language (2), choice-making (3), socialization (4), joint attention (5), and independence (6). Studies have also documented gains in these areas across settings, people, and materials (7). This evidence is in direct contrast to claims that individuals become robotic and lack spontaneity.
QUOTE: When it comes to supplemental therapies, many people with autism respond favorably to sensory stimulation. Patients are encouraged to hold objects with various textures or listen to music, for example. The Tomatis approach utilizes the playing of a loop of music, for several hours each and every day, in the hope of improving the child's attention and concentration.
ASAT: There is no empirical evidence supporting the benefits of auditory integration therapy, and research on sensory integration is limited and lacks well-controlled experimental designs. Further, the article does not clearly describe what is meant by "people with autism respond favorably to sensory stimulation." Although an individual may enjoy holding an object or listening to music (as evidenced by smiles or a happy affect), this enjoyment is unrelated to actual improvement in symptoms or learning important skills. Given the costs associated with these treatments as well as the lack of scientific evidence, suggesting they are a viable treatment option is irresponsible. (Please refer to http://www.asatonline.org/resources/treatments/auditory.htm for more information on AIT.)
QUOTE: Medical treatments for autism include the use of vaccines and some more, particularly controversial therapies, including chelation, which involves the injection of a form of acid into the blood to remove or improve metabolic functioning.
ASAT: This quote contains an error—vaccines are not used as a form of medical treatment for autism. Although there has been debate regarding the role of vaccines in the cause of autism, the Centers for Disease Control and Prevention (8), National Institutes of Health (9), American Academy of Pediatrics (10), and others (11) have documented that there is no evidence suggesting a link between autism and vaccines.
The science of applied behavior analysis and its application to the treatment of children with autism are often inaccurately portrayed in the media. Unfortunately, the article, "Discover Autism – A Wide Range of Therapy Programs" contributes to the misconceptions of interventions for individuals with ASD. Specifically, applied behavior analysis is underrepresented and other non-science based interventions are presented as viable, effective options without disclosure of the lack of research or potential side effects. Sadly, this kind of misinformation may result in parents seeking potentially dangerous and costly treatments to the exclusion of implementing empirically-supported treatment procedures, thereby wasting precious time in a child's life. It is important for parents and caregivers to access accurate information regarding autism treatments in order that they may make wise decisions for their children. For more information, please visit
Florence D. DiGennaro Reed, Ph.D., BCBA-D
Media Review Committee, Association for Science in Autism Treatment
Mary E. McDonald, Ph.D., BCBA-D
Board Member, Association for Science in Autism Treatment
1 Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G. & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26 (4), 359-383.
2 Carter, C. M. (2001). Using choice with game play to increase language skills and interactive behaviors in children with autism. Journal of Positive Behavior Interventions, 3(3), 489-497; Krantz, P. J., Zalenski, S., Hall, L. J., Fenske, E., & McClannahan, L. E. (1981). Teaching complex language to autistic children. Analysis & Intervention in Developmental Disabilities, 1(3-4), 259-297.
3 Carter, p. 489-497.
4 Carter, p. 489-497; Hupp, S. D., & Reitman, D. (2000). Parent-assisted modification of pivotal social skills for a child diagnosed with PDD-NOS: A clinical replication. Journal of Positive Behavior Interventions, 2(3), 183-187; Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled intervention study. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 47(6), 611-620; Krantz, P. J., Zalenski, S., Hall, L. J., Fenske, E., & McClannahan, L. E. (1981). Teaching complex language to autistic children. Analysis & Intervention in Developmental Disabilities, 1(3-4), 259-297; Kroeger, K. A., Schultz, J. R., & Newsom, C. (2007). A comparison of two group-delivered social skills programs for young children with autism. Journal of Autism and Developmental Disorders, 37, 808-817.
5 Kasari, p. 611-620.
6 Koegel, L. K., Koegel, R. L., Hurley, C., & Frea, W. D. (1992). Improving social skills and disruptive behavior in children with autism through self-management. Journal of Applied Behavior Analysis, 25(2), 341-353; Newman, B., Buffington, D. M., O'Grady, M. A., McDonald, M. E., et al. (1995). Self-management of schedule following in three teenagers with autism. Behavioral Disorders, 20(3), 190-196.
7 National Autism Center (2009). National Standards Report. Randolph, MA: National Autism Center.
8 Immunization Safety Review Committee, Board on Health Promotion and Disease Prevention, Institute of Medicine. (2001). Immunization safety review: measles-mumps-rubella vaccine and autism. Stratton K, Gable A, Shetty P, and McCormick M (Eds.). Washington, DC: National Academy Press.
10 Halsey N, Hyman S, and The Conference Writing Panel. (2001). Measles-mumps-rubella vaccine and autistic spectrum disorders. Pediatrics, 107(5), e84-107.
11 Immunization Safety Review Committee, op. cit.