While the history of autism spectrum disorder (ASD) treatment paints a grim picture, long gone are the days of implementing dieting and electroconvulsive shock therapy to “correct” the underlying neurological differences between neurotypical and neurodiverse people. Individuals with ASD were often shunned from society and institutionalized with other mentally and developmentally disabled individuals. However, as the 20th century progressed, the understanding and treatment of ASD was transformed. The transition happened largely in part when research began to focus on ASD treatments through a behavioral perspective. During the 1980s, Dr. Ivar Lovaas’ work produced the new gold standard forASD treatment: Applied Behavior Analysis.
Applied Behavior Analysis (ABA) is predicated on the basic principles that influence how human beings learn. Since learning must be shaped and socially-acceptable behaviors reinforced, ABA programs require significant time and effort from trained caregivers. On average, autistic children receive 25-40 hours of specialized instruction each week in order to learn basic behaviors from looking and listening to more complex skills like reading and understanding interactions from another person’s perspective. One strategy used to help autistic children acquire complex skills is Discrete Trial Training (DTT). This method helps children perform complex tasks by breaking the task into simpler subcomponents. In addition to teaching such behaviors, caregivers are tasked with helping children generalize the skills they learn to a diverse set of environments and interactions as well as providing strategies to help autistic children eliminate distractions.
As research has progressed, scientists have seen the best prognosis for autistic children when early intervention was taken and intensive behavioral therapy was immediately started. The Early Start Denver Model (ESDM) is a program that focuses on children between 12 and 48 months of age and relies on heavy parental involvement and ABA strategies. Instead of simply focusing on applied behavior, the ESDM also takes into account the neurological development an individual experiences over the course of the program. Since this program is targeted for young children, it is often easier to mold behaviors as their cognitive abilities are rapidly developing.
The ESDM focuses on a combination of treatment from specialists and parents in order to foster development.
The ESDM’s efficacy has been demonstrated in a study that compared the IQ, adaptive behavior, and severity of autism diagnosis between children who received ESDM-based care for two years versus children who were in community-provided care for the same duration. On average, the ESDM group improved by 17.6 points and the community care group improved by 7.0 points. This study not only showed the importance of the ESDM, but reinforced the significance of early diagnosis since both groups showed improvement.
Dr. Ivar Lovaas set the gold standard in 1987 when he formulated the ABA program as an ASD treatment. Since its inception, the ABA has become the most widely-used and recognized program for autism treatment in the United States. Researchers have also taken steps into improving an autistic child’s prognosis by vouching for early intervention and developing programs like the ESDM. However, as a society we have a long way to go. The costs of providing care for autistic children are extremely expensive and families either face a significant or insurmountable financial burden for the services their child needs. Therefore, many steps must be taken to create a world that is not necessarily autism free, but where each autistic child can receive the treatment they deserve.
I like how you both critiqued the previous methods to “fix” people with autism and provided how ideas about treating people with autism has changed. I agree that although the early intervention and time intensive treatment helps individuals with autism the most, the expensive nature of these programs that require highly trained teachers and parents able to put in a lot of time and money into helping their child makes this option unavailable for young children with ASD who cannot make the decision to participate themselves or help themselves get involved in the program. I think that progress needs to be made to make this a more affordable choice for parents of children with autism and for this treatment to be even more widely available by increasing awareness in pre-schools and among parents and taking action in creating legislation to make the program more accessible.
I enjoyed that you addressed that these current treatments for autism require the participation of the child, caregiver, and therapist or doctor. The treatments do not end after the doctor or therapist leaves, and it is up to the child and caregiver to continue using those skills in everyday life. As the saying goes, “it takes a village,” and that especially applies to helping autistic children. The child’s community should be a positive force in aiding in the treatment of the child, but the community should not be trying to cure the child’s autism. I like how in your last sentence you state that we should not be aiming to create a world that is “autism free.” Autistic children should receive the treatment they need in order to lessen symptoms and increase their ability to socialize and function in society, but that does not mean we need to cure what makes these individuals special. Neurodiversity is about recognizing the differences in individuals and celebrating those differences.
I also liked how you focused on treating autistic children because early intervention is of great importance. This post made we wonder if there are any behavioral treatments for adults with autism. I feel that children with autism sometimes receive more attention than the adults who still may be struggling with socialization and other important skills.
This post provided good information, and I am interested in learning more and seeing how these current treatments could change in the future as we find out more information on autism.