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.

Parentectomy (1950’s)

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).

References

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

Image/Video

ABA Therapy Help for Autism. Posted by Tyler Jackson. Retrieved from http://www.youtube.com/watch?v=_qDv7fC_izw&feature=player_embedded#!

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  38. Well, I’m surprised with the fact that shock therapy ever used as a treatment. But that actually give a good outcome. While the ECT,although this considered to be one potential treatment, I also read somewhere it can cause several side effects.

  39. Maggie says:

    Hi, just wondering what date this was published?
    I need it for a citation.
    Thanks.

  40. a rattlesnake says:

    they forget to mention all those other
    Wonderful chemicals they still currently give autistic kids. Since they can’t use LSD .
    such as amphetamines..anti seizure meds .and risperdone . . abd with autism ..all kinds of off label prescribing goes on .. .

  41. Megan Rotunno says:

    Hi Brooke and Kyra,

    I would like to use this particular article, Evolution of the Treatments for Autism, for a paper that I am writing. When was this particular blog post written.

    Thanks,

    Megan

  42. […] demonised by researchers and lay people alike. The history of attempted treatments of Autism is long and controversial, but I’ll cover some means in which people have attempted to cure Autism from different […]

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  44. Rolandia V says:

    According to multiple reports, via SI.com, Heat forward Michael Beasley, in his first game back with Miami after signing as a free agent this summer, had an incident in his first game. Despite scoring nine points and adding two rebounds, Beasley reportedly required “medical treatment” after punching himself in the head out of frustration. But if you are autistic and punch yourself, it’s considered no big deal…mmmm what a case of discrimination here.

  45. Sumner says:

    I was hoping to cite this for a paper I am writing. what is the publication date? Thank you!

  46. Kim Barnes says:

    I would like to use your article. How do you site it? Do you have a date? Thanks.

  47. Hi! Could you give us a date or any information to site your article? I need it in MLA format by tomorrow! Thanks, Shelby

  48. Kristine Isaacson says:

    I too would like to site your article for a research paper and would like to know the date of the article. Thanks, Kris

  49. Amar says:

    The first time the word autism was recognized was back in 1908 by Eugen Bleuler. He used the word autism on patients who were schizophrenic who displayed symptoms of being self absorbed and screened off from the world.

  50. Kate says:

    I would like to reference this article but when was the date of publication?
    Thank you!

  51. Lizzie says:

    I agree, I would like to cite some of this information in my assignment but how should I reference you? Or even which date was this published? Thanks

  52. […] still researching this topic, but I found a reference on another blog that refers to ‘parentectomy’ [1] as the approach favored by Bruno Bettelheim. He believed […]

  53. Melinda says:

    please tell me how you would like your article sited. Thank you. Melinda

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