Article Review: A Selective Review of Treatments for Children with Autism: Description and Methodological Considerations

Lee Ann Melchor

University of Central Florida

College of Education - Graduate Studies

A Selective Review of Treatments for Children with Autism: Description and Methodological Considerations

Recently, the CDC announced that roughly 1 in 88 children are diagnosed with autism with boys 5 times more likely to develop autism than girls. These staggering numbers combined with the lack of identifiable cure or cause of autism, leaves many parents vulnerable to miracle cures and ineffective and unproven treatment options. Of all the treatment options available, several programs were identified as being the most cited and most visible autism programs available. These programs include: UCLA’s Young Autism Project (YAP), Project TEACCH, LEAP, ABA Therapy and the Denver Health Science Program.

While there is no documented cure for autism, autism can be managed effectively using a combination of behavioral, education and biological interventions. In reviewing treatment options, autism and school professionals should consider the following questions: (a) Are these treatment programs effective? (b) What are the common elements of these programs? (c) What steps need to be taken to improve treatment outcome research for children with autism? (d) What implications do the answers to the above 3 questions have for school psychologists? (Gresham, 2000). Two primary distinctions are made when evaluating a treatment option: the efficacy of the treatment or the reduction in the autism symptoms while increasing functional skills and effectiveness across the settings in which the treatment options will be used.

In 1996, Bristol and his colleagues released a report to the National Institute of Health (NIH) in which he raised issue with the methods and the statistical data in autism interventions that must be addressed in order to gain a better understanding of what autism interventions work. These findings include:

• Research studies should use experimental designs and treatment comparison models.
• Use of randomly assigned children to treatment conditions.
• Treatment should be conducted across a wide variety of natural and laboratory settings in which a wide variety of behaviors and skills are assessed.
• Outside evaluators who are not vested in outcomes of research should not be used.
• Procedural integrity of the interventions should be consistently assessed.
• Longevity studies should be used to evaluate the long term effects of treatment over time.

The Clinical Child and Pediatric Psychology / Division 12 of the American Psychological Association (APA), formed a task force to evaluate the efficacy and effectiveness of research on childhood five childhood disorders, including autism. The goals of the task force include identifying what treatments are most effective for individuals with autism and under what circumstances.

In evaluating several of the leading programs for children with autism, including UCLA’s Young Autism Project (YAP), Project TEACCH, LEAP, ABA Therapy and the Denver Health Science Program, several key flaws were found. In the YAP program, which relies primarily on discrete trial training, the research studies utilized to evaluate YAP’s effectiveness, failed to randomly assign children to the research groups. Further research studies, failed to replicate the exact outcomes in later studies. Project TEACCH uses collaboration, sharing of information, as well as education programs for both the child and the parent. Project TEACCH uses a framework that combines vocational, social skills, and living skills. Research studies have been completed on the effectiveness of TEACCH in the classroom, but not on the effectiveness of the interventions being used in the home setting. LEAP program is a federally funded model that was one of the first to utilize inclusive practices for young children with autism and their families. LEAP emphasizes the use of a home-school alliance to promote academic outcomes of children. There is little data to support that LEAP has more effective outcomes than other autism programs. ABA Therapy is considered one of the most effective interventions for children with autism as it focuses on the role of the child’s environment impact on the child’s behavior. This article, however, focused on two ABA programs: Rutgers University’s Douglas Developmental Center and Princeton’s Child Development Institute. This article criticized that the studies conducted at Rutgers failed to use a control group and a comparison group, thereby nullifying the validity of the data collected. Princeton’s study also had several flaws including failing to randomly assign children, neglecting to use a comparison group receiving another treatment, failing to identify the treatment program adequately and poorly defined outcomes.

From this article, it has become clear that the autism field is hampered by the lack of adequately proven interventions. The lack of documented proven interventions is centered around the lack of an established, uniform criteria for evaluating the effectiveness of treatment options in the field of autism. If professionals in the field cannot agree on an established method for evaluating programs, how can they determine the most effective intervention programs available? Furthermore, if professionals cannot agree on the most effective interventions available, how more confusing is it to parents of children with autism to determine which treatment options are most effective for their child?

In summary, it is clear that there is a high need for a uniform set of procedures and criteria to be established to evaluate the effectiveness of programs. It is imperative for this to be established for advances to be made in the autism field. This is critical for not only protecting parents and children with autism but the field of autism as well.

Gresham, F. et al (2000). A Selective Review of Treatments for Children with Autism: Description and Methodological Considerations. School Psychology Review, 28(4), pp. 559-575.