The array of treatments for autism is indeed quite diverse, and taken together can be absolutely overwhelming to parents of newly diagnosed children. Consumer advocates who think that exposure to many diverse treatment options is a good thing are likely not considering the agonizing decisions parents must make about how best to help their child with autism, or the second-guessing and guilt that may come from worrying that one is not doing enough, or the extraordinary financial burdens that come from paying for numerous treatments out of pocket. Individuals with autism deserve a clearer path to effective intervention.
Thankfully, there is a resource available to help parents and other consumers develop the skills needed to differentiate science from pseudoscience. Dr. Sabrina K. Freeman is a prolific writer who has published numerous works related to autism and its treatment. Her latest book, The Complete Guide to Autism Treatments, may indeed be her most important contribution to parents of children with autism, as well as to those professionals who work with this clinical population. It is also noteworthy that Dr. Freeman is the parent of a 21 year-old daughter with autism, and holds a PhD in Sociology from Stanford University, where she specialized in small group research. As will be detailed below, Dr. Freeman shares her perspectives as a mom, which further contributes to the authenticity of this book, and may appeal to parents who may be more amenable to the cautionary words of one who walks in their shoes.
The book is comprehensive, thoroughly researched, and well organized. Throughout, Dr. Freeman communicates a critically important message: Individuals with autism deserve access to science-based treatment; their time, their potential, and the overall resources of their families should not be wasted. The Complete Guide to Autism Treatments is divided into two primary sections. Section I is organized around topics related to the various treatments for autism, of which there are several dozen. Section II highlights basic concepts about science, hypothesis testing, and research methodology. Section I begins with a review of behavior-analytic treatments for autism across home and school settings, as well as within the area of early intervention. The various offshoots of applied behavior analysis are also summarized and evaluated (e.g., intensive behavioral treatments, pivotal response training, positive behavior support, verbal behavior therapy, and fluency training). Then there is a fairly comprehensive subsection related to the myriad of non-behavioral treatments, including those that occur in school, as well as those that are child-initiated or parent-facilitated. These subsections are followed by biomedical therapies, speech and language therapies, and ultimately a final section for miscellaneous therapies not better categorized in the above subsections. Each of these subsections is divided, and in some cases divided further, in an effort to capture the more frequently-touted treatments for autism.
Each of these treatment subsections is organized around responses to a series of 8-9 questions. These questions are applied to each treatment discussed:
(1) What is ____? – Dr. Freeman defines the treatment and describes its rationale, theoretical underpinnings, and hypotheses about autism’s etiology and treatment.
(2) What evidence do the practitioners have that this really works? – Dr. Freeman summarizes and evaluates peer-reviewed research and other possible sources of support (e.g., anecdotal evidence) and reports the results of database searches.
(3) What does this therapy actually look like? – Dr. Freeman describes, often in great detail, the actual procedures associated with the treatment including side effects and/or adverse effects. This information is essential, as many parents may know little about the therapies to which they are subjecting their children.
(4) What else do I think? – Dr. Freeman speaks to broader issues that bear relevance when judging the merits of the particular intervention.
(5) Would I try it on my child? – Here Dr. Freeman offers a more personal take on the treatment: a take that is honest and at times, blunt. Even if readers disagree with Dr. Freeman’s stance, they will appreciate the candor and thoughtfulness of her position as a fellow parent.
(6) What kind of study would I like researchers to do? – Dr. Freeman argues that it is not sufficient that treatment proponents simply churn out publishable research, but rather that they design research that carefully addresses questions pertinent to that particular treatment. These may include, but not be limited to, better definition of the independent variable, use of tighter research designs, selection of more appropriate dependent variables, and a clearer demonstration of the relationship between the manipulation of the independent variable and the dependent variables.
(7) Who else recommends for or against ____ as a method for the treatment of autism? – Dr. Freeman highlights recommendations from professional-membership organizations, from state and federal government entities, and from other organizations such as Quackwatch. These recommendations should be an important factor in decision making and I applaud Dr. Freeman for reporting them throughout her book.
(8) So you’re still on the horns of a dilemma? – Dr. Freeman provides further information for those still struggling with their decision for any number of reasons.
(9) What’s the bottom line? – Dr. Freeman offers a “bottom line.” Essentially, based on the scientific research to date, she clearly states when there is either no evidence, not enough evidence, or sufficient evidence to conclude that a particular intervention is effective.
Section II, titled “How do we know what works and what doesn’t?” focuses on the scientific method, hypothesis testing, and research methodology. At times, the content may seem somewhat dense, but that speaks more to the complex nature of scientific inquiry than to Dr. Freeman’s writing style. These more technical sections are preceded by a number of caveats empowering parents to question the “experts” whom they will undoubtedly encounter over the course of their child’s treatment. There is considerable attention paid to the components of research, data interpretation, and analysis of a study, as well as descriptions of many all-too-common red flags in autism treatment. Section II ends with 57 pages of references!
This book has many notable strengths. The format of nine recurring questions within Section I provides a predictable framework for the reader. In fact, Dr. Freeman’s careful analysis of the state of the research underlying specific ABA treatments is offered in the same spirit and with the same diligence as the non-behavior analytic treatments. This is critically important, given that the abundance of research in ABA may mistakenly give some the impression that all that falls under the umbrella of ABA is well supported empirically.
Proponents of the various treatments would benefit from careful consideration of the suggestions offered in the “What kind of study would I like researchers to do?” section. Far too often, a single study is put forth as validation of an entire treatment and all of its theoretical and conceptual underpinnings. The reader will find that Dr. Freeman has individualized her recommendations based on each treatment’s existing research history. Execution of these research agendas may enable a number of treatments to live up to their promises.
Perhaps of greatest significance is that that the author is writing from the dual perspectives of professional and parent. When speaking as a parent, her commitment to science is unwavering and, appropriately so; she is unapologetic in honestly sharing her perspectives as an informed mother. This is greatly needed at a time when many individuals fear being perceived as close-minded or unwilling to recognize the contributions of other disciplines. Her professional perspective only adds further credence to her stance regarding treatment options.
There are wonderful insights throughout the book which will make this resource useful to those who will tend to read this book a few sections at a time. For instance, there is a very interesting discussion at the beginning of the book about participation in research with the caveat that precious time and resources should never be wasted on low-quality research, for not all research is created equally.
There are a few minor concerns. Many readers may have benefitted from an introduction to some of the content in Section II at the very beginning of the book. To her credit, Dr. Freeman makes the suggestion to review this content first. I suspect this introduction would have laid a foundation for readers to synthesize the tremendous amount of information in Section I. Organizationally, I believe that the judicious use of tables and charts would have facilitated comparisons across treatments.
In summary, I believe The Complete Guide to Autism Treatments is a much-needed contribution to the field of autism. The diligence and comprehensiveness of the various treatment reviews make this book an important “go-to” resource for parents and professionals alike. Undoubtedly this is a resource that the reader can expect to pick up time and time again.
David Celiberti, PhD, BCBA-D is President of the Association for Science in Autism Treatment.
