Laura Schreibman, PhD, professor of psychology at the University of California, San Diego, answers commonly asked questions about Autism. Schreibman has given presentations at several ICare4Autism Conferences. The next ICare4Autism International Autism Conference is on the 1st & 2nd of August this year.” Schreibman directs the UCSD Autism Intervention Research Program, a federally funded research program focusing on the experimental analysis and treatment of autism. She is the author of three books and more than 140 research articles and book chapters. The Science and Fiction of Autism, published in 2005 by Harvard University Press, is her most recent book.
Recent research has been moving toward individualized treatments for children with autism. Why are treatment options for these disorders specific to each case?
Over the many years that effective interventions have existed for autism, researchers and clinicians have noted that treatment outcome is highly variable for this population. Even with our very best treatments, some children fail to respond, even minimally. However, variability in treatment response should not be surprising in that the nature of the autism spectrum is such that there is a high degree of variability in the population.
There are factors other than the treatment that determine outcome. These include child characteristics (again, highly variable across children), interaction of specific treatment and skills being taught, parent and family variables and cultural variables. Considering all these factors, it would be highly surprising if any single form of treatment would be effective for all children.
For many years, and still today, many researchers have focused on comparing one treatment to another treatment, or a treatment versus “usual care” in the community. In my own opinion, the idea of trying to figure out which specific treatment is “best” is a dead issue. We need to stop trying to figure out a one-size-fits-all treatment and focus on a technology that allows us to be open minded about what effective and evidence-based treatments are available and how to best fit the combination of these treatments to the specific features and needs of the individual child.
What are the most effective treatments for autism spectrum disorders?
Only behavioral treatment has been empirically proven to effect positive change in these children. For example, we can identify principles by which environmental events affect behavior. The identification of these principles allowed for the development of highly structured treatments that were the first to be proven scientifically as effective. I refer here primarily to the work of Dr. Ivar Lovaas at UCLA. This form of treatment involves presenting the child with several learning “trials” in a precise and repetitive manner such that instructions are consistent and correct responses are rewarded with food, praise or access to a preferred activity. These trials are repeated until the child demonstrates mastery of the specific skill being taught.
Continued research by behavior analysts identified important limitations to these treatments for some youngsters and this led to the development of more naturalistic, less structured treatments. Such naturalistic interventions involve procedures that are more play-based and child-directed. The idea is to make the therapy more fun and enjoyable so the child is more likely to want to participate in the treatment.
The earlier identification of children at-risk for an ASD has resulted in the ability to provide early intensive treatment and allows for substantial improvements in many of these very young children.
However, the ability to treat such young children has required that we adapt and broaden our existing behavioral interventions for these toddlers. Thus, we now see strategies that follow more of a developmental model, with intervention directed at those behaviors infants and toddlers are more likely to show. These include engaging socially with adults, playing, imitating adults, using nonverbal gestures to communicate and the like. These skills are the building blocks that are so important in the development of more advanced skills, such as language.
What are some of the most common misconceptions about autistic children?
I believe the idea that somehow vaccines are responsible or contribute to autism is something that just won’t die. Despite the lack of any sound empirical evidence for a connection, it just seems to hang on.
I also believe that many people conceptualize autism as a disorder wherein the child sits in a corner rocking or banging his head. I think recognition and appreciation of the much more common lesser forms of the disorder is still lacking. Of course, on the other side is the misconception that all individuals with autism are savants — sort of the “Rain Man” phenomenon.