Which Autism Treatment Option is for You?


Lazarus Centre/Nov 2016

Introduction:

  • ABA. PECS. TEACCH. DIR/Floor time. RDI. Sensory Integration. Chelation. Gluten-Free Casein-Free (GFCF) diet. These are common autism treatment options suggested to parents. How to decide which one? We looked at 2 sources.

Description:

  • First, we considered a report the Ministry of Health published in 2010 and which offers offers guidelines on various options. It grades the level of evidence behind each method. To simplify, a score of A 1++ is the “best” possible score while GPP/4 would be “lowest” evidence based recommendation. The details are furnished in Annex 1. (Ministry of Health, Singapore, 2010). 
  • Second, we visited the website of Association for Science in Autism Treatment (ASAT). Its a not-for-profit organisation of parents and professionals committed to improving the education, treatment, and care of people with autism. It provides a detailed list of various intervention options which it critically evaluates based on evidence. (Association for Science in Autism Treatment, 2014)

What conclusion?

  • See table below. Basically both MOH and ASAT believe ABA has the strongest evidence. There is consensus that PECS is  effective for non-verbal children. They suggest that the rest have weak scientific evidence and do not recommend Chelation.
 Sources
  1. Ministry of Health, Singapore. March 2010. “Autism Spectrum Disorders in Pre-School Children. Clinical Practice Guidelines”. Singapore. Available from URL: http://www.moh.gov.sg/content/dam/moh_web/HPP/Doctors/cpg_medical/current/2010/ASD%20book%20Apr%2010.pdf
  2. Association for Science in Autism Treatment. Treatment-Summaries of Scientific Research on Interventions on Autism. Available from URL: http://www.asatonline.org/treatment/treatments_desc.htm
Definition for Treatment Options
  • ABA: Applied Behavior Analysis. Application of scientific principles of learning and behavior to bring about meaningful changes to socially significant behaviors.
  • PECS:  Picture Exchange Communication System. Based upon ABA, PECS uses pictures to develop a functional communication system for individuals with autism.
  • TEACCH: Treatment and Education of Autistic related Communication handicapped Children. Highly structured and individualized lessons designed to accommodate learning styles characteristic of individuals with autism spectrum disorders.
  • DIR: Developementally-based Individual-difference Relationship. Child-directed intervention where the therapist takes the lead from the child and seeks to engage the child by elaborating on the child’s chosen activity
  • RDI: Relationship Development Intervention. Focuses on motivating and enabling individuals with autism spectrum disorders to form personal relationships and emotional bonds with others through social and emotional development activities.
  • Sensory Integration: An intervention in which the participant receives sensory stimulation with the goal of improving attention and cognitive functioning, while decreasing disruptive or repetitive behaviors.
  • Chelation: Chelation therapy is a medical procedure that involves the administration of chelating agents to remove heavy metals from the body.
  • Gluten Free: A gluten-free casein-free diet is a diet that excludes gluten, a protein composite found in wheat and related grains, including barley and rye, as well as dairy products.
  • Source for Wikipedia, Association for Science in Autism Treatment, 2014
 MOH Report Levels of Evidence and Grades of Recommendation.
  • 1++ High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias
  • 1+Well conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias
  • 1-Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias
  • 2++High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal
  • 2+Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal
  • 2-Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal
  • 3 Non-analytic studies eg case reports, case series
  • 4 Expert Opinion
Grades of Recommendation
  • A: At least one meta-analysis, systematic review of RCTs, or RCT rated as 1+ + and directly applicable to the target population; or A body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results.
  • B: A body of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or Extrapolated evidence from studies rated as 1+ + or 1+
  • C: A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or Extrapolated evidence from studies rated as 2+ +
  • D: Evidence level 3 or 4; or Extrapolated evidence from studies rated as 2+
  • GPP: GPP = good practice points. Recommended best practice based on the on the clinical experience of the guideline development group.

Disclaimer: This article is written for a general audience. It does not take into account the specific intervention needs of a particular child. As such, parents are urged to consult their own expert therapist, psychologist, doctor or other such professionals for a detailed diagnosis and recommendation suitable for their own children. By reading this article, you accept that you shall keep Lazarus Centre Pte Ltd indemnified against all claims arising howsoever from the use of this article.[/column]