Parents of children with autism spectrum disorders (ASDs) have the formidable responsibility of ensuring that their children receive the most effective treatments available within a sufficient time period. However, many parents are ill prepared to make timely and well-informed decisions about what to do in this situation. When selecting treatments for their child, parents are faced with two challenges simultaneously. First, they need to respond relatively quickly; they cannot wait months or years to decide on their course of action. It is clear that early intervention for children with ASDs is associated with higher gains when implemented at an early age (Fenske, Zalenski, Krantz, & McClannahan, 1985). This predicament hardly provides parents with an adequate amount of time to evaluate their options, especially if their child was diagnosed at an older age. Second, parents need to choose an effective treatment, which should be implemented as soon as possible. The investment of time, money, and emotional interest on an ineffective treatment for their child could be devastating. To assist parents with these difficult decisions, we discuss a few ways to identify fad treatments (popular treatments lacking empirical support), and two fad treatments that lack empirical support are reviewed.
How to Identify a Fad Treatment
In selecting an effective treatment, we recommend that parents familiarize themselves with three critical issues: (a) the therapist’s qualifications; (b) the validity of the treatment; and (c) the treatment plan. Perhaps most importantly, parents should evaluate their child’s therapist or doctor to determine if the individual is actually qualified. Simply having a degree does not mean the person is qualified to provide services. Parents should consider if the therapist has a degree, possesses a state or national certification or license, and has sufficient experience in the specific area in which their child needs assistance. For example, it is ill-advised to receive behavior therapy from a psychologist whose training is in psychoanalysis. Qualification to provide a treatment requires formal training and supervision in the given treatment area. We recommend conducting an internet search for the prospective professional who might be providing services to the child. If accusations or negative reports are evident, parents might wish to consider a different therapist.
In addition to identifying the credentials of the therapist, parents should find out about the veracity of the treatment. To identify a fad treatment, it is helpful to know about the essential components of an effective treatment. An effective treatment is one that has been documented in a respectable scientific journal, has adhered to procedures and standards required of scientific study, and has been peer reviewed and determined to be of quality by other qualified specialists. In short, an effective treatment is based on evidence of its effectiveness. Often, if parents can even locate research on fad treatments, the available support tends to consist of personal stories, interviews by the founder of the treatment, and testimonials. Fad treatments are often promoted through appealing internet sites that tout high success rates with brief descriptions of treatments that sound technologically complex. Some fads are presented as heartwarming cures, breakthroughs, or promises of a speedy recovery.
A final recommendation for parents is to expect the therapist to provide a treatment plan. In order for a treatment plan to be effective, an effective, well-thought-out, individualized, and documented plan needs to form the foundation of treatment. The plan should directly address the symptoms of ASD, including any deficits in social interaction, repetitive behavior, and communication. Early intervention and parent training should be part of the plan. At the present time there is no cure for autism spectrum disorders, and therefore professionals cannot claim that a specific treatment will be entirely effective. However, professionals can offer treatment options that have been repeatedly shown to lessen the symptoms of autism, and they can explain to parents the likely gains to be expected and when they are expected to occur. If treatment continues well beyond the previously specified timelines and no observable gains occur, parents should question the effectiveness of the therapy.
By this point the reader should have a better understanding of how to identify fad treatments. In order to further illustrate the concept of fad treatments, two popular fad treatments currently embraced by many parents are discussed below. These treatments lack evidenced based research to validate their effectiveness for children with autism. Although there are many fad treatments available, only Facilitated Communication and Auditory Integration Training are reviewed here. A comprehensive review on fad treatments will be available soon (see Tuzikow & Holburn, In press).
Facilitated Communication
Facilitated Communication (FC) was developed by R. Crossley in Australia and designed to teach individuals with physical and communication difficulties to communicate with the assistance of a facilitator (Crossley & McDonald, 1980). It was introduced in the United States as a way to treat individuals with ASD (Bilken 1990). It is important to note that facilitated communication is not synonymous with functional communication, an effective treatment. Functional communication training is an evidenced based treatment that is commonly used to teach children with autism (Durand & Merges, 2001). Facilitated Communication involves physical assistance offered by the facilitator to assist the child to communicate using a writing or typing tool. A flaw in this approach is that the facilitator appears to be responsible for the communication rather than the individual (Jacobson, Mulick, & Schwartz, 1995). Furthermore, the availability of quality evidenced based research examining the effectiveness of FC is extremely limited and scientifically unconvincing.
Auditory Integration Training
Another fad treatment that has received popularity and support is Auditory Integration Training (AIT) created by Berard in France in the 1950’s (Berard, 2006). Based on the premises of AIT, many individuals with ASD have disorganized auditory processing skills. This disorganization ostensibly leads to unusual sensitivities to frequencies and difficulty making sense of auditory information. Proponents of AIT posits that if individuals with ASD listen to certain frequencies and volumes of sounds or music for 30 minutes, two times a day, for 10 days, they will increase their tolerance for certain frequencies, and sound distortion will improve. This is all the result of ostensibly retraining the acoustical reflex muscle (AIT Institute, 2010). Similar to many fads treatments, AIT is supported by controversial research studies (Edelson, Arin, Bauman, Lukas, Rudy, Sholar, & Rimland, 1999: Rimland & Eldeson, 1995). These studies are controversial due to countervailing scientific research showing that AIT did not improve the behaviors of individuals with autism (Mudford, Cross, Breen, Cullen, Reeves, Gould, et al., 2000, Zollweg, Palm, & Vance, 1997).
Conclusion
In conclusion, this article discussed several critical aspects parents should consider when selecting a treatment for their child. Therapists and doctors can be quite convincing in their attempts to recommend treatments for children with ASD, and their recommendations are most likely provided with only the best intentions. Unfortunately, sometimes these recommendations are treatments that have not been subjected to the same standards of scientific rigor as evidence-based-treatments, and therefore, they have not gained the acceptance of the scientific community. If implemented, fad treatments can prevent or delay a child from receiving an effective treatment. At worst, they cause harm. However, parents can sidestep potential treatment failures if they can determine that the therapist is qualified, the treatment is valid, and the plan is appropriate.
Jenny Tuzikow, PsyD, BCBA-D, is Senior Behavior and Steve Holburn, PhD, BCBA-D, is Research Scientist at the New York State Institute for Basic Research in Developmental Disabilities.
References
AIT Institute (2010). What is AIT: Berard auditory integration training (Berard AIT)? [cited 2010, February 7]. Retrieved from http://www.aitinstitute.org/what_is_auditory_integration_training.htm
Berard, G. (2006). Understanding the difference between Berard AIT and the Tomatis method: Guy Berard. [cited 2010, January 4] Retrieved from http://www.drguyberard.com/tomatis.html
Biklen, D. (1990). Communication unbound: Autism and praxis. Harvard Educational Review, 60, 291-315.
Crossley, R., & McDonald, A. (1980). Annie’s coming out. New York: Penguin.
Durand, V. M., & Merges, E. (2001). Functional communication training: A contemporary behavior analytic intervention for problem behaviors. Focus on Autism and Other Developmental Disabilities, 16, 110-119.
Edelson, S. M., Arin, D., Bauman, M., Lukas, S. E., Rudy, J. H., Sholar, M., & Rimland, B. (1999). Auditory integration training: A double-blind study of behavioral, electrophysiological, and audiometric effects in autistic subjects. Focus on Autism and Other Developmental Disabilities 14, 73-81.
Fenske, E.C., Zalenski, S., Krantz, P.J., & McClannahan, L.E. (1985). Age at intervention and treatment outcome for autistic children in a comprehensive intervention program. Analysis and Intervention in Developmental Disabilities, 5, 49-58.
Mudford, O.C., Cross, B. A., Breen, S., Cullen, C., Reeves, D., Gould, J., & Douglas, J. (2000). Auditory integration training for children with autism: No behavioral benefits detected. American Journal on Mental Retardation, 105, 118-129.
Rimland, B., & Edelson, S. M. (1995). Auditory integration training: A pilot study. Journal of Autism and Developmental Disorders, 25, 61-70.
Tuzikow, J., & Holburn, S. (In press). Identifying fad therapies for autism spectrum disorders and promoting effective treatment. In Matson, J. L., & Sturmey, P. (Eds.), International handbook of autism and pervasive developmental disorders.
Zollweg, W., Palm, D., Vance, V. (1997). The efficacy of auditory integration training: A double blind study. American Journal of Audiology, 6, 39-47.
