Gold Standard Treatment: Applied Behavioural Analysis (ABA)

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.

Other Complementary and Alternative Treatments

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:

  1. Awareness of scientific knowledge concerning treatments
  2. Choosing treatments based on scientific knowledge
  3. Recommend scientifically supported and most effective treatment

Additionally, we encourage families and professionals to use the following guidelines for evidence-based research recommended by Schreck and Miller (2010):

  1. Evidence based research has to have replicated studies
  2. A review of the studies have to be conducted by other professionals in the field
  3. Research has to be supported by two methodologically sound group studies conducted by independent research team or supported by at least 10 single subject design studies finding the AltT superior to no treatment or other treatment
  4. The treatment has to have a sound theoretical basis (e.g. based on a development model)
  5. The research has to measure observable outcomes

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.

Kemper, 2008

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:

Table 1:
Alternative treatments that are not recommended due to insufficient, inconclusive or conflicting evidence

ALTERNATIVE TREATMENT
RATIONALE/MECHANISM
POTENTIAL ADVERSE EFFECTS

Animal-assisted therapy

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)

Behavioural Optometry

Correcting eye movement disorders – Filling gaps in unusual visual behaviour

Insufficient evidence

Expressive Psychotherapy

Art elements to develop cognition, language, motor skills, self-expression and self-esteem, social and life skills

Insufficient evidence

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

Correct deficiencies

Insufficient evidence

Ingestible: Omega-3 Fatty Acids

Correct deficiencies

Insufficient evidence

Massage and other sensory-based interventions

Improve a range of motor and sensory functions

Insufficient evidence

Music Therapy

Musical elements to increase communication, attention, turn taking & social imitation

Insufficient evidence

Sound therapies (SAMONAS Sound Therapy and the Listening Programme)

Improve abnormal sound sensitivity

Insufficient evidence

Table 2:
Alternative treatments that are not recommended due to potential harm and detrimental effects to the child

ALTERNATIVE TREATMENT
RATIONALE/MECHANISM
POTENTIAL ADVERSE EFFECTS

Acupuncture

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

Correct deficiency

Adverse effects especially in high doses; overdose; Diarrhoea (Nystatin); Hepatotoxity

Chelation Therapy

Decrease toxic heavy metal (Childhood exposure to neurotoxins (Hg, Pb) believed to cause Autism)

Potential harm including death (hypocalcaemia); Hepatotoxity & Nephrotoxity; Stevens-Johnson syndrome

Craniosacral Therapy

Gentle manipulation of skull, spine & soft tissue effect behavioural change

Nausea & vomitting; Confusion; Neurological concerns

Facilitated Communication

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

Holding Therapy

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

Secretin Therapy

Leaky gut syndrome; Secretine reduces behavioural characteristics of autism

Diarrhoea; Vomitting; Constipation; Irritability

Weighted Vests

Reduce inattentiveness & stereotypic behaviour due to physical and sensory needs.

Affect growth; Musculoskeletal development

Reference

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.