Diagnosing and intervening on behalf of children with autism is of critical national importance with 10 percent of U.S. children now diagnosed. In 2010, the Center for Disease Control and Prevention set the lifetime cost of autism at $3.2 million per person diagnosed. But autism researcher Dr. Christopher Gillberg believes that many little girls with autism miss diagnosis and the early opportunities it affords, and their lost productivity is not included in those calculations.
Early Start Denver Model
Geraldine Dawson, Ph.D. and her team at the University of Washington developed the Early Start Denver Model (ESDM) and used it to prove that intensive, child centered interventions in the home, for 12- to 36-month-old children with autism can make a significant difference in their behavioral outcomes.
ESDM has three key features: behavioral rewards are based on what the child values; multiple areas of behavior are addressed; and it is carried out by parents, after training with professional facilitators. In addition, parents are taught to speak in phrases just one word longer than the child's best verbal response, to avoid overwhelming the toddler. They engage in a constant process of imitation where the parent models the desired behavior and they follow the lead of the child in deciding what new skills to address. The parent may set out clothing to put on, a plate of food to practice eating with spoon and a mirror to use playful imitation of each other's facial expressions and then begin with the activity the child chooses.
Dr. Eric Fombonne, Canada Research Chair in Child Psychiatry at McGill University in Montreal reviewed the ESDM project in the January 5, 2010 issue of "Pediatrics" noting Dr. Dawson had developed an effective method with modest yet important results. Children gained IQ points and increased their communication ability, achieved primarily in the first year of the intervention, Fombonne noted, and he predicted that follow up studies will show these gains increase over time.
Dr. Fombonne's response to the results achieved by ESDM is important in itself. He points out that curing autism is not the goal of early intervention and celebrates small gains, including increased joy in the life of a child, as a valid reason to intervene.
Applied Behavioral Analysis
Applied Behavioral Analysis (ABA) is an approach to bringing skills that other children acquire spontaneously into the repertoire of children with autism. These include enhanced attention, communication, imitation, play, activities of daily living and socialization skills. According to the description by the Center for Autistic Disorders, ABA starts by having the teacher watch the child and picking up on clues about what he is close to learning and uses this as the first skill to be targeted. It is endorsed by the U.S. Surgeon General, the New York State Department of Health, the National Academy of Sciences and the American Academy of Pediatrics, and it is a part of the Early Start Denver Model.
In the June 2008 issue of "Pediatrics" Drs. Scott Meyers and Chris Plauche-Johnson reviewed three studies comparing intensive programs of ABA with the programs of speech therapy and occupational therapy commonly available and found the ABA programs were significantly more effective.
Pharmacotherapy
Medications are not a stand-alone solution in the management of autism but they are widely used.
Research published in the 2008 issue of "Pediatrics" by David Mandell, M.D. demonstrated that psychotropic medications are used by at least 46 percent of the autistic population with 21 percent taking more than one medication.
Medications are prescribed to treat severe tantrums, aggression, hyperactivity and self-injurious behaviors according to Henry Kwok, M.D. writing in the September 2003 issue of "Current Opinion in Psychiatry." Dr. Kwok notes that antipsychotics and selective seratonin uptake inhibitors have been extensively used in the treatment of children with autism and are proven both effective and well tolerated. The use of anticonvulsants, when the child does not have seizures, is not supported by the same amount of research, which is the same circumstance for dietary enzymes and acetylcholinesterase inhibitors.
References
- Center for Disease Control and Prevention: Austism Spectrum Disorders
- "Research Autism";Autism in Women and Girls' Being Under-Diagnosed: February 2010
- National Institute of Mental Health: Autism Intervention for Toddlers : December 8, 2009
- "Pediatrics";Young preschoolers with autism: evidence for efficacy of early intervention; E. Fonbonne, M.D.; Jan 5, 2010
- Center for Autistic Disorders; Applied Behavioral Analysis
