Treatments & Approaches
Not everyone with ASD requires treatment, in as much that ASD is not always severely debilitating and at times, in some people, can be viewed as a difference, albeit that sometimes these differences require or benefit from intervention or understanding. In many cases, people with ASD can involve and contribute in society provided that their environment is friendly and that there is understanding of their differences. However, that is not always the case, and many people with ASD require intervention or special approaches to manage even limited involvement or integration, where it is desired or necessary.
It is generally accepted that there is no single cure for the symptoms of ASD, although a variety of pharmacological and non pharmacological interventions have been shown to have usefulness in the treatment or support of individuals. It is hardly surprising, given the diversity of symptom experience and overall abilities seen in individuals with ASD, that each individuals situation benefits or requires individualized assessment, considering not only the unique ASD experience of the individual and their personality, but also the environments that they are exposed to. Furthermore, people with ASD of all ages are more likely to experience mental ill health, particularly depression and anxiety, than people without ASD. Epilepsy, hearing and visual impairment, and sleep problems are also more commonly seen in people with ASD, as well as attention deficit hyperactivity disorder (ADHD). Co-morbidity or secondary problems can often be treated separately, and can sometimes be understood within the context of ASD experience and the vulnerabilities that this may dispose individuals to (for example, differences in social relatedness and impairments in understanding other people can contribute to anxiety).
The Scottish Intercollegiate Guidelines Network (SIGN) produced in 2007 its guidelines for the assessment, diagnosis and clinical interventions for children and young people with ASD. The complete guideline is available online at www.sign.ac.uk
It sometimes seems that a new therapy, treatment or approach to ASD arises or is revealed to us every few weeks or so. Methods such as cranial massage therapy, dolphin therapy, and auditory integration therapy have all but been considered ineffective, or at least are not recommended. The same too for dietary exclusions (gluten/casein) and certain vitamin/mineral therapies, although there continues to be extensive research into allergy induced autism, and gastrointestinal and metabolic issues considered by some to be relevant in ASD. Intensive behavioural approaches (such as applied behaviour analysis (ABA), have been reported to have some positive effect in some children with autism, although the level of input and potential cost means that such approaches are often out of reach or impractical to families. The Son-Rise program taught at the Options Institute is another relatively intensive behavioural method employed in the attempted treatment of some children with ASD. However, no formal studies have verified the effectiveness of this approach, despite some anecdotal evidence which supports the method for some children.
The behavioural management system TEACCH (Treatment and Education of Autistic and related Communication Handicapped Children) has shown to be a positive approach towards the teaching and support of people with ASD of all ages. The approaches accounts for the affinity with routine and the positive response to structure and predictability that people with ASD often have, taking also into consideration and responding appropriately to differences or impairments in communication and understanding. A formal TEACCH approach is recommended primarily for use with people with ASD who are less able, particularly in cognitive and communicative ability, although the principles of TEEACH can be employed positively with people with ASD with greater abilities in this regard.
The Picture Exchange Communication System (PECS) is a useful approach towards facilitating and improving communication with children (and adults in some cases), particularly those with very limited or no use of verbal communication. The system allows people with ASD to develop approaches to communication effectively and understand ultimately a priority in most ASD support or intervention.
Note on Interventions
Often there is a desire to attempt to cure the person of ASD, or, quite naturally, to implement every possible therapy available in an attempt to reach the child or improve their functioning. Parents or carers with a newly diagnosed child are often so understandably desperate to improve the outcomes for their child that they are vulnerable to attractive but expensive approaches, which have in reality a limited evidence base of success. It is important however to keep an open mind about possibly helpful approaches, whilst also being cautious in our pursuit of changing someone who is experiencing an often complex disability or difference.