According to Schreck & Miller’s (2010) research, “Applied Behavioural Analysis (ABA) has been extensively documented by researchers, national and state governments, and the US Surgeon General as the gold standard and most empirically validated of treatments for autism spectrum disorders”.What is ABA
ABA is in essence the only teaching approach for autism supported by controlled studies and post treatment follow up data. There have been over 1000 scientific and peer-reviewed journal articles which have shown successful outcomes for treating children with autism. It develops communicative speech and improved social relatedness in 90% of those treated. This program produces virtually normal social interaction, communicative and cognitive abilities in 40% to 50% of children with autism (Lovaas, 1987, McEachin, Smith & Lovaas, 1993).
ABA uses methods of behavioural psychology including discrete trial and positive reinforcement to analyse information and behaviour, in order to systematically teach new skills. We work to address the needs of each child individually through a comprehensive curriculum that covers all major areas (Early Learner skills, Communication and Language, Social skills, Play skills, Daily Living skills, Academic and Cognitive skills, and Generalization of skills). The basics of ABA are – breaking skills down, pairing it with reinforcement and providing sufficient practice for a child to learn new skills and to retain those skills.
Given the increasing autism prevalence in children (1 in 68 children as of March 2014), many families caring for individuals with autism are desperately seeking out various treatment options for their children. There are many options for treatments with new ones emerging on a regular basis. These treatments include various complementary and alternative therapies as an approach to dealing with the autism (Centers for Disease Control and Prevention, 2014).
However, research on the benefits of these different approaches have been much less studied or rather far less studied to confidently conclude their benefits, limitations and recommendation of use. Given the relative lack of information available about the various therapies, complementary and alternative therapies, Schreck and Miller (2010) encourage families and professionals to consider up-to-date scientific information of the given treatment and suggest the following:
Additionally, we encourage families and professionals to use the following guidelines for evidence-based research recommended by Schreck and Miller (2010):
Additionally, it is crucially important to determine if a certain alternative treatment is not only supported by evidence but is safe and not dangerous to the child. Certain treatments that have “proven” verbally to be effective for children with an Autism Spectrum Disorder are perhaps better suited for other conditions and not for a child at that certain age.
According to the AMS-MOH Clinical Practice Guidelines for Autism Spectrum Disorder published by the Ministry of Health Singapore (2010), there are alternative treatments that are not recommended due to insufficient, inconclusive or conflicting evidence and there are alternative treatments that are not recommended due to potential harm and detrimental effects to the child.
The following table describes the two different categories:
Different activities have different aims: Improve language & social skills; Teach responsibility & commitment; Increase attachment
Harm to child (Accidents, bites, scratches) & Harm to animal (Accidental agression)
Correcting eye movement disorders – Filling gaps in unusual visual behaviour
Art elements to develop cognition, language, motor skills, self-expression and self-esteem, social and life skills
Gluten-free/ Cassein-free diet
Leaky Gut syndrome; Insufficient intestinal enzyme activity
Dietary restrictions may increase rigidity in feeding; Nutritial deficiencies; Irritability, aggression & inattentiveness
Ingestible: Amino Acids
Ingestible: Omega-3 Fatty Acids
Massage and other sensory-based interventions
Improve a range of motor and sensory functions
Musical elements to increase communication, attention, turn taking & social imitation
Sound therapies (SAMONAS Sound Therapy and the Listening Programme)
Improve abnormal sound sensitivity
Unblocking flow of energy “qi”
Infection; Haemorrhage; Pain; Fear; Symptom aggravation
Auditory Integration Therapy
Provide stimulation to hearing mechanism, thereby, providing ‘normal’ hearing and correcting anomalies that affect speech and language development, sensitivity, and learning delays
Output harmful to hearing and potentially dangerous
Ingestible: Ascorbic Acid (Vitamin C), Digestive enzymes, Folate Vitamin B6/Magnesium Vitamin B12 Zinc Antibiotics/ Anti-Yeast Medication
Adverse effects especially in high doses; overdose; Diarrhoea (Nystatin); Hepatotoxity
Decrease toxic heavy metal (Childhood exposure to neurotoxins (Hg, Pb) believed to cause Autism)
Potential harm including death (hypocalcaemia); Hepatotoxity & Nephrotoxity; Stevens-Johnson syndrome
Gentle manipulation of skull, spine & soft tissue effect behavioural change
Nausea & vomitting; Confusion; Neurological concerns
Communicating through his/ her hand to the hand of the facilitator which then is guided to a letter, word, or picture on a keyboard.
Possibly promoting independent communicators into passive communicators; Forced communication; Potential physical force
Autism is a result of parent’s failure to bond with child. Holding child tightly in a way that ensures eye contact; deliberately provoking distress until child needs and accepts comfort
Provoking distress; Rage; Force potentially evokes fear, confusion, anger, betrayal; Violation of child’s individuality; Traumatised; Harm to psychological health
Hyperbaric Oxygen Therapy
Reduce inflammation of brain; Improve blood supply
Ear barotrauma; Pneumothorax; Oxygen-induced convulsions; Fire & explosions
Intravenous Immunoglobulin Therapy
Correcting autoimmune problems causing autism symptoms; via intravenous injections
Suppressing immune system; Mild eczema; Nausea and vomiting; Chills and fever; Hypo/ Hypertension; Rashes; Headache; Pain; Fear
Patterning with Masking
Enhances oxygen uptake into blood stream; wearing mask to rebreath CO2 that was exhaled in last breath, opening up arteries and improving blood supply
Risk of brain damage; Physical harm
Leaky gut syndrome; Secretine reduces behavioural characteristics of autism
Diarrhoea; Vomitting; Constipation; Irritability
Reduce inattentiveness & stereotypic behaviour due to physical and sensory needs.
Affect growth; Musculoskeletal development
Centers for Disease Control and Prevention (2014). Autism Spectrum Disorder (ASD): Data & statistics. Retrieved from: http://www.cdc.gov/ncbddd/autism/data.html
Ministry of Health Singapore (2010). Complementary and Alternative Medical Therapies (ASD). Retrieved from: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical/2010/cpgmed_ autism_spectrum_disorders_preschool_children.html
Kemper, K. J. (2008). The use of complementary and alternative medicine in pediatrics. American Academy of Pediatrics, 122 (6), 1374-1386.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of consulting and clinical psychology, 55(1), 3.
Schreck, K. A. & Miller, V. A. (2010). How to behave ethically in a world of fads. Behavioural Interventions, 25 (4), 307-324.
McEachin, J. J., Smith, T. & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioural treatment. American Journal of Mental Retardation, 97(4), 359-372.