World Autism Awareness Day 2014: Treating autism – therapies and treatments

Autism doesn't have a cure but that should stop one from getting help fro the treatment. Here are the therapies and treatments that can help to live with autism

World Autism Awareness Day is on 2nd April 2014.

When it comes to treating autism quick intervention is the key. Remember autism is a lifelong condition but its nature changes as the child matures. 'It is observed that in India, children with mild autism who are offered the correct therapy and support are able to pursue independent lives as adults albeit some restrictions. But an overwhelming majority of all children with autism, almost 60 percent of them, need supervision and assistance throughout their lives,' says Dr Pradnya Gadgil, consultant pediatric neurology and special interest in epilepsy, Kokilaben Dhirubhai Ambani Hospital.

The treatment for autism is largely based on therapies from a multidisciplinary professional team consisting of occupational therapy, sensory integration, behavioural therapy, speech and language therapy and many more. But Dr Gadgil also mentions that, 'of all the therapies it is applied behavioural analysis and relationship development intervention that is considered most effective to treat autism in children.'

Getting started with treatment

Before you look for a treatment to help your autistic child cope with the disorder get the right assessment done. 'Once you have identified the sings of autism get a detailed analysis done consulting your pediatrician and a pediatric psychologist. Every therapy or treatment plan is tailor-made for an autistic child, depending on the physiological and psychological parameters, IQ levels, attention deficit, behavioural impairment, speech and language impairment, delayed development skills,etc, says Dr Gadgil. Depending upon the level of neurobehavioural impairment and the extent of autistic spectrum disorder the child suffers from, the following therapies or treatments can be offered by the practitioner:

Applied behavioural analysis: Applied behavioural analysis or ABA is a therapy to treat autism where simple techniques and principles are used to bring about meaningful and positive changes in behaviour of a autistic child. ABA is considered to be a safe and effective way of dealing and treating children with autism to help them live a happy and productive life. The ABA principles and techniques can foster basic skills as looking, listening and imitating, as well as complex skills like reading, conversing and understanding another person's perspective.

'ABA isn't a one size fits all approach and has to be customized depending on the learner or the child's extent of impairment,' informs Dr Gadgil. Following are the principles of the ABA therapy that needs to be followed for effective results:

• The treatment goals and instructions should be designed to achieve developmentally appropriate targets of a broad range of skill areas such as - communication, sociability, self-care, play and leisure, motor development and academic skills.
• Goals should emphasize skills that will enable children to become independent and successful in both the short and long terms.
• The instruction plan needs to break down desired skills into manageable steps to be taught from the simplest (e.g. imitating single sounds) to the more complex (e.g. carrying on a conversation).
• The behavioural therapist or the instructor providing the therapy should use a variety of behaviour analytic procedures, some of which are directed by the instructor and others initiated by the child.
• Parents and other family members and caregivers should receive the training so they can support learning and skill practice throughout the day.
• The child's entire day should be structured to provide many opportunities both planned and naturally occurring - to acquire and practice skills in both structured and unstructured situations.
• The child should receive an abundance of positive reinforcement for demonstrating useful skills and socially appropriate behaviour. But there should be no reinforcement that could pose harm or prevent learning.

Relationship Development Intervention: Also known as RDIis an interactive parent and child led approach that focuses on the difficulties of a child's flexibility of thought, emotional regulation and perspective towards life in general. RDI is based on the idea that an autistic child can master the missed key developmental milestones through their relationship with parents, in an effective communication and interactive way. This is done through everyday activities such as washing up, cooking, going for a walk, etc.

The six components of RDI are:

• Emotional referencing: To help the child learn from the emotional and subjective experiences of others
• Social coordination: To help the child observe and control behaviour to successfully participate in social relationships
• Declarative language: Help to use language and non-verbal communication to express curiosity, invite interactions, share perceptions and feelings and coordinate with others.
• Flexible thinking: To help the child inculcates the habit and thought process to adapt and alter plans as the circumstances changes.
• Relational information processing: To help put things into context and solve problems that lack clear cut solutions.
• Foresight and hindsight: To help develop the ability to anticipate future possibilities based on past experiences.

Apart from ABA and RDI the other therapies that stand to be of help to treat and support autistic children are:

LEAP: This therapy is also called learning experience and is an alternative program for preschoolers and parents. In this approach a small group of autistic children are taught alongside a small group of typically developing children. The LEAP curriculum is designed to develop social and emotional growth, enhance language and communication abilities, increase independence in work and play activities, facilitate choice making, increase capacity to cope with transitions and improve behaviour, and improve overall cognition and physical abilities.

Each child with autism has an individually designed educational plan, which includes the mainstream curriculum, as well as specific objectives, behaviours and social interactions.

LEAP also uses a range of specific techniques including error-free learning, time delay, incidental teaching, pivotal response training, the picture exchange system, positive behaviour support and parent training.

The only drawback is that not many schools support the LEAP approach.

The TEACCH Approach: In the TEACCH approach a structured teaching method is taken up to help the autistic children. The intervention begins with an assessment of emerging skills. Work then focuses on enhancing them. This involves creating an individualized lesson plan in place of a standard school curriculum. The plan creates a highly structured environment to help the individual map out activities.

Teachers and aides use visual supports to organize the physical and social environment. The aim is to help the student more easily predict and understand daily activities and respond in appropriate ways. Visual supports likewise help the student approach specific tasks in a step by step manner.

Look for a special school that works on the TEACCH approach and help your autistic child learn the nuances to cope with the disorder.

Cognitive behavioural therapy or CBT: It is a type of psychological intervention used to change how people think and behave. CBT uses a variety of techniques to help people become more aware of how they think, so that they can change how they think and therefore how they behave. There is a significant amount of high quality research evidence to suggest that cognitive behavioural therapy may help reduce the symptoms of anxiety in some individuals with autism.

However, as with all complex interventions, those practitioners purporting to offer them must be appropriately trained, experienced and accredited.

Alternative therapies: 'Many caregivers opt for an alternative therapy approach like acupressure or acupuncture to treat autism, but their effect is not clearly known, hence it is recommended that parents take the approach suggested by the doctor or pediatric psychologists after a detailed assessment,' says Dr Gadgil. But for children who do not learn to speak in considerable time, alternative and augmentative communication approach may be needed.

Medications: Medications play a small but important role in treating autism. 'They are generally used for controlling behaviour, modifying the sleep-wake cycle, improving concentration, treating seizures, and so on. A small sub-group of patients those who have a proven gluten allergy in lab tests may benefit from other therapies such as a gluten-free diet too,' says Dr Gadgil.

References:

http://www.autismspeaks.org/what-autism/treatment/applied-behavior-analysis-aba

http://www.autismspeaks.org/what-autism/treatment/relationship-development-intervention-rdi

http://www.autism.org.uk/living-with-autism/strategies-and-approaches/health-and-service-based-interventions/leap.aspx

You may also like to read:

• World Autism Awareness Day 2014 Not enough doctors to treat autism in India
• Teach empathy to your child with autism start with saying sorry
• Ten things your student with autism wishes you knew
• Simple way to help detect autism earlier a five minute questionnaire
• Understanding autism its causes, symptoms and treatment
• 10 things every child with autism wishes you knew
• Simple way to help detect autism earlier a five minute questionnaire

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