Autism therapies

Mehrdad Mohammadian M.D.Child psychiatristTUMSTehran Psychiatric Institute

AUTISM TREATMENT

روشهاي درماني اتيسم

Autism therapiesAutism therapies attempt to lessen the deficits

and abnormal behaviors associated autism

spectrum disorders (ASD), and to increase

– The quality of life

– Functional independence of autistic individuals,

- especially children.

Treatment• Treatment is typically tailored to the child's

needs.

• Treatments fall into two major categories:

– Educational Interventions

– Medical Management • Training and support are also given to

-families of those with ASD.

Early in life Intensive, sustained special education

programs and behavior therapy early in life can help children with ASD acquire

– Self-care

– Social, and job skills

– Often can improve functioning

– Decrease symptom severity and maladaptive behaviors

3/three Claims that intervention by around

age three years is crucial are not substantiated.

Educational Interventions• Applied behavior analysis

• Communication interventions

• Relationship based, developmental models

• TEACCH

• Sensory integration

• Massage therapy

• Music

• Animal-assisted therapy

• Neurofeedback

• Patterning

• Packing

Medical Management• Prescription medication

• Dietary supplements

• Diets

• Chelation therapy

• Chiropractic

• Craniosacral therapy

• Electroconvulsive therapy

• Hyperbaric oxygen therapy

• Prosthetics

• Stem cell therapy

• Alternative medicine

Parent mediated interventions

• Parent mediated interventions offer support and practical advice to parents of autistic children.– Reduced maternal depression

– Improved maternal knowledge of autism

and communication style

– Improved child communicative behavior

Non-scientific intervention

•Religious interventions

•Anti-cure perspective

Massage Therapy• A review of massage therapy as a symptomatic

treatment of autism found

– Limited evidence of benefit.

• There were few high quality studies, and due to the risk of bias found in the studies analyzed, no firm conclusions about the efficacy of massage therapy could be drawn.

Music• Music therapy uses the elements of music to let

people express – Their feelings and communicate.

• Two small studies have reported short-term improvement in – Verbal and gestural communication skills

• of children with autism from a week's work of daily sessions; – No significant effects on behavior

problems were observed.

Animal therapy Animal therapy may include

– Horseback riding

– Swimming with dolphins Therapeutic riding programs provide both physical and emotional benefits, improving – Coordination

– Motor development

while creating a sense of well-being and increasing self-confidence.

Animal-assisted therapy• A 2007 meta-

analysis found that animal-assisted therapy is associated with a moderate improvement in autism spectrum symptoms.

Animal-assisted therapy• Where an animal such as a dog or a horse

becomes a basic part of a person's treatment, is a controversial treatment for some symptoms.

Horseback Riding

Dolphin therapy • Dolphin therapy was first used in the 1970s by

psychologist David Nathanson.

• He believed that interactions with dolphins would

– Increase a child's attention

– Enhancing cognitive processes

In a number of studies, he found that children with disabilities learned faster and retained information longer when they were with dolphins, compared to children who learned in a classroom setting.

Dolphin-assisted therapy

DAT• Reviews of published dolphin-assisted

therapy (DAT) studies have found important methodological flaws and have concluded that there is no compelling scientific evidence that DAT is a legitimate therapy or that it affords any more than

– Fleeting improvements in mood.

(NFB)

also called, Neurobiofeedback or EEG biofeedback is a type of biofeedback that uses realtime displays of electroencephalography or functional magnetic resonance imaging (fMRI) to illustrate brain activity, often with a goal of controlling central nervous system activity.

Neurofeedback• In its most traditional form, the output of EEG

electrodes is fed into a computer that controls

– a game-like audiovisual display

• Neurofeedback has been evaluated with positive results for ASD, but studies have lacked random assignment to controls.

Multiple studies have shown neurofeedback to be useful in the treatment of ADHD.

Packing• In packing, children

are wrapped tightly for up to an hour in wet sheets that have been refrigerated, with only their heads left free.

• The treatment is repeated several times a week, and can continue for years.

Packing therapy for autism

• In the 2005 edition of his book – Le packing, Pierre Delion,

• who pioneered the technique for children, suggests that the child in the pack undergoes a regression, replaying in a secure environment the relationship between a mother and her newborn.

• Delion and others believe that packing is beneficial.

• Many parents of autistic children believe that not only is it ineffective, but it is cruel.

Parent mediated interventions

• A 2006 randomized controlled trial (RCT) found that a twenty-week parent education and behavior management (PEBM) program provided significant improvements in parental mental health and well-being,

– Particularly for parents with preexisting mental health problems.

PCI-Therapy• Parent child interaction therapy is a model that has

demonstrated success with children with

– oppositional defiant disorder that has recently been applied to children with autism.

• A 2008 pilot trial of Parent-Child Interaction Therapy, a parent coaching intervention model, for boys aged 5–12 with high-functioning ASD and behavioral problems, found increases in child adaptability and reductions in parent perceptions of child problem behaviors.

Summary• Autism is a very complex disorder, and we

do not fully understand it.

• However, there are many biomedical abnormalities that have been identified, and most can be treated to some degree.

• By following the testing and treatments outlined above, many children will improve to some degree, and some will improve dramatically.

Summary

• Sometimes one treatment shows great benefit, but it is more common that each treatment helps a small amount.

• However, the cumulative effect of multiple treatments can be substantial.

• Younger children are the ones most likely to benefit, especially those who had a period of normal development followed by regression, but older children and adults can often benefit from the same treatments outlined here.

Thanks of Your Attention