Autism: no one treatment fits all

I AGREE with your recent editorial that autistic children will benefit from the Applied Behavioural Analysis (ABA) programme.

Nevertheless the data favouring one approach over others is not very robust. There is evidence of ABA benefiting children with inputs of up to 17 hours per week.

Another approach called Treatment Education Autistic Children, which teaches through visual learning, has shown short-term gains for pre-schoolers.

ABA uses a somewhat outdated approach to language with too much dependence on the trainer and a possibility of overstressing the child, particularly if he or she is not able for it. Indeed I have seen post-traumatic stress disorder following ABA in one child.

According to one authority, Claudia Wallis, an attempted replication of the 1987 ABA study got more modest success on academic measures and virtually no gains in social behaviour.

Ms Wallis also noted that ABA was good with skills, but “the kids lack the ability to think on their feet, to solve problems and to engage socially”.

It was stated originally that ABA produced children with autism who were indistinguishable from their peers. This has not been supported.

The cost effectiveness of ABA in terms of time, effort and money has not been adequately addressed. Nevertheless, it does benefit children with autism and has shown considerable parental satisfaction.

My belief is that ABA has to be combined with programmes like the Hanen speech and language programme, pragmatic language therapy, occupational therapy, the picture exchange communication system, use of Carol Gray’s social stories, training in reading non-verbal behaviour, etc.

Autism is a complex disorder, and no one treatment fits all.

Prof Michael Fitzgerald

Henry Marsh Professor

Child and Adolescent

Psychiatry

Trinity College

Dublin 2