Chapter 15
Autism: A Late 20th-Century Fad Magnet
Claudia Pisano
Caldwell College
Assessing Autism Interventions
RATES OF AUTISM

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 (http://www.cdc.gov/NCBDDD/autism/data.html)
Controversy, Fads, and Unsupported
Treatments

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
Intervention

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
Treatment
National Standards Report
Results
Biomedical Treatments
Not Directly Reported
Gluten Casein Free Diet
Unestablished
Facilitated Communication
Unestablished
Auditory and Sensory Integration
Unestablished
Floortime
Emerging
TEACHH
Emerging
ABA
Established
www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf
The Nature of Controversy

Interventions are controversial if
◦
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◦
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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
treatment
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
child
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
involved
◦ Evidence does implicate several different
neurochemical systems
 Still preliminary and tentative
Biomedical Fad Interventions

Several biomedical interventions with
little empirical support experience
popularity
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Pharmacologic Treatments
Nutritional Fad Interventions
Supplements
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
interventions.

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
barrier
◦ 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
education.
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
(DIR)

TEACCH (Treatment and Educational of
Autistic and Communication Handicapped
Children)
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
coping.
The Six Steps
1.
2.
3.
4.
5.
6.
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
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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
purposeful.

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
TEACCH
(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
lifespan.
Problem with TEACCH

TEACCH has been embraced by many
school districts

The program that is implemented in
North Carolina is mandated by the
legislature

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
implement
◦ “Branding” of ABA programs
 “We do Lovaas [or] discrete trial [or] verbal
behavior … therapy”
Conclusion
New ideas for intervention should be
encouraged.
 However, each new idea should be
rigorously tested and proven to work
before it is labeled an effective treatment
for children with autism.

References
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.
 http://www.cdc.gov/NCBDDD/autism/dat
a.html
