There is no cure for autism but there are a wide range of interventions that can enable a person with autism to better manage their condition.
It is important to recognise that each person experiences autism in different ways and that individuals may or may not respond positively to an intervention. The National Autistic Society's position statement says "the success of any approach will depend on the needs of the individual which vary greatly. It would therefore not be appropriate for the NAS to recommend one particular practice of therapy over any other". NHS Direct makes the point that some approaches have not been properly evaluated and advises people to find out as much as possible about a particular approach before making a choice. The site says that any approach should be positive, build on people's strengths and help to discover their potential, increase motivation and provide the opportunity for them to develop their skills.
It is also important to bear in mind the fact that the nature of support that is available on the NHS varies across the UK.
Given the bewildering array of different approaches to autism, we set out below those most commonly used in the UK together with an overview of other interventions.
EarlyBird
The EarlyBird programme has been set up by the National Autistic Society (NAS) to provide support for parents in between the time a diagnosis is made and school placement. The programme aims to help parents aid their child's communication and appropriate behaviour within the home environment and to help parents to establish good practice in dealing with their child at an early age so as to pre-empt the development of inappropriate behaviours
EarlyBird helps parents to understand their child's autism, "structure interactions in which communication can develop" and pre-empt problem behaviours and deal appropriately with those that do occur.
EarlyBird draws from the NAS Spell approach, the TEACCH approach and the Picture Exchange Communication System (PECS) - see below for further details.
The programme lasts for three months and consists of group training sessions combined with home visits. EarlyBird is based on the following principles:
The programme has expanded greatly since 2000, there are now 250 licensed teams providing EarlyBird in the UK.
TEACCH
Most UK schools that provide education to children with autism have adopted elements of the TEACH (Treatment and Education of Autistic and related Communication handicapped Children) approach. TEACCH uses an approach called structured teaching which is based on:
This approach encourages parents to work clsely with the professionals so that the techniques can also be used at home.
The TEACCH web site describes the long term goals of the approach as "both skill development and the fulfillment of fundamental human needs such as dignity, engagement in productive and personally meaningful activities, and feelings of security, self-efficacy and self-confidence".
The NAS summarises the TEACCH concepts and principles as:
With regard to behaviour, TEACCH stresses the importance of understanding the causes of unwanted behaviour as a first step in trying to reduce it.
PECS
The Picture Exchange Communication System starts by teaching the child to exchange a picture card for something that the child wants. Once this is learnt the child is then encouraged to-
The PECS approach consists of six distinct phases-
It is thought that PECS is effective because the children are highly motivated to request the wanted item. PECS is easy to use and inexpensive.
SPELL
SPELL(Structure, Positive approaches and expectations, Empathy, Low arousal, Links) is a framework developed by NAS for understanding and responding to the needs of people with autism, it is used in identifying underlying issues, in reducing the disabling effects of the condition and in providing a cornerstone for communication. The framework should be viewed as complementary to other approaches, especially TEACCH.
Structure is important as it makes the world appear a more predictable, accessible and safer place. For people with autism the environment should be structured in such a way as to ensure that each individual knows what is going to happen and what is expected of them. Structure enhances the positive aspects of a sense of order and a preference for visual organisation that are common festures of autism.
Positive approaches and expectations are important in ensuring that assessments and subsequent interventions are as effective as possible. Assessments should utilise as many perspectives as possible. Expectations of people with autism should be high but realistic and based on a thorough assessment of individual need.
Support given in a positive and sensitive manner can help to reduce anxiety, learn to tolerate and accept new or adverse experiences, develop new skills.
Empathy. Seeing the world from the perspective of someone with autism is important in enabling professionals and parents to understand what motivates them and what may also preoccupy or frighten them. Using an empathetic approach is an essential component in developing communication and reducing anxiety.
Low arousal. Many people with autism find background noise levels, bright colour schemes, odours lighting and clutter to be distracting. Such distractions should be kept to a minimum. This is not to say that there should be no arousal but that new experiences should be introduced in a considered and sensitive way.
Conversely, some people with autism may be under responsive to sensory experiences and may seek out additional or heightened sensations. It is best if these additional inputs are carefully regulated.
Links between professionals and parents are important in promoting and sustaining consistency of approach. Open communication between all parties involved with the person with autism will reduce misunderstanding and confusion and will prevent the use of fragmented or piecemeal approaches.
The Lovaas Method.
The Lovaas method is a behavioural approach which provides intensive treatment for 40 hours per week to children between the ages of 2 and 4. Skills are broken down into small tasks. The programme uses behaviour modification techniques with emphasis on positive reinforcements. Because of the intensive nature and length of the teaching sessions parents are encouraged to use a third person as well as themselves to deliver the programme. The NAS describes the treatment as "extremely long and intensive and can therefore be very expensive. However a growing number of parents have used this method and have been pleased with the results". The PEACH website provides more details of the Lovaas method in the UK.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are a type of anti-depressant which have been shown to have some success in reducing repetitive or ritualistic behaviours in some children with autism. They have also shown some success in improving eye contact and sociability. However, it is not yet possible to predict how individuals with autism may respond to these drugs or whether they will have any effect at all. Side effects can include agitation, chills, confusion, impaired co-ordination, nausea and restlessness.
Parents who are considering the use of SSRIs are advised to discuss this with a medical professional.
Vitamins
Whilst some people with autism have responded positively to additional vitamins, it is important to remember that each person is different and that effects are likely to vary. It is also important to remember that some vitamins can be toxic in high doses.
Vitamin B6 has been studied for over 40 years and has proved to be beneficial in 50% of cases. I is not understood why vitamin B6 should be beneficial in this way. It should have a beneficial effect within the first week, the NAS advises that if there is no such effect after three or four weeks then it should be stopped. A high dose of vitamin B6 should always be given with a "normal" dose of magnesium.
The British National Formulary recommends a daily dose of 20-50mg up to three times daily for "deficiency states" but points out that the safety of long-term supplementation with doses above 10mg daily has not been established. High doses of vitamin B6 over extended periods have led to tingling feelings and numbness in the hands and feet.
Vitamin C has been shown to have a calming effect on behaviour, one study involving 18 children with autism demonstrated a significant improvement in behaviour. It must be remembered that this was a small study and that it has not been replicated. Another study has indicated that Vitamin C may improve sleep and gastrointestinal problems in children with autism. Vitamin C is harmless for most people but can act as a laxative in others.
Vitamin A. Mary Megson, an American paediatrician is a strong advocate of using natural vitamin A (found in cod liver oil) for helping people with autism who have problems with vision, sensory perception, language processing and attention. It should be noted that Dr Megson's views are controversial, her paper (pdf document) suggests that autism may be linked to a "disruption of the G-alpha protein affecting retinoid receptors in the brain". There is no other evidence to suggest that natural vitamin A has beneficial effects for people with autism.
Diet
Dimethylglycine (DMG) is a food supplement which occurs naturally (in small amounts) in brown rice and liver. Some clinicians believe that it improves behaviour, eye contact and speech in 50% of people with autism. Unfortunately clinical trials have thus far failed to demonstrate these benefits. Dr Rimland reports that hyperactivity can be a side effect with DMG and advises that parents should supplement each dose of DMG with folic acid tablets. Rimland says that DMG can be taken alongside vitamin B6 and may improve the effectiveness of the DMG.
Gluten and casein free diets are thought by some to have positive effects on people with autism. The use of such a diet is based on the theory that the abnormal levels of opioid peptides found in the urine of some people with autism could be responsible for some symptoms that are seen in autism. These compounds are the result of the breakdown of certain foods. Casein (from milk) breaks down in the stomach to produce casomorphin which has opioid characteristics, similarly gluten (from wheat and other cereals) will produce compounds called glutenomophins.
Children whose autism is apparent at birth may have a problem with casein whereas children whose autism only becomes apparent at the age of 2 are more likely to have a problem with gluten.
Testimony from parents indicate some success with gluten and casein free diets but the clinical evidence is inconcusive so far. Introducing such a diet is a major step and parents are strongly advised to seek the support of their doctor and a knowledgeable dietician.
A yeast-free diet is described by NAS as a radical step which should only be done following tests of the person's urine and close consultation with a doctor and dietitian. The idea behind a yeast-free diet is to reduce the amount of undigested food being absorbed into the bloodstream- a condition known as "leaky gut". This causes an increase in peptides which can damage parts of the brain.
