(2-19-15)
Treatment of autism is primarily psychological and educational, little progress has been made in developing biological treatments of autism
The work of Ivar Lovaas was pivotal in demonstrating that children with autism could learn and that the most severe symptoms associated with autism that often lead to institutionalization (self-injurious behavior and aggression) could usually be controlled with behavioral techniques
At the same times, the early work failed to find a “watershed” change that would help the children move into normal developmental trajectories.
Lovaas’ more recent treatment research has focus on early and intensive intentions, and has lead to a spectrum of outcome: continuing severe behavior deficits (but community placement); continuing language deficits (but relatively good community adjustment); adjustment not longer distinguishable from age peers (Lovaas himself has never used the phase “cured” to describe his most successful outcomes). This range of outcomes appears consistent with the emerging view that “autism” is a heterogeneous grouping, with various etiological factors leading to a final common pathway of social, cognitive, emotional, language, and behavior symptoms
Intensive behavioral treatments
Learning treatments based on operant reinforcement principles are currently the most supported approach to treatment of children diagnosed with autistic disorder. Strongest associations are with very early intervention and very intensive intervention (dose/effect relationship). Significant variability in outcome suggests as yet unknown subject characteristics interact with treatment.
Pharmacological treatments
Medication has been of limited usefulness in the past in the treatment of autism. A variety of psychotropic medications have been used to attempt to control aggressive, anxious, or agitated behavior; with limited clinical benefit and predictable side effects.
Possibly the most common medication treatment used with autistic spectrum disorders is a CNS stimulant medication to reduce the ADHD usually seen as an associated symptom of autism. This is a symptomatic treatment of attention deficits, overactivity, and impulsivity (often seen in children with autism) and may benefit the child’s adjustment but does not address the primary autistic symptoms.
There is currently some interest in the use of oxytocin as a treatment of Autism and Asperger’s Disorder. Oxytocin has been found to play a role in pair bonding, social cognition, social memory, and repetitive behaviors. Administration of Pitocin (synthetic oxytocin) has been reported to lead to a decrease in repetitive behaviors and an increase in social cognition. This is currently an experimental treatment.
Experimental treatments
There has been a recent report of improvement in a group of children diagnosed with autism who underwent hyperbaric oxygen treatment; this treatment has gained popularity but this was the first report with a placebo control group. This remains a highly controversial treatment.
There has been recent interest in the use of oxytocin administered through a nasal spray as possibly increasing the social responsiveness of individual’s with autism. Some small studies have found positive results, larger studies appear less conclusive, and there is concern regarding possible long term problems in using this as a treatment (rat pups exposed to external oxytocin actually showed less social behavior as adults) and the underlying rationale (individuals with autism as a population do not seem to show atypical levels of oxytocin, although those individuals with low levels tend to show low social responsiveness).
Controversial treatments
As with other chronic and debilitating conditions affecting children, the lack of satisfactory legitimate treatments spurs both the development of new treatments (a good thing) and the exploitation of desperate families with bogus interventions promising cures for their children (a bad thing).
Instructor’s opinion
With increasing evidence that autism is more of a “common final pathway” than a unitary phenomenon, we are unlikely to ever find a “magic bullet” to cures all cases of autism. Intensive behavioral treatments remain the most well documented method of improving the lives and functioning of individuals with autism spectrum disorders.