PS 553 Assessing Autism Intervention

Overview of Autism Interventions

http://www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf

http://asatonline.org/intervention/treatments_desc.htm

http://www.health.state.ny.us/community/infants_children/early_intervention/disorders/autism/app_c.htm#APPENDIX_C

Psychosocial Interventions

Relationship Development InterventionSteven Gutstein, Ph.D. www.rdiconnect.com/http://www.youtube.com/watch?v=DNqvz7po598

Preliminary data that may support this intervention are cited on the developers’ website and in one published but uncontrolled study (Gutstein, Burgess, & Montfort, 2007). The intervention has not been evaluated in peer-reviewed studies with strong experimental designs.

Association for Science in Autism TreatmentEmerging Treatments: Additional high quality studies

must consistenly show positive outcomes before a firm conclusion can be drawn about treatment effectiveness

National Standards Project

Miller Method

The Miller Method™ uses adaptive equipment, includingPlatforms (that elevate the child (in hopes of

increasing eye contact)Large swinging balls (to expand the child's reality

system)Swiss cheese boards (to teach motor planning, as

well as to increase the child's understanding of his or her relation to environment and space)

http://www.youtube.com/watch?v=AUReFlvYRTg http://www.millermethod.org/

Evaluation of Miller Method

The Miller Method™ is not yet objectively substantiated as effective subject to the rigors of good science.

Professionals considering the Miller Method™ should portray the method as experimental, and should disclose this status to key decision makers influencing the child's intervention.

Association for Science in Autism TreatmentUnestablished: There is no reason to assume this

treatment is effective. Further, there is no way to rule out the possibility this treatments is ineffective or harmful

National Standards Project

Auditory Integration Training

Developed in 1960s by French physician Guy Berard

AIT is based on unproven theory that symptoms in autism are caused by auditory perception defects that distort sound or produce auditory

hypersensitivity (hyperacusis). Treatment consists of identification of sound

distortion or hypersensitivity followed by twice daily sessions for 2 weeks in which computer modified music determined to be optimum for the patient is played through a device called the Audiokinetron.

Concerns

Audiokinetron may potentially be unsafe, delivering levels of sound to the eardrum that may be harmful to hearing.

AIT devices do not have FDA approval for treating autism or any other medical problem.

The FDA has banned the importation of the Electric Ear and any other AIT device made by Tomatis International, of Paris, France.

Claims of Evidence for AITTwo studies are offered by AIT proponents which do

not meet the rigors of scientifically valid research:Gilmor, T. M. (1999). The Efficacy of the Tomatis

method for Children with Learning and Communication Disorders, International Journal of Listening, 13, 12. This journal does not fit the definition of “peer reviewed”

(review by published scientists) Conclusions in the paper are based on the technique of

meta-analysis of past studies (conclusions drawn from selected pieces of many studies) not empirically validated research.

Credibility of Journal’s mother organization (International Listening Association) is questionable. Web page contains quotes from Artists, Writers, and Rock Stars"Listen, learn, read” from Deep Purple http://www.listen.org/index.php?

option=com_content&view=category&layout=blog&id=42&Itemid=73

Claims of Evidence for AITSecond study offered by AIT proponents:

Neysmith-Roy,  J.  M. (2001). The Tomatis Method with severely autistic boys: Individual case studies of behavioral changes, South African Journal of Psychology, 31.

Case study does not qualify as empirically validated research. It is a description of somebody’s characteristics but has no controlled assessment of treatment variables.

Evaluating Auditory Integration TherapyNo well-designed scientific studies demonstrate

that AIT is useful (in any form including Tomatis®); therefore AIT is not recommended for children with autism.

The American Academy of PediatricsThe American Academy of Audiology

Unestablished: There is no reason to assume this treatment is effective. Further, there is no way to rule out the possibility this treatments is ineffective or harmful

National Standards Project

Facilitated Communication

Service provider holds the participant's hands, wrists, or arms to help him or her spell messages on a keyboard or a board with printed letters.

Research evidence, replicated across several hundred children with ASD, shows that the facilitators rather than the individuals with autism spectrum disorders control the communication and that FC does not improve language skills.

http://video.google.com/videoplay?docid=3439467496200920717&ei=jvhVSuPmBYa0qQL93cW7Cg&q=facilitated+communication+gina+green&hl=en#

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Facilitated Communication

Amazing Randi: http://www.randi.org/site/index.php/swift-blog/783-this-cruel-

farce-has-to-stop.html

FC: Mental Miracle or Sleight of HandDr. Gina Green

Evaluation of Facilitated CommunicationUnestablished: There is no reason to assume

this treatment is effective. Further, there is no way to rule out the possibility this treatments is ineffective or harmful

We believe it necessary to make readers aware that a number of professional organizations have adopted resolutions advising against the use of facilitated communication out of concerns regarding immediate threats to individual civil and human right of the person with autism

National Standards Project

Evaluation of Facilitated Communication American Academy of Child and Adolescent Psychiatry (1993,

October). Policy statement of facilitated communication. AACAP Newsletter, February 1994.

American Academy of Pediatrics (1998). Auditory integration training and facilitated communication for autism. Pediatrics, 102, 431-433.

American Association on Mental Retardation (1994). AAMR Board approves policy on facilitated communication. AAMR News & Notes, 7 (1), 1.

American Psychological Association (1994). Resolution on facilitated communication by the American Psychological Association. Adopted in Council, August 14, 1994, Los Angeles, California.

American Speech-Language-Hearing Association. (1995, March). Position statement on facilitated communication. ASHA, 37, 22.

Association for Behavior Analysis. (1995). Statement on facilitated communication. ABA Newsletter, 18 (2).

Traditional Speech & Language Therapies

Non-behavioral speech and language therapists have developed many different treatments most of which are aimed at stimulating children’s natural interest and ability in learning language.

The treatments usually take place in one-to-one sessions held from ½ to 3 hrs per week.

Evidence of Traditional Speech & Language TherapiesNo scientific studies have evaluated

whether any form of speech and language therapy, other than behavior analysis, helps children with autism.

There have been no studies to evaluate the effectiveness of PROMPT therapy with children with autism http://www.promptinstitute.com/http://www.youtube.com/watch?

v=4FulVU5-7XI

Integrated Treatment Model

What is an “Integrated” Treatment Model”?

(Sometimes referred to as combination model, comprehensive model, eclectic model, whole person model)

Using an “integrated” model assumes there are multiple effective therapies that, when combined, work even better than the single effective therapies.

Using an “integrated model” also assumes that proponents are using only the therapies that have been shown to work while ignoring the ones that have not.

But to find out which ones work, you MUST look for controlled studies that demonstrate effectiveness (use objective data, not testimony).

If this has not been done, then proponents may be taking away time from therapies that have been shown to be effective by advocating for an integrated model

There is currently NO evidence that combinations of therapies for autism are better than the sum of their parts.

Evaluation of Integrated Therapies

Eikeseth, Smith, Jahr, & Eldevik (2002)Compared applied behavior analysis (ABA)

with an integrated treatmentABA treatment consisted of language, social,

academic, fine/gross motor, and self-help skills

Integrated treatment consisted of: sensory integration therapy, speech therapy, and ABA

At a 1-year evaluation, 13 children who had received ABA treatment made significantly larger improvements than a comparison group of 12 children who had receive intensive, integrated therapy.

On average the ABA group gained 17 points in IQ, 13 points in language comprehension, 23 points in expressive language, and 11 points in adaptive behavior.

Evaluation of Integrated TherapiesHoward, Sparkman, Cohen, Green, &

Stanislaw (2005)compared the effects of 3 treatment approaches on preschool-

age children with autism29 children received intensive behavior analytic treatment

(IBT; 1:1 adult:child ratio, 25-40 hours per week)A comparison group (n =16) received intensive “eclectic”

intervention (a combination of methods, 1:1 or 1:2 ratio,30 hours per week) in public special education classrooms (designated the AP group).

A second comparison group (GP) comprised 16 children in non-intensive public early intervention programs (a combination of methods, small groups, 15 hours per week)

Evaluation of Integrated TherapiesHoward et al., (2005) continued

Independent examiners administered standardized tests of cognitive, language, and adaptive skills to children in all 3 groups at intake and about 14 months after treatment began. The groups were similar on key variables at intake.

At follow-up, the IBT group had significantly higher scores in all skill domains than the AP and GP groups except motor skills

Learning rates at follow-up were also substantially higher for children in the IBT group than for either of the other two groups.

These findings are consistent with other research showing that IBT is considerably more efficacious than “eclectic” intervention.

Bio-Medical Interventions

Vitamins and Other Vitamins and Other SupplementsSupplements Vitamins:

http://www.asatonline.org/resources/treatments/vitamin.htm Secretin:

http://www.asatonline.org/resources/treatments/secretin.htm Immunoglobulin Therapy

Immunoglobulin: protein antibody within the bloodstream that binds to antigens and deactivates them

Used in immune and inflammatory disorders Assumption that autism involves possible infectious agents

and/or immune deficiencies There is no concrete evidence establishing this relationship Only 3 studies that present data on IG therapy and autism

None of the studies used control groups or random assignment

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The New York State Department of The New York State Department of HealthHealth

““It is strongly recommended It is strongly recommended that intravenous immune that intravenous immune globulin therapy not be used as globulin therapy not be used as a treatment for autism in a treatment for autism in children because of substantial children because of substantial risks and lack of proven benefit risks and lack of proven benefit associated with this associated with this intervention” intervention”

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Secretin

Anecdotal reports of 3 children whose behaviors were seemingly helped by secretin generated much publicity and interest in its treatment potential

Recent studies, however, have failed to demonstrate any scientific evidence to justify the use of secretin infusion to treat children with autism.

Hyperbaric Oxygen Chamber

http://www.youtube.com/watch?v=cc8yFhFVehE One study suggested that hyperbaric oxygen therapy may

produce positive behavior changes in children with autism spectrum disorder (Rossignol et al., 2009), but another study, which was small but well-designed, found no benefit (Granpeesheh et al., 2009). There have been no studies with strong experimental designs on hyperbaric oxygen therapy for individuals with autism spectrum disorders. The equipment poses a fire risk and has caused serious injury, and the intervention may have significant side effects such as damaging the middle or inner ear and raising blood sugar levels (Liptak, 2005).

Association for Science in Autism Treatment