Sunday, February 03, 2013
Your January 2, 2013 article brought attention to the growing numbers of children diagnosed with autism—and the struggles families face in locating and obtaining effective treatment services. It also highlighted the increasing role technology has played in therapeutic contexts, such as the use of MP3 players like iPods.
The article stated that autism “has no means of detection or cure.” Diagnoses are based on the presence of specific symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). There are three main symptoms to look for, which can vary in appearance from one individual to another: abnormalities in social interaction, deficits in communication, and the persistence of a narrow range of interests and/or repetitive activities and behaviors. The Modified Checklist for Autism in Toddlers (Robins, Fein, & Barton, 1999) and the Child Autism Rating Scale, Second Edition (Schopler, Reichler, Devellis, & Daly, 2010) are just a couple of well-respected diagnostic tools used to identify autistic symptoms. Relative to the last decade, the medical community is doing much better at diagnosing children with autism early. Yet there are scores of children who are not accessing science-based treatment: parents and providers are often distracted by a litany of 400+ so-called therapies, many of which have been touted by the media, despite a lack of scientific evidence.
Presentation of the Integrated Listening System (iLs) as a “breakthrough” for autism may be misleading for families who are in a particularly vulnerable position, desperate for something—anything— to help their child make progress. The iLs program falls into the category of auditory integration training (AIT). The American Speech-Language-Hearing Association (ASHA) Working Group on Auditory Integration Training adopted a technical report in 2003 emphasizing that there is little research to support AIT’s use for improving behavioral symptoms; this has not changed in the last ten years. In fact, a recent attempt was made to conduct a meta-analysis of the published literature on AIT and other sound therapies on the core symptoms of autism. The investigators were not able to perform the analysis due to a variety of design issues, such as the use of questionable assessment method and the characteristics of participants. While AIT may potentially benefit certain medical conditions, it lacks evidence to support its use with individuals with autism.
The iLs approach is based on a research study that has not yet been published in a peer-reviewed journal, where it would have undergone rigorous scrutiny by other scientists. Other treatments the children were receiving prior to or during their participation in the study are not described in the preliminary paper iLs released. Channel 15’s article does not address what other therapies Huey had received and whether these treatments were carried out properly by qualified providers. Progress reported in the iLs study was based on clinicians’ subjective impression of whether the children’s symptoms had improved.
Research in childhood autism treatment strongly supports the use of intensive, highly structured, and consistent therapeutic programs started at a young age, and individually tailored to the child's pattern of strengths and deficits. The clock is ticking for children with autism, and every moment and dollar spent on a questionable approach is time and money that could have been allocated toward an effective treatment. Interventions with the strongest evidence of effectiveness do not work in mysterious ways, but are described objectively to allow the study to be repeated by another investigator. Before encouraging readers to seek out the next “breakthrough” intervention, it is our duty to first look at the research supporting it. The current scientific evidence of commonly-endorsed autism interventions can be found on our website at http://asatonline.org/treatment/treatments_desc.htm.
We live in a world overwhelmed by marketing and advertising, and autism treatment is no exception. Treatments proclaiming “breakthroughs” and “cures” may grab the spotlight, but treatments with scientific evidence produce results. Clinicians, as well as other professionals who could be looked to as authorities, must take responsibility for staying informed of the current research regarding various autism interventions and pass the information along to parents, other professionals, and the public.
Alice Walkup, MS, BCBA, and David Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment
American Speech-Language-Hearing Association. (2004). Auditory Integration Training Position Statement. Retrieved January 31, 2013, from 10.1044/policy.TR2004-00260
Robins, D. L., Fein, D., Barton, M. L., & Greene, J. A. (2001). The Modified Checklist for Autism in Toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31, 131–144.
Schopler, E, Van Bourgondien, M. E., Wellman, G. J., & Love, S. R. (2010). Childhood autism rating scale (2nd ed.). Los Angeles, CA: Western Psychological Services.
Sinha, Y., Silove, N., Wheeler, D., & Williams, K. (2006). Auditory integration training and other sound therapies for autism spectrum disorders: A systematic review. Archives of Disease in Childhood, 91(12), 1018-1022.