There is a broad array of autism therapies, but the efficacy of each varies dramatically from person to person. Progress toward development of medical and behavior modification remedies, for the more debilitating affects of autism, has been hindered significantly by widespread disagreements over such things as the nature and causes of autistic spectrum disorders, and by a relative paucity of efficacious therapies thus far recognized by medical authorities.
With advances in psychosocial and pharmacological interventions, the behavioral and cognitive functioning of individuals affected by autistic disorders might improve. Intensive, sustained special education programs and behavior therapy early in life might increase the ability of children with autism to acquire language and learning skills. In adults with autism, some studies have found beneficial effects of the antidepressant medications clomipramine and fluoxetine, and the newer antipsychotic medications such as Risperdal and, more traditionally, the much older drug haloperidol, possibly due to the preponderance of co-morbid disorders in those with autism significantly adding to behavioural and functional challenges more than the autism itself.
In many cases, several medications will be tried unsuccessfully, and palliative drug treatments may lose much of their effectiveness for mitigating symptoms later in life. Distinguishing between beneficial, palliative and detrimental treatments is not always straightforward.
A treatment and education of children with autism came through the application of the principles and techniques of Applied Behavior Analysis (ABA). O. Ivar Lovaas's name is widely associated with ABA-based treatment, as he was one of the first psychologists to demonstrate that children with autism could learn language, play, social, self-help, and academic skills. The ABA method is highly disputed by many autistics, and is regarded useless by many others.
Applied Behavior Analysis
ABA'-based approaches—often referred to as Discrete Trial, Intensive Behavior Intervention, and ABA—are some of the best known and most widely used in the field, and focus on the development of attention, imitation, receptive and expressive language, play, social, and pre-academic, and self-help skills. Using a one-to-one therapist-child ratio and the "antecedent-behavior-consequence" (ABC) model, interventions based on this work involve trials or tasks. Each consists of (a) an antecedent, which is a directive or request for the child to perform an action; (b) a behavior, or response from the child, which may be categorized as successful performance, noncompliance, or no response; and (c) a consequence, defined as the reaction from the therapist, which ranges from strong positive reinforcement to a strong negative response, "No!"(Autism Society of America, 2001).
Lovaas' ABA methods are widely regarded as the first scientifically validated therapy for autism. Early intervention, generally before school-age, seems to be critical to achieving optimal outcomes. The New York State Department of Health worked with a multi-disciplinary panel of autism experts to publish Clinical Practice Guidelines for young children diagnosed with autism. The panel reviewed research on a variety of treatment methodologies and cited ABA as a critical element in any intervention program for young children with autism. That same year, in the Surgeon General of the United States’ first report on mental health, intensive ABA based treatment was cited as an effective intervention for children with autism.
ABA techniques based on B. F. Skinner's Verbal Behavior claim to have succeeded in helping nonverbal children start to talk, typically going from zero words to several dozen. By allowing children to express their needs, even rudimentary speech can alleviate frustration and tantrums.
The scientific validity of Lovaas's methods has been questioned by many professionals, by parents, and by those diagnosed as autistics themselves. Lovaas's initial studies looked promising, but there are no double-blind studies that compare the Lovaas approach against a control group not receiving ABA. Sallows and Graupner's 2005 study, which compared groups treated by professionals vs. parents, replicated the results of Lovaas, but found little difference in outcome between the groups. This study represents the most comprehensive and rigorous replication to date, and their findings nearly mirror Lovaas's.
Some people have made ethical challenges to autism treatment by pointing out that early ABA was based around the use of aversives and saying that these aversives can be confusing and/or painful..
ABA has come into widespread use in the 1990s, and the demand is outstripping the supply of committed and experienced service providers. As a result, parents of children need to be extra vigilant in choosing appropriate treatments for their children; this is especially so with regard to choosing providers, who may be inexperienced, use questionable methods or even deceive parents about their competency with ABA or any other program. Such problems have led to horror stories from some parents.
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