Autism: Evaluating a treatment
Dr Avril Brereton
How can
we judge whether a suggested treatment is
worthwhile?
Both parents of
children with autism and professionals working
with children often ask this question. Go to the
local library, surf the net, watch television,
listen to the radio….autism and suggested
treatments, even cures for it, are everywhere.
It can be difficult to work out whether or not
treatments described in the media, on line and
in books are valid. So how can we go about
determining whether or not treatments are
legitimate? The most common way to start is by
searching the autism treatment literature and
evaluating widely used interventions according
to specific research criteria.
Francis (2005)
recently published a critical update of autism
interventions and found that there was a lack of
solid scientific data on the efficacy of most of
these methods/interventions. Interventions
evaluated were grouped according to:
Psychoeducational/Behavioural approaches -
TEACCH, ABA and PECS;
Psychopharmacological interventions; Less
traditional/complementary approaches – auditory
integration therapy, sensory integration, music
therapy.
Many studies
failed to fulfil basic research criteria such
as:
-
Random
assignment to different treatment conditions
-
The use of
standard intervention protocols that capture
a wide range of skills and symptoms
-
The use of
outside evaluators
-
Assurance of
high compliance with the defined treatment
protocol
-
The use of
longitudinal designs that evaluate treatment
effects both during treatment and at set
points after the treatment has been
accomplished
-
Sample sizes,
matching of controls and assessment issues
(Francis, 2005).
Research criteria
and grades of evidence such as those listed
above must be met in order to determine whether
or not a treatment/intervention has been
properly empirically validated.
When you
read an article describing a treatment for
autism ask yourself the following:
-
Is this a
reputable publication? Is this a peer
reviewed journal of high quality?
-
Was it a
randomised controlled trial? How were the
groups allocated into treatment or non
treatment (control group)? Is the sample
biased in any way?
-
Was the
sample well described? Did the children have
autism, how do you know? How big was the
sample? Was the treatment group matched
with a control group who did not receive
treatment?
-
Was the
treatment well described? Does the treatment
cover a wide range of symptoms of autism and
skills? Is there a description of how
clinicians made sure they all provided the
same treatment? How was the treatment
evaluated? By whom? What measures were used
and were they reliable and valid
instruments?
-
Did the
clinicians who delivered the treatment also
measure effectiveness? Is there information
about treatment effectiveness over time?
Given our current
state of knowledge, there is not only one way to
manage/teach a child with autism. A multi-modal
approach to treatment is more likely to promote
development, improve behaviour and reduce stress
experienced by the child and family. The
efficacy of behavioural and educational
interventions and their cost effectiveness often
lack solid data. There is a need for rigorous
studies following evidence-based recommendations
in order to help parents and professionals to
decide which approach will be more effective at
meeting their child’s needs (Jordan et al, 1998;
NAS National Autism Plan for Children, 2003)
Treatment studies
therefore remain a priority for research.
Who has
written best practice guidelines?
This is a list of
some recent documents that outline best practice
in autism assessment, diagnosis, early
intervention and treatment.
-
1996 – New
York State Dept of Health Early Intervention
Programme.
Clinical Practice Guideline. Report of
the Recommendations. Autism/Pervasive
Developmental Disorders. Assessment and
Intervention for Young children (Age 0-3
years). (Updated 2003)
-
1999 – Iowa
Dept of Education/University of Iowa
Hospitals.
Best Practice Guidelines in Assessment,
Programme Planning and the ECSE Supplement
for Individuals with Autism. An action plan
to develop a statewide strategy for
addressing issues governing the special
education and related services for children
with autism.
-
2002 –
California Dept of Developmental Services.
Best practice Guidelines for Screening,
Diagnosis and Assessment.
(Document re treatment due end of 2007)
-
2002 –
Department for Education and Skills: Autism
Working Group. London.
Autism spectrum disorders : good
practice guidance.
-
2003 –
Children's Mental Health Ontario.
Evidence-Based Practices for Children
and Adolescents with Autism Spectrum
Disorders.
** highly recommend**
-
2003 –
National Autistic Society for NIASA in
collaboration with The Royal College of
Psychiatrists, The Royal College of
Paediatrics and the All Party Parliamentary
Group on Autism.
National Autism Plan for Children: Plan
for the identification, assessment,
diagnosis and access to early interventions
for pre-school and primary school aged
children with autism spectrum disorders.
-
2004 – New
Mexico Public Education Dept/Dept of Health
– Family Infant Toddler (FIT) program.
Autism spectrum Disorders: Guidance on
providing supports and services to young
children with ASD and their families.
References
Children's Mental
Health Ontario (2003) Evidence-Based
Practices for Children and Adolescents
with Autism Spectrum Disorders.
Francis, K.
(2005). Autism interventions: a critical
update. Developmental Medicine & Child
Neurology, 47, 493-499
Freeman, B.
(1997). Guidelines for Evaluating Intervention
Programs for Children with Autism. Journal
of Autism and Developmental Disorders, 27,
641-651
Howlin, P. (1998).
Children With Autism and Asperger’s
Disorder. A Guide for Practitioners and Carers.
Chichester: John Wiley & Sons.
National Autistic
Society for NIASA in collaboration with The
Royal College of Psychiatrists, The Royal
College of Paediatrics and the All Party
Parliamentary Group on Autism (2003).
National Autism Plan for Children: Plan for the
identification, assessment, diagnosis and access
to early interventions for pre-school and
primary school aged children with autism
spectrum disorders.
National Institute
of Mental Health
www.nimh.nih.gov/publicat/autism.cfm
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