HOW TO DETERMINE IF A
TREATMENT REALLY HELPED
Written by Stephen M. Edelson, Ph.D.
Center for the Study of Autism, Salem, Oregon
There are many types of interventions
available today for autistic individuals, including nutritional,
biomedical, educational, sensory, and behavioral. When beginning
a new intervention, it is important to be as objective as possible
to determine whether the treatment truly helped the person. If the
treatment is not helping, then it does not make sense to continue
it especially if it involves a great deal of time, money, or effort.
When deciding to try a new treatment, whether
‘proven’ or not, here are a few tips to help determine whether the
person may have improved from the specific treatment:
1. When a parent begins to learn about all of
the various treatments given to autistic children, he/she sometimes
tries many at once in order to see improvement as soon as possible.
However, if the child improves after receiving several treatments,
it will be impossible to determine which one(s) really made a difference.
A general rule is to try a treatment for about two months before
beginning a new one, to determine whether or not the treatment was
helpful. However, if it is quite clear that the child improved from
a treatment, even after a week or two, then another treatment can
be started.
2. Parents should consider completing the Autism
Treatment Evaluation Checklist (ATEC) monthly for a few months prior
to the intervention and then monthly following the intervention.
The ATEC was designed specially to evaluate treatment effectiveness.
If improvement occurs due to maturation, then one typically sees
gradual improvement over time. However, if there is a sharp improvement
after the intervention is started, then the treatment may be helping.
There is no charge for use of the ATEC. You can complete the checklist
on the Internet at: www.autism.com/atec or obtain a hardcopy of
the checklist by writing to the Autism Research Institute (4182
Adams Ave., San Diego, CA 92116 USA; fax: 619-563-6840).
3. If at all possible, tell no one when a child
starts a new treatment. This includes teachers, friends, neighbors,
and relatives. If there is a noteworthy change in the child, it
is likely that the people who come in contact with the child will
say something about the improvement. It is also a good idea not
to ask “Have you noticed any changes in my child?” In this way,
any spontaneous statements regarding the child’s improvement will
be credible.
4. People who do know that the child received
a specific treatment can, independently, compile a list of what
changes they have noticed in the child. After a month or two, you
can compare their observations. If similar changes are observed
by different people, then there is a reasonable chance that these
changes are real. It is important they these observations be written
down; otherwise, when appropriate behaviors replace inappropriate
ones, you may not remember what the child’s behavior was like before
the treatment, especially if the behavior was an undesirable one.
5. Parents and others should note in writing when
the child’s behavior ‘surprises’ them. Basically, parents usually
know how their child will respond in various situations; and once
in a while, their child may do something that is unexpected. If
a child improves soon after an intervention is begun, one can assume
that the child will act differently than before; and his/her behavior
will likely lead to more ‘surprises’ than usual-hopefully good ones!
Some people suggest that parents should give their
children only treatments for which there is ample research evidence
to support their effectiveness. However, when a relatively new treatment
is introduced, there will likely be a limited amount of research,
if any, on its effectiveness. It takes, on average, five to ten
years to complete enough research to support or refute an intervention’s
efficacy. Additionally, chances are fairly good that even after
ten years, the results will be mixed, because researchers often
use different populations and assess changes using different measures.
Be leery of any treatment if it has been around for ten or more
years, and there are no research studies to support its effectiveness.
For example, Ritalin is one of the most frequently prescribed treatments
for autism, but we are not aware of any published studies supporting
its effectiveness with this population.
Before trying a new treatment, learn as much as
possible about the treatment. Rather than just focusing on positive
reports, it is also important to seek out criticisms of the treatment.
When evaluating conflicting claims, look to the nature of the studies
and their methodologies - poorly conducted studies should not be
given the same credence as methodologically sound research.
It is important to keep in mind that no treatment
will help everyone with autism.
Although one child may have improved dramatically from a certain
treatment, another child, even with similar characteristics, may
not benefit from the same treatment. Careful observation along with
a critical perspective will allow parents and others to decide whether
or not a treatment is truly beneficial.
I would like to thank Dr. Bernard Rimland for his constructive comments
on an earlier draft of this article.
The purpose of this copyright is to protect your
right to make free copies of this paper for your friends and colleagues,
to prevent publishers from using it for commercial advantage, and
to prevent ill-meaning people from altering the meaning of the document
by changing or removing a few paragraphs.
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