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Behavioral Treatments

Most typically-developing children learn as a result of natural curiosity and the desire for parental praise. When these are absent in children with autism, normal behavior and learning are derailed. Early research suggested that a form of instruction known as discrete trial training (DTT) could help by reinforcing good responses with tangible rewards. Other techniques building on this approach are pivotal response training (PRT) and natural environment teaching (NET), in which daily situations are used as opportunities for teaching with a similar reward system. Collectively these programs are known as applied behavior analysis (ABA).

These techniques have been criticized for rote teaching that doesn’t fit with the stages of typical childhood development and doesn’t help children learn to be rewarded by their own successes. As a result, therapists, educators and parents have sought treatments that let the child determine the topic for interaction, which the adult then expands on. Examples of these approaches, which can be conducted by a therapist or a coached parent, are relationship development intervention (RDI) and Floor Time (also known as DIR). Although they have not been subjected to the same degree of empirical scrutiny as ABA programs, they provide a curriculum that takes the child’s own emotional and developmental needs into consideration.

Pharmaceutical Treatments

When they are used, medicines should be employed alongside behavioral treatments, not to replace or precede them. For example, pre-verbal children with ASD are easily frustrated and agitated, but before prescribing a medication to treat the agitation, one should try to teach the child to communicate.

In the hands of a knowledgeable child psychiatrist, pediatrician or child neurologist, medications can play a crucial role in an overall treatment plan. When deciding which drugs to prescribe, clinicians rely on research, experience, careful observation and discussions with parents. One or two medicines at a time is the usual standard of practice. Using three or more agents at once can make it very hard to understand the effects of each drug, and to monitor their side effects.

Different classes of psychoactive medicines can treat different symptoms like agitation, inattention, aggression, repetitive movements and self-injury. There is no single medication that every child with autism should take. Medicines in autistic children, just like in adults, work in a symptom-specific manner. Children metabolize many psycho-active medications differently from adults, and all have potential side-effects.

Alternative Treatments

Alternative treatments for autism have proliferated in recent years. Popular treatments include diets that remove gluten-casein, sugar or red dye have been popular in the past. More radical are chelation treatments designed to remove mercury and other toxic metals, which may also remove iron and magnesium that a healthy body needs to grow.

If a treatment sounds too good to be true, it probably is. Beware of logic that cuts both ways: If one source says that heavy metals in your child’s hair means he has been exposed to too many heavy metals, consider the other saying that no heavy metals in the hair means it’s all staying in your child’s body.

Promising alternative and complementary treatments should be studied empirically like any other drug. Researchers, such as Dr. Robert Hendren at UCSF, have studied the impact of omega-3 fatty acids and are currently conducting trials to gauge the effects of hyperbaric oxygen and vitamin B-12 on children with autism.