'Best' Treatment for Autism Emerges

April 22, 2004 — -- Sophia Augier says she'll never forget what the father of an autistic child told her shortly after her own three sons were diagnosed with the condition.

She had been desperately searching for a way to prevent her sons from retreating from life, like so many others with autism — and he told her, "Get busy."

For Augier and her husband, Marc, that meant putting their sons on an intense therapy called ABA, or applied behavior analysis. It's been called controversial — but it's not new.

In fact, an informal survey of autism experts across the country shows that it is more widely practiced, especially as the number of autism cases rises. The Centers for Disease Control says one out of every 166 children now has an autism spectrum disorder.

ABA is a form of behavior modification which involves giving children one simple command at a time, which is repeated to them hour after hour, day after day, until they do it.

Then they are rewarded with praise, or a snack or a toy, until they can eventually do it on their own.

"ABA is one of the few approaches where there is strong empirical data demonstrating effectiveness," said Cynthia R. Johnson, the director of the Autism Center at the Children's Hospital of Pittsburgh.

The Best of the Many

Autism therapy has ranged from gluten-free diets, to megavitamins, to anti-fungal and heavy-metal treatments, but "none of these interventions has evidence-based research supporting its use, and some of these interventions may be potentially dangerous," said Dr. Susan M. Anderson, director of the Autism Program at the University of Virginia's Children's Medical Center.

Joseph E. Morrow, a certified behavior analyst and president of Applied Behavior Consultants, said he was open to some of these treatments, like gluten-free diets and megavitamins, "but the fact remains that only ABA has scientific controlled studies supporting its effectiveness." He said his company only uses ABA.

Other behavioral therapies "seem to be very complementary to ABA, but do not have the same level of efficacy studies behind them," said Dr. Leonard Rappaport, the director of the Developmental Medicine Center at Boston's Children's Hospital.

He noted the studies supporting ABA "were done quite some time ago, but are positive and show lasting effects." His center regularly suggests ABA — 30 hours a week when possible.

Dr. Ernest F. Krug III, head of developmental-behavioral pediatrics at William Beaumont Hospital in Berkley, Mich., says ABA should generally be the first intervention.

"At a minimum, [it can] bring the children under instructional control so that they can benefit from other interventions," he said.

"ABA is not a specific technique but rather a science of how to assess and modify behavior," said Vanessa Jensen, executive director of the Cleveland Clinic Center for Autism, where the Augier boys have been treated.

Everyone uses ABA on a daily basis, said Wendy Stone, pediatrics professor at Vanderbilt Children's Hospital in Tennessee, "whether it's ignoring whining behavior in our children, or working ourselves to the bone to get a paycheck at the end of the week."

She noted that the term ABA is now often used to refer exclusively to a certain type of treatment that advocates say is better than others. But that has never been demonstrated empirically.

"There is currently no evidence based research to indicate that this 'brand' of ABA is superior to any other type of implementation of ABA."

Exceptions and Limitations

The Kelly O'Leary Center for Autism Spectrum Disorders in Cincinnati employs ABA strategies and methodologies, but director Dr. Patty Manning-Courtney said there are limitations, "basically the lack of qualified consultants, and the cost," she said.

"Specialists providing ABA are in great demand and parents have trouble finding 30 hours per week," said Rappaport. "Also, due to the shortage, quality may not be as well controlled as one might hope."

In addition, "autism is a very complex disorder that defies simple or 'one-size-fits-all' treatment," said Michael L. Cuccaro, an associate clinical professor of psychiatry at Duke University Medical Center.

ABA is one of the few interventions for children with autism that is truly based on empirical evidence, he said, but recent studies of medications have also been shown to reduce disruptive and interfering behaviors in autism.

Katherine A. Loveland, a professor at the University of Texas Medical School in Houston, said ABA's usefulness depends on the needs of the individual.

"For example, individuals who already have some basic social skills and language often need other approaches that will encourage the development of flexible social communication skills and interpersonal awareness," she said.

She is not a practitioner of ABA, but sometimes recommends it to families when she thinks it's appropriate.

Moreover, Dr. Max Wiznitzer, of Rainbow Babies & Children's Hospital in Cleveland, said "some research has shown that individuals with autism and very low IQs … may have a behavioral but not a cognitive improvement with ABA."

He recommends ABA, but also discusses the pros and cons of other interventions.

Emphasizing Early Action

Whatever their feelings about ABA, the experts surveyed by ABCNEWS said autism is becoming a significant health issue for the United States. With numbers rising, the cost to the country could be enormous, said Darryn Sikora, a child development psychologist at Oregon Health & Science University.

Scientists also agree there is good news though: the condition is treatable.

"It does not necessarily doom a child to a lifelong disability," said Sikora. "However, effective treatment requires both early identification (prior to age 3) and intensive intervention before kindergarten, and then continued support through elementary school and sometimes beyond."

ABCNEWS' Roger Sergel and Andrew Chang contributed to this report.