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An Argument for Using Science in the Treatment of Autism

If Autism Spectrum Disorders are not treated with evidence-based interventions, it’s estimated that individual lifetime care costs could be as high as $US3.2million. Quoting studies in the United States indicating that adults who undertook early intervention programs cost the community less to support, (as much as $US1 million less over their lifetime) Professor Karola Dillenburger from Queen’s University Belfast says governments investing in early, evidence-based intervention will be saving money for their communities and improving the chances of a child reaching their full potential.  

The 2007 Australian report Economic Costs of Autism Spectrum Disorder estimated the cost of ASD to the community to be between $AUD4.5 and $AUD7 billion per year. Professor Dillenburger, a chartered clinical psychologist and academic is visiting Australia during National Psychology Week and urges parents to look to science when deciding on treatments for their children with an ASD. Specifically, the science of behaviour.

Is there Anything Wrong with Trying New Autism Treatments?

Very few parents with newly diagnosed ASD children will have ample funds to spend on treatment for their children. Benison O’Reilly, mother of a son with autism, and author of The Australian Autism Handbook, counts herself among the privileged few who can afford to fund extensive treatment. However, with a background in medical writing, and a medical practitioner husband, O’Reilly’s family first looked to interventions that had the “runs on the board”. Parents of a newly diagnosed child can be overwhelmed with information and desperate to commence treatment, says Professor Dillenburger so offers this advice, “You can either try out a lot of different treatments with your child, or you can go with what we already know works…by doing fads, you could be missing opportunities to target behavioural change.” 

After personally funding treatments costing well over what the government would allocate her child per year, O’Reilly advises parents, “Intensive early intervention remains a child’s best hope of success.” However, she acknowledges that her experience may not be typical: “Many of my friends were seduced by the idea that they could cure their kids with supplements and special diets.  Some parents find that these methods do help their children; others do not. However, none of these interventions have ever been found to be curative.”

O’Reilly says parents tend to build programmes of intervention based on what is important to their family. “Some parents are very focussed on building skills in their children: on IQ and language and school placement. For them an intensive behavioural therapy program is probably the best intervention. Other parents care less about that and just want an emotional connection with their child, so they will  tend to gravitate towards something like Floortime, which is relationship-focussed.” Dr Dillenburger’s question to parents wondering how to choose from many options is straightforward -  “do you want to apply science to the treatment of your autistic child, or not?”

Using Behavioural Science to Treat Autism

Applied Behavioural Analysis (ABA) is the name given to “the application of the science of behaviour across numerous procedures” explains Professor Dillenburger, and her argument for it to be the principle treatment approach is endorsed by the US Surgeon General. In 1999 the Surgeon General endorsed ABA-based interventions as demonstrating “efficacy in reducing inappropriate behaviour and in increasing communication, learning and appropriate social behaviour.” Professor Dillenburger points to this as the beginning of the current “groundswell” of parent and practitioner support to universally endorse ABA as best practice for the treatment of autism.

In ABA interventions, therapists use an understanding of how behaviour can be shaped, to individually tailor therapeutic strategies for a child with autism.  Assessment techniques are used to understand behaviours that are present before an intervention, and then teaching techniques are used to increase the frequency, duration and use of the new behaviours. Measurement and evaluation of the target behaviours and skills is then used to draw conclusions about whether treatment has been successful or not.  By consistently applying behavioural psychology to treatment strategies, researchers have demonstrated that ABA has positive effects on the behaviour of children with an Autism Spectrum Disorder.

In ABA, only one set of behaviours is observed at a time, allowing the treating clinician to make a more accurate assessment of whether a set of behaviours has changed due to an intervention. This is another reason why Professor Dillenburger does not support what she calls the “eclectic approach”,  or “pick and mix” – where a range of methods with no coherent theoretical base are used at the same time, by practitioners who she believes may not have the expertise to effectively administer or evaluate such a diverse range of programs. 

O’Reilly’s family tried intensive ABA, speech therapy, occupational therapy, and a relationship-focussed intervention called Relationship Development Intervention (RDI):   Early intervention is what set our son on the right developmental trajectory.  RDI really helped our emotional connection with our son and taught us the best way to interact with him and encourage ongoing development – it’s based on research into typical child development, but modified to meet the special challenges of kids with ASD. However,  I do think RDI would not have been successful for us without the year of ABA our son had beforehand. ABA taught him how to ‘attend’ to us – a huge challenge for many kids on the spectrum  - so that we could really engage him in RDI.”

Evidence-Based Intervention for Autism Spectrum Disorders in Australia

The Australian Government has committed some ongoing funding to early intervention services, basing its policy decisions on a report lead by Professor Margot Prior from The University of Melbourne and Jacqueline Roberts, Professor of Autism, School of Education and Professional Studies at Griffith University. From the list of interventions eligible and ineligible for government funding, applied behavioural analysis (ABA) or early intensive behavioural intervention, are the only interventions that receive the classification ‘Eligible based on established research evidence’. Recent updates (May 2012) to the Helping Children with Autism Strategy Guidelines are also available.

Professor Dillenburger is optimistic about the Australian Government’s approach to early intervention funding while still advocating for more investment in early intervention programs. O’Reilly’s experience is an example of the potential costs involved in treatment for a child with a diagnosed ASD: “My son is 11 years old and

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