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.
| Therapy | MOH | ASAT | Comments |
|---|---|---|---|
| ABA | “Early Intensive Behavior Intervention (EIBI) can be recommended as an intervention option” (A, 1++) | "ABA is an effective intervention for many individuals with autism spectrum disorders. ABA interventions should be supervised by qualified behavior analysts". | Highest A1++ rating from MOH and is the only "effective intervention" recommended by ASAT. |
| PECS | “ may be recommended for pre-school children with ASD because they expand (spoken or written) communication, may stimulate speech acquisition in non-verbal children and enhance expression in verbal children.”(A, 1+) | “The application of ABA methods to teach AAC is an appropriate intervention for children with autis who have limited or no communication skill." | Slightly lower A1+ rating vs A1++ for ABA while ASAT describes this as "appropriate" compared to "effective" for ABA |
| TEACCH | “Structured Teaching can be recommended as an intervention option” (C,2+) | “To date there are no studies with strong experimental designs evaluating whether or not TEACCH intervention is effective”. | Low rating |
| DIR and RDI | “..may be considered as intervention options for children with ASD” (D,3) | “Professionals should present (DIR and RDI) as untested and encourage families who are considering this intervention to evaluate it carefully” | Untested |
| SI | “not recommended as standard therapy ….but may be considered where the child has sensory difficulties that affect daily functioning” (D,3) | “Professionals should present Sensory Integration as untested and encourage families who are considering this intervention to evaluate it carefully. | Untested |
| Chelation | “not recommended ..because of insufficient evidence of efficacy and the potential for harm including death” (*†Grade D,*Level*3) | Chelation therapy is not recommended as a treatment for autism spectrum disorders | Not recommended. Risk of "death" |
| Gluten Free or Casein Free Diet (GFCF) | “not recommended …because of conflicting evidence” (D,3)“ | "We recommend that interventionists ..present the GFCF diet as non-supported as a treatment for autism and advise parents who are considering this intervention to evaluate it carefully” | Not recommended |
| Therapy | MOH | ASAT | Comments |
Sources
- 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
- 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]