Autism therapies attempt to lessen the deficits and abnormal behaviours associated with autism and other autism spectrum disorders (ASD), and to increase the quality of life and functional independence of autistic individuals, especially children. Treatment is typically tailored to the child's needs. Treatments fall into two major categories: educational interventions and medical management. Training and support are also given to families of those with ASD.[2]
Studies of interventions have methodological problems that prevent definitive conclusions about efficacy.[3] Although many psychosocial interventions have some positive evidence, suggesting that some form of treatment is preferable to no treatment, the methodological quality of systematic reviews of these studies has generally been poor, their clinical results are mostly tentative, and there is little evidence for the relative effectiveness of treatment options.[4] Intensive, sustained special education programs and behavior therapy early in life can help children with ASD acquire self-care, social, and job skills,[2] and often can improve functioning, and decrease symptom severity and maladaptive behaviors;[5] claims that intervention by around age three years is crucial are not substantiated.[6] Available approaches include applied behavior analysis (ABA), developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy.[2] Educational interventions have some effectiveness in children: intensive ABA treatment has demonstrated effectiveness in enhancing global functioning in preschool children,[7] and is well established for improving intellectual performance of young children.[5] Neuropsychological reports are often poorly communicated to educators, resulting in a gap between what a report recommends and what education is provided.[8] The limited research on the effectiveness of adult residential programs shows mixed results.[9]
Many medications are used to treat problems associated with ASD.[10] More than half of U.S. children diagnosed with ASD are prescribed psychoactive drugs or anticonvulsants, with the most common drug classes being antidepressants, stimulants, and antipsychotics.[11] Aside from antipsychotics,[12] there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD.[13][14] A person with ASD may respond atypically to medications, the medications can have adverse effects, and no known medication relieves autism's core symptoms of social and communication impairments.[15]
Many alternative therapies and interventions are available, ranging from elimination diets to chelation therapy. Few are supported by scientific studies.[16][17][18][19][20] Treatment approaches lack empirical support in quality-of-life contexts, and many programs focus on success measures that lack predictive validity and real-world relevance.[21] Scientific evidence appears to matter less to service providers than program marketing, training availability, and parent requests.[22] Even if they do not help, conservative treatments such as changes in diet are expected to be harmless aside from their bother and cost.[23] Dubious invasive treatments are a much more serious matter: for example, in 2005, botched chelation therapy killed a five-year-old boy with autism.[24]
Treatment is expensive;[25] indirect costs are more so. For someone born in 2000, a U.S. study estimated an average discounted lifetime cost of $4.01million (2013 dollars, inflation-adjusted from 2003 estimate[26]), with about 10% medical care, 30% extra education and other care, and 60% lost economic productivity.[27] A UK study estimated discounted lifetime costs at 1.51million and 975thousand for an autistic person with and without intellectual disability, respectively[28] (2013 pounds, inflation-adjusted from 2005/06 estimate[29]). Legal rights to treatment are complex, vary with location and age, and require advocacy by caregivers.[30] Publicly supported programs are often inadequate or inappropriate for a given child, and unreimbursed out-of-pocket medical or therapy expenses are associated with likelihood of family financial problems;[31] one 2008 U.S. study found a 14% average loss of annual income in families of children with ASD,[32] and a related study found that ASD is associated with higher probability that child care problems will greatly affect parental employment.[33] After childhood, key treatment issues include residential care, job training and placement, sexuality, social skills, and estate planning.[30]
Before autism was well understood, children in Britain and America would often be put in institutions on the instruction of doctors and the parents told to forget about them. Observer journalist Christopher Stevens, father of an autistic child, reports how a British doctor told him that after a child was admitted, usually "nature would take its course" and the child would die due to the prevalence of tuberculosis.[34]
Educational interventions attempt to help children not only to learn academic subjects and gain traditional readiness skills, but also to improve functional communication and spontaneity, enhance social skills such as joint attention, gain cognitive skills such as symbolic play, reduce disruptive behavior, and generalize learned skills by applying them to new situations. Several model programs have been developed, which in practice often overlap and share many features, including:[2]
Several educational intervention methods are available, as discussed below. They can take place at home, at school, or at a center devoted to autism treatment; they can be done by parents, teachers, speech and language therapists, and occupational therapists.[2][36] A 2007 study found that augmenting a center-based program with weekly home visits by a special education teacher improved cognitive development and behavior.[37]
Studies of interventions have methodological problems that prevent definitive conclusions about efficacy.[3] Although many psychosocial interventions have some positive evidence, suggesting that some form of treatment is preferable to no treatment, the methodological quality of systematic reviews of these studies has generally been poor, their clinical results are mostly tentative, and there is little evidence for the relative effectiveness of treatment options.[4] Concerns about outcome measures, such as their inconsistent use, most greatly affect how the results of scientific studies are interpreted.[38] A 2009 Minnesota study found that parents follow behavioral treatment recommendations significantly less often than they follow medical recommendations, and that they adhere more often to reinforcement than to punishment recommendations.[39] Intensive, sustained special education programs and behavior therapy early in life can help children acquire self-care, social, and job skills,[2] and often improve functioning and decrease symptom severity and maladaptive behaviors;[5] claims that intervention by around age three years is crucial are not substantiated.[6]
In the U.S., under IDEA compliance, public schools are required to employ high qualified staff. A Certified Autism Specialist has a masters degree, two years career experience working with the autism population, earns 14 continuing education hours in autism every two years, and is registered with International Institute of Education [40]
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Autism therapies - Wikipedia, the free encyclopedia