Evolution of the Treatments of Autism
By: Brooke Durbin & Kyra Mandas
We use the word “treatment” for Autism because thus far in the history of ASD there is no cure for it. There are only different treatments for the symptoms of ASD. Today the most successful treatment is ABA Therapy. ABA stands for Applied Behavioral Analysis and is a teaching approach which teaches social, motor, and verbal behaviors as well as reasoning skills. Historically there have been many attempts at treating ASD. In 1950’s the answer from Dr. Bettelhiem was to put the children in school. Around 1960 individuals were treated with medications such as LSD. In 1976 electric shock was used during therapy to punish for undesired behavior. In the 1980’s to 1990’s biochemical, nuerosensory, pyscho-dynamic and behavioral treatments where used.
Bettelheim, head of the Universitiy of Chicago’s Orthogenic School for Disturbed Children, believed the cause of autism was the mothers (Herbert, Sharp, &Gaudiano, 2002). He disagreed with Leo Kanner’s previous view that the source was in part biological and in part the parents and took a “refrigerator” mother only approach to the cause. He used everything a child did and warped it to fit his belief. For example when a young autistic girl was obsessed with the weather he said she was actually sensing her mother not wanting. He broke weather down to we/eat/her showing she thought her mother wanted to eat her (Herbert, et al., 2002). Because of this belief he developed “parentectomy” where he removed the children from the parents for a long period of time. It became apparent after Bettelheim’s suicide that his previous successful results had been falsified. Bettelheim’s great success stories turned out to involve children that weren’t actually autistic. He had fabricated many results and had no actual training in psychoanalysis. Although, it is clear that Bettelheim’s treatment was in reality unsuccessful there were still some psychoanalytic therapists who continued to follow his ideas (Herbert et al. 2002).
Lysergic Acid Diethylamide (1960-1965)
Between 1960-1965 scientists investigated the use of LSD-25, a serotonin-inhibiting drug, as a treatment for autism. The idea behind using drugs to treat autism is based on the concept that autism is a personality and therefore the drugs are meant to alter the person’s perceptive state (Seattle Community Network, 2009). It was first used as a way to cure autism but this research was criticized and seen as abusive to the patients. Due to the severe criticism of LSD as a cure it reduced the number of studies done on it as a therapy (Seattle Community Network, 2009). An early study by Bender, Goldschimdt, & Siva (1962) tried using LSD as a treatment by giving a daily maintenance dose. The children were observed to be over all happier and were in an improved mood after being given the drug (Bender, et al., 1962) Although, these studies showed positive results it is a very controversial treatment method that was developed before much was known about autism and is not used today.
Aversive Punishment (1976)
In 1976 electric shock therapy was in full swing and used as punishment. An article discussing the outcomes of shock therapy in autistic children by Lichstein and Schribman (1976) showed many positive outcomes. Shock therapy was used as a punishment for undesirable behaviors. When the child engaged in the unwanted behavior the child received a shock to decrease the frequency of that behavior. The shock is painful but is not at a dangerous level. The electric shock was also used in an avoidance contingency where the child had to obey the “come here” command in order to avoid a shock to the feet. Both these contingencies helped increase positive behavior and decrease negative behaviors with minimal side effects. One positive outcome included the child generalizing the punishment to multiple behaviors. Since these behaviors are seen as being in the same response class it could explain why the child was able to generalize. They saw an increase in social behavior after treatment. Besides the children becoming more affectionate the experimenters observed the children being more alert and over all looked happy. After these studies it was believed that the positive side effects outweighed the negative side effects (Lichstein & Schribman, 1976).
Electroconvulsive Therapy (1930’s- Present)
Although many people may view electroconvulsive therapy as controversial treatment, a study has been done showing positive results. Wachtel, Contrucci-khun, Griffin, Thompson, Dhossche and Reti (2009) of the Kennedy Krieger Institute, colleagues at Hopkins Hospital and the University of Mississippi Medical center used Electroconvulsive therapy (ECT) on an eight year old autistic boy. Although this is a very controversial treatment they thought it was the only option since the autistic boy had severe self destructive behaviors and had to be restrained for his own safety. After the administration of the ECT three times a week for five weeks the child showed major improvements. The boy’s self injurious behaviors decreased from 109.3 per hour to 19.4 per hour (Wachtel, et al., 2009). It is still unclear why this therapy works and this is the first known successful case (Wachtel, et al., 2009). The therapy may have been helpful in this case but it is clearly still unknown whether this type of therapy should be revisited by researchers.
1980s-1990s – Currently there treatments in biochemical, Nuerosensory, psycho-dynamic and behavioral.
Biochemical – diet (1920’s -Present)
Due to the theory that autism is caused by diet one treatment involves taking out gluten and casein from the child’s diet as a curative treatment. This theory first began in the 1920s and studies are still being conducted today (Elder, Shankar, Shuster, Theriaque, Burns, & Sherrill, 2006). In one study when gluten and casein were removed from the diets of 149 autistic children they saw improvements in three months (Elder, et al., 2006). Although there are studies done much of the evidence is anecdotal (Herbert, et al., 2002). In a preliminary study by Elder, et al. parents noted improvements in behavior and language, however data was no significant. To increase the success of this therapy it is paired with other behavioral treatments as well (Elder, et al. 2006).
Neurosensory – auditory therapy (1980’s)
Auditory integration training (AIT) was first developed by Berard in France in 1982 (Sinha, Silove, Wheeler, & Williams, 2006). The therapy is meant treat the auditory sensitivity many autistic children suffer from. Berard believed that these sensitivities to different sound waves caused many behavior and learning problems. During therapy the children would listen to a two half hour session of music for ten days. The music was modified and used devices to filter and dampen certain frequencies in an effort to give the child a “re-education” of hearing. This method received attention after he had great success by using AIT to completely cure a young girl with autism. There are other methods of AIT as well which all require the child to listen to modified sounds or voices for a set period of time trying to mend the defects in the auditory processing. This type of treatment has had success stories but like many other treatments of autism it needs more empirical research behind it before it is used universally (Sinha, et al., 2006)
Psycho-dynamic – holding therapy
Holding therapy is a treatment for autism developed by Martha Welch (Foxx et al. 1999); however, it is not backed by any empirical evidence. Physical methods are used to restrain the child and force the child to make eye contact with the adult. Holding therapy is based to two ideas although neither one has any experimental evidence behind it (Mercer, 2009). First is the idea that autism is based on a disturbance in the relationship between the mother and child which goes back to the idea of refrigerator mothers. The second idea is that this disturbance in attachment can be forcefully fixed when the child is physically controlled by the adult. This type of therapy can be dangerous for the child and there is no empirical evidence to back up this treatment (Mercer, 2009).
Similar to “holding therapy” Temple Grandin who is a high functioning autistic, developed a squeeze machine that gave her total body pressure without being touched by another person which she disliked (Mercer, 2009). Although there are similarities between holding therapy and the squeeze machine, they are very different. The squeeze machine is under the control of the patient whereas holding therapy is an adult asserting control over the child. Another therapy, sensory integration therapy, either was developed parallel to or right after holding therapy and uses pressure and weights to change a child’s experience. They use items such as trampoline jumping. This therapy also does not have empirical evidence behind it yet and is not used regularly (Mercer, 2009).
Behavioral – Applied Behavior Analysis (1960’s- Present)
Applied behavior analysis (ABA) therapy developed by Ivar Lovaas in the 1960s is currently viewed as the most effective therapy for children with autism and has the most research behind it (“Applied Behavior Analysis,”2009). One significant study done by Lovaas treated 19 children with autism using ABA and 49% of them reached average IQ scores and were in standard classes (Herbert, J.D., Sharp. I.R., & Gaudiano, B.A., 2002). The earlier the intervention the more effective this therapy is (“Applied Behavior Analysis,” 2009). This is an intense therapy approach which is ideally done for most of the child’s awake hours (Herbert, et al. 2002). A therapist will come to the child’s home and the parents are taught to continue the therapy once the therapist is gone. Because the therapy is very intense it helps the children learn basic concepts that they otherwise would not have learned in a normal classroom setting The focuses are on teaching motor, social, and reasoning skills (“Applied Behavior Analysis,” 2009). ABA uses careful observation of behaviors followed by positive reinforcement. This means when the child does the correct behavior they receive something they find rewarding such as a sticker. The theory behind this method is to look at what triggers an unwanted behavior and what reinforces the behavior. Then the parent or therapist can stop the trigger and the reinforcement afterwards. When appropriate behavior happens it is reinforced. Ideally with the reinforcement for the good behaviors and the removal of the reinforcement for the unwanted behaviors, even with the trigger the child will learn to behavior appropriately. Generally ABA is taught in a one-on-one setting or in a small classroom where the teacher to student ratio is very close. It is necessary for the children to receive specific attention so that programs are catered specifically for each child (“Applied Behavior Analysis,” 2009).
Applied Behavior Analysis for Children With Autism. (2009). Retrieved November 7, 2010, from http://autism.healingthresholds.com/therapy/applied-behavior-analysis-aba
Bender, L., Goldschmidt, L., & Siva, D.V. (1962). LSD-25 helps schizophrenic children. American Druggist, 146(13), 33. Retrieved from http://www.erowid.org/references/refs_view.php?A=ShowDoc1&ID=2220
Elder, J.H., Shanker, M., Shuster, J., Theriaque, D., Burns, S., & Sherrill, L. (2006). The grluten-free, casein-free diet in autism: Results of a preliminary double blind clinical trial. Journal of Autism and Developmental Disorders, 36(3), 413-420. doi:10.1007/s10803-006-0079-0
Foxx, R., Glenn, S., Green, G., Jacobson, J., Lee, L., Lesto, S., Maurice, J., Niederberger, S., Perry, L., Romanczyk, R., Shook, G., & Taylor, B. (1999). ASAT supports proven treatments and informed choice. Science in Autism Treatment, 1(2), 1-14. Retrieved from www.asatonline.org/pdf/Fall99v2.pdf
Herbert, J.D., Sharp, I.R., & Gaudiano, B.A. (2002). Separating fact from fiction in the etiology and treatment of autism. The Scientific Review of Mental Health Practices, 1(1), 1-35. Retrieved from http://www.srmph.org/0101/autism.html
Lichstein, K.L, & Schreibman, L. (1976). Employing electric shock with autistic children. Journal of Autism and Childhood Schizophrenia, 6(2), 163-173. doi:10.1007/BF01538060
Mercer, J. (2009, September 17). Re: Child myths: Holding therapy and autism. Retrieved from http://www.psychologytoday.com/blog/child-myths/200909/holding-therapy-and-autism
Seattle Community Network. (2009). Drugs and other treatments as they relate to the spectrum. Retrieved November 14, 2010, from http://www.scn.org/autistics/pharmaceuticals.html
Sinha, Y., Silove, N., Wheeler, D., & Williams, K. (2006). Auditory integration training and other sound therapies for autism spectrum disorders: A systematic review. Archives of Disease in Childhood, 91(12), 1018-1022. doi:10.1136/adc.2006.094649
Wachtel, L.E., Conntrucci-Kuhn, S.A., Griffin, M., Thompson, A., Dhossche, D.M., & Reti, I.M. (2009). ECT for self-injury in an autistic boy. European Child and Adolescent Psychiatry, 18, 458-463. doi: 10.1007/s00787-009-0754-8
ABA Therapy Help for Autism. Posted by Tyler Jackson. Retrieved from http://www.youtube.com/watch?v=_qDv7fC_izw&feature=player_embedded#!