As with other professionals in their areas of expertise, we are bound to an ethical code and professional standard. We must implement scientifically proven treatments to ensure the maximum success of our clients. It is crucial that we not waste time with ineffective treatments. It is the one thing we cannot give back in a child’s life.
There are countless treatment methods available for treating autism. How does a parent make the decision between so many methods? What guides the decision to try one treatment over another or to combine treatments? This is where the difference between science and pseudoscience becomes critical.
What matters is what helps the individual and family the most. Extraordinary claims require extraordinary evidence. Claims of a cure or recovery from autism draw attention without necessarily demonstrating how improvement is measured. Whatever works is important – what works for each individual is the issue. The illusion of something working can cloud good judgment.
This education section is to address topics, interests and issues of individuals and parents of children receiving services. It is intended to offer some guidelines on treatment strategies that are able to meet the requirements of science and most importantly – effectiveness. Sections that follow will provide brief guidelines of issues of concern.
One of the most important issues in behavior change is how we determine when treatment is working. Many successes are reported as anecdotes and are often powerful emotional statements. To truly determine if a behavior is changing and if that change is a result of treatment, you must measure the behavior.
Measuring behavior before the treatment is applied (baseline data) and comparing it to behavior during and after treatment (treatment data) is essential. It is also important to consider measuring the validity and acceptability of behavior change. A change alone does not always represent a good change, just that change was made. Crucial to ABA is the issue of social validity; that is does the change improve the quality of life for the client and those involved with the client.
Treatment strategies range in terms of the premises behind what will change the behavior at issue. This points back to measurement to help guide how we can design a treatment that is ethical, acceptable and measurable.
This is a guideline to detecting the true effectiveness of any procedure. Does the treatment address the behavior and does the behavior change in the desired direction such that there is strong agreement that the behavior change has improved a socially significant behavior? Does the change make life better for the person receiving the treatment? Is the treatment something that can be continued in the absence of a professional; that is have we been able to teach parents and other caretakers how to use effective strategies? Treatment needs to result in improvements that will be effective in environments other than the treatment environment. This generality of treatment is one of the requirements of ABA.
A highly recommended report for parents regarding the strength of evidence for various treatments for autism can be found in the National Autism Council’s Summary Report. For an extensive review of research on treatments see http://www.nationalautismcenter.org, the National Standards project. This used to be a free service but due to high demand a fee has been implemented. The report classifies the strength of evidence into the categories of (1) Established, (2) Emerging, (3) Unestablished and (4) Ineffective/Harmful.
Intensity of Treatment
A number of studies indicate that early intervention and lots of it make a clinically significant difference. The more hours of treatment a child receives along with strategies that enable parents to use and maintain treatment increase the effectiveness compared to lesser treatment. While professional treatment can bring about significant improvements, significant changes are more likely when parents’ involvement is effective because they have been taught how to continue an effective strategy in the daily routines of their child’s life.
A number of links to resources and materials have been reviewed based on the issues above so that these topics can be identified as to their potential effectiveness and parents can use their own criteria for deciding how best to help their child and improve the quality of life for their own family.
In the end it is the parents’ decision and any guidelines offered here are to help parents make the best decisions they can based on the educational information and resources presented.