- Behavioural modification
- Drug therapies
- Parental involvement
Antidepressants such as Fluoxetine affect the activity of the neurotransmitter serotonin and are used to treat high functioning autistic people. It reduces repetitive behaviours and anxiety-type symptoms.
Stimulants such as Ritalin reduce hyperactivity and improve focus of autistic patients.
Antipsychotics such as Haloperidol and Risperidone have been used to treat the stereotypical movements and fidgetiness in autistic patients. It reduces social withdrawal, aggression/self-absuive behaviours and repetitive movements. There are, however, serious side effects such as 1/3 patients develop dyskinesia (involuntary body movements).
Fenfluramine lowers levels of serotonin which has shown improvement in thought processes but has had no effect on language or cognitive ability.
Key study – McCracken et al (2002)
Aim – to compare the effectiveness of risperidone as a treatment for behavioural disturbances in young people with autism.
Method – a multi-side, double blind trial, using 101 children aged between 5 and 17 years, 82 boys and 19 girls. Children were randomly assigned to receive either Risperidone or a placebo. For 8wks participants in the Risperidone condition received doses varying between 0.5 and 3.5mg per day. Before and after treatment, all the children were assessed on an irritability scale and an improvement scale.
Results – 56.9% reduction in irritability score for risperidone condition and 14.1% reduction for placebo condition. On improvement scale, 69% of the treatment group were ‘much improved’ or ‘very much improved’ as opposed to 12% of placebo group. After 6mnths 2/3 of those who showed positive responses to the drug continued to show beneficial effects.
Conclusion – Risperidone is effective in reducing tantrums, aggression and self-injurious behaviour in young autistic people.
- There is some evidence of improvement in behaviour and thought processes
- Can reduce social awareness, stereotyped motor behaviour and aggression
- Can provide relief from specific symptoms which can relieve the stress on carers
- Drugs aren’t a cure for autism
- Potentially serious side effects (many drugs haven’t been tested on children)
- Needs to be combined with other interventions
- No drug reduces enough of the symptoms to be used long term
- Many children don’t respond to the drug, no effect on their symptoms
Parents involved in therapeutic programmes at home, not just relying on a therapist
Parents can help the children to apply the behaviours they’ve learnt to a wide range of everyday conflicts.
Treatment was a programme of warm acceptance and reinforcement and an extreme version was ‘holding therapy’ where the child was forced to have close, physical contact with the mother. Parents have to reinforce adaptive behaviour (behaviour that helps the child fit into the environment) whilst avoiding reinforcement for undesirable behaviour.
Koegel et al (1982) demonstrated that 30 hours of parent training was as effective as 200 hours of clinical treatment in improving behaviour
Koegel et al (1996) found that most benefit derived when parents concentrated on improving their autistic child’s general motivation and responsiveness rather than targeting specific problem areas
Lovaas believed that one of the key elements of ABA therapy was the involvement of parents.
- Puts a lot of pressure on families
- Some can’t be treated at home and need a professional therapist
- Stress for carers as training takes up a lot of time, money and effort
Involves the use of reward for appropriate behaviour and is based on operant conditioning.
ABA (applied behavioural analysis) uses reinforcement to improve selected behaviours, using the principles of SLT (modelling and positive reinforcement) to improve certain behaviours
DTT (discrete trial training) is when skills are broken down to their basic components and repeated one-to-one lessons are taught. Each trial consists of 3 parts:
- Antecedent – requesting the child to perform a task e.g. choose a crayon
- Behaviour – response from child e.g. they pick a green crayon
- Consequence – a reaction from the therapist plus reinforcement e.g. well done, lets draw a picture
Lovaas technique – language development therapy (same principle as DTT – positively reinforced specifically for language development).
Key study – Lovaas (1987)
Aim – to investigate the effectiveness of intensive behavioural therapy
Method – 19 patients, younger than 46mnths, received intensive behavioural therapy for at least 40 hours a week for 2yrs. The therapy was on a one-to-one basis. There were 2 control groups: one were the non-intensive group and only received 10 hours of one-to-one therapy each weelk and the other group received no therapy. Each child given a task and their response resulted in a reinforcement or punishment. IQ and level of functioning at school was measured.
Results – 47% of treatment group achieved normal intellectual functioning and a further 40% attained the mildly retarded level. Following treatment, most children joined mainstream school. When children were discharged to their parents, they continued to improve. Those who remained in institution tended to regress.
Conclusion – a large proportion of the autistic children were ‘transformed into normal children’.
- Therapy provided at home wasn’t observed and this could have been a confounding variable, as they could have had different approaches to therapy
- The study compared different intensities of the same therapy rather than comparing different treatments
- Such intensive behaviour therapy is expensive and not available to all children
- Unethical because it involves control and manipulation
- Progress is slow and behaviour often regresses once treatment stops
- Studies are small so lack generalisability