PS 553 Assessing Autism Intervention

1. PS 553 Assessing Autism Intervention

2. Overview of Autism Interventions http://www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf http://asatonline.org/intervention/treatments_desc.htm http://www.health.state.ny.us/community/infants_children/early_intervention/disorders/autism/app_c.htm#APPENDIX_C

3. Psychosocial Interventions

4. Relationship Development Intervention • Steven Gutstein, Ph.D. • www.rdiconnect.com/ • http://www.youtube.com/watch?v=DNqvz7po598 • Preliminary data that may support this intervention are cited on the developers’ website and in one published but uncontrolled study (Gutstein, Burgess, & Montfort, 2007). The intervention has not been evaluated in peer-reviewed studies with strong experimental designs. • Association for Science in Autism Treatment • Emerging Treatments: Additional high quality studies must consistenly show positive outcomes before a firm conclusion can be drawn about treatment effectiveness • National Standards Project

5. Miller Method • The Miller Method™ uses adaptive equipment, including • Platforms (that elevate the child (in hopes of increasing eye contact) • Large swinging balls (to expand the child's reality system) • Swiss cheese boards (to teach motor planning, as well as to increase the child's understanding of his or her relation to environment and space) • http://www.youtube.com/watch?v=AUReFlvYRTg http://www.millermethod.org/

6. Evaluation of Miller Method • The Miller Method™ is not yet objectively substantiated as effective subject to the rigors of good science. • Professionals considering the Miller Method™ should portray the method as experimental, and should disclose this status to key decision makers influencing the child's intervention. • Association for Science in Autism Treatment • Unestablished: There is no reason to assume this treatment is effective. Further, there is no way to rule out the possibility this treatments is ineffective or harmful • National Standards Project

7. Auditory Integration Training • Developed in 1960s by French physician Guy Berard • AIT is based onunproven theory that symptoms in autism are caused by auditoryperception defects that distort sound or produce auditoryhypersensitivity (hyperacusis). • Treatment consists of identification of sounddistortion or hypersensitivity followed by twice daily sessionsfor 2 weeks in which computer modified music determined to beoptimum for the patient is played through a device called theAudiokinetron.

8. Concerns • Audiokinetron may potentially be unsafe, delivering levelsof sound to the eardrum that may be harmful to hearing. • AIT devices do not have FDA approval for treating autism or any other medical problem. • The FDA has banned the importation of the Electric Ear and any other AIT device made by Tomatis International, of Paris, France.

9. Claims of Evidence for AIT • Two studies are offered by AIT proponents which do not meet the rigors of scientifically valid research: • Gilmor, T. M. (1999). The Efficacy of the Tomatis method for Children with Learning and Communication Disorders, International Journal of Listening, 13, 12. • This journal does not fit the definition of “peer reviewed” (review by published scientists) • Conclusions in the paper are based on the technique of meta-analysis of past studies (conclusions drawn from selected pieces of many studies) not empirically validated research. • Credibility of Journal’s mother organization (International Listening Association) is questionable. Web page contains quotes from Artists, Writers, and Rock Stars • "Listen, learn, read” from Deep Purple • http://www.listen.org/index.php?option=com_content&view=category&layout=blog&id=42&Itemid=73

10. Claims of Evidence for AIT • Second study offered by AIT proponents: • Neysmith-Roy,  J.  M. (2001). The Tomatis Method with severely autistic boys: Individual case studies of behavioral changes, South African Journal of Psychology, 31. • Case study does not qualify as empirically validated research. It is a description of somebody’s characteristics but has no controlled assessment of treatment variables.

11. Evaluating Auditory Integration Therapy • No well-designed scientific studies demonstrate that AIT is useful (in any form including Tomatis®); therefore AIT is not recommended for children with autism. • The American Academy of Pediatrics • The American Academy of Audiology • Unestablished: There is no reason to assume this treatment is effective. Further, there is no way to rule out the possibility this treatments is ineffective or harmful • National Standards Project

12. Facilitated Communication • Service provider holds the participant's hands, wrists, or arms to help him or her spell messages on a keyboard or a board with printed letters. • Research evidence, replicated across several hundred children with ASD, shows that the facilitators rather than the individuals with autism spectrum disorders control the communication and that FC does not improve language skills. • http://video.google.com/videoplay?docid=3439467496200920717&ei=jvhVSuPmBYa0qQL93cW7Cg&q=facilitated+communication+gina+green&hl=en# • 50.12

13. Facilitated Communication • Amazing Randi: • http://www.randi.org/site/index.php/swift-blog/783-this-cruel-farce-has-to-stop.html • FC: Mental Miracle or Sleight of Hand • Dr. Gina Green

14. Evaluation of Facilitated Communication • Unestablished: There is no reason to assume this treatment is effective. Further, there is no way to rule out the possibility this treatments is ineffective or harmful • We believe it necessary to make readers aware that a number of professional organizations have adopted resolutions advising against the use of facilitated communication out of concerns regarding immediate threats to individual civil and human right of the person with autism • National Standards Project

15. Evaluation of Facilitated Communication • American Academy of Child and Adolescent Psychiatry (1993, October). Policy statement of facilitated communication. AACAP Newsletter, February 1994. • American Academy of Pediatrics (1998). Auditory integration training and facilitated communication for autism. Pediatrics, 102, 431-433. • American Association on Mental Retardation (1994). AAMR Board approves policy on facilitated communication. AAMR News & Notes, 7 (1), 1. • American Psychological Association (1994). Resolution on facilitated communication by the American Psychological Association. Adopted in Council, August 14, 1994, Los Angeles, California. • American Speech-Language-Hearing Association. (1995, March). Position statement on facilitated communication. ASHA, 37, 22. • Association for Behavior Analysis. (1995). Statement on facilitated communication. ABA Newsletter, 18 (2).

16. Traditional Speech & Language Therapies • Non-behavioral speech and language therapists have developed many different treatments most of which are aimed at stimulating children’s natural interest and ability in learning language. • The treatments usually take place in one-to-one sessions held from ½ to 3 hrs per week.

17. Evidence of Traditional Speech & Language Therapies • No scientific studies have evaluated whether any form of speech and language therapy, other than behavior analysis, helps children with autism. • There have been no studies to evaluate the effectiveness of PROMPT therapy with children with autism http://www.promptinstitute.com/ • http://www.youtube.com/watch?v=4FulVU5-7XI

18. Integrated Treatment Model

19. What is an “Integrated” Treatment Model”? • (Sometimes referred to as combination model, comprehensive model, eclectic model, whole person model) • Using an “integrated” model assumes there are multiple effective therapies that, when combined, work even better than the single effective therapies. • Using an “integrated model” also assumes that proponents are using only the therapies that have been shown to work while ignoring the ones that have not. • But to find out which ones work, you MUST look for controlled studies that demonstrate effectiveness (use objective data, not testimony). • If this has not been done, then proponents may be taking away time from therapies that have been shown to be effective by advocating for an integrated model • There is currently NO evidence that combinations of therapies for autism are better than the sum of their parts.

20. Evaluation of Integrated Therapies • Eikeseth, Smith, Jahr, & Eldevik (2002) • Compared applied behavior analysis (ABA) with an integrated treatment • ABA treatment consisted of language, social, academic, fine/gross motor, and self-help skills • Integrated treatment consisted of: sensory integration therapy, speech therapy, and ABA • At a 1-year evaluation, 13 children who had received ABA treatment made significantly larger improvements than a comparison group of 12 children who had receive intensive, integrated therapy. • On average the ABA group gained 17 points in IQ, 13 points in language comprehension, 23 points in expressive language, and 11 points in adaptive behavior.

21. Evaluation of Integrated Therapies • Howard, Sparkman, Cohen, Green, & Stanislaw (2005) • compared the effects of 3 treatment approaches on preschool-age children with autism • 29 children received intensive behavior analytic treatment (IBT; 1:1 adult:child ratio, 25-40 hours per week) • A comparison group (n =16) received intensive “eclectic” intervention (a combination of methods, 1:1 or 1:2 ratio,30 hours per week) in public special education classrooms (designated the AP group). • A second comparison group (GP) comprised 16 children in non-intensive public early intervention programs (a combination of methods, small groups, 15 hours per week)

22. Evaluation of Integrated Therapies • Howard et al., (2005) continued • Independent examiners administered standardized tests of cognitive, language, and adaptive skills to children in all 3 groups at intake and about 14 months after treatment began. The groups were similar on key variables at intake. • At follow-up, the IBT group had significantly higher scores in all skill domains than the AP and GP groups except motor skills • Learning rates at follow-up were also substantially higher for children in the IBT group than for either of the other two groups. • These findings are consistent with other research showing that IBT is considerably more efficacious than “eclectic” intervention.

23. Bio-Medical Interventions

24. Vitamins and Other Supplements • Vitamins: http://www.asatonline.org/resources/treatments/vitamin.htm • Secretin: http://www.asatonline.org/resources/treatments/secretin.htm • Immunoglobulin Therapy • Immunoglobulin: protein antibody within the bloodstream that binds to antigens and deactivates them • Used in immune and inflammatory disorders • Assumption that autism involves possible infectious agents and/or immune deficiencies • There is no concrete evidence establishing this relationship • Only 3 studies that present data on IG therapy and autism • None of the studies used control groups or random assignment

25. The New York State Department of Health • “It is strongly recommended that intravenous immune globulin therapy not be used as a treatment for autism in children because of substantial risks and lack of proven benefit associated with this intervention”

26. Secretin • Anecdotal reports of 3 children whose behaviors were seemingly helped by secretin generatedmuch publicity and interest in its treatment potential • Recent studies, however, have failed to demonstrateany scientific evidence to justify the use of secretin infusionto treat children with autism.

27. Hyperbaric Oxygen Chamber • http://www.youtube.com/watch?v=cc8yFhFVehE • One study suggested that hyperbaric oxygen therapy may produce positive behavior changes in children with autism spectrum disorder (Rossignol et al., 2009), but another study, which was small but well-designed, found no benefit (Granpeesheh et al., 2009). There have been no studies with strong experimental designs on hyperbaric oxygen therapy for individuals with autism spectrum disorders. The equipment poses a fire risk and has caused serious injury, and the intervention may have significant side effects such as damaging the middle or inner ear and raising blood sugar levels (Liptak, 2005). • Association for Science in Autism Treatment