Study: Children with autism can learn social skills

A recent study indicated that children with autism can learn how to be social.

When Debra Kamps, senior scientist at the University of Kansas Life Span Institute, first began researching how to improve the social and communication skills of children with autism in natural settings like schools in the 1970s, it was hard to find children with autism spectrum disorders (ASD) who were in classrooms with their typically developing peers.

Today, Kamps and her colleagues from KU and the University of Washington can say with certainty that they know how teachers, speech therapists and others can teach social and communication skills to kids with ASD and their peers in the classroom, at lunch and even at recess after the results of the first large randomized study of a social communication intervention verified years of earlier research.

"We know how to do this, and our research has shown us that it is not hard to teach people how to do it," she said.

The four-year study, funded by the U.S. Department of Education, involved 95 students with ASD in Kansas and Washington. Of that group, 56 children participated in a two-year intervention from kindergarten through first grade in which each child was grouped with two to three typically developing classmates in a peer network, while the remaining 39 were the control group.

The social peer network focused on teaching social communication skills such as requesting, commenting and saying "niceties" such as please and thank you while playing with toys and board games.

To find out if the children were continuing to use social skills, the researchers followed up with probes outside of the intervention sessions at four points in time.

"We found that the children who participated in the social network not only made significant progress in social communication during the intervention but also made many more initiations to their peers in general," Kamps said. "Teachers also reported that children in the intervention were more social and had better classroom behavior."

Although peer networks are still not used routinely in schools, often due to lack of resources, Kamps hopes that the promising results from larger studies will change that, and she said that some teachers who participated in the study have adopted the Peer Networks intervention in their classrooms.

"Seeing the expression on the faces of the children when their peer buddies come to class -- that's what's kept me going all these years," she said.

See video from the project here: http://autismconnections.ku.edu/connecting-kids/play-tips

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Persistent debunked autism fads

This study from Emory University discusses why debunked autism treatment fads continue to persist.

The communication struggles of children with autism spectrum disorder can drive parents and educators to try anything to understand their thoughts, needs and wants. Unfortunately, specialists in psychology and communication disorders do not always communicate the latest science so well.

These factors make the autism community especially vulnerable to interventions and "therapies" that have been thoroughly discredited, says Scott Lilienfeld, a psychologist at Emory University.

"Hope is a great thing, I'm a strong believer in it," Lilienfeld says. "But the false hope buoyed by discredited therapies can be cruel, and it may prevent people from trying an intervention that actually could deliver benefits."

Lilienfeld is lead author of a commentary, "The persistence of fad interventions in the face of negative scientific evidence: Facilitated communication for autism as a case example," recently published by the journal Evidence-Based Communication Assessment and Intervention. Co-authors of the commentary are Julia Marshall (also from Emory) and psychologists James Todd (from Eastern Michigan University), and Howard Shane (director of the Autism Language Program at Boston Children's Hospital).

The authors describe a litany of treatments for autism that have been attempted with little or no success over the years, including gluten- and casein-free diets, antifungal interventions, chelation therapy, magnetic shoe inserts, hyperbaric oxygen sessions, weighted vests, bleach enemas, sheep-stem-cell injections and many more.

As a case study, however, the article focuses on one intervention in particular: Facilitated Communication, or FC.

FC purports to allow previously nonverbal individuals with autism and related disorders to type by using a keyboard or letter pad. A facilitator offers support to the individual's arms, allowing him or her to type words and complete sentences.

Soon after its introduction into the United States in the early 1990s, however, FC was convincingly debunked. Studies overwhelmingly demonstrated that facilitators were unconsciously guiding the hands of individuals with autism toward the desired letters, much as individuals using a Ouija board unknowingly guide the planchette to certain numbers and letters.

"The emotional appeal of FC is very powerful and understandable," Lilienfeld says. "And no doubt the overwhelming majority of people who use FC are sincere and well-meaning. The problem is, it doesn't work."

In some cases, the authors note, FC has resurfaced with minor variations in the technique and a new name, such as "rapid prompting," or "supported typing."

By reviewing published surveys of practitioner use and canvassing the popular and academic literatures, Lilienfeld and his co-authors show that FC continues to be widely used and widely disseminated in much of the autism community despite its scientific refutation. They examine a number of potential reasons for the surprising persistence of FC and other autism fads. They note that the inherent difficulties in treating autism may give rise to an understandable desire for quick fixes of many kinds.

Lilienfeld and his colleagues underscore the pressing need for experts in the autism field to better educate the public about not only what works for the condition, but what does not.

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Is their a link between autism and lyme disease? No.

Some patients have asked about a link between autism and lyme disease. There does not appear to be a significant link. - JR

Autism-Lyme 

Correlation Debunked

Researchers find zero evidence for Lyme-induced autism.

WIKIMEDIA, SCOTT BAUER, USDA

The hypothesized link between autism and Lyme disease loses ground with a new study that found no evidence of an infection in patients with the social development disorder. The results, published today (April 30) in the Journal of the American Medical Association, imply that antibiotics against the Lyme disease pathogen—a popular new strategy for autism—will not ameliorate most patients’ symptoms.

“The data don’t address whether a single case of autism was ever caused by Lyme disease, but it rules out the suggestion that it does so with any frequency,” said Armin Alaedini, an immunologist at Columbia University Medical Center in New York and an author on the study. “I think that for me, this is the end of looking into the link between autism and Lyme.”  

In recent years, some doctors have anecdotally noted that many of their autism patients have Lyme disease. Two small studies listed in a booklet from a 2007 meeting of the Lyme-Induced Autism Foundation, a Corona, California-based organization that advocates an “eclectic healing approach,” reported that 1 in 5 autistic patients had the tick-borne disease. Websites on the topic now put that number closer to 9 out of 10. These statistics, however, have not been peer-reviewed. Nonetheless, some doctors prescribe antibiotics to autistic children and say the therapy quells their symptoms.

To systematically assess the prevalence of Lyme disease among people with autism, Armin Alaedini, an immunologist at Columbia University Medical Center in New York, and his colleagues analyzed blood samples from 120 children and teens: 70 participants had autism, and 50 served as healthy controls. Alaedini looked for antibodies against the bacterium underlying Lyme, Borrelia burgdorferi, and found that not a single participant tested positive for the infection.

“This means that you wouldn’t see 20 percent of children with autism getting their disease from Lyme,” Alaedini said. He entered into the study objectively, he said, wanting to explore a correlation that had gained traction among doctors and the public. “Autism has become a hot topic, and a lot of people are publishing findings that are bogus but still alarm parents.”

M. Ajamian et al., “Serologic markers of Lyme disease in children with autism,” Journal of the American Medical Association, 309: 1771-72, 2013.

Link to article here

Success of "Integrated Play Groups" for children with autism

This article explains how "Integrated Play Groups" where children interact with each other instead of with adults helps children with autism.

It's an often agonizing challenge facing any parent of a child with autism: How can I help my son or daughter socialize with his or her typically developing peers? The solution, SF State's Pamela Wolfberg found, may lie in a different type of playgroup that focuses on collaborative rather than adult-directed activities.

A new study shows that "Integrated Play Groups," or IPGs, developed by Wolfberg over several years, are effective in teaching children with autism the skills they need to interact with their peers and engage in symbolic play such as pretending. In IPGs, adults help children with autism and their typically developing peers engage in playful activities of mutual interest, but do not direct the play themselves. That sets them apart from more traditional interventions, according to Wolfberg, a professor of special education and communicative disorders.

"Children learn much better how to play through interactions with peers than they do from adults, because adults are not like children anymore," she said. "We can definitely have wonderful interactions with kids through play, and we should. But this is qualitatively different."

Wolfberg and her colleagues studied 48 children with autism during free-play activities, in which they did not know the other children, twice before and once after those same children participated in an Integrated Play Groups program with familiar peers. They found that, following the IPG intervention, the children's ability to interact with kids they did not know and to engage in pretend play had risen dramatically, indicating the IPGs were successful in providing them with transferable social and symbolic play skills.

Children with autism, according to Wolfberg, tend to have a "very restrictive play repertoire," in which they may have unusual interests and repeat the same activity, most often by themselves. The goal of Integrated Play Groups is to move children from engaging in lower levels of play, such as simply banging something, to engaging in more symbolic play that involves reciprocal interaction with peers.

"The earthquake-rescue theme is the most popular in San Francisco, and we had a little boy just like that, who had an affinity to bang things," she said. "So the kids came up with this idea of building cardboard blocks and having an earthquake, and he was the construction worker. He was able to participate in other kids' interest, build something more elaborate and have a whole fantasy about it."

The success of IPGs is an opportunity for parents, educators and therapists seeking to help children with autism in socializing with their peers. In addition, the IPG model also teaches typically developing children about autism and lets them learn how to form friendships with kids who might play, communicate or relate differently.

"This is what families want for their kids," added Wolfberg. "This flips around the idea that kids with autism are incapable of socializing or incapable of pretending. They have the same innate drive to participate with peers and to engage in playful experiences, but what has been happening is we have not been able to tap into their potential."

Future research will involve collaboration with assistant professor Betty Yu and graduate students to look more closely at how Integrated Play Groups can help children with autism better communicate with their typically developing peers, another challenge they face. Wolfberg also has been adapting the IPG model to be used in other countries, including Saudi Arabia, where she traveled this fall.

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Importance of spotting autism early

A study shows the importance of spotting and treating autism early and how it affects long-term prognosis.

Among infants as young as 6 months old who exhibited symptoms of autism, therapy provided by parents seemed to prevent developmental delays by age 3 in most of the tots, a small new study suggests.

Researchers from the University of California, Davis MIND Institute found that six of the seven infants in the study had caught up in language and other learning skills between the ages of 2 and 3 -- before the age most children with autism are usually diagnosed.

But the therapy program used in the study -- administered by parents during daily feeding, diapering and play routines -- needs to be researched in larger, randomized trials, the study authors cautioned.

"These data do not prove this intervention either prevented autism or ... changed the course," said study author Sally Rogers, a professor of psychiatry and behavioral sciences. "We were really testing a proof of concept: Could the infants' developmental patterns be changed?" she explained.

"Parents are hearing more and more about autism and the early signs for it. We don't have diagnostic tools or validated treatments for this age group. So parents and pediatricians are sort of in limbo on this, which is why we're working so hard on it," Rogers said.

The study was published online Sept. 9 in the Journal of Autism and Developmental Disorders.

As many as one in 68 children in the United States has an autism spectrum disorder (ASD), according to the U.S. Centers for Disease Control and Prevention. ASDs are characterized by deficits in typical behavior, communication and social skills, and are about five times more common among boys than girls, the CDC reports.

Children with autism are diagnosed at an average age of 4, though some children can be diagnosed as early as age 2, according to the CDC.

Rogers and her colleagues researched the effects of "Infant Start" therapy on seven infants who were between 6 and 15 months old at the start of the study. Four had siblings with autism, but all seven were highly symptomatic for an ASD, exhibiting issues such as reduced eye contact, social engagement and intentional communication. All infants were otherwise healthy, with normal vision and hearing.

Parent participants underwent one-hour training sessions for 12 weeks that coached them to support their infants' attention to faces and voices, and helped them interpret and improve their babies' interest in social interactions.

Typically, children diagnosed with autism begin therapy between the ages of 3 and 4 years, six to eight times later than the children in this study, Rogers noted.

"Within six to eight weeks, parents were carrying out interactions at the same skill level as trained therapists," Rogers said. "It was framed all through play and pleasurable interactions through parents and children."

After follow-up assessments at 24 and 36 months of age, all but one of the infant participants tested normally for learning skills and language. These "very preliminary results" were compared to a similar group of four symptomatic infants who didn't receive the therapy -- all of whom continued to show significant developmental delays by the age of 3, Rogers said.

Dr. Paul Wang, senior vice president and head of medical research for the research and advocacy group Autism Speaks, called the study results "promising" but said much more research is needed to determine effective autism therapies for younger children.

"The goal of early autism screening is early treatment," Wang said. "Unfortunately, we're in a situation where we're really pushing early screening ... and now really need to invest in treatment research to show what are the most effective treatments at that early age. We need to come up to speed."

Rogers agreed, saying randomized, clinical trials are needed that enroll dozens of young children showing symptoms of autism and then follow them for several years. But the parent-driven Infant Start therapy would be inexpensive to implement, she noted.

"Whenever parents are delivering it and there's one visit a week with a therapist rather than 20, 30 or 40 hours with someone [else], you're saving a lot of money," she said.

But, "it doesn't mean parents should be drafted into the role of therapist," Rogers noted. "The reason we moved to this model is because babies are so young and don't respond well to strangers. They know their family and prefer their parents."

Wang said that the absence of official guidelines for screening infants symptomatic for autism doesn't mean parents and doctors can't act on early suspicions.

"If there are significant symptoms that have drawn the parents' attention, and the pediatrician or other referral source is concerned about it, we should not dismiss that," Wang said. "We should not say, 'The kid is too young, there's nothing we can do.' We don't know yet what's going to be best but we have early intervention services at this young age that can be started."

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Personalized interventions help autistic children

Personalized interventions help improve communication in children with autism.

A UCLA-led study has found that the communication skills of minimally verbal children with autism can be greatly improved through personalized interventions that are combined with the use of computer tablets.

The three-year study examined different approaches to improving communication abilities among children with autism spectrum disorder and minimal verbal skills. Approximately 30 percent of children with ASD overall remain minimally verbal even after years of intervention.

UCLA professor Connie Kasari, the paper's senior author, worked with researchers at Vanderbilt University and the Kennedy Krieger Institute. They found that children's language skills greatly improved when spoken- and social-communication therapy was tailored based on their individual progress and delivered using computer tablets.

The trial involved 61 children with ASD, ages 5 to 8. For six months, each child received communication therapy focusing on social communication gestures, such as pointing, as well as play skills and spoken language.

Half of the children were randomly selected to also use speech-generating applications on computer tablets for at least half of the time during their sessions. The tablets were programmed with audio clips of words the children were learning about during their therapy sessions and images of the corresponding objects. Working with a therapist, the child could tap a picture of a block, for example, and the tablet would play audio of the word "block." The researchers found that children who had access to the tablets during therapy were more likely to use language spontaneously and socially than the children who received the communication intervention alone -- and that incorporating the tablets at the beginning of the treatment was more effective than introducing it later in the therapy.

"It was remarkable how well the tablet worked in providing access to communication for these children," said Kasari, professor of human development and psychology in the UCLA Graduate School of Education and professor of psychiatry at UCLA's Semel Institute for Neuroscience and Human Behavior. "Children who received the behavioral intervention along with the tablet to support their communication attempts made much faster progress in learning to communicate, and especially in using spoken language."

Researchers also conducted follow-up visits with the children three months after the initial study period and found that their improvement had been maintained during that time. The study was the first ASD research to use a sequential multiple assignment randomized trial, or SMART, design. The approach, which enables researchers to tailor interventions according to how each child in the study responds, was designed by Daniel Almirall and Susan Murphy, biostatisticians at the University of Michigan who were members of the research team. It also was the first randomized, controlled trial on this underserved population of children to use a computer tablet combined with an effective behavioral intervention.

Other study authors were Rebecca Landa of Kennedy Krieger and Johns Hopkins University, and Ann Kaiser of Vanderbilt. The study was funded by a High Risk High Impact grant from the Autism Speaks Foundation.

The findings were published in the June issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

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iPad access could help children with autism speak

A study shows that iPad access may help speaking skills for children with autism.

Adding access to a computer tablet to traditional therapy may help children with autism talk and interact more, new research suggests.

The study compared language and social communication treatment -- with or without access to an iPad computer tablet -- in 61 young children with an autism spectrum disorder (ASD) and found that the device helped boost the effect of the treatment.

"All the children improved, but they improved more if they had access to the iPad," said Connie Kasari, professor of human development and psychology and psychiatry at the University of California, Los Angeles' Semel Institute for Neuroscience and Human Behavior.

The children used the iPad when they were engaged in play, she said. "It focused on helping them initiate conversation, using the iPad to comment on what they were doing. The iPad worked because it is a visual stimulant with auditory feedback," she explained. For instance, children would mispronounce a word, hear it pronounced correctly on the iPad, and then learn to say it correctly, she said.

But, Kasari emphasized, "The iPad is just a tool." It worked because it was used within a treatment aimed at helping improve the children's communication skills, she noted.

The study was published in the June issue of the Journal of the American Academy of Child & Adolescent Psychiatry. Autism Speaks, a research and advocacy organization, funded the study.

Autism spectrum disorders are a group of developmental disorders. Communication and social problems are hallmarks of ASDs. As many as one in 68 U.S. children has an autism spectrum disorder, according to estimates from the U.S. Centers for Disease Control and Prevention.

Children in the study were between the ages of 5 and 8. All were considered "minimally verbal," which experts define as speaking fewer than 20 functional words, Kasari said. "The majority had far fewer." About 30 percent of children with an autism spectrum disorder are minimally verbal, she said, sometimes even after years of treatment.

For the first three months, all of the children received two sessions a week, totaling two to three hours a week. At the three-month mark, nearly 78 percent of children in the iPad-added group had an early response, but just 62 percent of those in the group without it did, the investigators found.

An early response was defined as an improvement of 25 percent or more in half of the 14 measures, such as the number of spoken words and the use of new words, Kasari said.

If a child was not progressing at the three-month mark, the researchers added the tablet. But adding it later was not as effective as using it from the start, Kasari's team found. The researchers followed the children for three years.

"The idea of using an iPad is a novel approach," said Dr. Ruth Milanaik, an attending physician at the Cohen Children's Medical Center in New Hyde Park, N.Y. Milanaik treats children with autism and reviewed the study's findings.

"The idea of technology being used to help children who really need different approaches is so important," she said. It's crucial, however, she agreed, to understand that the iPad "was simply a tool" and that it was an adjunct to the traditional interventions that aimed to improve communication and other developmental advances.

While a 25 percent improvement -- the measure used to define response -- may not seem like much to some, Milanaik said that "every small step, for the parents of an autistic child, is monumental."

Kasari and her team are continuing to study the iPad, planning to enroll about 200 children in four cities during a planned five-year study.

If the research continues to bear out, the hope would be to use the iPads in school programs and to train parents in its use at home, both experts agreed.

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Autism study conducted entirely online

This article discusses a clinical trial for autism that was done completely online.

UC San Francisco researchers have completed the first Internet-based clinical trial for children with autism, establishing it as a viable and cost effective method of conducting high-quality and rapid clinical trials in this population.

In their study, published in the June 2014 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, the researchers looked at whether an Internet-based trial was a feasible way to evaluate whether omega-3 fatty acids helped reduce hyperactivity in children with autism. The authors found that not only was it a valuable platform for conducting the randomized clinical trial, but that it was both cost and time effective, as well.

"Recruitment for clinical trials in children with autism is one of the biggest challenges we face in studying potential treatments, and we found that process to be accelerated and streamlined by using existing online communities for enrollment," said lead author Stephen Bent, associate professor of medicine at UCSF. "This trial can serve as a model for how to efficiently test potential treatments through the growing power of online communities."

Using the Interactive Autism Network's (IAN) robust online community of parents, the researchers enrolled 57 children from 28 states into the randomized trial.

The enrolled children were randomly assigned to either receive 1.3 grams of omega-3 fatty acids or an identical placebo daily for six weeks. Once a week the participants' parents received an email asking them to complete outcome measures on how their child was doing and report on the child's level of hyperactivity. The children's teachers reported on changes in hyperactivity as well. The parent and teacher responses were submitted to a database, allowing the researchers to access the data immediately.

Because the IAN requires that parents complete a short questionnaire and verify that their child has been professionally diagnosed in order to participate in the online network, the researchers were able to confirm the participants met the diagnostic criteria for autism without a clinic visit.

While the researchers found that the omega-3 fatty acids did not lead to a statistically significant reduction in hyperactivity, they concluded the online trial was a promising technique for evaluating treatments for autism.

"The entire study was completed in slightly more than three months from the start of enrollment, and demonstrates there are many advantages including low cost, rapid enrollment, high completion rate, convenience for participating families, and the ability to participate from virtually any location," said Bent. "We had 100 percent completion of all outcome measures from parents and teachers, indicating that there is an ease to this method of testing that engages parents at a higher rate than traditional trials."

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Autism treatment may cost millions over a lifetime

A study shows that autism treatment for one person may run into the millions over a lifetime.

The lifetime cost of supporting just one person with autism can range from $1.4 million to $2.4 million, with factors as varied as lost wages, residential care and special education driving up expenses, a new study has found.

Medical care plays a role in pushing these costs, but is not the main factor, said study senior author David Mandell, director of the Center for Mental Health Policy and Services Research at the University of Pennsylvania Perelman School of Medicine.

Lost wages are a critical driver for the lifetime cost of autism, as parents leave work to care for their autistic children and adults with the disorder fail to find or maintain employment, Mandell said.

Other major factors include the expense of special education for children and residential care for adults.

"When we think about what is needed to support people with autism, we so often look to medical care for that support," he said. "I think this shows there are other places we need to look as well."

In the study, researchers cast a wide net to gather data on a variety of economic concerns related to autism spectrum disorder, both in the United States and in the United Kingdom.

The investigators concluded that the average lifetime cost to care for a person with autism without intellectual disabilities is about $1.4 million in both the United States and the United Kingdom.

People with autism who also have intellectual disabilities cost about $2.4 million during their lifetime in the United States and about $2.2 million in the United Kingdom.

"This study shows us what we've all known but never had the data to support -- that autism is alarmingly expensive," said Michael Rosanoff, associate director of public health for Autism Speaks, the nonprofit advocacy group that funded the research.

Medical care for children with autism can cost between $6,467 and $18,106 a year, depending on the age of the child and the level of intellectual disability. For adults with autism, medical costs range between $13,580 and $27,159 annually, according to the study.

By comparison, special education for children with autism costs one-and-a-half to nearly five times as much as their medical care. Costs for special education run between $13,980 and $62,920 a year, again depending on age and intellectual disability, the study found.

Parents' lost wages cost an average $18,720 annually for the care of a child with autism, outpacing medical expenses. "Mothers drop out of the workforce to care for their children with autism, and those wages are substantial," Mandell said.

Residential care is the largest average expense for adults with autism, costing between $18,080 and $36,161 annually -- more than twice the amount spent on medical care. Lost wages for adults with autism cost about $10,718 a year, the study authors said.

The numbers for both children and adults suggest that "there's a very high expense of not properly caring for children with autism," Mandell said.

"If we were able to provide better and more appropriate care for these children, mothers wouldn't be dropping out of the workforce," he said. "We also really need very different workplace policies that support the parents of children with disabilities."

The adult costs of autism could reflect a failure to properly prepare children with autism for their entry into the wider world, Mandell said. With better education and training, these children might be able to live outside residential facilities and hold steady jobs.

"That's the $2.4 million question, isn't it? If we provided better early intervention, would we then see a different trajectory that would result in reduced costs for adults with autism?" Mandell said. "Our study doesn't answer that, but it needs to be answered."

Rosanoff noted that as astronomical as these figures are, the true cost is likely greater. Researchers prepared the study based on the U.S. Centers for Disease Control and Prevention's estimate of autism prevalence, which was 1 in 88 people.

But two months ago the CDC revised its estimate, and now figures that 1 in 68 people have autism, he said.

"The numbers in this report are an underestimate of the true cost of autism in society, at least in the U.S.," Rosanoff said.

According to the U.S. National Institutes of Health, autism -- or autism spectrum disorders -- represent a range of developmental disorders characterized by impaired social interactions, problems with verbal and nonverbal communication, and repetitive behaviors or severely limited activities and interests.

The study findings were published online June 9 in the journal JAMA Pediatrics.

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Study shows that dog ownership is beneficial to children with autism

A study shows that dog ownership has beneficial effects for children with autism.

A recent study published in the Journal of Pediatric Nursing has strengthened the notion that dog ownership can be beneficial to children on the autism spectrum.

It was reported by Gretchen Carlisle, PhD, of the University of Missouri Research Center for Human-Animal Interaction (ReCHAI) that “Children with autism spectrum disorders often struggle with interacting with others, which can make it difficult for them to form friendships.” This comes on the heels of reports that the majority of children with autism strongly bond with dogs.

Dr. Carlisle says, “Children with autism may especially benefit from interacting with dogs, which can provide unconditional, nonjudgmental love, and companionship to the children.” In the study, 70 people who had children with autism participated.

The results showed that 66 percent of these families had dogs in the house, and an astounding 94 percent said their children had formed strong bonds with the family pet.

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What are the treatment options for autism?

This article discusses the possible treatment options for children with autism. Please note that children with multiple disorders present with autism. A consultation and a neuro-genetic diagnosis are very important early on. - JR

There is currently no one standard treatment for autism.

For many people with ASD, it is not too late to benefit from treatment, no matter how old they are when they are diagnosed. People of all ages, at all levels of ability, can often improve after well-designed interventions.

But there are many ways to help minimize the symptoms and maximize abilities. People who have ASD have the best chance of using all of their abilities and skills if they receive appropriate therapies and interventions.

The most effective therapies and interventions are often different for each person. However, most people with ASD respond best to highly structured and specialized programs.¹In some cases, treatment can help people with autism to function at near-normal levels.

Research shows that early diagnosis and interventions, such as during preschool or before, are more likely to have major positive effects on symptoms and later skills. Read more about early interventionsfor autism.

A genetic, neurometabolic diagnosis can be helpful in treatment and in finding co-morbid conditions. Seizures are common and found in 30% of children. If your child has had a regression, staring spells or other events of unclear etiology, ask your doctor. 

Because there can be overlap in symptoms between ASD and other disorders, such as attention deficit hyperactivity disorder (ADHD),2 it’s important that treatment focus on a person’s specific needs, rather than the diagnostic label.

Select the links for more information on each type of treatment for ASD.

Types of Therapies for ASD

• Behavioral management therapy 
• Cognitive behavior therapy 
• Early intervention 
• Educational and school-based therapies 
• Joint attention therapy 
• Medication treatment 
• Nutritional therapy 
• Occupational therapy 
• Parent-mediated therapy 
• Physical therapy 
• Social skills training 
• Speech-language therapy 

If you have a question about treatment, talk to a health care provider who specializes in caring for people with ASD. These resources have more information about treatments for autism:

• The Centers for Disease Control and Prevention describes some treatment options.
  http://www.cdc.gov/ncbddd/autism/treatment.html
• The Autism Speaks organization offers a Family Services Resources guide. You can search the guide to find autism-related care and services in your area.
  http://www.autismspeaks.org/community/fsdb/search.php 

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Complementary medicine is commonly used to treat children with autism

Treatment for autistic children is often seen using alternative medicine in complement to medicine treatments.

In a study of the range of treatments being employed for young children with autism and other developmental delays, UC Davis MIND Institute researchers have found that families often use complementary and alternative medicine (CAM) treatments and that the most frequent users of both conventional and complementary approaches are those with higher levels of parental education and income.

There is no Food and Drug Administration-approved medical treatment for the core symptoms of autism spectrum disorder, a lifelong neurodevelopmental condition whose hallmarks are deficits in social relatedness, repetitive thoughts and behaviors and, often, intellectual disability.

In the search for treatments to help their children, families may turn to unconventional approaches such as mind-body medicine (e.g. meditation or prayer), homeopathic remedies, probiotics, alternative diets or more invasive therapies such as vitamin B-12 injections, intravenous immunoglobulin or chelation therapy -- some of which carry significant risks.

The research is published online today in the Journal of Behavioral and Developmental Pediatrics. It was led by Robin Hansen, director of the Center for Excellence in Developmental Disabilities at the MIND Institute and chief of the Division of Developmental Behavioral Pediatrics in the UC Davis School of Medicine.

"In our Northern California study population, it does not appear that families use complementary and alternative treatments due to the lack of availability of conventional services, as has been suggested by other research," Hansen said. "Rather, they use the treatments in addition to conventional approaches."

The cause or causes of most neurodevelopmental disorders are not known, and the conditions have no cure. Many children suffer from a wide array of associated symptoms that may not be directly associated with their condition and that make their daily lives and those of their families stressful. Such symptoms include irritability, hyperactivity, gastrointestinal problems and sleep disorders.

The study included nearly 600 diverse children between 2 and 5 years with autism and developmental delay who were enrolled in the Childhood Autism Risk from Genetics and the Environment (CHARGE) study. Of the participants, 453 were diagnosed with autism and 125 were diagnosed with developmental delay.

CAM use was more common among children with autism than children diagnosed with other types of developmental delay, 40 percent versus 30 percent respectively. Nearly 7 percent of children with autism were on the gluten-free/casein-free diet, particularly children with frequent gastrointestinal problems.

"We were pleased to find that most families utilizing CAM therapies were choosing ones that were low risk," said Kathleen Angkustsiri, assistant professor of developmental and behavioral pediatrics and a study co-author.

However, a small but statistically significant number -- about 4 percent -- were found to use alternative treatments classified by the study as potentially unsafe, invasive or unproven, such as antifungal medications, chelation therapy and vitamin B-12 injections.

"Our study suggests that pediatricians and other providers need to ask about CAM use in the context of providing care for children with autism and other developmental disorders, and take a more active role in helping families make decisions about treatment options based on available information related to potential benefits and risks," said Roger Scott Akins, lead author and a former postdoctoral fellow at the MIND Institute, who now is chairman of the Division of Neurodevelopmental Pediatrics at Naval Medical Center Portsmouth, Va.

Irva Hertz-Picciotto, professor of public health sciences and principal investigator for the CHARGE study, said the research supports the emergent need for identifying validated treatments for neurodevelopmental conditions.

"These findings emphasize the enormous and urgent need for effective treatments and for rigorous research that can identify them and verify their effectiveness and safety," Hertz-Picciotto said. "Of course it is reasonable for parents to keep searching for ways to help their children, when there are few effective treatments and none that can help every child."

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New and odd ideas for treating autism symptoms.

Fasten your seatbelt - new and unusual autism treatments (???): hot baths and worm eggs, were presented at a recent meeting  to help with autism symptoms. 

I was asked what I thought of these treatments... My impression, from a medical  standpoint is..."YIKES", "OMG" and "You are kidding, right?". 

It goes without saying, but Ill say it....I DO NOT recommend these therapies.   1) There does not seem to be biologic plausibility. 2) This is not nearly convincing data. 3) There may be dangers in these treatments (the picture of the child sitting alone in the bath is intended to be alarming).  

http://www.autism-watch.org/ is still a good site. 

Hardly a nihilist on therapeutics, I look forward to more data on effective treatments.    - JR

A new study shows that two unusual treatment approaches may have beneficial effects on the symptoms of autism in children and adults with the disorder. Using a hot bath to raise body temperature and thereby mimic the effects of infection, or using worm eggs to stimulate the production of immunoregulatory factors in the gut to diminish inflammatory signals, both attenuated symptoms of autism. These findings support the idea that disruption of systems in the body that control inflammation may contribute to the disorder. The study was presented at the American College of Neuropsychopharmacology (ACNP) Annual Meeting.

Approximately 1 in 88 children are afflicted with autism spectrum disorder (ASD). A prevailing hypothesis of ASD is that a hyperactive immune system, resulting in elevated levels of inflammation, may contribute to the disorder. Consistent with this possibility, it is known that approximately one third of those with ASD show a clinical improvement in symptoms in response to a fever.

In a new study led by Eric Hollander MD, a professor at Albert Einstein College of Medicine in New York, the effects of two novel treatment approaches that modify aspects of inflammation were tested on ASD symptoms.

First, as fever may trigger the release of protective anti-inflammatory signals in the body, the effects of raising body temperature to mimic fever on ASD symptoms were assessed. It was found that children with ASD and a history of positive behavioral response to fever had improved social behaviors when bathed each day in a hot tub at 102oF compared with water at 98 oF.

Second, using a more unusual approach, adults with ASD were treated for 12 weeks with Trichuris suis ova (TSO), which are the eggs of the worm helminth trichura (whip worm). This worm is safe in humans as it does not multiply in the host, is not transmittable by contact, and is cleared spontaneously. However, the worms can inhibit immune-mediated responses and diminish inflammation.

The subjects for this study were 10 high functioning ASD patients who were able to give informed consent and who had a history of allergies or a family history of immune-inflammatory illness. Patients were treated for 12 weeks with the worm eggs (2500 eggs every two weeks) but were also subjected to a 12 week placebo phase in a randomized order. It was found that adults with ASD had improvement in repetitive and ritualistic behaviors in response to treatment with the worm eggs.

This is not the first time that worm eggs have been used successfully to treat diseases, particularly immune-related diseases, in humans such as Crohn's Disease. As noted by Dr. Hollander, "TSO has been shown to improve various immune inflammatory illness by shifting the ratio of T regulator/T helper cells and their respective cytokines.."

The findings support the idea that inflammation may contribute to the symptoms of autism, at least in some individuals, and highlight novel treatment approaches. However, as noted by Dr. Hollander, the small sample size and unusual treatment approach means that caution should be exercised when interpreting the studies:

"Future studies in autism spectrum disorders are needed to replicate and expand these findings, and to study younger subjects with more severe irritability."

Nevertheless, the findings raise the intriguing possibility that approaches designed to module immune responses in ASD patients may be future treatment approaches for the disorder.

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Teaching children with Autism to turn their symptoms into strengths

This article looks at how some treat Autism symptoms by helping the child turn his or her symptoms into strengths.

A novel approach to treating children diagnosed with autism spectrum disorder could help them navigate their world by teaching them to turn their symptoms into strengths.

In the article "Symptoms as Solutions: Hypnosis and Biofeedback for Autonomic Regulation in Autism Spectrum Disorders," published in the winter edition of the American Journal of Clinical Hypnosis, Dr. Laurence Sugarman, a pediatrician and researcher at Rochester Institute of Technology, details a treatment method that teaches affected children how to control their psychophysiology and behavior using computerized biofeedback and clinical hypnosis.

The article coincides with the publication of the second edition of Sugarman's textbook, Therapeutic Hypnosis with Children and Adolescents, Crown House Publishing, 2013, written with William Wester.

Sugarman's model is tied to learning to self-regulate the autonomic nervous system -- including the fight or flight mechanism -- that, for many people with autism, is an engine idling on high.

"Teaching kids with autism spectrum disorder skills in turning down their fight or flight response and turning up the opposite may fundamentally allow them to be more socially engaging, decrease some of the need for cognitive rigidity and repetitive behaviors and, more importantly, allow them to feel better," says Sugarman, director of RIT's Center for Applied Psychophysiology and Self-regulation in the Institute for Health Sciences and Technology.

His treatment model underlies three ongoing projects at the center involving different age groups: teaching coping skills to RIT students with anxiety or autism; developing a computer-based role-playing game using autonomous biofeedback for teenagers; and creating a new service and research program for family members with autism for AutismUp (formerly Upstate New York Families for Effective Autism Treatment). The latter, called the Parent Effectiveness Program, began this fall and will repeat in the spring. The study trains parents of young children diagnosed with autism and measures results of their training on the behaviors of their affected children.

Sugarman developed his method in response to the rise in autism spectrum disorders he has witnessed in his 30 years working with children in primary care and, then, in developmental behavioral pediatrics at the Easter Seals Diagnostic and Treatment Center in Rochester. Instead of trying to change the symptoms associated with autism, his approach recognizes the symptoms as an effort to self-regulate inner turmoil.

The treatment integrates autonomic biofeedback and clinical hypnosis into his therapy. Sensors attached to his patients measure respiration, perspiration, heart rate and variation, and blood flow/circulation. Children with autism learn to correlate the signals and visual representations displayed on the computer screen (the "Dynamic Feedback Signal Set") with their emotions. During therapy sessions, the children practice changing their feedback response and learn to manipulate their own internal wiring. Sugarman uses clinical hypnosis to generalize and internalize feedback techniques -- discerning situations and controlling their responses -- into their daily lives.

Sugarman is a proponent of clinical hypnosis. He is the past-president of the American Board of Medical Hypnosis, the credentialing body for competency in clinical hypnosis for physicians in the United States. He also has a long association with the American Society of Clinical Hypnosis as an approved consultant, fellow in clinical hypnosis, past vice president and past co-director of education for the society.

"Hypnosis is a 250-year-old Western study of how social influence and internal physiology can be changed," he says. "Mindfulness is a slice of this."

Sugarman teaches pediatric hypnosis workshops around the world. This fall, he presented at the Regional Center for Child and Adolescent Psychiatry in Oslo, Norway, and the Milton Erickson Geselleschaft in Heidelberg, Germany. In Heidelberg, Sugarman also presented his treatment model and research using biofeedback and hypnosis with children with autism receiving "very affirmative responses."

"We think we can make a big difference for young people with autism spectrum disorder," Sugarman says. "The need is there."

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Autism treatment found beneficial regardless of treatment model

A new study shows that children who receive early treatment for autism benefit regardless of the approach or treatment model used.

Researchers at the University of North Carolina at Chapel Hill have found that preschoolers with Autism Spectrum Disorder (ASD) who receive high-quality early intervention benefit developmentally regardless of the treatment model used -- a surprising result that may have important implications for special-education programs and school classrooms across the country.

"This is the first study designed to compare long-standing comprehensive treatment models for young children with ASD," said Brian Boyd, a fellow at UNC's Frank Porter Graham Child Development Institute (FPG) and one of the study's co-principal investigators. Boyd also is an assistant professor in occupational science and occupational therapy in UNC's School of Medicine.

"We know that more children are being diagnosed with ASD each year, and that it can cost an estimated $3.2 million to treat each child over a lifetime. Understanding that a child can benefit from a high-quality program, rather than a specialized program, may help reduce those costs by decreasing the need for teachers and other school practitioners to be trained to deliver multiple specialized services," Boyd said. He stressed it remains important to ensure educators are trained to provide high-quality programs that meet the special behavioral, communication and other needs of children with ASD.

Previous research has shown that when children with ASD have access to early intervention via treatment programs, they improve developmentally. Until now, however, debate has persisted over which approach to use, said Boyd. The study appeared in the June issue of Journal of Autism and Developmental Disorders.

Two frequently used comprehensive treatment models have a long history: LEAP (Learning Experiences and Alternative Program for Preschoolers and their Parents) and TEACCH (now known only by its acronym).

FPG's study examined the relative effects of the LEAP and TEACCH school-based comprehensive treatment models when compared to each other and to special-education programs that do not use a specific model. The multisite study took place only in high-quality classrooms and enrolled 74 teachers and 198 3- to 5-year-olds in public school districts.

The study found that children made gains over the school year regardless of the classroom's use of LEAP, TEACCH or no specific comprehensive treatment model. "Each group of children showed significant positive change in autism severity, communication and fine- motor skills," said Kara Hume, FPG scientist and co-author. "No statistically significant differences were found among models, which challenged our initial expectations -- and likely the field's."

"This study may shift the field's thinking about comprehensive treatment models designed for young children with ASD," said co-author Samuel L. Odom, FPG's director and the study's principal investigator. "Perhaps it's not the unique features of the models that most contribute to child gains but the common features of the models that most influence child growth."

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