The results of three new studies about treatments for autistic children—one about an ‘alternative medicine’ treatment, one about medications and one about educational-behavioral therapies—cohere closely with my husband and my experience of using such treatments for our son Charlie. In the three separate studies, the authors made an extensive review of published research about all three treatments; more than a few studies had to be discarded due to a lack of high-quality research.
The studies are published in the April 4th edition of Pediatrics, the journal of the American Academy of Pediatrics. The analyses were funded by the Agency for Healthcare Research and Quality and the full report can be read as a PDF file.
Charlie’s a teenager now, but when he was much younger we tried quite a few biomedical treatments. We did purchase some secretin, the gastrointestinal hormone used to treat stomach ulcers that, in 1998, was reported to have produced significant improvements in some autistic children. After listening to reports from other families about using secretin and reviewing the evidence, we decided not to use the pig secretin (which was what families were using) for Charlie. An article about the Pediatric studies in Business Week notes that, after analyzing seven randomized controlled trials about secretin, the authors “found no benefit in treating autism symptoms and that it wasn’t even worth further study.”
Findings were more encouraging about the use of medications and behavioral treatments. Regarding the former, the authors noted that some antipsychotic medications, including risperidone and aripiprazole, have benefits in helping autistic children better manage such ‘challenging’ behaviors as self-injurious and aggressive behaviors. However, a randomized, controlled trial on SSRIs showed that these had no benefit in controlling repetitive behaviors, while one about using stimulants to counter hyperactivity was positive, but more research is needed.
Charlie takes a number of different medications including aripiprazole (Abilify) and an SSRI. A brief trial of stimulants a few years ago was disastrous for him. He took risperidone for a few years and it initially helped (we did see the common side effects of weight gain), and then it did not seem to be helping. A difficult period followed in which we took Charlie off of risperidone and started him on other medications (a very challenging process as Charlie has little language to tell us about the effects of all this). He now takes some other medications besides the two mentioned above for anxiety. He has done well with all this, though a key aspect of figuring out the right medications and dosages has been finding a very good neurologist with an excellent office staff.
The third study in Pediatrics looked at behavioral therapy and found it, as many previous studies and reports have, beneficial for some children (especially in regard to ‘challenging’ behaviors) and not so much for others. As the Wall Street Journal says, this third study looked at 34 studies of these treatments, 23 of which the reviewers rated as ‘poor quality’:
Early intensive behavioral treatments can involve multiple hours of practicing skills with a therapist each week for years. Experts have long advocated their use for improving cognitive and social symptoms, but research to assess their value has been difficult to conduct.
…there was enough evidence to suggest that these therapies improved IQ, language skills and day-to-day skills in some children with autism-spectrum disorders, the researchers said. Overall, however, more and better-quality research was needed, Dr. [Zachary Warren, a study author and director of Vanderbilt's Treatment and Research Institute for Autism Spectrum Disorders] said. “Our ability to say this one specific approach should be utilized for the child in front of me — we’re not quite there yet,” he said.
Behavioral therapy in the form of Applied Behavior Analysis (ABA) has been the basis of my son’s education since he was two years old. There are limitations to ABA, which can be an overly highly structured teaching methodology. Charlie is on the moderate to severe end of the autism spectrum and has had the full range of ‘challenging’ behaviors (such as head-banging) and I have found (anecdotally) that families whose children have fewer of these, or whose children have more verbal and academic abilities, have not always found ABA so effective.
I do have to say that, thanks to the years of education and the right combination of medications, Charlie has been doing well, especially after some extremely difficult years when he entered puberty and grew about nine inches. Over the years, we’ve read research study upon research study and heard tell of too many ‘amazing autism treatments.’ Have we become hardened? weary? or rather wary? Parents who can only nod when someone tells them about some ‘new thing they’ve heard of.’ Our goal is to help steer Charlie into a happy, productive, adulthood and life in the community: It was not too long ago that Charlie would have been sent to an institution as a child. Current research is limited, current treatments don’t work for everybody, but the options for Charlie today are better than in the past, and we are glad for each day he lives with us.
Photo of a child using the Picture Exchange Communication System (PECS) by jennratonmort.