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Evaluating Treatments for Autism:  Current Status of the Science

Evaluating Treatments for Autism:  Current Status of the Science. Rachel Hoffman, M. A. Anne Shroyer, B.S. Overview. Conflicts in Treatment Selection Why Science Matters Evidence-Based vs. Alternative Treatments Being an Advocate More In-Depth Look at Autism Treatments

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Evaluating Treatments for Autism:  Current Status of the Science

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  1. Evaluating Treatments for Autism:  Current Status of the Science Rachel Hoffman, M. A. Anne Shroyer, B.S.

  2. Overview • Conflicts in Treatment Selection • Why Science Matters • Evidence-Based vs. Alternative Treatments • Being an Advocate • More In-Depth Look at Autism Treatments • General Recommendations for Treatment Selection

  3. The Dilemma • Search for an effective treatment starts at diagnosis • Many available treatments • Sheer number overwhelming • Effectiveness not always clear • Which one to choose??

  4. One Mother’s Story • “Can you give me a little background about your son?” • “What was it like receiving a diagnosis, and what came next?”

  5. The Importance of Science • Teachers and Science • Why Science Matters Video

  6. What Is Science? • Systematic method • Rules out other variables • Conclusions supported with high degree of confidence • Replication of results

  7. Science and Autism Treatment Science effectively demonstrates: • Which treatments are effective • To what extent they’re effective • In what cases they’re effective

  8. Objective Evidence • Uninfluenced by personal biases • Data dependent • “How much?” • E.g., amount of hand raising in class, before and after intervention • Causal relationships

  9. Subjective Evidence • Open to personal biases • Opinion dependent • “How good?” • E.g., someone’s feelings about a treatment’s efficacy • Correlational relationships

  10. Correlation ≠ Causation • Important to distinguish between the two terms • Correlation • Degree to which two events are related • Causation • When one event results in a subsequent event

  11. Correlations – Example 1 • Ice cream consumption and drowning • When rate of one increases, so does the other • Does eating ice cream cause drowning? • What else might cause increases in both? • Increases tend to occur in hot summer months

  12. Correlations – Example 2 • Why an increase in autism diagnoses? • Proposed reasons • More chemicals in the environment • Increase in Rx drug use • Broadening of diagnostic criteria • Increased awareness of symptoms

  13. Evidence-Based Practice • Backed by scientific evidence • Lots of research on specifics of treatment • Demonstrated effectiveness • Objective data • Most likely to result in improvements

  14. Alternative Treatments • “Pseudoscientific” • Effectiveness generally unevaluated • Subjective data - testimonials and case studies • Popular - but, risky • Safety may be unclear

  15. Alternative Treatments – What’s the Harm? • Can lead to waste of • Time • Money • Opportunities • Effort • Can result in crushing disappointment • No measurable improvements

  16. Eclectic Treatment Approach • Using components from multiple treatments • So what’s the harm in trying a little of everything?

  17. Alternative Treatments – An Analogy • Weight loss • Diet and exercise vs. over-the-counter pill • Which is more likely to improve your quality of life? • Relate this to selection of autism treatment • Consider long-term quality of life and independence • Time wasted in treatment can not be returned

  18. Red Flags in Treatment Claims • “Cure” claim • Little training provided to caregivers • Non-individualized treatments • Effectiveness based on testimonials / case studies

  19. INTERMISSION

  20. Making an Informed Choice • One child in every 110 is classified as having ASD (Rice, 2006) • Therapies began claiming astonishing results • Difficult to choose which therapy is best • Parents have sought the recommendations of professionals

  21. Professional Recommendations • Medical: • Chelation, sensory diet, GFCF diet, chiropractic, Hyperbaric Chamber, drug therapy, etc. • Non-medical: • Applied Behavior Analysis (ABA), TEACCH, sensory integration, music therapy, etc. • Treatments range in effectiveness and safety • Physicians may lack knowledge on effectiveness (Golnik& Ireland, 2009)

  22. A Few Types of Autism Therapies • Facilitated Communication • Sensory Integration Therapy • Chelation • Applied Behavior Analysis

  23. Facilitated Communication • Created in the 1970’s • Claims to provide a form of communication for non-verbal individuals • Large anecdotal claims of effectiveness (Finn, Bothe, & Bramlett, 2005)

  24. Facilitated Communication Video • FC Frontline Clips.MP4

  25. Facilitated Communication • Objective research found FC ineffective (Finn, Bothe, & Bramlett, 2005; Kezuka, 1997; Jacobson, Mulick, & Schwartz,1995) • Learners’ response dependent on the facilitator (Kezuka, 1997) • Harmful • Wrongful accusations and disappointments (Jacobson, Mulick, & Schwartz,1995)

  26. Facilitated Communication Video • FC Frontline Clips.MP4

  27. Sensory Integration Therapy • Began to be used for autism in the late 1970’s • Claims to be effective in improving sensory processing in the brain • Involves activities such as: • Swinging • Rocking • Massages • Pressure/weighted vests

  28. Sensory Integration Video • What it is based on • Sensory room • Videoshort clip of swinging

  29. Sensory Integration Therapy • 1-10 hours, 1-3 times a week, 3-6 months • $30-120 per session • Parent training: Some • Does it work? • Not enough objective research available (Maurice, Green, & Luce, 1996) • Found ineffective in the reduction of stereotypy (Hodgetts, Magill-Evans, & Misiaszek, 2011; Reichow, Barton, Good, & Wolery, 2009)

  30. Chelation • Began to be used for autism in the early 1980’s • Claims to stop further damage caused by mercury poisoning • Complex, time consuming, and distressing • Removal of heavy metals through IV or oral medication

  31. Chelation • 1-10 hours a week, 1month to a year • $30-120 per session • Parent training: None • Does it work? • 2008 stopped research due to dangers associated • Reserved for the treatment of children only with heavy-metal poisoning (Van der Linde, Pillen, Gerrits& Bouwes Bavinck, 2008)

  32. Wick & Smith 2009

  33. Applied Behavior Analysis • Behavioral psychology emerged in the early 1900’s • Measure objective observable events • Systematically manipulate events in the immediate environment to improve behavior • Rule out other explanations • Replicate the results

  34. ABA Video • Video • Video PECS

  35. Applied Behavior Analysis • Therapy may include: • One-on-one instruction using prompts and reinforcement • Teaching in natural environment • Facilitated peer play • Individualized interventions to reduce problem behavior • Interventions based on ABA include • Pivotal Response Training • Verbal Behavior Therapy • Picture Exchange Communication System (PECS) • Early Start Denver Model

  36. Applied Behavior Analysis • 15-40 hours, 3-5 days a week, 1-3 years • Costs vary: average $50-120 per session • Parent training: Yes • Does it work? • Research demonstrates ABA as the most effective approach to the treatment of autism (Maurice, Green, & Luce, 1996)

  37. General Recommendations • Who claims the treatment will help? • Be skeptical • Financial benefits • Research the information closely

  38. General Recommendations Cont. • Ask others for help in deciphering difficult topics • Be cautious of new treatments with little reviews • Be sure to request objective measures

  39. Scientifically Proven Treatments • Additional Resources: • Texas Autism Research and Resource Center: http://www.dads.state.tx.us/tarrc/research/treatment.html • National Standards Project: http://www.nationalautismcenter.org/about/national.php • National Professional Development Standards on Autism Spectrum Disorders: http://autismpdc.fpg.unc.edu/content/briefs • Institute of Education Services- What Works Clearinghouse: http://ies.ed.gov/ncee/wwc/reports/

  40. Where is Trevor now? • Trevor with his mother making a pizza

  41. Thank You! Questions

  42. References • Finn, P., Bothe, A. K., & Bramlett, R. E. (2005). Science and pseudoscience in communication disorders: criteria and applications. American Journal of Speech-Language Pathology,14(3), 172-186. doi:10.1044/10580360(2005/018) • Golnik, A., & Ireland, M. (2009). Complementary alternative medicine for children with autism: a physician survey. Journal Of Autism And Developmental Disorders, 39(7), 996-1005. • Hodgetts, S., Magill-Evans, J., & Misiaszek, J. E. (2011). Weighted vests, stereotyped behaviors and arousal in children with autism. Journal of Autism Developemntal Disorders, 41, 805–814. doi: 10.1007/s10803-010-1104-x • Jacobson, J. W., Mulick, J. A., & Schwartz, A. A.(1995). A history of facilitated communication: Science, pseudoscience, and antiscience science working group on facilitated communication. American Psychologist, 50, 9, 750-765. doi: 10.1037/0003- 066X.50.9.750

  43. References Cont. • Kezuka, E. (1997). The role of touch in facilitated communication. Journal of Autism and Developmental Disorders, 27, 5, 571-593. • Leaf, R., McEachin, J., &Taubman, M. (2008). Sense and nonsense in the behavioral treatment of autsim: It has to be said. NY, NY. DRL Books, Inc. • Luiselli, J. K., Russo, D. C., Christian, W. P., & Wilczynski, S. M. (2008). Effective practices for children with autism: Educational and behavioral support interventions that work. NY, NY. Oxford University Press. • Maurice, C., Green, G., & Luce, S. (1996) Behavioral Intervention for young children with autism. Austin, TX: PRO-ED. • Reichow, B., Barton E. E., Good, L., & Wolery, M. (2009). Brief report: effects of pressure vest usage on engagement and problem behaviors of a young child with developmental delays. Journal of Autism and Developmental Disorder, 39, 1218–1221. doi: 10.1007/s10803-009-0726-3.

  44. References Cont. • Rice, C. (2006). Prevalence of autism spectrum disorders . Autism and Developmental Disabilities Monitoring Network, 58, 1-20. • Schreck, K. A. & Mazur, A. (2008). Behavior analyst use of and beliefs in treatments for people with autism. Behavioral Interventions, 23, 201-212. doi: 10.1002/bin.264 • Todd, J.T. (1987). The great power of steady misrepresentation: Behaviorism's presumed denial of instinct. Behavior Analyst, 10, 117-118. • Van der Linde, A., Pillen, S., Gerrits, G., & Bouwes Bavinck, J. (2008). Stevens-johnson syndrome in a child with chronic mercury exposure and 2,3-dimercaptopropane-1-sulfonate (DMPS) therapy. Clinical Toxicology (Philadelphia, Pa.), 46, 5, 479-481. • Weiss, M. J. & Ferraioli, S. (2009). Identifying evidence based treatments. ABA Special Interest Group Newsletter. 25(1): 1-4. • Wick, J., & Smith, T. (2009). Controversial treatments for children with autism in the popular media. ABA Special Interest Group Newsletter. 25(1): 5-11.

  45. References Cont. • whyscience.co.uk • sciencepunk.com • raisingchildren.net • http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5810a1.htm

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