Autism and Communication (cont.)Medical Author:
Roxanne Dryden-Edwards, MD
Roxanne Dryden-Edwards, MDDr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland. Medical Editor:
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACRDr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology. In this Article
 How is autism treated in children and adults?Misinformation about autism is very common. Claims of a cure for autism are constantly presented to families of individuals with autism. There are various treatment models found within both the educational and clinical settings. Yet, there is only one treatment approach that has prevailed over time and is effective for all persons, with or without autism. That treatment model is an educational program that is suitable to a student's developmental level of performance. For adults, that treatment model refers to a vocational program that is suitable to the individual's developmental level of functioning. Under the Individuals with Disabilities Educational Act (IDEA) Act of 1990, students with a handicap are guaranteed an "appropriate education" in the Least Restrictive Environment (LRE), which is generally considered to be as normal an educational setting as possible. As a result of this legislation, children with autism have often been placed in a mainstreamed classroom and pulled out for whatever supplementary services were needed. Depending on the child's needs, he or she could be placed up to 100% of the school day in a mainstreamed or a special education setting or any combination of the two. There is an increasing trend, however, among the advocates for children with autism, to segregate these children into small, highly structured and controlled academic settings that are almost free from auditory and visual stimulation. All instruction is broken down into manageable segments. Information is presented in tiny units and the child's response is immediately sought. A classic stimulus-response approach is used to maximize learning. Each unit of information is mastered before another is presented. A fundamental behavior such as putting hands on the tabletop, for example, must be mastered before the child is required to perform any other tasks, or before more information is presented. The long-term effects of this type of treatment as well as the ability of the child to transfer this to a broader context continue to be evaluated. For people with autism whose symptoms include self injurious behaviors, the focus of treatment has shifted from restriction and punishment to more of a focus on understanding potential motivators for negative behaviors, as well as rewarding and otherwise encouraging appropriate behaviors. Individuals with autism need to be taught how to communicate and interact with others. This is not a simple task, and it involves the entire family as well as other professionals. Parents of a child or adult with autism must continually educate themselves about new treatments and keep an open mind. Some treatments may be appropriate for some individuals but not for others. Many treatments have yet to be scientifically proven. Treatment decisions should always be made individually after a thorough assessment and based on what is suitable for that person and his or her family. It is important to remember, despite some recent denials, that autism is usually a lifelong condition. The kind of support that is appropriate will change as the individual develops. Families must beware of treatment programs that give false hope of a cure. Acceptance of the condition in a family member is a very critical, foundational component of any treatment program and is understandably quite difficult. Several medications have been tried or are under current scrutiny for the treatment of autism. No medication has consistently proven to be of benefit for either curing or comprehensively managing autism in closely controlled clinical trials. In the past, a piece on a television news show prompted a great deal of interest in the hormone secretin as a treatment for autism. A child with autism who has with chronic gastrointestinal complaints showed dramatic improvement following some routine testing performed by a gastroenterologist during which a small dose of secretin was administered. The family and their physicians felt that the secretin may have resulted in the improvement in the symptoms of autism. Many physicians began prescribing secretin, which can be costly for their autistic patients. However, studies published appear to completely refute the claim that secretin treatment benefits autistic patients. This example underscores the importance of good clinical trials in determining whether a drug will help patients with autism. Some medications have been found to help address some symptoms that may present in autism. For example, haloperidol (Haldol), is thought to help treat aggression and methylphenidate has been determined to be helpful in addressing hyperactivity in persons with autism. Risperidone (Risperdal) has been found to be quite helpful in many people whose autistic symptoms include odd, repetitive behaviors (stereotypies), hyperactivity, irritability, throwing tantrums, being aggressive towards others of injuring oneself. Persons with autism seem to have a higher mortality rate at younger ages compared to average individuals. This is particularly true for mortality that is related to seizures or infection. It is, therefore, important for the autistic population to receive good medical care from practitioners who have knowledge and experience in addressing their unique medical needs. Due to a number of potential factors, autistic persons tend to be vulnerable to nutritional problems. Specifically, factors like variations in appetite, refusal of many foods, food allergies and side effects to some medications can disproportionately impact the food intake, and therefore the nutritional status of this population. As individuals with autism also seem to be vulnerable to emotional struggles like anxiety, depression and attention problems, the involvement of mental health professionals should be sought when appropriate. Psychotherapeutic approaches that have been found to help improve functioning in some persons with autism include comprehensive behavioral therapy to address problematic behaviors. Social skills training and support are important in helping people with autism navigate interactions with others, since many of this population crave social interaction despite their limitations in engaging others socially. Cognitive behavioral treatment in verbal individuals with anxiety and voice output communication who are less verbal are considered promising areas of treatment as well . Patient CommentsViewers share their comments
Autism and Communication - Symptoms
Question: What were the symptoms of your child's autism initially?
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