Autism therapies - AbsoluteAstronomy.com

Autism therapies attempt to lessen the deficits and abnormal behaviours associated with autism

Autism

Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...

and other autism spectrum disorders (ASD), and to increase the quality of life

Quality of life

The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and politics. Quality of life should not be confused with the concept of standard of...

and functional independence of autistic individuals, especially children. Treatment is typically tailored to the child's needs. Treatments fall into two major categories: educational interventions and medical management. Training and support are also given to families of those with ASD.

Studies of interventions have methodological problems that prevent definitive conclusions about efficacy

Efficacy

Efficacy is the capacity to produce an effect. It has different specific meanings in different fields. In medicine, it is the ability of an intervention or drug to reproduce a desired effect in expert hands and under ideal circumstances.- Healthcare :...

. Although many psychosocial

Psychosocial

For a concept to be psychosocial means it relates to one's psychological development in, and interaction with, a social environment. The individual needs not be fully aware of this relationship with his or her environment. It was first commonly used by psychologist Erik Erikson in his stages of...

interventions have some positive evidence, suggesting that some form of treatment is preferable to no treatment, the methodological quality of systematic review

Systematic review

A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine...

s of these studies has generally been poor, their clinical results are mostly tentative, and there is little evidence for the relative effectiveness of treatment options. Intensive, sustained special education programs and behavior therapy early in life can help children with ASD acquire self-care, social, and job skills, and often can improve functioning, and decrease symptom severity and maladaptive behaviors; claims that intervention by around age three years is crucial are not substantiated. Available approaches include applied behavior analysis

Applied Behavior Analysis

Applied behavior analysis is a science that involves using modern behavioral learning theory to modify behaviors. Behavior analysts reject the use of hypothetical constructs and focus on the observable relationship of behavior to the environment...

(ABA), developmental models, structured teaching

TEACCH

Treatment and education of autistic and related communication handicapped children is a service, training, and research program for individuals of all ages and skill levels with autism spectrum disorders. The TEACCH approach was developed at the University of North Carolina, originating in a...

, speech and language therapy, social skills

Social skills

A social skill is any skill facilitating interaction and communication with others. Social rules and relations are created, communicated, and changed in verbal and nonverbal ways. The process of learning such skills is called socialization...

therapy, and occupational therapy

Occupational therapy

Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...

. Educational interventions have some effectiveness in children: intensive ABA treatment has demonstrated effectiveness in enhancing global functioning in preschool children, and is well-established for improving intellectual performance of young children. Neuropsychological reports are often poorly communicated to educators, resulting in a gap between what a report recommends and what education is provided. The limited research on the effectiveness of adult residential programs shows mixed results.

Many medications are used to treat problems associated with ASD. More than half of U.S. children diagnosed with ASD are prescribed psychoactive drug

Psychoactive drug

A psychoactive drug, psychopharmaceutical, or psychotropic is a chemical substance that crosses the blood–brain barrier and acts primarily upon the central nervous system where it affects brain function, resulting in changes in perception, mood, consciousness, cognition, and behavior...

s or anticonvulsant

Anticonvulsant

The anticonvulsants are a diverse group of pharmaceuticals used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of bipolar disorder, since many seem to act as mood stabilizers, and in the treatment of neuropathic pain. The goal of an...

s, with the most common drug classes being antidepressant

Antidepressant

An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...

s, stimulant

Stimulant

Stimulants are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others...

s, and antipsychotic

Antipsychotic

An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...

s. Aside from antipsychotics, there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD. A person with ASD may respond atypically to medications, the medications can have adverse effects

Adverse effect (medicine)

In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...

, and no known medication relieves autism's core symptoms of social and communication impairments.

Many alternative therapies and interventions

Alternative therapies for developmental and learning disabilities

Alternative therapies for developmental and learning disabilities include a range of practices used in the treatment of dyslexia, ADHD, Asperger syndrome, autism, Down syndrome and other developmental and learning disabilities. Treatments include changes in diet, dietary supplements, biofeedback,...

are available, ranging from elimination diet

Elimination diet

An elimination diet is a method of identifying foods that an individual cannot consume without adverse effects. Adverse effects may be due to food allergy, food intolerance, other physiological mechanisms , or a combination of these...

s to chelation therapy

Chelation therapy

Chelation therapy is the administration of chelating agents to remove heavy metals from the body. For the most common forms of heavy metal intoxication—those involving lead, arsenic or mercury—the standard of care in the United States dictates the use of dimercaptosuccinic acid...

. Few are supported by scientific studies. Treatment approaches lack empirical support in quality-of-life contexts, and many programs focus on success measures that lack predictive validity and real-world relevance. Scientific evidence appears to matter less to service providers than program marketing, training availability, and parent requests. Even if they do not help, conservative treatments such as changes in diet are expected to be harmless aside from their bother and cost. Dubious invasive treatments are a much more serious matter: for example, in 2005, botched chelation therapy

Chelation therapy

killed a five-year-old boy with autism.

Treatment is expensive; indirect costs are more so. For someone born in 2000, a U.S. study estimated an average discounted

Net present value

In finance, the net present value or net present worth of a time series of cash flows, both incoming and outgoing, is defined as the sum of the present values of the individual cash flows of the same entity...

lifetime cost of $ ( dollars, inflation-adjusted from 2003 estimate), with about 10% medical care, 30% extra education and other care, and 60% lost economic productivity. A UK study estimated discounted lifetime costs at ₤ and ₤ for an autistic person with and without intellectual disability, respectively ( pounds, inflation-adjusted from 2005/06 estimate). Legal rights to treatment are complex, vary with location and age, and require advocacy

Advocacy

Advocacy is a political process by an individual or a large group which normally aims to influence public-policy and resource allocation decisions within political, economic, and social systems and institutions; it may be motivated from moral, ethical or faith principles or simply to protect an...

by caregiver

Caregiver

Caregiver may refer to:* Caregiver or carer - an unpaid person who cares for someone requiring support due to a disability, frailty, mental health problem, learning disability or old age...

s. Publicly supported programs are often inadequate or inappropriate for a given child, and unreimbursed out-of-pocket medical or therapy expenses are associated with likelihood of family financial problems; one 2008 U.S. study found a 14% average loss of annual income in families of children with ASD, and a related study found that ASD is associated with higher probability that child care problems will greatly affect parental employment. After childhood, key treatment issues include residential care, job training and placement, sexuality, social skills, and estate planning

Estate planning

Estate planning is the process of anticipating and arranging for the disposal of an estate. Estate planning typically attempts to eliminate uncertainties over the administration of a probate and maximize the value of the estate by reducing taxes and other expenses...

Historical approach

Before autism was well understood, children in Britain and America would often be put in institutions on the instruction of doctors and the parents told to forget about them. Observer

The Observer

The Observer is a British newspaper, published on Sundays. In the same place on the political spectrum as its daily sister paper The Guardian, which acquired it in 1993, it takes a liberal or social democratic line on most issues. It is the world's oldest Sunday newspaper.-Origins:The first issue,...

journalist Christopher Stevens, father of an autistic child, reports how a British doctor told him that after a child was admitted, usually "nature would take its course" and the child would die due to the prevalence of tuberculosis

Tuberculosis

Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

Educational interventions

Educational interventions attempt to help children not only to learn academic subjects and gain traditional readiness skills, but also to improve functional communication and spontaneity, enhance social skills such as joint attention, gain cognitive skills such as symbolic play, reduce disruptive behavior, and generalize learned skills by applying them to new situations. Several model programs have been developed, which in practice often overlap and share many features, including:

early intervention that does not wait for a definitive diagnosis;
intense intervention, at least 25 hours per week, 12 months per year;
low student/teacher ratio;
family involvement, including training of parents;
interaction with neurotypical
Neurotypical
Neurotypical is a term that was coined in the autistic community as a label for people who are not on the autism spectrum: specifically, neurotypical people have neurological development and states that are consistent with what most people would perceive as normal, particularly with respect to...

peers;
structure that includes predictable routine and clear physical boundaries to lessen distraction; and
ongoing measurement of a systematically planned intervention, resulting in adjustments as needed.

Several educational intervention methods are available, as discussed below. They can take place at home, at school, or at a center devoted to autism treatment; they can be done by parents, teachers, speech and language therapists, and occupational therapists. A 2007 study found that augmenting a center-based program with weekly home visits by a special education

Special education

Special education is the education of students with special needs in a way that addresses the students' individual differences and needs. Ideally, this process involves the individually planned and systematically monitored arrangement of teaching procedures, adapted equipment and materials,...

teacher improved cognitive development and behavior.

Studies of interventions have methodological problems that prevent definitive conclusions about efficacy

Efficacy

. Although many psychosocial

Psychosocial

interventions have some positive evidence, suggesting that some form of treatment is preferable to no treatment, the methodological quality of systematic review

Systematic review

s of these studies has generally been poor, their clinical results are mostly tentative, and there is little evidence for the relative effectiveness of treatment options. Concerns about outcome measures, such as their inconsistent use, most greatly affect how the results of scientific studies are interpreted. A 2009 Minnesota study found that parents follow behavioral treatment recommendations significantly less often than they follow medical recommendations, and that they adhere more often to reinforcement than to punishment recommendations. Intensive, sustained special education programs and behavior therapy early in life can help children acquire self-care, social, and job skills, and often improve functioning and decrease symptom severity and maladaptive behaviors; claims that intervention by around age three years is crucial are not substantiated.

Lovaas

Applied behavior analysis (ABA) is the applied research field of the science of behavior analysis, and it underpins a wide range of techniques used to treat autism and many other behaviors and diagnoses. ABA-based interventions focus on teaching tasks one-on-one using the behaviorist principles of stimulus, response and reward, and on reliable measurement and objective evaluation of observed behavior. There is wide variation in the professional practice of behavior analysis

Professional practice of behavior analysis

The professional practice of behavior analysis is one domain of behavior analysis: others being behaviorism, experimental analysis of behavior and applied behavior analysis...

and among the assessments and interventions used in school-based ABA programs. Many interventions rely heavily on discrete trial teaching (DTT) methods, which use stimulus-response-reward techniques to teach foundational skills such as attention, compliance, and imitation. However, children have problems using DTT-taught skills in natural environments. These students are often taught with Natural language procedures

Natural language procedures

Natural language training is a set of procedures used by behavior analysts. These procedures are used to mirror the natural areas of language use for children. Behavior analysts language training procedures run along a continuum from highly restrictive such as discrete trial training to very...

to help lessen problems from DTT. In functional assessment, a common technique, a teacher formulates a clear description of a problem behavior, identifies antecedents, consequents, and other environmental factors that influence and maintain the behavior, develops hypotheses about what occasions and maintains the behavior, and collects observations to support the hypotheses. A few more-comprehensive ABA programs use multiple assessment and intervention methods individually and dynamically.

ABA-based techniques have demonstrated effectiveness in several controlled studies: children have been shown to make sustained gains in academic performance, adaptive behavior

Adaptive behavior

Adaptive behavior is a type of behavior that is used to adjust to another type of behavior or situation. This is often characterized by a kind of behavior that allows an individual to change an unconstructive or disruptive behavior to something more constructive. These behaviors are most often...

, and language, with outcomes significantly better than control groups. A 2009 review of educational interventions for children, whose mean age was six years or less at intake, found that the higher-quality studies all assessed ABA, that ABA is well-established and no other educational treatment is considered probably-efficacious, and that intensive ABA treatment, carried out by trained therapists, is demonstrated effective in enhancing global functioning in pre-school children. These gains maybe complicated by initial IQ. A 2008 evidence-based review of comprehensive treatment approaches found that ABA is well-established for improving intellectual performance of young children with ASD. A 2009 comprehensive synthesis of early intensive behavioral intervention (EIBI), a form of ABA treatment, found that EIBI produces strong effects, suggesting that it can be effective for some children with autism; it also found that the large effects might be an artifact of comparison groups with treatments that have yet to be empirically validated, and that no comparisons between EIBI and other widely recognized treatment programs have been published. A 2009 systematic review came to the same principal conclusion that EIBI is effective for some but not all children, with wide variability in response to treatment; it also suggested that any gains are likely to be greatest in the first year of intervention. A 2009 meta-analysis

Meta-analysis

In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. In its simplest form, this is normally by identification of a common measure of effect size, for which a weighted average might be the output of a meta-analyses. Here the...

concluded that EIBI has a large effect on full-scale intelligence and a moderate effect on adaptive behavior. However, a 2009 systematic review and meta-analysis found that applied behavior intervention (ABI), another name for EIBI, did not significantly improve outcomes compared with standard care of preschool children with ASD in the areas of cognitive outcome, expressive language, receptive language, and adaptive behavior.
Applied behavior analysis is cost effective for administrators

Recently behavior analysts have built comprehensive models of child development (see Behavior analysis of child development

Behavior analysis of child development

Child development in behavior analytic theory has origins in John B. Watson's behaviorism. Watson wrote extensively on child development and conducted research . Watson was instrumental in the modification of William James' stream of consciousness approach to construct a stream of behavior theory...

) to generate models for prevention as well as treatment for autism.

Pivotal response therapy

Pivotal response therapy or treatment (PRT) is a naturalistic intervention derived from ABA principles. Instead of individual behaviors, it targets pivotal areas of a child's development, such as motivation, responsivity to multiple cues, self-management, and social initiations; it aims for widespread improvements in areas that are not specifically targeted. The child determines activities and objects that will be used in a PRT exchange. Intended attempts at the target behavior are rewarded with a natural reinforcer: for example, if a child attempts a request for a stuffed animal, the child receives the animal, not a piece of candy or other unrelated reinforcer.

Aversion therapy

The Judge Rotenberg Educational Center

Judge Rotenberg Educational Center

The Judge Rotenberg Educational Center is a school for special needs students that operates in Canton, Massachusetts, providing applied behavior analysis and educational services to children and adults with severe developmental disabilities and emotional or behavior disorders, as well as providing...

uses aversion therapy

Aversion therapy

Aversion therapy is a form of psychological treatment in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort...

, notably contingent shock (electric shock

Electric shock

Electric Shock of a body with any source of electricity that causes a sufficient current through the skin, muscles or hair. Typically, the expression is used to denote an unwanted exposure to electricity, hence the effects are considered undesirable....

delivered to the skin for a few seconds), to control the behavior of its patients, many of which are autistic. The practice is controversial.

Communication interventions

The inability to communicate, verbally or non-verbally, is a core deficit in Autism. Children with Autism are often engaged in repetitive activity or other behaviors because they cannot convey their intent any other way. They do not know how to communicate their ideas to caregivers or others. Helping a child with Autism learn to communicate their needs and ideas is absolutely core to any intervention. Communication can either be verbal or non-verbal. Children with Autism require intensive intervention to learn how to communicate their intent.

Communication interventions fall into two major categories. First, many autistic children do not speak, or have little speech, or have difficulties in effective use of language. Social skills

Social skills

have been shown to be effective in treating children with autism. Interventions that attempt to improve communication are commonly conducted by speech and language therapists, and work on joint attention, communicative intent, and alternative or augmentative and alternative communication

Augmentative and alternative communication

Augmentative and alternative communication is an umbrella term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language...

(AAC) methods such as visual methods. Little solid research supports the efficacy

Efficacy

of speech therapy for autism; AAC methods do not appear to impede speech and may result in modest gains. A 2006 study reported benefits both for joint attention intervention and for symbolic play intervention, and a 2007 study found that joint attention intervention is more likely than symbolic play intervention to cause children to engage later in shared interactions.

Second, social skills

Social skills

treatment attempts to increase social and communicative skills of autistic individuals, addressing a core deficit of autism. A wide range of intervention approaches is available, including modeling and reinforcement, adult and peer mediation strategies, peer tutoring, social games and stories, self-management, pivotal response therapy, video modeling

Video modeling

Video modeling is a form of observational learning in which desired behaviors are learned by watching a video demonstration and then imitating of the behavior of the model. In video self-modeling , individuals observe themselves performing a behavior successfully on video, and then imitate the...

, direct instruction, visual cuing, Circle of Friends

Circle of friends (disability)

The Circle of Friends approach is a method designed to increase the socialization and inclusion of a disabled person with their peers. A Circle of Friends consists of a "focus" child, for whom the group was established, six to eight classroom peers, and an adult facilitator who meet once weekly to...

and social-skills groups. A 2007 meta-analysis of 55 studies of school-based social skills intervention found that they were minimally effective for children and adolescents with ASD, and a 2007 review found that social skills training has minimal empirical support for children with Asperger syndrome

Asperger syndrome

Asperger's syndrome that is characterized by significant difficulties in social interaction, alongside restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development...

or high-functioning autism

High-functioning autism

High-functioning autism is an informal term applied to autistic people who are deemed to be "higher functioning" than other autistic people, by one or more metrics. There is no consensus as to the definition. HFA is not yet a recognised diagnosis in the DSM-IV-TR or the ICD-10.The amount of...

Relationship based, developmental models

Relationship based models give importance to the relationships that help children reach and master early developmental milestones. These are often missed or not mastered in children with ASD. Examples of these early milestones are engagement and interest in the world, intimacy with a caregiver, intentionality of action.

Floortime/DIR

The Floortime/DIR (Developmental, Individual Differences based, Relationship based ) approach is a developmental intervention to autism developed by Stanley Greenspan

Stanley Greenspan

Stanley Greenspan was a clinical professor of Psychiatry, Behavioral Science, and Pediatrics at George Washington University Medical School and a practicing child psychiatrist...

and Serena Weider. Its core precept is to understand the child's sensory differences, follow the child's lead and use these to encourage children with ASD to climb up the developmental ladder. This approach is based on the idea that the core deficits in autism are individual differences in the sensory system, motor planning problems, the inability to relate and the inability to connect ones desire to intentional action and communication. When addressed through a combination of sensory support and DIR/Floortime techniques, the facilitator is playfully obstructive to redirect the child to play and relate to their therapist. As a result, children can become more social, less repetitive and also develop symbolic abilities.

The DIR model is based on the idea that due to individual processing differences children with ASD do not master the early developmental milestones that are the foundations of learning. DIR outlines six core developmental stages that children with ASD have often missed or not mastered:

Stage One: Regulation and Interest in the World: Being calm and feeling well enough to attend to a caregiver and surroundings. Have shared attention.
Stage Two: Engagement and Relating: Interest in another person and in the world, developing a special bond with preferred caregivers. Distinguishing inanimate objects from people.
Stage Three: Two way intentional communication: Simple back and forth interactions between child and caregiver. Smiles, tickles, anticipatory play.
Stage Four: Social Problem solving: Using gestures, interaction, babble to indicate needs, wants, pleasure, upset. Get a caregiver to help with a problem. Using pre-language skills to show intention.
Stage Five: Symbolic Play: Using words, pictures, symbols to communicate an intention, idea. Communicate ideas and thoughts, not just wants and needs.
Stage Six: Bridging Ideas: This stage is the foundation of logic, reasoning, emotional thinking and a sense of reality.

Most typically developing children have mastered these stages by age 5 years. However, children with ASD struggle with or have missed some of these vital developmental stages. When these foundational abilities are strengthened through the child's lead and through meaningful play with a caregiver, children begin to climb up the developmental ladder. An introduction to DIR/Floortime can be found in the book - Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think, by Stanley Greenspan

Stanley Greenspan

Stanley Greenspan was a clinical professor of Psychiatry, Behavioral Science, and Pediatrics at George Washington University Medical School and a practicing child psychiatrist...

, M.D. and Serena Wieder, PhD.

The P.L.A.Y. Project (or PLAY Project)

The P.L.A.Y. Project (or PLAY Project) (an acryonym for PLAY and Language for Autistic Youngsters) is a community-based, national autism training and early intervention program established in 2001 by Richard Solomon, MD. Based on the DIR® (Developmental, Individualized, Relationship-based) theory of Stanley Greenspan MD, the program is designed to train parents and professionals to implement intensive, developmental interventions for young children (18 months to 6 years) with autism. The program is operating in nearly 100 agencies worldwide including 25 states and in 5 countries outside of the U.S. (Australia, Canada, England, Ireland and Switzerland). The PLAY Project has been operating since 2001 from its headquarters in Ann Arbor, MI.

In September 2009, The P.L.A.Y. Project received a $1.85 million grant from the National Institute of Mental Health (NIMH) to conduct a three-year controlled, clinical study of the P.L.A.Y. Project model. Drawing participants from five Easter Seals autism service locations, the study compares the outcomes of 60 children who participate in The P.L.A.Y. Project with the outcomes of 60 children who receive standard community interventions, making it the largest study of its kind. Before and after the 12-month intervention, each child is assessed with a battery of tests to measure developmental level, speech and language, sensory-motor profile, and social skills.

The results of previous research on the program were published by the peer-reviewed British journal, Autism (May, 2007).

Son-Rise

Son-Rise is a home-based program that emphasizes on implementing a color and sensory-free playroom. Before the home-based program, however, an institute teaches the method to the parents for a week. The staff train parents how to accept their child without judgment through a series of dialogue sessions. What differentiates them from other play therapies is after they mimic a child's repetitive and restricted behaviors and the child moves further away from interaction, the facilitator continues to join them only this time through parallel play. The goal is to get the child's willing engagement. Proponents claim that children will decide to become non-autistic after parents accept them for who they are and engage them in play. The program was started by the parents of Raun Kaufman

Raun Kaufman

Raun Kahlil Kaufman is a teacher and writer who serves as CEO for the early Intervention therapy program Son-Rise. Son-Rise is located at the Autism Treatment Center of America, a division of the Option Institute in Sheffield, Massachusetts, which is an independent non-profit organization that...

, who is claimed to have gone from being autistic to normal via the treatment in the early 1970s. No independent study has tested the efficacy of the program, but a 2003 study found that involvement with the program led to more drawbacks than benefits for the involved families over time, and a 2006 study found that the program is not always implemented as it is typically described in the literature, which suggests it will be difficult to evaluate its efficacy.

TEACCH

Treatment and education of autistic and related communication handicapped children (TEACCH), which has come to be called "structured teaching", emphasizes structure by using organized physical environments, predictably sequenced activities, visual schedules and visually structured activities, and structured work/activity systems where each child can practice various tasks. Parents are taught to implement the treatment at home. A 1998 controlled trial found that children treated with a TEACCH-based home program improved significantly more than a control group.

Sensory integration

Unusual responses to sensory stimuli

Stimulus (physiology)

In physiology, a stimulus is a detectable change in the internal or external environment. The ability of an organism or organ to respond to external stimuli is called sensitivity....

are more common and prominent in children with autism, although there is not good evidence that sensory symptoms differentiate autism from other developmental disorders. Several therapies have been developed to treat Sensory Integration Dysfunction

Sensory Integration Dysfunction

Sensory integration dysfunction is a neurological disorder characterized by a neurological sensory integration deficit. The more current diagnostic nosology uses the term sensory processing disorder to describe this condition....

. Some of these treatments (for example, sensorimotor handling) have a questionable rationale and have no empirical evidence. Other treatments have been studied, with small positive outcomes, but few conclusions can be drawn due to methodological problems with the studies. These treatments include prism lenses, physical exercise, auditory integration training

Auditory integration training

Auditory integration training is a procedure pioneered in France by Guy Bérard, who promoted it as a cure for clinical depression and suicidal tendencies, along with what he said were very positive results for dyslexia and autism, although there has been very little empirical evidence regarding...

, and sensory stimulation or inhibition techniques such as "deep pressure"—firm touch pressure applied either manually or via an apparatus such as a hug machine

Hug machine

A hug machine, also known as a hug box, a squeeze machine, or a squeeze box, is a deep-pressure device designed to calm hyper-sensitive persons, usually individuals with autism spectrum disorders...

or a pressure garment. Weighted vests, a popular deep-pressure therapy, have only a limited amount of scientific research available, which on balance indicates that the therapy is ineffective. Although replicable treatments have been described and valid outcome measures are known, gaps exist in knowledge related to sensory integration dysfunction and therapy. Because empirical support is limited, systematic evaluation is needed if these interventions are used.

The term Sensory integration in simple terms means the ability to use all of ones senses to accomplish a task. Occupational Therapists sometimes prescribe sensory treatments for children with Autism however in general there has been little or no scientific evidence of effectiveness.

A recent book My Stroke of Insight by Jill Bolte Taylor gives some insight, from a brain researcher's point of view, on what sensory dysfunction feels like. Other books on sensory integration include The Out of Sync Child - Recognizing and Coping with Sensory Processing Disorder by Carol Kranowitz and Lucy Jane Miller.

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

Bias

Bias is an inclination to present or hold a partial perspective at the expense of alternatives. Bias can come in many forms.-In judgement and decision making:...

found in the studies analyzed, no firm conclusions about the efficacy of massage therapy could be drawn.

Music

Music therapy

Music therapy is an allied health profession and one of the expressive therapies, consisting of an interpersonal process in which a trained music therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their...

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-assisted therapy

Animal-Assisted Therapy

Animal-assisted therapy is a relatively new field of study, although the human-animal bond has existed for thousands of years. AAT is a type of therapy that involves animals as a form of treatment. The goal of AAT is to improve a patient’s social, emotional, or cognitive functioning...

, 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. A 2007 meta-analysis

Meta-analysis

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

Review

A review is an evaluation of a publication, a product or a service, such as a movie , video game, musical composition , book ; a piece of hardware like a car, home appliance, or computer; or an event or performance, such as a live music concert, a play, musical theater show or dance show...

s of published dolphin

Dolphin

Dolphins are marine mammals that are closely related to whales and porpoises. There are almost forty species of dolphin in 17 genera. They vary in size from and , up to and . They are found worldwide, mostly in the shallower seas of the continental shelves, and are carnivores, mostly eating...

-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.

Neurofeedback

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

attempts to train individuals to regulate their brainwave patterns by letting them observe their brain activity more directly. 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.

Patterning

Patterning is a set of exercises that attempts to improve the organization of a child's neurologic impairments. It has been used for decades to treat children with several unrelated neurologic disorders, including autism. The method, taught at the The Institutes for the Achievement of Human Potential

The Institutes for The Achievement of Human Potential

The Institutes for The Achievement of Human Potential is a non-profit organization providing teaching programs and literature which it promotes as improving the health and neurological development of normal children and of children who have sustained a brain injury.Although the institute's programs...

, is based on oversimplified theories and is not supported by carefully designed research studies.

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. It is intended as treatment for autistic children who harm themselves; most of these children cannot speak. Similar envelopment techniques have been used for centuries, such as to calm violent patients in Germany in the 19th century; its modern use in France began in the 1960s, based on psychoanalytic theories such as the theory of the refrigerator mother

Refrigerator mother

The term refrigerator mother was coined around 1950 as a label for mothers of children diagnosed with autism or schizophrenia. These mothers were often blamed for their children's atypical behavior, which included rigid rituals, speech difficulty, and self-isolation.The "refrigerator mother" label...

. Packing is currently used in hundreds of French clinics. There is no scientific evidence for the effectiveness of packing, and some concern about risk of adverse health effects.

Parent mediated interventions

Parent mediated interventions offer support and practical advice to parents of autistic children. Randomized and controlled studies suggest that parent training leads to reduced maternal depression, improved maternal knowledge of autism and communication style, and improved child communicative behavior. A Cochrane Review

Cochrane Library

The Cochrane Library is a collection of databases in medicine and other healthcare specialties provided by the Cochrane Collaboration and other organisations. At its core is the collection of Cochrane Reviews, a database of systematic reviews and meta-analyses which summarize and interpret the...

(2002) of the evidence found two relevant research items, and observed "intensive intervention (involving parents, but primarily delivered by professionals) was associated with better child outcomes on direct measurement than were found for parent-mediated early intervention, but no differences were found in relation to measures of parent and teacher perceptions of skills and behaviours". A 2006 randomized controlled trial

Randomized controlled trial

A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...

(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. 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

Parent-Child Interaction Therapy

Parent–child interaction therapy is a form of psychotherapy developed by Sheila Eyberg for children ages 2–7 and their caregivers. It uses a unique combination of behavioral therapy, play therapy, and parent training to teach more effective discipline techniques and improve the parent–child...

, 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.

Medical management

Drugs, supplements, or diets are often used to alter physiology in an attempt to relieve common autistic symptoms such as seizures, sleep disturbances, irritability, and hyperactivity that can interfere with education or social adaptation or (more rarely) cause autistic individuals to harm themselves or others. There is plenty of anecdotal evidence to support medical treatment; many parents who try one or more therapies report some progress, and there are a few well-publicized reports of children who are able to return to mainstream education after treatment, with dramatic improvements in health and well-being. However, this evidence may be confounded by improvements seen in autistic children who grow up without treatment, by the difficulty of verifying reports of improvements, and by the lack of reporting of treatments' negative outcomes. Only a very few medical treatments are well supported by scientific evidence using controlled experiments.

Prescription medication

Many medications are used to treat problems associated with ASD. More than half of U.S. children diagnosed with ASD are prescribed psychoactive drug

Psychoactive drug

s or anticonvulsant

Anticonvulsant

s, with the most common drug classes being antidepressant

Antidepressant

s, stimulant

Stimulant

s, and antipsychotic

Antipsychotic

s. Only the antipsychotics have clearly demonstrated efficacy.

Research has focused on atypical antipsychotics, especially risperidone

Risperidone

Risperidone is a second generation or atypical antipsychotic, sold under the trade name . It is used to treat schizophrenia , schizoaffective disorder, the mixed and manic states associated with bipolar disorder, and irritability in people with autism...

, which has the largest amount of evidence that consistently shows improvements in irritability, self-injury, aggression, and tantrums associated with ASD. Risperidone is approved by the Food and Drug Administration

Food and Drug Administration

The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...

(FDA) for treating symptomatic irritability in autistic children and adolescents. In short-term trials (up to six months) most adverse events were mild to moderate, with weight gain

Weight gain

Weight gain is an increase in body weight. This can be either an increase in muscle mass, fat deposits, or excess fluids such as water.-Description:...

, drowsiness, and high blood sugar requiring monitoring; long term efficacy and safety have not been fully determined. It is unclear whether risperidone improves autism's core social and communication deficits. The FDA's decision was based in part on a study of autistic children with severe and enduring problems of tantrums, aggression, and self-injury; risperidone is not recommended for autistic children with mild aggression and explosive behavior without an enduring pattern.

Other drugs are prescribed off-label in the U.S., which means they have not been approved for treating ASD. Large placebo

Placebo

A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...

-controlled studies of olanzapine

Olanzapine

Olanzapine is an atypical antipsychotic, approved by the FDA for the treatment of schizophrenia and bipolar disorder...

and aripiprazole

Aripiprazole

Aripiprazole is an atypical antipsychotic and antidepressant used in the treatment of schizophrenia, bipolar disorder, and clinical depression...

were underway in early 2008. Some selective serotonin reuptake inhibitor

Selective serotonin reuptake inhibitor

Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitor are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. The efficacy of SSRIs is disputed...

s (SSRIs) and dopamine

Dopamine

Dopamine is a catecholamine neurotransmitter present in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this substituted phenethylamine functions as a neurotransmitter, activating the five known types of dopamine receptors—D1, D2, D3, D4, and D5—and their...

blockers can reduce some maladaptive behaviors associated with ASD. Although SSRIs reduce levels of repetitive behavior in autistic adults, a 2009 multisite randomized controlled study found no benefit and some adverse effects in children from the SSRI citalopram

Citalopram

Citalopram brand names: Celexa, Cipramil) is an antidepressant drug of the selective serotonin reuptake inhibitor class. It has U.S...

, raising doubts whether SSRIs are effective for treating repetitive behavior in autistic children. A further study of related medical reviews determined that the prescription of SSRI antidepressants for treating autistic spectrum disorders in children lacked any evidence, and could not be recommended. One study found that the psychostimulant methylphenidate

Methylphenidate

Methylphenidate is a psychostimulant drug approved for treatment of attention-deficit hyperactivity disorder, postural orthostatic tachycardia syndrome and narcolepsy. It may also be prescribed for off-label use in treatment-resistant cases of lethargy, depression, neural insult and obesity...

was efficacious against hyperactivity associated with ASD, though with less response than in neurotypical children with ADHD. Of the many medications studied for treatment of aggressive and self-injurious behavior in children and adolescents with autism, only risperidone and methylphenidate demonstrate results that have been replicated. A 1998 study of the hormone secretin

Secretin

Secretin is a hormone that controls the secretions into the duodenum, and also separately, water homeostasis throughout the body. It is produced in the S cells of the duodenum in the crypts of Lieberkühn...

reported improved symptoms and generated tremendous interest, but several controlled studies since have found no benefit. Oxytocin

Oxytocin

Oxytocin is a mammalian hormone that acts primarily as a neuromodulator in the brain.Oxytocin is best known for its roles in sexual reproduction, in particular during and after childbirth...

may play a role in autism and may be an effective treatment for repetitive and affiliative behaviors; two related studies in adults found that oxytocin decreased repetitive behaviors and improved interpretation of emotions, but these preliminary results do not necessarily apply to children. An experimental drug STX107 has stopped overproduction of metabotropic glutamate receptor 5

Metabotropic glutamate receptor 5

Metabotropic glutamate receptor 5 is a protein that in humans is encoded by the GRM5 gene.- Function :The amino acid L-glutamate is the major excitatory neurotransmitter in the central nervous system and activates both ionotropic and metabotropic glutamate receptors...

in rodents, and it has been hypothesized that this may help in about 5% of autism cases, but this hypothesis has not been tested in humans.

Aside from antipsychotics, there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD. Results of the handful of randomized control trials that have been performed suggest that risperidone, the SSRI fluvoxamine

Fluvoxamine

Fluvoxamine is an antidepressant which functions as a selective serotonin reuptake inhibitor . Fluvoxamine was first approved by the U.S. Food and Drug Administration in 1993 for the treatment of obsessive compulsive disorder . Fluvoxamine CR is approved to treat social anxiety disorder...

, and the typical antipsychotic haloperidol

Haloperidol

Haloperidol is a typical antipsychotic. It is in the butyrophenone class of antipsychotic medications and has pharmacological effects similar to the phenothiazines....

may be effective in reducing some behaviors, that haloperidol may be more effective than the tricyclic antidepressant clomipramine

Clomipramine

Clomipramine is a tricyclic antidepressant . It was developed in the 1960s by the Swiss drug manufacturer Geigy and has been in clinical use worldwide ever since.- Indications :...

, and that the opiate antagonist naltrexone hydrochloride is not effective. A person with ASD may respond atypically to medications, the medications can have adverse side effects, and no known medication relieves autism's core symptoms of social and communication impairments.

Dietary supplements

Many parents give their children dietary supplement

Dietary supplement

A dietary supplement, also known as food supplement or nutritional supplement, is a preparation intended to supplement the diet and provide nutrients, such as vitamins, minerals, fiber, fatty acids, or amino acids, that may be missing or may not be consumed in sufficient quantities in a person's diet...

s in an attempt to treat autism or to alleviate its symptoms. The range of supplements given is wide; few are supported by scientific data, but most have relatively mild side effects.

A review found some low-quality evidence to support the use of vitamin B6

Vitamin B6

Vitamin B6 is a water-soluble vitamin and is part of the vitamin B complex group. Several forms of the vitamin are known, but pyridoxal phosphate is the active form and is a cofactor in many reactions of amino acid metabolism, including transamination, deamination, and decarboxylation...

in combination with magnesium

Magnesium

Magnesium is a chemical element with the symbol Mg, atomic number 12, and common oxidation number +2. It is an alkaline earth metal and the eighth most abundant element in the Earth's crust and ninth in the known universe as a whole...

at high doses, but the evidence was equivocal and the review noted the possible danger of fatal hypermagnesemia

Hypermagnesemia

Hypermagnesemia is an electrolyte disturbance in which there is an abnormally elevated level of magnesium in the blood. Usually this results in excess of magnesium in the body....

. A Cochrane Review

Cochrane Library

of the evidence for the use of B6 and magnesium found that "[d]ue to the small number of studies, the methodological quality of studies, and small sample sizes, no recommendation can be advanced regarding the use of B6-Mg as a treatment for autism."

Dimethylglycine

Dimethylglycine

Dimethylglycine is a derivative of the amino acid glycine with the structural formula 2NCH2COOH. It can be found in beans and liver. It can be formed from trimethylglycine upon the loss of one of its methyl groups...

(DMG) is hypothesized to improve speech and reduce autistic behaviors, and is a commonly used supplement. Two double-blind, placebo

Placebo

A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...

-controlled studies found no statistically significant effect on autistic behaviors, and reported few side effects. No peer-reviewed studies have addressed treatment with the related compound trimethylglycine

Trimethylglycine

Trimethylglycine is an organic compound that occurs in plants as either glycine betaine or a choline-containing glycine betaine compound. Trimethylglycine was the first betaine discovered by science; originally it was simply called betaine because, in the 19th century, it was discovered in sugar...

.

Vitamin C

Vitamin C

Vitamin C or L-ascorbic acid or L-ascorbate is an essential nutrient for humans and certain other animal species. In living organisms ascorbate acts as an antioxidant by protecting the body against oxidative stress...

decreased stereotyped behavior in a small 1993 study. The study has not been replicated, and vitamin C has limited popularity as an autism treatment. High doses might cause kidney stones or gastrointestinal upset such as diarrhea.

Probiotic

Probiotic

Probiotics are live microorganisms thought to be beneficial to the host organism. According to the currently adopted definition by FAO/WHO, probiotics are: "Live microorganisms which when administered in adequate amounts confer a health benefit on the host"...

s containing potentially beneficial bacteria

Bacteria

Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...

are hypothesized to relieve some symptoms of autism by minimizing yeast overgrowth

Candidiasis

Thrush redirects here. For the hoof infection see Thrush .Candidiasis or thrush is a fungal infection of any of the Candida species , of which Candida albicans is the most common...

in the colon

Colon (anatomy)

The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...

. The hypothesized yeast overgrowth has not been confirmed by endoscopy

Endoscopy

Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...

, the mechanism connecting yeast overgrowth to autism is only hypothetical, and no clinical trials to date have been published in the peer-reviewed literature. No negative side effects have been reported.

Melatonin

Melatonin

Melatonin , also known chemically as N-acetyl-5-methoxytryptamine, is a naturally occurring compound found in animals, plants, and microbes...

is sometimes used to manage sleep problems in developmental disorders. Adverse effects are generally reported to be mild, including drowsiness, headache, dizziness, and nausea; however, an increase in seizure frequency is reported among susceptible children. A 2008 open trial found that melatonin appears to be a safe and well-tolerated treatment for insomnia

Insomnia

Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...

in children with ASD. and suggested controlled trials to determine efficacy; a small 2009 retrospective study had similar results for adults.

Although omega-3 fatty acids, which are polyunsaturated fatty acid

Polyunsaturated fatty acid

Polyunsaturated fatty acids are fatty acids that contain more than one double bond in their backbone. This class includes many important compounds, such as essential fatty acids and those that give drying oils their characteristic property....

s (PUFA), are a popular treatment for children with ASD, there is very little scientific evidence supporting their effectiveness, and further research is needed.

Several other supplements have been hypothesized to relieve autism symptoms, including BDTH₂

BDTH2

BDTH2 is a powerful chelation agent that is marketed as a dietary supplement to parents of children with autism, and can be used to separate heavy metals from mining drainage and other polluted soil.- Preparation :This compound may be prepared by reacting cysteamine with isophthaloyl...

, carnosine

Carnosine

Carnosine is a dipeptide of the amino acids beta-alanine and histidine. It is highly concentrated in muscle and brain tissues....

, cholesterol

Cholesterol

Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...

, cyproheptadine

Cyproheptadine

Cyproheptadine , sold under the brand name Periactin, is a first-generation antihistamine with additional anticholinergic, antiserotonergic, and local anesthetic properties.- Indications :...

, D-cycloserine, folic acid

Folic acid

Folic acid and folate , as well as pteroyl-L-glutamic acid, pteroyl-L-glutamate, and pteroylmonoglutamic acid are forms of the water-soluble vitamin B9...

, glutathione

Glutathione

Glutathione is a tripeptide that contains an unusual peptide linkage between the amine group of cysteine and the carboxyl group of the glutamate side-chain...

, metallothionein

Metallothionein

Metallothionein is a family of cysteine-rich, low molecular weight proteins. They are localized to the membrane of the Golgi apparatus...

promoters, other PUFA such as omega-6 fatty acids, tryptophan

Tryptophan

Tryptophan is one of the 20 standard amino acids, as well as an essential amino acid in the human diet. It is encoded in the standard genetic code as the codon UGG...

, tyrosine

Tyrosine

Tyrosine or 4-hydroxyphenylalanine, is one of the 22 amino acids that are used by cells to synthesize proteins. Its codons are UAC and UAU. It is a non-essential amino acid with a polar side group...

, thiamine (see Chelation therapy), vitamin B₁₂

Vitamin B12

Vitamin B12, vitamin B12 or vitamin B-12, also called cobalamin, is a water-soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins...

, and zinc

Zinc

Zinc , or spelter , is a metallic chemical element; it has the symbol Zn and atomic number 30. It is the first element in group 12 of the periodic table. Zinc is, in some respects, chemically similar to magnesium, because its ion is of similar size and its only common oxidation state is +2...

. These lack reliable scientific evidence of efficacy or safety in treatment of autism.

Diets

Atypical eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur; this does not appear to result in malnutrition

Malnutrition

Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....

. Although some children with autism also have gastrointestinal (GI) symptoms, there is a lack of published rigorous data to support the theory that autistic children have more or different GI symptoms than usual; studies report conflicting results, and the relationship between GI problems and ASD is unclear.

In the early 1990s, it was hypothesized that autism can be caused or aggravated by opioid peptide

Opioid peptide

Opioid peptides are short sequences of amino acids that bind to opioid receptors in the brain; opiates and opioids mimic the effect of these peptides. Opioid peptides may be produced by the body itself, for example endorphins. The effects of these peptides vary, but they all resemble opiates...

s like casomorphine that are metabolic products of gluten

Gluten

Gluten is a protein composite found in foods processed from wheat and related grain species, including barley and rye...

and casein

Casein

Casein is the name for a family of related phosphoprotein proteins . These proteins are commonly found in mammalian milk, making up 80% of the proteins in cow milk and between 60% and 65% of the proteins in human milk....

. Based on this hypothesis, diets that eliminate foods containing either gluten or casein, or both, are widely promoted, and many testimonials can be found describing benefits in autism-related symptoms, notably social engagement and verbal skills. Studies supporting these claims have had significant flaws, so these data are inadequate to guide treatment recommendations.

Other elimination diet

Elimination diet

s have also been proposed, targeting salicylates, food dyes, yeast

Yeast

Yeasts are eukaryotic micro-organisms classified in the kingdom Fungi, with 1,500 species currently described estimated to be only 1% of all fungal species. Most reproduce asexually by mitosis, and many do so by an asymmetric division process called budding...

, and simple sugars. No scientific evidence has established the efficacy of such diets in treating autism in children. An elimination diet may create nutritional deficiencies that harm overall health unless care is taken to assure proper nutrition. For example, a 2008 study found that autistic boys on casein-free diets have significantly thinner bones than usual, presumably because the diets contribute to calcium and vitamin D deficiencies.

Chelation therapy

Based on the speculation that heavy metal poisoning

Heavy metals

A heavy metal is a member of a loosely-defined subset of elements that exhibit metallic properties. It mainly includes the transition metals, some metalloids, lanthanides, and actinides. Many different definitions have been proposed—some based on density, some on atomic number or atomic weight,...

may trigger the symptoms of autism, particularly in small subsets of individuals who cannot excrete toxins effectively, some parents have turned to alternative medicine

Alternative medicine

Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

practitioners who provide detoxification treatments via chelation therapy

Chelation therapy

. However, evidence to support this practice has been anecdotal

Anecdote

An anecdote is a short and amusing or interesting story about a real incident or person. It may be as brief as the setting and provocation of a bon mot. An anecdote is always presented as based on a real incident involving actual persons, whether famous or not, usually in an identifiable place...

and not rigorous. Strong epidemiological

Epidemiology

Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...

evidence refutes links between environmental triggers, in particular thimerosal containing vaccine

Vaccine

A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins...

s, and the onset of autistic symptoms. No scientific data supports the claim that the mercury in the vaccine preservative thiomersal

Thiomersal

Thiomersal , and commonly known in the US as thimerosal, is an organomercury compound. This compound is a well established antiseptic and antifungal agent....

causes autism or its symptoms, and there is no scientific support for chelation therapy as a treatment for autism.

Chelation therapy can be hazardous. In August 2005, an incorrect form of EDTA used for chelation therapy resulted in hypocalcemia, causing cardiac arrest

Cardiac arrest

Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...

that killed a five-year-old autistic boy.

Thiamine

Thiamine

Thiamine or thiamin or vitamin B1 , named as the "thio-vitamine" is a water-soluble vitamin of the B complex. First named aneurin for the detrimental neurological effects if not present in the diet, it was eventually assigned the generic descriptor name vitamin B1. Its phosphate derivatives are...

tetrahydrofurfuryl disulfide (TTFD) is hypothesized to act as a chelating agent in children with autism. A 2002 pilot study administered TTFD rectally to ten autism spectrum

Autism spectrum

The term "autism spectrum" is often used to describe disorders that are currently classified as pervasive developmental disorders. Pervasive developmental disorders include autism, Asperger syndrome, Childhood disintegrative disorder, Rett syndrome and Pervasive Developmental Disorder Not Otherwise...

children, and found beneficial clinical effect. This study has not been replicated, and a 2006 review of thiamine by the same author did not mention thiamine's possible effect on autism

Autism

. There is not sufficient evidence to support the use of thiamine (vitamin B₁) to treat autism.

Chiropractic

Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine...

is an alternative medical practice whose main hypothesis is that mechanical disorders of the spine affect general health via the nervous system, and whose main treatment is spinal manipulation

Spinal manipulation

Spinal manipulation is a therapeutic intervention performed on spinal articulations which are synovial joints . These articulations in the spine that are amenable to spinal manipulative therapy include the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse...

. A significant portion of the profession rejects vaccination

Vaccination

Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...

, as traditional chiropractic philosophy equates vaccines to poison. Most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous, ineffective, and unnecessary, and in some cases suggesting that vaccination causes autism or that chiropractors should be the primary contact for treatment of autism and other neurodevelopmental disorders. Chiropractic treatment has not been shown to be effective for medical conditions other than back pain, and there is insufficient scientific evidence to make conclusions about chiropractic care for autism.

Craniosacral therapy

Craniosacral therapy is an alternative medicine therapy used by osteopaths, massage therapists, naturopaths, and chiropractors. A craniosacral therapy session involves the therapist placing their hands on the patient, which allows them to "tune into the craniosacral rhythm"...

is based on the theory that restrictions at cranial sutures

Cranial sutures

*Surgical suture, to describe stitches and other techniques for holding tissues together.* Geology, to describe a certain type of boundary between layers of rock....

of the skull affect rhythmic impulses conveyed via cerebrospinal fluid

Cerebrospinal fluid

Cerebrospinal fluid , Liquor cerebrospinalis, is a clear, colorless, bodily fluid, that occupies the subarachnoid space and the ventricular system around and inside the brain and spinal cord...

, and that gentle pressure on external areas can improve the flow and balance of the supply of this fluid to the brain, relieving symptoms of many conditions. There is no scientific support for major elements of the underlying model, there is little scientific evidence to support the therapy, and research methods that could conclusively evaluate the therapy's effectiveness have not been applied. No published studies are available on the use of this therapy for autism.

Electroconvulsive therapy

Studies indicate that 12–17% of adolescents and young adults with autism satisfy diagnostic criteria for catatonia

Catatonia

Catatonia is a state of neurogenic motor immobility, and behavioral abnormality manifested by stupor. It was first described in 1874: Die Katatonie oder das Spannungsirresein ....

, which is loss of or hyperactive motor activity. Electroconvulsive therapy

Electroconvulsive therapy

Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...

(ECT) has been used to treat cases of catatonia and related conditions in people with autism. However, no controlled trials have been performed of ECT in autism, and there are serious ethical and legal obstacles to its use.

Hyperbaric oxygen therapy

Hyperbaric medicine, also known as hyperbaric oxygen therapy , is the medical use of oxygen at a level higher than atmospheric pressure. The equipment required consists of a pressure chamber, which may be of rigid or flexible construction, and a means of delivering 100% oxygen...

(HBOT) can compensate for decreased blood flow by increasing the oxygen content in the body. It has been postulated that HBOT might relieve some of the core symptoms of autism. A small 2009 double-blind study of autistic children found that 40 hourly treatments of 24% oxygen at 1.3 atmospheres provided significant improvement in the children's behavior immediately after treatment sessions. The study has not been independently confirmed; further studies are planned or in progress.

Prosthetics

Unlike conventional neuromotor prostheses, neurocognitive prostheses would sense or modulate neural function in order to physically reconstitute cognitive processes such as executive function and language. No neurocognitive prostheses are currently available but the development of implantable neurocognitive brain-computer interfaces has been proposed to help treat conditions such as autism.

Affective computing

Affective computing

Affective computing is the study and development of systems and devices that can recognize, interpret, process, and simulate human affects. It is an interdisciplinary field spanning computer sciences, psychology, and cognitive science...

devices, typically with image or voice recognition capabilities, have been proposed to help autistic individuals improve their social communication skills. These devices are still under development. Robots have also been proposed as educational aids for autistic children.

Stem cell therapy

Mesenchymal stem cells and cord blood

Cord blood

Umbilical cord blood is blood that remains in the placenta and in the attached umbilical cord after childbirth. Cord blood is collected because it contains stem cells which can be used to treat hematopoietic and genetic disorders.-Collection:...

CD34

CD34 molecule is a cluster of differentiation molecule present on certain cells within the human body. It is a cell surface glycoprotein and functions as a cell-cell adhesion factor. It may also mediate the attachment of stem cells to bone marrow extracellular matrix or directly to stromal cells...

+ cells have been proposed to treat autism, but this proposal has not been tested.

Alternative medicine

Acupuncture

Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....

has not been found to be helpful. However, ongoing research suggests that so-called "sham acupuncture" used in the cited study is an ineffective method to test the usefulness of acupuncture.

Religious interventions

The Table Talk
Table Talk (Luther)
Martin Luther's Table Talk is a collection of his sayings. It was compiled by Johannes Mathesius and published at Eisleben in 1566.Mathesius spoke enthusiastically of the privilege of eating with Luther and hearing him converse...

of Martin Luther

Martin Luther

Martin Luther was a German priest, professor of theology and iconic figure of the Protestant Reformation. He strongly disputed the claim that freedom from God's punishment for sin could be purchased with money. He confronted indulgence salesman Johann Tetzel with his Ninety-Five Theses in 1517...

contains the story of a twelve-year-old boy who may have been severely autistic. According to Luther's notetaker Mathesius

Johannes Mathesius

Johannes Mathesius , also called Johann Mathesius or John Mathesius, was a German minister and a Lutheran reformer. He is best known for his compilation of Martin Luther's Table Talk, or notes taken of Luther's conversation and published afterwards...

, Luther thought the boy was a soulless mass of flesh possessed by the devil

Demonic possession

Demonic possession is held by many belief systems to be the control of an individual by a malevolent supernatural being. Descriptions of demonic possessions often include erased memories or personalities, convulsions, “fits” and fainting as if one were dying...

, and suggested that he be suffocated. In 2003, an autistic boy in Wisconsin suffocated during an exorcism

Exorcism

Exorcism is the religious practice of evicting demons or other spiritual entities from a person or place which they are believed to have possessed...

in which he was wrapped in sheets. Some Pentecostal and charismatic

Charismatic movement

The term charismatic movement is used in varying senses to describe 20th century developments in various Christian denominations. It describes an ongoing international, cross-denominational/non-denominational Christian movement in which individual, historically mainstream congregations adopt...

Christians believe that autism is the result of a "generational curse" visited upon a child for the sins of a parent, and can be cured through repentance and divine healing.

Ultraorthodox Jewish parents sometimes use spiritual and mystical interventions such as prayers, blessings, recitations of religious text, holy water, amulets, changing the child's name, and exorcism.

One study has suggested that spirituality

Spirituality

Spirituality can refer to an ultimate or an alleged immaterial reality; an inner path enabling a person to discover the essence of his/her being; or the “deepest values and meanings by which people live.” Spiritual practices, including meditation, prayer and contemplation, are intended to develop...

and not religious activities involving the mothers of autistic children were associated with better outcomes for the child.

Anti-cure perspective

The exact cause of autism

Causes of autism

Many causes of autism have been proposed, but understanding of the theory of causation of autism and the other autism spectrum disorders is incomplete. Heritability contributes about 90% of the risk of a child developing autism, but the heritability of autism is complex and typically it is...

is unclear, yet some organizations advocate researching a cure. Some autism rights organizations view autism as a way of life rather than as a disease and thus advocate acceptance over a search for a cure.

Historical approach

Educational interventions

Lovaas

Pivotal response therapy

Aversion therapy

Communication interventions

Relationship based, developmental models

Floortime/DIR

The P.L.A.Y. Project (or PLAY Project)

Son-Rise

TEACCH

Sensory integration

Massage therapy

Music

Animal-assisted therapy

Neurofeedback

Patterning

Packing

Parent mediated interventions

Medical management

Prescription medication

Dietary supplements

Diets

Chelation therapy

Chiropractic

Craniosacral therapy

Electroconvulsive therapy

Hyperbaric oxygen therapy

Prosthetics

Stem cell therapy

Alternative medicine

Religious interventions

Anti-cure perspective

Further reading