Behavior Therapy Trumps Medications for Autism, Study Says

Research concludes behavior-based interventions are the most effective.

April 01, 2011, 5:25 PM

April 4, 2011— -- Shannon Penrod, 48, of Saugus, Calif., could feel a change coming over her son Jem Miller. By the time he was two, parts of his speech gradually began to disappear.

In just a few months, what started as, "Mama what are you doing?" turned to "Mama, what doing?" Then he retreated into silence.

"He didn't even acknowledge me in a room or seek me out," said Penrod.

Within six months, Jem was diagnosed with autism, a disorder characterized by withdrawn social and behavioral skills.

"Autism was like a thief coming into the night and stealing pieces of my child," said Penrod. "Something in him seemed like it was just going away."

While Jem's deteriorating language skills and apparent emotional separation from his family was hard to bear for Penrod and her husband, learning about Jem's diagnosis was not the hardest part, she said. Finding the right treatment was.

While there is no cure for autism, there is no shortage of purported treatments to manage the range of symptoms associated with the wide spectrum of the disorder. And, like Penrod, many parents of newly diagnosed children find themselves inundated with overflowing and at times conflicting treatment recommendations.

Penrod said each autism specialist she took Jem to see recommended a different type of treatment.

"One told me to stay away from behavioral therapy or my son would end up like a robot," she said.

Instead, Penrod first tried specialized diets and prescription medications to ease her son's erratic behavior.

But three study reviews published Monday in the Journal of Pediatrics found that early intensive behavioral interventions are more effective for autism symptoms than medical interventions.

Some of the common forms of medical treatment that are prescribed for children with autism include antidepressants, stimulants, and antipsychotics -- drugs often used to treat patients with schizophrenia, anxiety disorders, and depression. One of the three reviews also looked at secretin, which is used to alleviate gastrointestinal issues that are found in some children diagnosed with autism.

The reviews found little evidence to support the purported benefits of these treatments.

Families Have So Many Types of Behavior Therapies To Choose From

Behavioral interventions vary widely. They focus on improving a child's learning by helping children with autism develop physical and social skills.

Interactive, avatar-based computer programs are among the more innovative approaches to behavioral intervention. While they are considered experimental, many experts say these novel efforts may prove effective in some children with autism.

Dr. David Beversdorf, an assistant professor of neurology at the University of Missouri, said a computerized approach that can teach behavior skills by simulating the "real world" could help ease the social pressure for children who may feel anxious in their actual environment.

"It can be approached as a 'game' rather than as a 'training,'" said Beversdorf.

But like many autism interventions, these behavioral technologies may not work for every child on the spectrum. Initial studies show that avatar-based technology is not effective for non-verbal or lower-functioning children. These studies also suggest that computerized programs are unable to replicate subtle facial cues that could help a child learn in the real world.

Still, many experts say avatar technology can be one of many cost-effective and easily-accessible approaches to supplement other forms of autism therapy.

"The potential for implementing this form of therapy should be viewed as an extension of traditional therapies," said Dr. Larry Yin, medical director of the Boone Fetter Autism Clinic in California.

A Child With Autism: Progress Made, But Mother Says More To Go

After nearly six months trying different treatments, Penrod finally decided to enroll Jem in applied behavioral analysis, a more conventional type of behavioral intervention that includes private parent-to-child behavioral learning.

"ABA is really the autism miracle in my living room," said Penrod.

Jem, now eight years old, has transitioned from a specialized preschool to a regular second grade classroom. But Penrod said her son's success did not come without setbacks.

"My child, his first year, got 40 hours of therapy a week," said Penrod. "We rearranged our entire life because at least one of us had to be present with him at all times."

While Penrod received financial assistance from the behavioral program, their community, and their school district, many families have to bear the cost of behavioral treatment on their own.

Twenty-four states cover some costs of behavior therapies such as applied behavior analysis. But while some studies suggest behavioral intervention improves social and cognitive performance in some children with autism, many state health programs consider the treatment experimental.

Although Jem's language and interaction skills have improved, he still shows signs of autism. But Penrod said she hopes that with continual therapy, her son may one day be able to drop his autism diagnosis.

"Even if he doesn't 'win the autism lottery,' we know he'll have a good productive life," said Penrod. "He may struggle with his language and social skills, but that's better for us than where we were."

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