Treatments and Therapies

You, or your family member, have received a diagnosis on the Autism spectrum. What comes next? Can it be fixed? What can you do for yourself? Where can you get help?

Not only can it be a long and frustrating process to get a diagnosis. Families for decades have found it even harder to get a clear sense of what to do next. This was especially true in the past when there was less awareness of Autism. A few specialized services helped a few children, sometimes as an adjunct to research and training. Then as now, when a new treatment or therapy appeared to hold promise, parents and concerned professionals would flock to it, often to have their hopes disappointed. Most families felt lucky if they could just survive. They resigned themselves to a lifetime of care for their disabled member. Some broke under impossible strains, and gave up their autistic child or adult to some form of custodial care.

From the 1990s, we have seen a strong reaction against stoic acceptance or desperation. Special education is now mandatory in all North American jurisdictions. In what might be called a revolution of rising expectations, sufficient numbers of parents of young children are refusing to accept a life sentence for their autistic children and themselves. Two current expressions of this revolution in North America have been efforts to promote and fund research, and the wave of support for early intervention programs, especially those using Applied Behavior Analysis (ABA) techniques. Internet access has been very significant in these movements.

Various treatments and therapies have helped to make lives of people with Autism more bearable and meaningful, if none may actually cure their Autism. We outline some of them, with these cautions.

  1. No single or simple cause of Autism is known: there is no magic bullet, no elixir, no quick fix.
  2. Treatments and therapies used by and with persons with Autism did not usually develop from theories into practices. More commonly, observations of good or bad reactions to certain substances or experiences prompted a notion that a particular approach might help. A good many of these treatments and therapies may have been developed for people with other disabilities, and were applied more recently to people on the Autism spectrum.
  3. Given the range of persons affected by Autism and related disorders, the pervasiveness of the impairments, and the likelihood that Autism has several causes, no one form of treatment alone is going to be enough for any individual person.
  4. A broader approach, based on developmental processes and relationships, may work better in the long term than a focus on only one symptom or problem area.
  5. Each individual can benefit from a holistic approach, uniquely designed for his or her abilities, and drawing upon various treatments and therapies.
  6. While most treatments or therapies have been proposed for children with Autism, some approaches could help some adults as well and are worth considering. We note, however, that some articulate adults strongly resist the idea that they need any form of treatment or therapy, and want only their distinctive differences to be accepted and respected by society.
  7. What is the difference between a treatment and a therapy in the Autism context? Both terms may be used interchangeably, but may differ in shades of meaning. A treatment implies that it can or might cure a disease or challenging condition; it is more intrusive, may have side effects, and is usually based on a medical model. A therapy is a way of easing the symptoms and helping a person to have some quality of life; it is less intrusive, does no harm if it is not fully successful, and is usually based on relationships.
  8. Thousands of print publications and millions of Internet pages have some information about treatments and therapies that might help someone with Autism. We comment on those in which we have some experience and which can be relevant to adults. We hope that others will add to the collective wisdom that accumulates in this site. Keywords may be used to search the Internet for website resources. Our OAARSN bulletins note news and resources as they come to our attention.
  9. Our purpose is to provide an information service and opportunities for discussion. Please note our disclaimer: "OAARSN provides resources for information purposes only. We do not endorse any treatment, program, product or services. The contents of this website are not medical, legal, technical or therapeutic advice. Information should be reviewed with qualified professionals. We will not be held responsible for misuse of information or for any adverse effects of recommendations mentioned on this website or on any other websites linked to it. Views, opinions or announcements posted by subscribers to any area of this site do not necessarily reflect those of OAARSN, and we do not assume responsibility for any discrepancies or errors."

Communication Therapies
Impairment of speech and language is a defining factor in the diagnosis of Autism in young children. At least one in three adults with Autistic Disorder does not speak, and a significant number who can utter spoken words may not be able to use language as an effective means of communication. Many challenging behaviours of people with Autism, such as aggression, self-injury, anxiety and depression, may be expressions of frustration at their inability to communicate effectively with others.

Traditionally, someone who could not speak tended to be dismissed as nonverbal and incapable of understanding or rational thought. Advocates of disability rights have gained a hearing for arguments that:

How have professionals and caregivers tried to help overcome this profound disability? People with Autism form part of the client group for Augmentative and Alternative Communication (AAC) for which the international body is ISAAC. In Ontario, we also have Augmentative Communication Community Partnerships Canada (ACCPC)

These are some of the communication systems that can help:
1. Sign Language was developed for hearing-impaired individuals, but was often taught to autistic children in the 1970s. Signs and gestures were seen as a basic form of human communication and well suited to the good fine motor skills of children with classic Autism. Simultaneous use of sign and spoken language was usually taught. Signed English is the best system of sign language, if sign and speech are being learned together, as its syntax matches that of spoken language. Signed Speech, or using sign and speech together, stimulated some children, who had previously been non-verbal, to begin speaking as well. At the time, it was imagined that people with Autism might live in group homes or other congregate settings, in which sign language would be the lingua franca. However, the general inability of most ordinary people to use and understand sign language means that this medium has been less effective in community settings. Autistic adults who know sign language usually have to have other forms of communication as well.

2. Picture Communication Symbols have been used since the mid-1980s, supported by the insights that some people with Autism think in pictures rather than words and so might learn better with visual cues than with spoken language. The Picture Exchange Communication System (PECS) uses stylized drawings--of everyday objects, activities and even relationships and feelings--that may be used to prompt steps in a complex task or to offer options among which choices may be made. Computer software is now available to make sets of PECS symbols that are appropriate to each person, but the vocabulary is usually designed for young children rather than adults.

3. Facilitated Communicating (FC) is a method of Alternative and Augmentative Communication (AAC) that is also called Supported Typing (ST) in Ontario. Since its introduction in the early 1990s, FC techniques seemed to help particularly adults and children who had not been able to speak because of their Autism. Some have been able with FC to break out of their isolation and to show clearly that "though they cannot speak, they have things to say." Some adults who have received help with FC or ST have been able to progress to independent typing and even speech. Some have been able to continue in literacy and further education programs, and a few have graduated from college. Even when users do not achieve independent typing, FC or ST can be a strategy to improve motor skills so they can make choices by pointing to or touching objects, pictures, letters, words or phrases.

A facilitator or communication assistant provides varying degrees of physical support, as well as emotional support, to the user of a communication aid. Such aids range from simple boards with numbers and alphabet letters to computerized devices with voice, display and printed output and can include arrays of pictorial symbols or photographs. The most common method involves the facilitator or assistant providing physical support in the form of backward pressure as the communicator focuses on reaching forward to touch or type on the device.

A survey of FC and validation tests is presented in D. Biklen and D.N. Cardinal, Contested Words, Contested Science: Unraveling the Facilitated Communication Controversy (New York: Teachers College Press, Columbia University, 1997). Seven impressive communicators express themselves in the book Autism and the Myth of the Person Alone (edited by D. Biklen, New York University Press, 2005). For more information click here: http://www.ont-autism.uoguelph.ca/FC-ST-2009.pdf

Ontario has the Bridges-Over-Barriers support group started by and for adults with Autism who use Supported Typing to share their successes, struggles and strategies. See the Bridges webpage on the OAARSN site.

4. Social Stories are a communication-based technique developed by Carol Gray of Michigan to help autistic children to know how to interact appropriately with others in social situations. The technique allows adults with Autism as well, to read, rehearse, and write in advance what to expect in social situations. Four kinds of sentences are used in any story:

Social stories can help persons with Autism to become more independent in routines, and to know how to do an activity, how to ask for help, and how to respond appropriately to feelings of anger and frustration.

5. Lifelong Learning
Adults with quite severe Autism have too often been presumed to be incapable of growing and learning. When those around them have given up hope, a person may well conform to their low or negative expectations. But we have found that expressing confidence and hope and providing opportunities and interests are very worthwhile.

Adults who have found they can express their thoughts with FC or ST have asked for learning material and experiences, and some have gone on to formal postsecondary education. Those whose intelligence was not realized when they were children deserve every encouragement, and show that it is never too late to learn when one is supported positively.

One aid to learning has been text-to-speech software like WriteOutloud, in which the learner may take in meaning three ways—through the eyes reading text of a chosen topic of interest, through touch when typing from the text, and through the ears when hearing the voice output of what one has typed. One man we know, who has a good varied life, finds typing with WriteOutloud to be a favourite activity which he can continue for up to three hours by himself. Later, in conversations using ST, it is clear that he has taken in and thought about the subject matter and ideas. Another man was over 50 when he first used WriteOutloud: the experience has stimulated him to speak with his voice so others can understand him at last (WriteOutloud is a product of Don Johnston Incorporated).

Education and Management Programs
Most methods are designed entirely for young children, though some proponents claim they could work with adults too.

1: Applied Behavior Analysis (ABA), Behaviour Modification or Lovaas Method
These techniques, formalized as the Lovaas Method from the 1960s, assume that all behaviour is learned through the consequences that follow. If a child likes the consequence, the behaviour will be repeated; if a child does not like the consequence, the behaviour is less likely to be repeated. This approach is based on the premise that children with Autism do not learn from their environment as normal children do, and therefore need a very intensive and structured learning program. Autism is viewed as a combination of numerous behavioural deficits that have to be changed to bring the child into our world. Three common techniques of behavior management are a system of rewards for appropriate behaviours, extinction of undesirable behaviors, and “Time-Out” or removal of the child by an adult from a problem situation. The intervention is advocated by families of children with Autism since the late 1990s in many parts of the world, especially North America. In Ontario, where it is funded for eligible young children at a unit cost of up to $80,000 a year, the intervention is also known as Early Intensive Behavioural Intervention (EIBI).

2. TEACCH methods (Treatment & Education of Autistic & Related Communication Handicapped Children) were developed under the leadership of Dr Eric Schopler in North Carolina from the 1980s. They also use behaviour modification but in a more cognitive way than ABA, emphasizing skills the children already possess and using visual cues and schedule boards. The long-term goals are both skill development and fulfillment of fundamental human needs such as dignity, engagement in productive and personally meaningful activities, and feelings of security, self-efficacy, and self-confidence. To accomplish these goals, TEACCH developed the intervention approach called “Structured Teaching.”

3. The Son-Rise Program at the Autism Treatment Center of America™ teaches parents how to develop and implement child-centred programs in their own homes. Parents encourage and motivate the child in activities that they observe he or she enjoys. The child is the teacher, on the belief that going with rather than against the child makes the child more motivated to explore and develop.

4. The Daily Life Therapy approach, developed by Dr Kiyo Kitahara of Japan, and practised at the Boston Higashi School, is holistic, based on relationships, and effectively combines elements of various specific therapies. The approach has three principles which foster human dignity and self-esteem and allow the child (or adult) to contribute to and benefit from society.

5. Gentle Teaching (or Compassionate Practices)
The methods outlined above are used predominantly with children rather than adults. Forms of Behaviour Modification may be tried when an adult with Autism has “challenging behaviours.” A non-violent, non-aversive alternative teaches people with special vulnerabilities to feel safe and loved. Caregivers work to create feelings of safety and love in the context of a community of true companionship and interdependence.

Medication and Dietary Intervention
1. Medication

Our culture is conditioned to expect a medical cure for any ill. When something goes wrong, we look to physicians to prescribe some drug that will make it better. Various kinds of psychotropic drugs are used to help with specific symptoms of people with autism—such as attention deficit and hyperactivity, aggressiveness and destructiveness, depression, obsessions and perseveration, anxiety, self-injury, and seizures.

However, no specific medication has been developed or is approved to address all the symptoms of Autism Spectrum Disorders, which are various and complex, and no medication helps all people with Autism. Many people with Autism do not need drugs. And some suffer paradoxical reaction or side-effects which, in some people may be worse than the symptoms for which medication was prescribed.  The use of any form of medication for persons with autism is contentious. On the one hand, it may seem unethical to administer drugs to people who cannot give informed consent. On the other hand, it is argued that if the life of a person with autism might be more bearable with medication, this should not be denied because of dogmatic opposition to all medication.

2. Diet Theories Relating to Autism
Parents in the past, observing that their autistic children had more difficulties when they had eaten certain foods, may have informally modified their diets. Some claim that children whose diet is modified early enough may recover from the symptoms of Autism. The publication of this book impressed parents of both children and adults with the potential for a cure: Unraveling the Mystery of Autism and Pervasive Developmental Disorders: A Mother’s Story of Research and Recovery (by Karyn Seroussi, Simon and Schuster, 2000). Seroussi claimed her family had cured her son’s Autism with the success of a gluten-free, casein-free diet before the child was 3 years old. The diet was combined with early and intensive learning programs.

Could dietary intervention help adults with Autism, who may now be found to be intolerant of gluten and casein? Hopes of any dramatic recovery might be slight, given the earlier years of developmental delays. But at least current digestive problems can be alleviated by removing casein, gluten and possibly other foods, leading to improvements also in sleep patterns, general outlook and behaviour. Little research has been published on diet and Autism in adults. But, in A Positive Approach to Autism (2000), Stella Waterhouse recommends that every child and adult with Autism be assessed professionally so that digestive problems, intestinal/bowel disease and/or food intolerances can either be ruled out or the necessary treatment implemented. Several theories proposing a link between diet and Autism are discussed at: http://www.ont-autism.uoguelph.ca/diet-theories-SB.pdf

A diet that excludes certain foods must be carefully managed to ensure that all essential nutrients and micronutrients are included from alternative safe foods. At least some people with Autism appear to lack certain micronutrients (vitamins and minerals) that are needed for digestion or the functioning of the brain and nervous system, or that their systems do not use these substances effectively. The value of various vitamins in treating Autism was advocated from the 1960s by Dr Bernard Rimland, sometimes in very large dosages. As with the challenges of determining appropriate medication dosages, vitamins and other supplements pose similar challenges since they may vary in bioavailability and also be metabolized at different rates.

The implementation of a diet or its supplementation with vitamins, minerals or other alternative products should be done with the support of a health professional such as a registered dietitian or a physician.

Sensory, Mind and Body Therapies
1. Sensory Integration

Pioneering a special field of occupational therapy in the 1960s, Dr Jean Ayres defined sensory integration as the process by which our brains process information from all our senses and use it to regulate our motor activities. From the 1990s, her theories of sensory integration dysfunction, presented in works such as Sensory Integration and Learning Disorders (1973) were found to be relevant to understanding Autism as a neurological disorder that includes problems of perceptual and sensory processing and impaired motor skills. Experiences reported by autistic savants like Temple Grandin and Donna Williams have also helped our understanding. While most sensory integration therapists work with very young children, their insights and techniques can also work with teenagers and adults.

Sensory integration theory helps to explain unusual behaviours observed to some degree in most people with Autism. These include their abnormal perceptions of any sensory stimuli, and their responses expressed in "sensory defensive behaviours" as well as in high levels of anxiety and difficulties in attending to tasks, controlling impulses, tolerating frustration and balancing emotional reactions. Such behaviours are not consistent all the time or in different environments, and each individual has a unique combination. People with Autism may actually seek some sensations to block out other sensations, or they may seem unresponsive because their nervous systems "shut down" to protect them from sensory overload. People with Autism show abnormal reactions to the more commonly understood senses of sight, hearing, taste and smell, but the theory of sensory integration is explained with special reference to three systems--tactile (touch), vestibular (movement and gravity), and proprioceptive (awareness of body position).

These insights have been developed into an understanding of the movement disorders or differences of persons with Autism (and others) as a result of their unreliable sensory feedback. These may be latent at all times, but most difficult when starting, executing, continuing, stopping, combining and switching movements or actions. Problems with sensory integration help to explain the behaviors variously described as stereotypic, self-stimulatory, impulsive, perseverative and non-responsive, as well as what others see as profound difficulties with communication and relationships.

Occupational therapists who work in this field have developed detailed assessment tools to measure sensory integration dysfunction and consistent strategies to manage challenging behaviour. Successful sensory integration techniques include the Wilbarger Protocol for Sensory Defensiveness, the Sensory Diet, general calming and alerting strategies, and advice for a wide range of specific problems. In Building Bridges through Sensory Integration (1998), advice is offered on adapting home, school and childcare environments and routines to be more consistent and predictable, as well as creative suggestions for activities, equipment and resources.

Special forms of occupational therapy that have helped persons with Autism:

1. Art Therapy is defined as a form of psychotherapy that utilizes art materials and the processes involved in making art. Art therapists have been working with children and adults since Autism was first recognized—to help them overcome their isolation by progressing developmentally, finding ways of coping, and gaining a sense of self and relatedness to the world.

Art materials and mark making are explored for their tactile and sensory qualities. Communication is encouraged by using both the representational and the expressive potential of art materials. The person with Autism is helped by the therapist to make some sense of their experiences and to develop confidence and self-esteem. A relationship is encouraged by the framework of a safe place and a regular time, with clear and consistent boundaries.

2. Music Therapy can make a difference in the lives of people with health or learning difficulties including Autism, by enhancing the quality of life and the psychological, physical, cognitive and social functioning. Music is nonverbal, not threatening, immediate in time, and naturally motivating and reinforcing. Songs, with lyrics composed like social stories, can be used to learn and practice social skills.

According to the Joint Declaration of the 1982 International Symposium of Music Therapists:
"Music therapy facilitates the creative process of moving towards wholeness in the physical, emotional, mental and spiritual self in areas such as: independence, freedom to change, adaptability, balance and integration... As the musical elements of rhythm, melody and harmony are elaborated across time, the therapist and client can develop relationships which optimize the quality of life."

Music therapy can help persons with Autism to:

3. Animal-Facilitated Therapy may help people with Autism who may think in some of the same ways as animals do. Temple Grandin, the autistic savant who designs livestock-handling equipment on the basis of her unique insights into animal behaviour, says that persons with Autism share with animals their thinking in pictures and by associations. They are also alike in having fear as their main emotion, especially fear of novel or unusual situations. This approach includes also riding, caring for and relating to horses and other animals, but has been most highly developed with dogs trained to support people with Autism.

Service dogs can be trained to support persons with Autism to cope with their sensory and social differences. Jim Sinclair, who has trained a series of service dogs to help him with his own autistic sensory difficulties, explains on his website the ways that dogs can help children and adults with Autism.

4. Horticulture as Therapy
The American Horticultural Therapy Association defines its focus as a complementary therapy profession that uses gardening and horticultural activities to improve and maintain physical health, mental health and social adjustment, recreational and leisure options, educational and occupational status. Horticultural therapy can enhance self-esteem, alleviate depression, improve motor skills, provide opportunities in problem solving, encourage work adjustment and social interaction, and teach marketable gardening and business skills. Some or all of these together help individuals to be more included in the everyday community.

People with various ills and disabilities can benefit from horticulture as therapy. Persons with Autism who have movement and sensory differences can be helped by the restorative powers of landscapes and healing gardens--the calm and quiet spaces, the integrity of designs and structures, the soothing greens with touches of brighter colours, the fragrances and textures and the feeling of protection and safety. The physical labour of working in gardens provides great opportunities for sensory integration as well as regular exercise in the open air, the pace can be adjusted to each person’s abilities, and satisfying relationships are possible with friends and other gardeners as well as therapists. Those who have usually been in dependent relationships, receiving services from caregivers all the time, can experience the responsibility and dignity of a vital role in nurturing the plants.

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