According to the Centers for Disease Control in the United States, every 1 in 59 children has autism spectrum disorder [1]. In the United Kingdom, more than 1 in 100 people are autistic. Autism is a lifelong developmental disability, but there are several interventions and approaches to the disability that can improve a child’s chances of fulfilling their potential [2].
Choosing an approach is often difficult, since only a minority have been evaluated for how effective they are. Furthermore, many approaches are accompanied by bold claims – usually about how helpful they are – without providing enough supporting evidence. In addition, autism is a complex disability: while an approach may work well for one child, it may not necessarily work for another [3]. This means that every child requires an intervention that is suited to their individual needs. Finally, there are several types of therapies available, so choosing between these can be especially daunting for a parent or caregiver.
Another layer of complication is the type of approach being considered. There are several behavioral, educational and communication-based interventions available. There are also biomedical interventions, which include restrictive diets, supplements, hormone interventions and drugs. The quality and associated risk of interventions like these vary enormously [4], so it’s always important to consult a healthcare professional – like your paediatrician – before introducing any new approach to your child.
The idea that a biomedical intervention can be used to treat autism is highly controversial. The UK-based National Autistic Society states that there is little scientific evidence to indicate that these interventions can be used to manage or even treat autism itself, rather than target other conditions that co-exist alongside it [4].
According to Research Autism [5], it is important that any intervention follows a set of principles. The intervention should be:
Given the sheer volume and diversity in the kinds of treatments offered, it can be difficult to distinguish which approaches or interventions might pose significant risk or harm. Here are some red flags, delineated by the National Autistic Society, that can help you determine whether an approach might not be what it seems [6]:
The National Autistic Society also maintains a frequently-updated website where they outline approaches that concern them [7].
SPELL stands for structure, positive approaches and expectations, empathy, low arousal and links [8]. This is the National Autistic Society’s framework or way of understanding and responding to the unique requirements of people with autism. Each of these is one of five principles that should guide our way of approaching autism and emphasises ways to change the environment and our own responses or behaviours to meet an autistic person’s needs.
TEACCH is an evidence-based method that is based on the unique learning needs of people with autism, and prescribes that teachers must adjust their teaching styles and intervention strategies to accommodate these [9]. The needs identified include: strengths in visual information processing, so autistic people are considered to be visual learners; and difficulties with social communication, attention and executive function. TEACCH’s recommendations include using: physical organisation; individualised systems; work and activity schedules; and a visual structure of materials in tasks and activities.
Social stories refer to a social learning tool devised by Carol Gray to help improve the social skills of people with autism [10]. They usually involve comic-books style illustrations which take autistic people through a social scenario in order to: model appropriate social interaction; show them how to interpret social cues; prepare them for a similar type of interaction; and help them understand why they should behave in a particular way.
Visual supports are a way to communicate effectively with people who have autism, when usual methods might be difficult for autistic people might be challenging to parse or understand. These supports usually depict objects or concepts (like a routine) through simple, colourful and labelled illustrations. They can take many forms, including: mobile phone apps; photographs; short videos; tactile symbols or visual references; line drawings; or even written words. These visual supports are useful because they’re: portable; durable; easy to find or produce; personalised; and consistent, since a type or style of support can be used many times over.
Therapy or counselling is another supportive measure to help autistic people give expression to the challenges they face; identify useful coping strategies; learn relaxation techniques and find ways to relate to other people. Therapists use a number of varied approaches, including cognitive behavioural therapy, solution-focused therapy or a psychoanalytic approach (an approach which autistic people may find challenging, according to the National Autistic Society). Again, different interventions work well for different individuals.
ResearchAutism.net has provided ratings for several different approaches to autism spectrum disorder. You can also find their principles for autism intervention here.
Before beginning any new approach or intervention, it is critical that parents and caregivers ask a healthcare professional to advise them as they make their decisions.
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