What Do We Know About Autism: Causes

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What Do We Know About AutismCauses Treatments

• Stuart Harder
• Marleen Zak
• St. Croix River Education District

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Causes of Autism

• Autism and the other disorders in the autism
  spectrum are
• behaviorally defined syndromes
• generally regarded to be of neurobiological
  origin
• although there is some disagreement about
  neurobiology as there is an equal focus on
  environmental factors as well
• Autism is not caused by inappropriate parenting
  or other psychosocial variables in the home life
  of the developing child
• This thought came out of early ideas about
  mothers who were described as refrigerator moms

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So, what is known?

• The specific underlying psychological or
  neuro-physiological mechanisms are simply not
  known.
• Although a number of different theories have been
  put forward, none has withstood closer scrutiny.
• Probably several causes lead to disorders in the
  autism spectrum.
• There is no reason to suppose there is only one
  pathway.

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What Does the Diagnosis "Autism" Mean?

• There are 5 Pervasive Developmental Disorders
• Autistic Disorder
• Rett's Syndrome
• Childhood Disintegrative Disorder
• Asperger's Disorder
• Pervasive Developmental Disorder (PDD) Not
  Otherwise Specified (NOS)

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Characteristics of Autism

• significant difficulties with social interactions
  does not pay attention to other people does
  not play with other children does not
  reciprocate
• significant difficulties in verbal and nonverbal
  communication grabs what is wanted or leads to
  get what is wanted copies or parrots words
  (echolalia) if has words, does not converse
• significant difficulties in the development of
  play uses only parts of toys lines up or
  stacks objects no imaginative play
• highly restricted, repetitive and stereotyped
  patterns of behavior and interests
• may talk continuously about one topic or repeat
  the same questions may spin and stare at
  objects may flap fingers or pieces of string
  mouth or hit self
• highly resistant to even slight changes in
  routines

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Retts Syndrome

• differs from autism primarily in that it is
  associated with loss of previously acquired hand
  skills between ages 5 months and 30 months and
  onset of severe or profound mental retardation
• motor skills are replaced with repetitive
  movements of the hands.

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Childhood Disintegrative Disorder

• diagnosed when a child shows significant losses
  in social behavior, language, play and adaptive
  behavior after development was apparently normal
  for at least the first 2 years and before 10
  years of age.
• both Rett's Disorder and Childhood Disintegrative
  Disorder appear to be very rare
• little behavioral research has been conducted
  with persons with these diagnoses.

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Asperger's Disorder

• differs from Autistic Disorder in that impairment
  is primarily within the domain of social
  interactions
• development of other adaptive behavior,
  cognition, and language are not significantly
  delayed
• repetitive patterns of behavior or rituals must
  also be present.
• this disorder tends to be recognized and
  diagnosed later, usually after 3 years of age.
• whether this is because the characteristics are
  less noticeable or the disorder has a later age
  of onset is not known.

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Pervasive Developmental Disorder Not Otherwise
Specified ("PDD NOS")

• this label is used when severe impairments in
  reciprocal social interaction or communication
  skills are present or when stereotyped and
  restricted activities and interests are
  exhibited, but the criteria listed above for
  disorders in the spectrum are not met completely.
  
• it is a borderline category and sometimes
  referred to as "atypical autism."

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Niemann (1996) writes Fortunately, recent
discoveries in the way the brain develops, from
the moment of conception and during the early
years, provide greater insights into the
construction timetable of the human brain and the
capacities and limitations imposed on behavioural
and other interventions. Rather than being seen
as a static event, it is important to keep in
mind that the development of the brain is a
dynamic process that is constantly evolving and
changing in concert with the environment in which
the child is placed. The limiting factors are
both the biological structure of the brain as
well as the environment. Limiting either one will
compromise human potential. Conversely, enriching
both will enhance the road to developing an
individuals full potential. (p. 7)
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Some Controversies About Causes of Autism What
Does the Research Say?
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Vaccines

• The prevalence of autism has risen dramatically
  in the past two decades.
• Estimated somewhere between
• 1 in 139 and 1 in 181 children
• between the ages of 4 and 17
• This implies that there are around 300,000
  children diagnosed with an ASD
• Some have suggested that the increased prevalence
  of ASDs corresponds with an increase in the
  number of vaccinations recommended for children

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Before Proceeding Correlational Evidence

• Correlation of two events is not sufficient
  evidence to assert that one caused the other as
  the two events could be unrelated
• This is the type of evidence used in the
  autism-vaccine controversy
• A correlation between number of vaccines in a
  given time period and number of autism cases

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Example of logical problem with correlations

• If a child is born during a full moon
• the birth and the full moon coincide
• but the full moon did not cause the birth
• and the birth did not cause the full moon
• An increase in the number of births during many
  full moon cycles - even over years - is still not
  evidence that the full moon is responsible for
  increased deliveries
• Further study of such correlations is necessary
  to reveal evidence to either support or
  disconfirm a causal hypothesis or to isolate a
  third factor that will account for the
  relationship between the two factors

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Thimersol

• One specific hypothesis of vaccines being linked
  to autism suggests that thimerosal, a
  preservative previously used in childhood
  vaccines that was removed from vaccines
  manufactured in the US in 1999, can cause autism.
  
• Thimerosal is still present in some versions of
  the flu vaccine.

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What is the theory?

• Several versions of this theory target different
  mechanisms for how thimerosal damages the child
  and causes autism.
• They all, however, state that some damage occurs
  to the developing child after vaccination.
• Advocates of the "thimerosal causes ASDs"
  hypothesis have also suggested that the
  prevalence of ASDs will substantially decrease
  subsequent to thimerosal being removed from
  childhood vaccines.

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What does the research say?

• Fombonne and colleagues (2006) in Pediatrics
• has shown that decreased thimerosal in childhood
  vaccines is not correlated with decreased
  prevalence of ASDs.
• Fombonne and colleagues have collected data on
  the prevalence of ASDs in children in Montreal
  from 1987 through 1998.
• Thimerosal was removed from vaccines in Canada by
  1996. Fombonne et al. found that there was a
  statistically significant increase in the
  prevalence of ASDs for children who received
  thimerosal-free versions of the recommended
  childhood vaccines.
• Similar findings have been obtained in Denmark
  and Sweden and will likely be revealed in the US
  in the not too distant future.

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Measles-Mumps-Rubella (German Measles)

• ASDs clearly have a genetic origin but one
  environmental trigger has been identified.
• If a pregnant mother contracts rubella, there is
  an increased chance of the child having an ASD
  (Chess et al., 1971/74/77).
• As the MMR vaccine decreases the chance of
  rubella infections, its use should decrease the
  likelihood of this environmental triggering of
  autism.
• However, some have posited that the MMR vaccine
  triggers regression that is sometimes part of the
  course autism
• (i.e., some children with ASDs lose skills that
  they previously acquired in early development).

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Hypothesis MMR Vaccine Injures the Gut

• Most of the popularization of this theory has
  been spurred by Andrew Wakefield.
• Injures a child's gut in a specific manner
  producing problems similar to those caused by
  irritable bowel syndrome.
• Suggested measles was the cause because he and
  his colleagues purportedly detected components of
  the measles virus in the gastrointestinal tracts
  and blood of children with autism that were not
  present in typically developing children.

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DSouza et. al. (2006) Pediatrics

• Attempted to determine whether measles was more
  likely to found in the bodies of children with
  ASDs than in typically developing children.
• Largest sample of subjects for this type of study
  and used the same technique, polymerase chain
  reaction assays, that had purportedly detected
  measles in children with ASDs.
• They found that this technique produced many
  positive reactions in both children with ASDs and
  typical children.

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However

• These reactions were further analyzed and found
  to be false positives for all subjects.
• The products of the reactions were cloned and
  genetically sequenced and none of these sequences
  contained the components of the measles virus.
• That is, neither the children with ASDs nor the
  typical children showed any evidence of measles
  virus in their bodies.
• There were no differences found in anti-measles
  antibodies across the study groups of children.

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Some side notes

• Taken in combination with numerous other studies
  showing no relation between the MMR vaccine and
  ASDs, provides fairly definitive evidence against
  the "MMR causes autism" hypothesis.
• It should also be noted that Andrew Wakefield was
  found to have been paid over 150,000 by a group
  seeking to pursue litigation against vaccine
  manufacturers in the United Kingdom.
• Once this severe conflict of interest was
  revealed, ten of Wakefield's co-authors requested
  that their names be withdrawn from the original
  publication used as support for this hypothesis.

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• D'Souza et al., (2006). No Evidence of Persisting
  Measles Virus in Peripheral Blood Mononuclear
  Cells From Children With Autism Spectrum
  Disorder. Pediatrics, 118(4), 1744-1745.
• Fombonne et al., (2006). Pervasive Developmental
  Disorders in Montreal Prevalence and Links with
  Immunizations. Pediatrics, 118(1), 139-150. 37.
• Wing, L. Potter, D. (2002). The epidemiology of
  autistic spectrum disorders Is the prevalence
  rising? Mental Retardation and Developmental
  Disabilities Research Reviews, 8(3), 151-161.

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Pseudo Scientific Claims What to Watch For

• Claim of high "success" rates.
• Rapid effects are promised.
• The therapy is said to be effective for many
  symptoms or disorders.
• The "theory" behind the therapy contradicts
  objective knowledge (and sometimes, common
  sense).
• The therapy is said to be easy to administer,
  requiring little training or expertise.
• Other, proven treatments are said to be
  unnecessary, inferior, or harmful.
• Promoters of the therapy are working outside
  their area of expertise.
• Promoters benefit financially or otherwise from
  adoption of the therapy.
• Testimonials, anecdotes, or personal accounts are
  offered in support of claims about the therapy's
  effectiveness, but little or no objective
  evidence is provided.
• Catchy, emotionally appealing slogans are used in
  marketing the therapy.

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More

• Belief and faith are said to be necessary for the
  therapy to "work."
• Skepticism and critical evaluation are said to
  make the therapy's effects evaporate.
• Promoters resist objective evaluation and
  scrutiny of the therapy by others.
• Negative findings from scientific studies are
  ignored or dismissed.
• Critics and scientific investigators are often
  met with hostility, and are accused of
  persecuting the promoters, being "close-minded,"
  or having some ulterior motive for "debunking"
  the therapy.

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Lets Look At TheTherapies Being Offered
ToFamilies and Their ChildrenWho Are Diagnosed
WithAutism Spectrum DisordersWhat Does The
Research Tell Us?
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Psychological, Educational, and Therapeutic
Interventions

• Animal Therapy
• Therapeutic Horseback Riding
• Dolphin Therapy
• Pet Therapy
• Applied Behavior Analysis (ABA)
• Art Therapy
• Auditory Integration Therapy (AIT)
• Tomatis Method
• Berard Method
• Fast Forward
• Earobics
• Augmentative and Alternative Communication (AAC)

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Psychological, Educational, and Therapeutic
Interventions

• Developmental Therapies
• Developmentally-based Individual-difference
  Relationship-based Intervention (DIR)
• Floor Time
• Greenspan Method
• Facilitated Communication
• Glasses
• Holding Therapy
• Music Therapy
• Oral-Motor Training/Therapy
• Kaufman Method
• Prompts for Restructuring Oral Muscular Targets
  (PROMPT)
• Rosenfeld-Johnson Method

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Psychological, Educational, and Therapeutic
Interventions

• Patterning
• Picture Exchange Communication System (PECS)
• Project TEACCH (Treatment and Education of
  Autistic and related Communication-handicapped
  Children)
• Psychoanalytic and Humanistic Play Therapy
• Recreational Sports/Exercise
• Relationship Development Intervention (RDI)
• Sensory Integrative Therapy (Sensory Integration,
  SI, or SIT)
• Socialization related classes

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Psychological, Educational, and Therapeutic
Interventions

• Social Skills Groups
• Social Stories
• Son Rise (Options)
• Video Modeling
• Vision Therapy
• Irlen lenses
• Glasses
• Eye exercises
• Rapid Eye Therapy
• Iridology
• Ambient lenses
• Yoked prisms

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Biomedical Interventions

• Anti-Fungal Medication
• Flagyl (metronidazole)
• Diflucan (fluconazole)
• Nystatin
• Anti-Yeast Medication
• Chelation Therapy
• Craniosacral Therapy
• Herbs and Homeopathic Treatments
• Hyperbaric Oxygen Therapy
• Magnets

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Biomedical Interventions

• Medications
• Risperdal (risperidone)
• Ritalin (methylphenidate)
• Prozac (fluoxetine)
• Secretin
• Special Diets
• Gluten-free (wheat)
• Casein-Free (dairy)
• Gluten-Free Casein-Free Diet (GfCf Diet)
• Sugar free
• Removal of food dyes
• Foods thought to produce maladaptive behavior

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Biomedical Interventions

• Vitamin and Supplement Therapy
• Vitamin A
• Vitamin B6
• Vitamin B12
• Vitamin C
• Vitamin D
• Magnesium
• Dimethylglycerine (DMG)
• Calcium
• Omega 3 Fatty Acids

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Developmentally-based Individual-difference
Relationship-based intervention (DIR)/Floor
Time Description Also called Greenspan Method.
In Floor Time, the adult participates with the
child in his/her space. The childs actions set
the lead for actions that the adult can extend or
elaborate. For example, if the child wants to
line up cars in a row, the parent or service
provider may playfully intrude in this activity
(e.g., moving one of the cars or blocking a car
and asking where its going). Floor Time is
usually provided by parents under the direction
of psychologists. However, it may be an
intervention strategy used by professionals in
other disciplines such as speech therapy or
special education. Research Summary DIR is
widely considered to be a plausible intervention
approach (i.e., one that could be effective), but
it has not been evaluated in peer-reviewed
studies with strong experimental designs
(National Research Council, 2001). Recommendation
s An important area for future research is to
evaluate DIR in studies with strong experimental
designs. Professionals should present DIR as
untested and encourage families who are
considering this intervention to evaluate it
carefully. Selected References Systematic
reviews of scientific studies National
Research Council (2001). Educating Children with
Autism. Washington DC National Academy Press.
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Picture Exchange Communication System
(PECS) Description One of the methods used
under an ABA approach, PECS uses pictures and
other symbols to develop a functional
communication system. PECS teaches students to
exchange a picture of a desired item for the
actual item. Research Summary Studies show that
PECS is effective in teaching communications that
involve single words or short phrases, and that
gains may generalize to everyday settings.
Ongoing consultation from an expert in this
approach is likely to be necessary to maintain
these gains. RecommendationsThe application of
ABA methods to teach PECS is an appropriate
intervention for children with autism spectrum
disorders who have limited or no communication
skills. To increase the utility of this
intervention, an important area for future
research is to investigate PECS procedures for
promoting initiation of communication and
acquisition of complex, flexible
language. Selected scientific studies
Howlin, P., Gordon, R. K., Pasco, G., Wade, G.,
Charman, T. (2007). Journal of Child Psychology
Psychiatry, 48, 473-481. Yoder, P.,
Stone, W. L. (2006). Randomized comparison of two
communication interventions for preschoolers with
autism. Journal of Consulting and Clinical
Psychology, 74, 426-425. Bondy, A. Frost,
L. (2001). The Picture Exchange Communication
System. Behavior Modification, 25, 725-744.
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Sensory Integrative Therapy (Sensory Integration,
SI, or SIT) Description An intervention in
which the participant receives sensory
stimulation with the goal of improving attention
and cognitive functioning, while decreasing
disruptive or repetitive behaviors. Examples
include brushing the body, compressing the elbows
and knees, swinging from a hammock suspended from
a ceiling, and spinning around and around on a
scooter board. Examples of sensory diet
interventions include wearing a weighted vest or
wristbands, putting a body sock on the
participant, or massaging the childs mouth or
other body parts. Sensory Integrative Therapy is
often supervised by an occupational
therapist. Research Summary Although Sensory
Integrative Therapy has been a popular
intervention for individuals with autism spectrum
disorders since the 1970s, reviewers have
concluded, There exist so few studies that
conclusions cannot be drawn (Dawson Watling,
p. 419). Recommendations An important area for
future research is to evaluate Sensory
Integration in studies with strong experimental
designs. Professionals should present Sensory
Integration as untested and encourage families
who are considering this intervention to evaluate
it carefully. Systematic reviews of scientific
studies Dawson, G., Watling, R. (2000).
Interventions to facilitate auditory, visual, and
motor integration in autism A review of the
evidence. Journal of Autism and Developmental
Disorders, 30, 415-421. Smith, T., Mruzek,
D., Mozingo, D.Sensory Integrative Therapy. In
J. W. Jacobson R. M. Foxx (Eds.) (2005)., Fads,
dubious and improbable treatments for
developmental disabilities (pp. 331-350). Mahwah,
NJ Laurence Erlbaum Associates.
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Sensory Integration - A Few More Comments Many
people with autism are also hypersensitive or
under-sensitive to light, noise, and touch. They
may be unable to stand the sound of a dishwasher,
or, on the other extreme, need to flap and even
injure themselves to be fully aware of their
bodies. These sensory differences are sometimes
called "sensory processing disorder" or "sensory
processing dysfunction," and they may be
treatable with sensory integration therapy.
Sensory Processing Disorder and Autism Sensory
integration therapy is essentially a form of
occupational therapy, and it is generally offered
by specially trained occupational therapists. It
involves specific sensory activities (swinging,
bouncing, brushing, and more) that are intended
to help the patient regulate his or her sensory
response. The outcome of these activities may be
better focus, improved behavior, and even lowered
anxiety.
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Because it has become a bit of a fad, however,
many well-meaning occupational therapists have
learned just a little about sensory integration
therapy, and may be doing a poor job of
implementing the approach. While this is unlikely
to do a child any particular harm, it's unlikely
to help much - and if a parent is paying for
private therapy, it can be a very expensive
mistake. What Do Sensory Integration
Therapists Do for Children with Autism? It's
important to know that sensory processing
disorder is NOT an official diagnosis, and there
is disagreement as to whether sensory integration
therapy is actually effective. While there are
plenty of anecdotal stories about the success of
sensory integration therapy - and research
studies that support those stories - there are
also plenty of studies which dispute their
findings.
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Question Does Sensory Integration Therapy Really
Work? Answer The answer to this question seems
to be "maybe." The American Association of
Pediatrics says "occupational therapy using
sensory integration techniques to address sensory
processing problems is commonly used in children
with ASD. Although many believe occupational
therapy is subjectively effective in educational
and clinical settings, research data to support
its effectiveness is scant." The Aetna Insurance
Corporation has developed a policy relative to
sensory integration therapies of various sorts,
and summarizes its policy as follows "Aetna
considers sensory and auditory integration
therapies experimental and investigational for
the management of persons with various
communication, behavioral, emotional, and
learning disorders and for all other indications.
The effectiveness of these therapies is
unproven." They back up their policy decision
with dozens of specific studies by major
researchers in the field.
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Dr. Lucy Jane Miller, director of the Knowledge
in Development Foundation, which specializes in
sensory dysfunction and sensory dysfunction
therapy, says "Outcomes depend, but we do see
major changes." Miller stresses the importance of
including and training parents as part of the
process of therapy, and makes it clear that her
approach to sensory integration therapy focuses
on concrete, short-term goals that are customized
to each patient and his or her family. As is
suggested by the opinions described, research to
date has not been conclusive. Studies suggest
that, for example, that children are more likely
to focus well after exercise than after sitting
still - but this kind of finding seems to be a
statement of the obvious. There are small studies
which suggest that sensory integration is
extremely helpful, and other equally small
studies that suggest the opposite. So far, no one
has truly shown that the specific therapeutic
tools of sensory integration are more effective
than, say, a brisk walk around the block, or a
session with a jump rope. Nevertheless, anecdotal
findings do seem to suggest that sensory
integration therapy (also called sensory
dysfunction therapy) can make a significant
difference for some people.
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It's important to note that, while sensory
integration therapy is generally recommended for
children, there's no special reason why teens or
adults shouldn't benefit from focused therapeutic
work. Says Dr. Miller "It's never too late to
get treatment the brain is still plastic. And
it's never too late to understand
yourself." Sources Aetna, Inc. Clinical Policy
Bulletin Sensory and Auditory Integration
Therapy The Aetna Insurance Corporation
website American Association of Pediatrics.
Technical Report The Pediatrician's Role in the
Diagnosis and Management of Autistic Spectrum
Disorder in Children. PEDIATRICS Vol. 107 No. 5
May 2001, p. e85. Baumesiter, AA et al. A
critique of the application of sensory
integration therapy to children with learning
disabilities. J Learn Disabil. 1994
Jun-Jul27(6)338-50.
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Hatch-Rasmussen, Cindy M.A., OTR/L. Sensory
Integration Center for the Study of
Autism Miller, Lucy Jane, Ph.D., Director, KID
Foundation Interview, February, 2006. Miller,
Lucy Jane, Ph.D. Sensational Kids Hope and Help
for Children with Sensory Processing Disorder
(SPD). Overview of Sensory Processing Disorder
from the Knowledge in Development Foundation
website. Sensory Integration International
Website/Ayers Clinic Smith SA, et al. Effects of
sensory integration intervention on
self-stimulating and self-injurious behaviors. Am
J Occup Ther. 2005 Jul-Aug59(4)418-25. "Sensory
Integration/Occupational Therapy" on Totally
Sensational website
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Chelation Therapy Description A treatment that
aims at lowering the levels of mercury, lead, or
other heavy metals, in ones body. The
participant takes medication every other week or
on some regular schedule until the urine levels
are reported to stabilize. Then, the participant
takes lipoic acid which chelates the metal that
is tightly bound to the cells. Research Summary
There have been no scientific studies of
chelation therapy for individuals with autism
spectrum disorders. It is doubtful that
individuals with autism spectrum disorders have
high levels of heavy metals or that chelating
agents would be effective in reversing
neurological damage from metal exposure (Levy
Hyman, 2005). Some forms of chelation therapy may
cause severe side effects or even death (Kane,
2006). Thus, this therapy appears implausible and
unacceptably risky as such, it is an
inappropriate treatment for autism spectrum
disorders. Recommendations Chelation therapy is
not recommended as a treatment for autism
spectrum disorders. Selected report of
side-effects Kane, K. (2006, Jan. 6).
Death of 5-year-old boy linked to controversial
chelation therapy. Pittsburgh Post Gazette.
Retrieved January 30, 2006 Systematic reviews of
scientific studies Levy, S. E., Hyman,
S. L. (2005). Novel treatments for autistic
spectrum disorders. Mental Retardation and
Developmental Disabilities Research Reviews, 11,
131-142.
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Special Diets Description Alteration of the
participants food intake for the purpose of
changing behavior. Many diets involve eliminating
substances from the participants food
intake. Examples Gluten-Free (wheat),
Casein-Free (dairy), Sugar Free, Removal of food
dyes, Foods thought to produce maladaptive
behavior Research Summary One well-designed but
small study on the gluten-free casein-free diet
found no improvement in cognitive, language, or
motor skills with the diet however, there may
have been a reduction in autistic behaviors such
as repetitive statements (Knivsberg, Reichelt,
Hoien, Nodland, 2002). A second well-designed
but small study found no evidence of benefit
(Elder et al., 2006). Additional study of the
theoretical basis and efficacy of the GfCf diet
is warranted (Millward, Ferriter, Calver,
Connell-Jones, 2004). There is a risk that
removing gluten and casein from an individials
diet will lead to inadequate nutrition,
therefore, dietary counseling is important for
families who place their children on the diet
(Hyman Levy, 2003). There are no scientific
studies on other dietary interventions for
children with autism spectrum disorders. Recommen
dations An important area for research is to
conduct studies with strong scientific designs to
evaluate the GfCf diet and other dietary
interventions for individuals with autism
spectrum disorders. Professionals should present
diets as untested as a treatment for autism
spectrum disorders, recommend dietary counseling
to ensure adequate nutritional intake, and
encourage families who are considering this
intervention to evaluate its effects and
side-effects carefully.
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Selected References Selected scientific
studies Knivsberg, A-M., Reichelt, K. L.,
Hoien, T., Nodland, M. (2002). A randomised,
controlled study of dietary intervention in
autistic syndromes. Nutritional Neuroscience, 5,
251-261. Elder, J. H., Shankar, M.,
Shuster, J., Theriaque, D., Burns, S.,
Sherrill, L. (2006). The gluten-free, casein-free
diet in autism Results of a preliminary double
blind clinical trial. Journal of Autism and
Developmental Disorders. Accessed April 6, 2006,
on-line at www.springerlink.com Systematic
reviews of scientific studies Levy, S.
E., Hyman, S. L. (2003). Use of complementary
and alternative treatments for children with
autism spectrum disorders is increasing.
Pediatric Annals, 32, 685-691. Millward,
C., Ferriter, M., Calver, S., Connell-Jones, G.
(2004). Gluten- and casein-free diets for
autistic spectrum disorder. The Cochrane Database
of Systematic Reviews, 3.
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Applied Behavior Analysis (ABA) Description
Practitioners of applied behavior analysis (ABA)
aim to improve socially important behavior by
using interventions that are based upon
principles of learning theory and that have been
evaluated in experiments using reliable and
objective measurement. ABA methods are intended
to support persons with autism spectrum disorders
in many ways To increase behaviors (e.g.
to increase on-task behavior, or social
interactions) and to teach new skills (e.g., life
skills, communication skills, or social
skills) To maintain behaviors (e.g., self
control and self monitoring procedures to
maintain and generalize job-related social
skills) To generalize or to transfer
behavior from one situation or response to
another (e.g., from completing assignments in the
resource room to performing as well in the
mainstream classroom) To restrict or
narrow conditions under which interfering
behaviors occur (e.g., modifying the learning
environment) and To reduce interfering
behaviors (e.g., self injury or stereotypy).
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Research Summary Many studies show that ABA is
effective in increasing behaviors and teaching
new skills (Goldstein, 2002 Odom et al., 2003
McConnell, 2002). In addition, many studies
demonstrate that ABA is effective in reducing
problem behavior (Horner et al., 2002). A number
of studies also indicate that, when implemented
intensively (more than 20 hours per week) and
early in life (beginning prior to the age of 4
years), ABA may produce large gains in
development and reductions in the need for
special services (Smith, 1999) however, large
studies with strong experimental designs are
needed to confirm the results reported for
intensive, early intervention. The United States
Surgeon General (1999) concluded, "Thirty years
of research demonstrated the efficacy of applied
behavioral methods in reducing inappropriate
behavior and in increasing communication,
learning and appropriate social
behavior." Recommendations ABA is an effective
intervention for many individuals with autism
spectrum disorders. ABA interventions should be
supervised by qualified behavior analysts.
Because of the scientific support for ABA,
professionals and families may wish to obtain
additional information about this approach
resources are listed in the references below. An
important area for research is to conduct large
studies with strong scientific designs to
evaluate long-term outcomes of early, intensive
ABA and other comprehensive ABA intervention
programs.
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Selected References Systematic reviews of
scientific studies Goldstein, H. (2002).
Communication intervention for children with
autism A review of treatment efficacy. Journal
of Autism and Developmental Disorders, 32,
373-396. Horner, R. H., Carr, E. G.,
Strain, P. S., Todd, A. W., Reed, H. K.(2002).
Problem behavior interventions for young children
with autism A research synthesis. Journal of
Autism and Developmental Disorders. 32, 423-446.
McConnell, S. (2002).Interventions to
facilitate social interaction for young children
with autism Review of available research and
recommendations for educational intervention and
future research. Journal of Autism and
Developmental Disorders, 32, 351-372. Odom,
S. L., Brown, W. H., Frey, T., Karasu, N.,
Smith-Canter, L. L., Strain, P. S. (2003).
Evidence-based practices for young children with
autism Contributions from single-subject design
research. Focus on Autism and Other Developmental
Disabilities, 18, 166-175. Smith, T.
(1999). Outcome of early intervention for
children with autism. Clinical Psychology
Science and Practice, 6, 33-49. United
States Surgeon General (1998). Mental health A
report of the Surgeon General. Washington, DC
Author.
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Position statements from professional
organizations Maine Administrators of
Services for Children with Disabilities (MADSEC).
(1999). Report of the MADSEC autism task force
(revised ed.). Manchester, ME Author. New
York State Department of Health, Early
Intervention Program. (1999). Clinical practice
guideline The guideline technical report.
Autism/ pervasive developmental disorders,
assessment and intervention for young children
(Age 0-3 Years). Albany, NY Author. For
additional information Maurice, C. Green,
G., Luce, S. C. (Eds.). Behavioral intervention
for young children with autism A manual for
parents and professionals. (pp. 45-67). Austin,
TX Pro-Ed. Maurice, C., Green, G.,
Foxx, R. (Eds.). Making a difference Behavioral
intervention in autism. Austin, TX Pro-Ed.
52
Defeat Autism Now (DAN!) is a project of the
Autism Research Institute, founded in the 1960's
by Dr. Bernard Rimland. DAN! doctors are
trained in the "DAN! Protocol," an approach to
autism treatment which starts with the idea that
autism is a biomedical disorder. Specifically,
DAN! doctors feel that autism is a disorder
caused by a combination of lowered immune
response, external toxins from vaccines and other
sources, and problems caused by certain
foods. What Do DAN! Doctors Prescribe? In an
article called "Advice to Parents of Children
with Autism," authors associated with the Autism
Research Institute say Many physicians do
not conduct extensive medical testing for autism,
because they believe, incorrectly, that the only
useful medical treatments are psychiatric
medications to reduce seizures and behavioral
problems.
53
Some of the major interventions suggested by DAN!
practitioners include o Nutritional
supplements, including certain vitamins,
minerals, amino acids, and
essential fatty acids o Special diets
totally free of gluten (from wheat, barley, rye,
and possibly oats) and free of dairy (milk, ice
cream, yogurt, etc.) o Testing for
hidden food allergies, and avoidance of
allergenic foods o Treatment of
intestinal bacterial/yeast overgrowth (with
pro-biotics, supplements and other
non-pharmaceutical medications) o
Detoxification of heavy metals through chelation
(a potentially hazardous medical procedure)
How Are DAN! Doctors Trained? DAN!
doctors are credentialed medical doctors who
choose to attend a one-day DAN! training. There
is no further credentialing, testing, or follow
up. According to a spokesperson for the
Autism Research Institute We make
every attempt to provide a comprehensive seminar
for practitioners teaching them techniques for
assessing, testing and treating children on the
spectrum using the biomedical approach. We are
now insisting anyone on the ARI Clinician's
Registry attend at least one training or
conference every two years. However, due to the
overwhelming legal ramifications, we do not
"certify" any practitioner.
54
We encourage parents to thoroughly investigate
the credentials and expertise of any
practitioner, but DAN! nor ARI will not police
practitioners. Our medical director, Elizabeth
Mumper, M.D., and I are continually looking to
improve this situation. However, at present, we
do not have the perfect solution. Why Might
Parents of Children with Autism Be Interested in
Seeing a DAN! Doctor? The answer is simple
there are hundreds of parents who claim that
their children were literally cured of autism as
a result of the DAN! protocol. Whether their
claims are absolutely true is uncertain - but
there is no doubt that some children have done
very well under the care of DAN! physicians and
clinicians. Where Can Parents Find DAN!
Doctors? The Autism Research Institute
(ARI) has a list of doctors who have been through
the one-day DAN! training. Of course, parents
should be very wary, and follow the excellent
advice offered by ARI spokespeople regarding
selection of a local pediatrician. In addition, I
recommend that parents consult with their own
pediatrician regarding the safety of any DAN!
treatment - and check in with parent support
groups to be sure that the DAN! doctor of their
choice is really what he or she appears to be.

55
References Email interview with Maureen
H. McDonnell, RN DAN! Conference Coordinator and
former DAN! clinician. March, 2007.
Interview with Dr. Cynthia Molloy, M.D., M.S.
Assistant Professor of Pediatrics, Center for
Epidemiology and Biostatistics, Cincinnati
Children's Hospital Medical Center, March 13,
2007. James B. Adams, Ph.D., Arizona State
University, Tempe, Arizona Stephen M. Edelson,
Ph.D., Autism Research Institute, San Diego,
California Temple Grandin, Ph.D., Colorado State
University, Fort Collins, Colorado Bernard
Rimland, Ph.D., Autism Research Institute, San
Diego, California "Advice for Parents of Young
Autistic Children" Spring (2004)