The May 2011 journal, Pediatrics, published two review articles looking at the role of different interventions for those in the autism spectrum. Researchers at Vanderbilt University did literature reviews from the last decade to determine what, if any, decent research there has been on the many types of interventions available.
I was not surprised to find that they found lots of studies, but few meeting the full criteria of quality research. Out of over 7500 articles identified in searches, there were only 34 that met the criteria for quality research on behavioral intervention and 18 for medication interventions. All the rest were lacking in one of 4 areas: 1) Risk of bias of outcomes based on study design, 2) Consistency or similarities of effect size across studies, 3) Directness of relationship of intervention and outcome and 4) Precision or level of certainty around the effect.
What they found with both articles were that behavioral interventions were more often linked with positive outcomes with language, social and adaptive skills. There still needs to be more research to quantify better what behavioral interventions can do, however. Medications were found to be focusing on inappropriate behaviors and did not have any significant effect on language, social and adaptive skills. Risperidone (Risperdal) and aripirazole (Abilify) decreased irritability, challenging and repetitive behaviors but had significant side effects and no effect on language, social and adaptive skills.
I personally feel that we need to look much closer at how we are trying to behaviorally help these children. I have seen numerous children who did well if approached correctly, but who decompensated when pushed beyond their limits, and then were sent off to be started on a medication to make them more cooperative. It almost never worked as well as people wanted and then they were back looking for more medication to fix “it”.
I am not against medication when needed, which is when a child’s own internal stress, anxiousness, obsessive and compulsive behaviors, or phobias, are making his/her life horrible. But we have to spend more time understanding the “whys” of his behavior first, and making environmental alterations. Then, if these emotional stresses are still impeding his ability to function, adding medication would be a reasonable adjunct intervention.
If I ran the world, I would redo our educational system for these children. I would allow them to have more time developing their language, social and adaptive skills before putting academics in front of them. If that meant that their first few years of school were spent with a large amount of time with ABA and Floortime/DIR or TEACCH interventions, then so be it. We definitely are not set up in an inclusive classroom with pull out to accomplish what most of these children need. They also need more access to para professionals (aka assistants, associates, aides, etc.) who can anticipate when they are becoming overwhelmed and provide them with the release from the situation to regroup and re-regulate their emotions.
These children have a lot to offer us, but we need to understand that we are there to be their teachers, coaches, and support people. We are not there just to make sure a benchmark for that school year is reached. Let’s think about how we can make today better for one child (or older person) in the autism spectrum.