Chapter 15
Autism: A Late 20th-Century Fad Magnet
Claudia Pisano
Caldwell College
Assessing Autism Interventions
Researchers estimated that across the US it
was 10 to 20 children per 10,000 (Jacobson, Foxx, & Mulick, 2005)
Historically it was shown to be 4 to 5 children
per 10,000 (Jacobson, Foxx, & Mulick, 2005)
As of 2012, it is 1 in 88 children will be
diagnosed with Autism (
Controversy, Fads, and Unsupported
Google Search
1 hour
Using the words “Autism” & “Treatment”
Search Yielded 65 distinct interventions
The Only Proven Treatment
Interventions that are based in Applied
Behavior Analysis (Jacobson, 2000)
Only intervention to produce
comprehensive and lasting results.
The Nature of Fads
Nobody creates a fad. It just happens.
People love going along with the idea of
a beautiful pig. It’s like a conspiracy.
– Jim Henson
What is a fad?
Merriam- Webster – a practice or interest
followed for a time with exaggerated zeal
Aquirre, Quarantelli, and Mendoza (1988)
defined specific characteristics of fads
◦ They are homogenous, novel, and odd
Bikhchandani, Hirschleifer, and Welch (1998)
◦ Used social learning theory to describe fads
Types of Fads According to Kozloff
Ordinary Fads
◦ Inexpensive and harmless
Pernicious Innovations In Education
◦ Passing Fads
◦ Chronic Malignancies
The Parents
Parents are part of the reason for the
continuation of fads due to:
◦ Nature of the disorder
 Shotgun approach
◦ Lack of knowledge
◦ Inconsistencies among professionals
The Nature of Evidence Based
A lot of studies do not meet our scientific
standards for evidence based practice.
The suggestion is that they should be
categorized as unproven and not
implemented until they are established.
National Autism Center
National Standards Report
Biomedical Treatments
Not Directly Reported
Gluten Casein Free Diet
Facilitated Communication
Auditory and Sensory Integration
The Nature of Controversy
Interventions are controversial if
Presented as efficacious in the absence of confirming studies
When pilot studies supporting them have not been replicated
When treatments go farther than the data that do support them
When treatment is used in an isolated fashion when multimodal
approaches are needed
◦ They are packaged with so many potentially active elements that
the effects of some of them are obscured or even counteracted
Controversy can be an essential part to helping medicine grow
The legal proceedings in which parents are fighting to have
effective autism treatments provided by school and health
services has been instrumental in the search for the best
Areas of Agreement
Kabot, Masi, & Segal (2003)
6 Guidelines for Effective Treatment
1. Intervention should be started at the earliest
possible age
2. Must be intensive
3. Parent training & support is critical
4. Social & Communication domains should be the
foci of the intervention
5. Treatment should be systematic, built on
individualized goals and objectives tailored to the
6. An emphasis on generalization is critical to the
effective intervention.
Biomedical Fad Interventions
Researchers generally agree that autism
develops as a result of some abnormality
or insult to the nervous system of
developing children.
◦ Multiple developmental processes are
◦ Evidence does implicate several different
neurochemical systems
 Still preliminary and tentative
Biomedical Fad Interventions
Several biomedical interventions with
little empirical support experience
Pharmacologic Treatments
Nutritional Fad Interventions
Vaccine Link
Pharmacologic Treatments
Pharmacologic Treatments
Dr. Fred Volkmar is a preeminent researcher in
the area of medical approaches to autism.
◦ He cautions that medication treatment studies are
complicated by the complexity of ASD, uncertain
etiology, and methodological problems.
◦ Robust animal models of autism are lacking
 Current animal models tap into some aspects of autism but
do not mimic the complex expression of autism in humans
 Animal models of disease are the foundation needed to
develop efficacious and safe medications.
◦ Conclusions about medication efficacy should be
approached with caution.
Nutritional Fad Treatments
Restriction in diet plays a role in the
management of many medical disorders
(Diabetes, seizures, phenylketonuria)
It is reasonable that doctors and parents
would consider and try nutritional
Chief among dietary manipulations is the
Gluten-free, Casein-Free diet, based on the
“leaky gut” theory.
The “Leaky Gut” Hypothesis
Some children with autism have gut membranes
damaged by inflammation
◦ Makes the gut “leaky”
◦ Gut cannot fully process gluten and casein
Glutomophine and casomorphine cross a “leaky” gut
membrane, enter the body, and cross the blood-brain
◦ Interfere with neurotransmitter activity and result in
increased opioid activity
Incomplete breakdown of gluten and casein turns into
opioid peptides
◦ Could be caused by
 Yeast overgrowth
 Immunological abnormalities
 Gastroenterological disease secondary to Autism.
Dietary Treatments for “Leaky Guts”
Aimed at restoring healthy gut flora, reducing
inflammation, and sealing the “leaky” Gut
◦ GF/CF diet
 No gluten, no casein
◦ Specific Carbohydrate Diet
 Only monosaccharides (simple sugars)
 Some types of cheese allowed
◦ Body Ecology Diet
 A combination approach
So far, no large scale, randomized trials of these
dietary interventions, that control for
confounding variables (especially maturation and
diffusion of treatment)
Dr. Kenneth Bock on Dietary
Intervention for Autism
Chelation Therapy … to be continued
Mechanical Fad Interventions
Facilitated Communication
Auditory Integration Training
Sensory Integration Training
Facilitated Communication
First proposed by Crossley and popularized
by Biklen
A form of assisted typing
It was hypothesized that the technique
allowed for revelation of previously
untapped cognitive abilities and enabled
quicker rates and more sophisticated types
of learning, despite deficits in formal
Auditory Integration Training
Technique involves the use of audiograms
to identify auditory hypersensitivities.
◦ Sounds are played at high, low, and
hypersensitive frequencies
◦ Approximately 20 half hour session over a 10
day period.
The goal is to normalize hearing and the
manner in which the brain processes
auditory information.
Sensory Integration Training
Sensory integration is a neurological process, the way
the brain organizes and interprets touch, movement,
body awareness, sight, sound, and gravity.
Performed by an occupational or physical therapist
Child is given a “diet” of sensory stimulation
The “diet” consists of vestibular and tactile
stimulation, purposeful movements, use of weighted
vests, and brushing among other techniques.
Psychosocial Fad Interventions
Floortime: A Developmental, Individual
Differences, Relationship-Based Approach
TEACCH (Treatment and Educational of
Autistic and Communication Handicapped
Floortime (DIR)
Developed by Dr. Stanley Greenspan
◦ Autism is an inability to relate to other
affectionately in a reciprocal fashion in a variety
of contexts.
So, he developed his form of play therapy
 In the model he takes into account that each
child with autism has their own strengths
and weaknesses.
 He also states that these must be identified
The “Criterion”
Each child must master six foundational
milestones in sequential order.
When they have mastered the milestones,
they will have the basic capacity for
communication, thinking, and emotional
The Six Steps
Self-regulation and interest in the world
The formation of relationships,
attachment, and engagement
Reciprocal communication
Complex communication
Representational capacity
Representational differentiation
The End “Result”
Children whom have progressed through
these milestones can
Develop a positive sense of self
Engage in positive affective relationships
Use language to express a variety of emotions
Tolerate strong emotions without loss of control
Use imagination to create new ideas
Use language to express a variety of emotions
Tolerate change
Be flexible in dealing with people and situations
How does it work?
The child's actions are assumed to be
It is the parent's or caregiver's role to
follow the child's lead and help him
develop social interaction and
communication skills.
An Example
A boy may frequently tap a toy car against
the floor. During a Floortime session, his
mother may imitate the tapping action, or
put her car in the way of the child's car. This
will prompt the child to interact with her.
From there, the mother encourages the
child to develop more complex play schemes
and incorporate words and language into
play. Floortime is more child-directed than
some teaching methods. Its goal is to
increase back-and-forth interaction and
communication between child and adult.
Let’s Watch and Learn!
You can go through life with out being
able to tie shoelaces (buy slip-ons), but
who wants to go through life alone? unknown
(Treatment and Education of Autistic and
Communication Handicapped Children)
Founded by Eric Schopler in the Early 1970’s
University of North Carolina Chapel Hill
First statewide, comprehensive, community
programs aimed at improving services for
children with autism.
TEACCH (cont.)
Works with existing skills the child has
 Priority is structured teaching
◦ Organizing the physical environment
◦ Using visual materials so that the child can
function as independently as possible without
prompts from an adult
◦ Cultivating strengths and interests instead of
focusing on remediation of the deficits
TEACCH (cont.)
Broad based and life long approach
 Teaches communication
 Teaches leisure and social skills
 Promotes independent works skills
TEACCH also attempts to provide
networks and integrate services over the
Problem with TEACCH
TEACCH has been embraced by many
school districts
The program that is implemented in
North Carolina is mandated by the
To the best of our knowledge, no other
state has such a mandate
ABA Is It a Fad?
Despite the flaws in some studies, there is
enough research to demonstrate the
effectiveness of behavioral interventions.
NY State Department of Health (1999)
◦ “…ABA programs were the only form of
intervention that met the burden of
demonstrating significantly positive outcomes
under rigorous scientifically controlled
circumstances, and constituted treatment of
choice for young children with autism”
Based on what we know about fads, what do
you think?
ABA Is It a Fad? (cont.)
ABA does face problems with fads and
internal controversies
◦ Recommendations for high levels of training
and expertise that may be difficult to
◦ “Branding” of ABA programs
 “We do Lovaas [or] discrete trial [or] verbal
behavior … therapy”
New ideas for intervention should be
 However, each new idea should be
rigorously tested and proven to work
before it is labeled an effective treatment
for children with autism.
Jacobson, J. W., Foxx, R. M., & Mulick, J.A.
(Eds). (2005). Controversial therapies for
developmental disabilities: Fad, fashion, and
science in professional practice. Hillsdale, NJ:
Lawrence Erlbaum Associates, Inc.

Autism: A Late 20th-Century Fad Magnet