by Stephen M. Edelson, PhD
Interventions available today for individuals with autism include nutritional, biomedical, educational, sensory, and behavioral. They present a bewildering array of choices for caretakers, who often want to know, “How do I know if an autism treatment helps?”
How many different treatments does a child need? How soon should one expect results? When is the best time to add a new treatment? When should one abandon a treatment that is not helping? How do we know?
In evaluating any intervention, we need to be as objective as possible. Below are some tips to help determine when a child has improved from a specific treatment:
Parents eager to see improvement sometimes try several new treatments at once. Then when the child improves, it is impossible to determine which one(s) really made a difference.
A general rule is to try a treatment for about two months and determine whether or not it was helpful before beginning a new one. However, if it is quite clear that the child improved from a treatment, even after a week or two, then another treatment can be started.
Use Objective Measures
Improvement due to growth and maturation typically manifests gradually. In contrast, an effective intervention can produce sudden sharp improvement.
Structured observation can bring the nature of behavioral changes into focus.
Consider completing the Autism Treatment Evaluation Checklist (ATEC) monthly for a few months prior to a new intervention and again following the intervention.
The ATEC was designed specially to evaluate treatment effectiveness. You can obtain this free checklist by writing to the Autism Research Institute (4182 Adams Ave., San Diego, CA 92116; fax: 619-563-6840) or, for immediate results, complete the ATEC on the Internet at www.autism.com/ind_atec
Keep It Confidential
If possible, tell no one when a child starts a new treatment. This includes teachers, friends, neighbors, and relatives. If a noteworthy change occurs, people in contact with the child are likely to say something about it.
Do not ask, “Have you noticed any changes in my child?” Spontaneous statements regarding the child’s improvement are more credible than responses to hopeful questions.
Ask people who do know that the child is receiving a specific treatment to compile a list of changes they notice. Compare their observations after a month or two. If different people report similar changes, you can consider the changes real.
Be sure to keep records of these observations. You may not remember what the child’s behavior was like before the treatment, especially if the old behavior was undesirable.
Expect the Unexpected
Parents and others should also record times when the child’s behavior ‘surprises’ them. Parents usually know how their child will respond in various situations. Only once in a while will he/she do something unexpected.
If a child improves soon after an intervention is begun, his/her behavior will likely lead to more ‘surprises’ than usual – hopefully good ones!
Tried and True vs. New and Promising
Some people suggest that parents should give their children only treatments proven effective by ample research evidence. However, even when very promising new treatments are introduced, usually little, if any, research is available.
Learn as much as possible about a new treatment before you try it. Seek out criticisms as well as positive reports.
When evaluating conflicting claims, compare the studies and their methodologies – poorly conducted studies don’t deserve the same credence as methodologically sound research.
It takes five to ten years to complete enough research to support or refute an intervention’s efficacy. Even then, evidence can be mixed, because researchers often use different populations and assess changes using different measures.
Be leery of any treatment that has been around for ten or more years with no research studies to support its effectiveness.
For example, Ritalin is one of the most frequently prescribed treatments for autism, but we are not aware of any published studies supporting its effectiveness with this population.
Remember, too, that no treatment will help everyone. Although one child may improve dramatically from a certain treatment; another, even with similar characteristics, may not benefit as much or at all.
Careful observation along with a critical perspective allows parents and others to know when a treatment is truly beneficial.
I would like to thank Dr. Bernard Rimland for his constructive comments on an earlier draft of this article.
Dr. Stephen M. Edelson is the Director of the Autism Research Institute <www.autism.com>.