Evaluating
Treatments
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Every
individual with autism is different. A medication or an educational program
that works for one may not work for another. For example, one child may make
really good progress on a highly structured, discrete trial educational
program. Another child may go into sensory overload in a discrete trial program
and make little progress. That child will require a gender approach.
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Most
autism specialists agree that many hours of early educational intervention are
needed, but they disagree on whether it should be the Lovaas ABA (Applied
Behavior Analysis) or one of the more social-relationship based models, such as
the Greenspan (Floortime) method. I have observed that the person actually
doing the teaching is often a more important part of the equation than is the
method. Good teaching tends to do the same thing, regardless of the theoretical
basis of the teaching method. They have a natural instinct about what works and
doesn't work for a child, and they adapt whatever method they happen to be
using accordingly. If you notice that a particular teacher does not get along
with your child, or doesn't seem to have that "feel" for working with
him or her, then try another teacher.
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Change One Thing at a Time
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It
is impossible to determine if a new diet, medication, or educational program is
working if several new things are started at the same time. Start one thing at
a time. Many parents are afraid to do this because they want to do the best for
their child, and fear that "time is running out." In most cases, a
short thirty-day trial period is all that is needed between different
treatments to observe the effects. Another good evaluation method is a blind evaluation,
where the person offering the evaluation does not know a new educational
program or a new medication is being tried. For instance, if the teacher at
school mentions your child's behavior has greatly improved, that would be a
good indication that a new treatment you're trying at home is working (you
didn't tell the teacher beforehand about it). With medication, especially,
parents must balance risk versus benefit. A good rule of thumb with medication
is that there should be a fairly dramatic, obvious improvement to make it worth
the risk or the side effects. For example, if a medication reduced rage attacks
from ten per week to one per month, that would be a medication that really
works. If a medication makes a child slightly less hyper, that may not be
enough benefit to make it worth the risk.
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Many
treatments are now available. Some have been verified by rigorous scientific
studies and others have not. Discrete trial educational programs and SSRI
antidepressant medications, such as Prozac or Zoloft, are backed by scientific
studies. Interventions such as Irlen lenses or special diets have less
scientific backing. However, there are some individuals who are helped by these
treatments. One of the reasons that some scientific studies have failed to show
results may be because only a certain subgroup of people on the autism spectrum
will respond to some treatments. Further studies, especially those that will
illuminate what interventions are most helpful to different subgroups, are
needed.
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In
conclusion, introduce one new intervention at a time, and keep a diary of its
effects. Avoid vague terms such as "my child has really improved." Be
specific about the observed changes, either positive or negative, and make
entries at least once a day. An example of a well-worded, useful evaluation
would be "my child learned ten new words in one week" or "his
tantrums went from five a day to one within four days." ?Good information will help you make good
decisions that will help your child in the long run.
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The Problem with Short Drug Trials
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Recently
there have been increasing problems with the use of very short, unrealistic
drug trials for evaluating psychiatric drugs. The severe side effects that can
occur with atypical anti-psychotics such as Risperdal (risperidone) or Seroquel
(quetiapine) are not going to show up in a six-to-eight-week trial. I am concerned
that the FDA approved Risperdal for five-year-olds with autism. Even though it
is approved, it would probably be a bad choice for most five-year-olds because
the risk of long-term side effects is too high. In very young children, other
safer treatments such as special diets or Omega-3 fish oil supplements should
be tried first. There are too many powerful drugs being given out to very young
children. However, in older children and adults, there are some cases where
Risperdal would be a good choice,
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Temple
Grandin "The Way I See It: A Personal Look at Autism &
Asperger's" (2011)
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