TREATMENT AND MANAGEMENT

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source : http://www.autism-resources.com/

There is no standard, universally accepted treatment of autism; in fact, every single method has its detractors. General approaches may be summarized as follows:

  • Biochemical (food allergies, medication, food and vitamin supplements)
  • Neurosensory (sensorial integration, over stimulation and patterning, auditory training, facilitated communication, daily life therapy)
  • Psycho-dynamic (holding therapy, psychotherapy and psychoanalysis, option institute(which also falls in behavioral))
  • Behavioral (Discrete trials (Lovaas and others), behavior modification with and without aversives, TEACCH)

Note: Many of the programs mentioned above also use other approaches to some degree and an attempt was made to place them in the most appropriate category.

The literature seems to show that food allergies and the possibility of candida should be checked immediately because a significant number of children may be autistic because of these problems which can be controlled through drugs or diet. As far as other kinds of drug therapy are concerned, there is no drug that is universally successful in treating autistic symptoms and that in some cases usually useful drugs may produce negative results and vice-versa. Vitamin B6 with magnesium and some other vitamins and DMG produce positive results in many cases.

Any educational program (SI,AIT, psychotherapy, behavioral, etc), if done intensively, produces some positive results. There are rare cases of recovery claimed by every educational method. In addition, some methods have been reported by parents as producing negative results.

Behavioral approaches are backed by scientific studies as well as anecdotal evidence. The best known, because of the amount of related scientific literature, are Lovaas’ version of discrete trial and the North Carolina TEACCH programs. Both are very structured programs with a lot of positive reinforcement, two factors which seem to important.

Clearly, it is important to have centers of expertise for PDD, autism, and related disorders in order to help families and school boards in experimenting and choosing the right therapy for each child.

Note: this list is far from complete at this time and misses some well-known treatments.

Vitamin B6
Some have attributed some success in reducing the characteristic symptoms of autistics through the ingestion of large amounts of Vitamin B6. Bernard Rimland pursued this line of investigation. Magnesium is given with it. I think the reason is that high vitamin B6 tends to deplete the body’s magnesium. Suggestions have been that it reduces hyperactivity and obsessive/compulsive behaviors. To make it usable with small children, at least one company provides it in powder form.
dimethylglycine (DMG)
Bernard Rimland pursued this line of investigation. Suggestions are that it sometimes helps autistics with speech & with their attention span. DMG does not require a prescription in the US, being considered a food supplement (once called vitamin B-16, but it was ruled not a vitamin because no specific medical problem is associated with a deficiency of it.) The health food store people say that it is supposed to increase “oxygen uptake” by the blood stream and athletes sometimes take it for that reason.
Eliminating dietary gluten/casein
For some children, the effects of this intervention are obvious to their parents within hours or days. Children who seem to respond most dramatically to the removal of dairy have a history of ear infections, inconsolable crying, poor sleeping patterns, and excessive craving of milk and dairy foods. Gluten intolerance is generally indicated by loose stools and/or a craving for bread and pasta. This is a relatively harmless intervention and should be attempted as soon as possible, to see if a child does respond. If so, further exploration into biochemical treatment is recommended.
Fenfluramine
A drug that decreases blood serotonin concentrations. Some autistics have abnormally high blood serotonin concentrations so experiments were carried out to see if this drug affected the behavior of such autistics (or other autistics). Some success was reported. Dr. Edward R. Ritvo pursued this line of research.
Periactin (AKA cyproheptadine)
Another drug that decreases serotonin concentrations. This drug is normally used as an antihistamine but because of its additional affect on serotonin, has been tried on autistics.
Piracetam
Has shown promise in helping autistic children become more talkative, sociable, less aggressive and have an increased attention span. Available without prescription.
Auditory Integration Training (AIT)
A method of changing a person’s sensitivity to sound at different frequencies. It was originally developed to combat the onset of some kinds of deafness, but was tried on an autistic child and cured her. Since then it has not produced any cures, but has been credited with success in reducing some of the symptoms of some children. In particular, some autistic children show a strong aversion to some sounds, and with Auditory Integration Training have lost their aversion and exhibited other reductions in the symptoms of autism. There are two methods of AIT, the Tomatis and the Berrard. They are different enough that they should perhaps be considered different therapies.
Tomatis Method
A kind of AIT developed by Alfred Tomatis. Over several weeks, the person listens to classical music with the low frequencies filtered out. Over time, voices (also filtered) are introduced, then the missing frequencies. Treatment requires weeks, typically 2 hours of listening a day.
Sensory Integration Therapy (SIT)
A method of helping people who are her oversensitive to the 5 senses by overwhelming them with sensory experiences, e.g. swing them, roll them, get them jumping and spinning. Usually provided by occupational therapists who have learned the method.
Holding Therapy
Martha Welch is the primary proponent who argues that autism results from a failure to bond with the child. The child is forcibly held by the mother. Both Temple Grandin and Bernard Rimland have argued that it provides sensory stimulation and the psychogenic basis is erroneous. Temple Grandin has stated that forced holding is not necessary. under such a theory, Holding Therapy can be classified as a kind of sensory stimulation.
Behavioral Therapy
(also “Lovaas Method”, “Behavioral Intervention”, “Applied Behavioral Analysis” (ABA), “Discrete Trial Training” (DTT)) Use of behavior modification (a.k.a. operant conditioning) which was originally developed by B.F. Skinner (a prime developer of Behavioral Psychology) outside the purvue of autism. Lovaas and other psychologists adapted it as a therapy/educational method for autistic children, and it is his adaptation which is known as The Lovaas Method or DTT. Catherine Maurice’s book Let Me Hear Your Voice is an account of two children recovering from Autism through use of this method, and Lovaas’s The Me Book and Maurice’s Behavioral Intervention for Young Children With Autism are a widely used handbooks for this type of method. Behavioral Therapy now has a lot of adherents who are vociferous in their claims that it is the only method with a study (complete with control group) documenting its success rate. The study is documented in Lovaas’s paper “Behavioral Treatment of Normal Educational and Intellectual Functioning in Young Autistic Children”. Detractors of the method claim that participants of the study were not truly autistic, that the children are turned into robots, and that the method is dehumanizing and severe. The method also arouses controversy in cases where adherents use of punishment & aversives to decrease self-destructive behaviors. (See more complete citations to the above-mentioned books and paper in the section below: “Bibliography“).
Aversives
Term for employment of punishment. One class of aversive would be physical pain though the term is not specific to that. Use of aversives in the treatment of autistic or any children is a very controversial topic (see “Controversies“.). Many condemn all use (or probably more specifically, all use of pain as an aversive) and some say there are alternatives that are always equally or more effective. Proponents say selected employment has produced immediate positive results that has saved the lives of autistic children inclined to continuous self-injurious behavior who have resisted all the non-aversive alternatives. They also say experience has shown that the degree of pain required is often so little as to defy logic: a very slight pain or something not painful can often stop a child from engaging in very painful self-injury.
Natural Language Paradigm (NLP)
A behavior intervention, thus could be classed with the Lovaas method, though there are differences. A source of information on it is Koegel & Koegel’s book. A newer name for this is “Pivotal Response Training”.
Pivotal Response Training (PRT)
Newer name for “Natural Language Paradigm”.
Irlen Lenses
Developed to treat dyslexia and other learning disabilities, the use of coloured lenses to treat the visual processing difficulties of people with autism is relatively new (1994). It has been popularized by Donna Williams (author of Nobody Nowhere and Somebody Somewhere).
Prism Lenses
Lenses in glasses that are prisms: thicker at one edge than the opposite edge.
Social skills training and social stories
Teaching verbal individuals (including those called “high functioning” and “Asperger’s”) many of the unwritten social rules and body language signals that people use in social interaction and conversation. Carol Gray uses a technique called “social stories” to help illustrate these social rules in a variety of situations and appropriate responses. Social stories and “scripting” are also used with nonverbal individuals to teach appropriate responses and prepare the individual for transitions. In very young child, they may be in the form of photographs or pictures.
Anafranil (cloripramine)
a tricyclic antidepressant which may relieve some symptoms of autism.
Desipramine
a tricyclic antidepressant.
Zoloft (sertraline)
Second-generation antidepressant (SSRI, or selective serotonin reuptake inhibitor). Studies on SSRIs reveal significant improvement in perseverative behaviors and some other autistic spectrum symptoms (social withdrawal, behavioral rigidity, etc.).
Ritalin (methylphenidate)
one of a group of stimulants which include amphetamine, amantidine and fenfluramine. it can sometimes be very effective for certain hyperactive children (so much so that it gets overused for others). See also “Dexedrine”.
Dexadrine
?
Ritalin SR
?
Dexedrine
used to treat ADD and ADHD in the same way as Ritalin. Likely used less than Ritalin because its name is associated with drug abuse. One develops a tolerance for both drugs so that increases in dosage over time are often necessary to maintain their effect.
Psychology
a lot of treatments on this list come under the general heading of psychology (in its most general sense, perhaps all do). There are parents of autistic children for whom “psychology” is a dirty word because they associate it with theories and treatments of autism which hypothesize bad parenting, e.g. lack of bonding between mother and child (see “History” section below). Treatments associated with such theories include Psychotherapy and Holding Therapy. Other therapies in this list (such as Behavioral Therapy) clearly fall under the heading of Psychology, yet are certainly not predicated on any “bad parenting” theory.
Psychotherapy
See “Psychology” above, and “History” section below.
Psychodynamic Therapy/Psycho-dynamic Therapy
I’m not certain whether this term is used for a specific therapy, but I’ve seen it used for what might be termed Psychotherapy and related kinds of therapy. (see “Psychology” above and “History” section below).
SRRI “Selective Serotonin Reuptake Inhibitor”
A class of psychoactive drugs that includes Prozac, Zoloft, Luvox, and Paxil (paroxetine), part of a larger class of such drugs that also includes non-selective serotonin reuptake inhibitors. Serotonin is a brain chemical released by neurons and “reuptaken” by neurons.
Prozac (fluoxetine)
Also an SRRI (see Zoloft). Studies have been done.
Clomipramine
From American Health October, 1993: Washington: Psychiatrists at the National Institute of Mental Health have found that clomipramine, an antidepressant, also relieves many of the symptoms of autism, a severe developmental disorder. Patients’ ability to interact with others is much improved.
Clonidine
Normally used to regulate blood pressure and perhaps other purposes. It is used for ADD children at suppertime or bedtime to help them attend to evening activities and to settle down sufficiently to get enough sleep.
Dilantin (phenytoin)
an anti-convulsant used for seizures when others do not work. It is usually avoided in children due to possible serious side effects during development.
Lithium
a salt used primarily to treat bipolar disorder, also used in other, possibly related conditions including autism.
Naltrexone
? (oral version of naloxone) a narcotic antagonist reported by Lensing & Panksepp to have a dramatic and global effect on autism. Hypothesis: In the late 70’s and early 80’s several of scientists suggested that the behavior of some autistic individuals sometimes resembles the behavior of people stoned on hard drugs (heroin, morphine, etc): little sociability, fixes on strange objects, little or no pain sensation, no interest in life, states of euphoria, etc. It was suggested that perhaps these autistic individuals have, for whatever reason, an excess of pleasure, painkilling hormones in the brain such as endorphines to which they are addicted (like joggers to joggers’ high which is produced by endorphines). As a result they may require/desire a minimum dose every day and that the self-stim and/or auto-aggression may be ways to produce these hormones and satisfy the craving. Naltrexone’s effect: Naltrexone blocks the effects of drugs such as heroin and morphine on the brain and has been used since the early 70’s for drug addicts. Therefore, naltrexone should also block the effects of the natural hormones such as endorphines. (Morphine apparently is very close in structure to and simulates the endorphines.). A number of very well controlled studies on the effect of naltrexone on autistic traits and deficiencies have been published. Nearly all indicate some positive results for many of the test subjects: less auto-aggression, less hyperactivity, more sociability, more communication, etc. Not all the studies report all of these effects but most report some positives.
Play Therapy
Roughly consists of therapist playing with child while talking to the child and trying to induce the child to talk. The goal is to help the child acquire language and the working knowledge of every day life we all require. The method is to use play, which is a component of a typical child’s language acquisition, in conjunction with constant interaction with a therapist. Play therapy has been used for autistic children and children with emotional disturbances.
Melatonin
A hormone that has a role in the immune system and in controlling ones sleepcycle. It is sometimes given to children who have trouble sleeping at night. For that reason and others, it has been tried on Autistic children. Lately a lot of claims have been made about the benefits of melatonin for a variety things.
Haldol (haloperidol)
a neuroleptic which is used to abate symptoms of psychosis.
Trexan
the trade name for Naltrexone.
Vision Integration Therapy
?
Craniel Sacral Therapy
a form of myofacial release performed by physical therapists and osteopaths.
Cognative approaches
?
Luvox (fluxovamine)
Antidepressant which is being used for obsessive compulsive disorder and in some cases autism.
Prednisone
a steroid. It and other steroids are used when Landau Kleffner Syndrome is suspected, but there have been reports of children responding to steroids even though they don’t have the classic EEG findings of LKS and their language disability was always present.
EPD (Enzyme Potentiated Desensitization) shots
Sort of homeopathic brew of stuff that your allegric/sensitive to and it is given in shot form once every 6-8 weeks. It is being used for people with multiple chemical/environmental sensitivities/ADD/ADHD/Autism.
Doman-Delacatto
brain stimulation activities for brain-injured children developed by Glenn Doman and Carl Delacatto. It involves cross-patterning, patterning and sensory exercises developed to enhance memory and processing.
Dolphin Therapy (or Dolphin-Assisted Therapy)
I can’t give details, but involves being in a tank with a dolphin or dolphins. Used for Autism, Down’s Syndrome, ADD, Muscular Dystrophy and spinal cord injuries among other disabilities. Researchers in the field include Dr. Betsy Smith (Florida International University) and Dr. John Lilly.
Therapy Dogs
experimental therapy to see if teaching children with disabilities to learn typical human/pet interaction is of use.
Risperdol (risperidone)
(Risperdal?) anti-dopanine agent which also works against serotonin. A neuroleptic.
Epsom Salt Baths
see Phenolsulphertransferase (PST) deficiency in section “Theories and Causes“.
Dimethyl Amino Ethanol (DMAE)
A food substance (abundant in fish) said to effect mood, memory, and learning. Sold as a nutritional supplement by some health-food outfits.
Ginko Bilboa supplements
?
Cranio-Scaral Therapy
Involves unlocking certain areas in the body that are blocked in order for the cerebral spinal fluid to flow correctly. Among the practicioners are some chiropractors.
Tegretol
Drug used to prevent seizures, also sometimes used for autistic symptoms.
Nizoral (ketoconazole)
Anitfungal medication used in the treatment of candida and other yeast infections.
Nystatin
Anitfungal medication used in the treatment of candida and other yeast infections.
Folic Acid
?
Eliminating dietary yeast
?
Music Therapy
?
Intravenous Immunoglobulin (IGIV, IgIV, or IVIG)
IV solution something like a blood transfusion, but uses only a solution made from donated blood rather than whole blood. Used to address certain immune-system problems.
Intravenous Gamma Globulin (IVIgG)
A treatment for autism based upon the theory that autism can be caused by an autoimmune condition in the brain. The treatment is generally confined to patients who show a positive response to Myelin Basic Protein, a protein component of brain myelin.
Adderall
?
Imipramine
?
Desyrel
?
Clonazepam (Klonopin)
?
Dipiperon
Drug used to treat hyperactivity.
MST Surgery
Surgery typically done for LKS children, but has been used with autistic children for whom intractible seizures appear to be a cause.
Secretin infusion
Experimental treatment reported to have helped autistic children. Secretin is a hormone involved in digestion.
Floortime
Intervention method developed by Stanley Greenspan for developmentally disabled children including autistic children. Stanley Greenspan has a series of books including The Challenging Child and The Child With Special Needs.

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