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Treatment Options for Autism Spectrum Disorders (ASD)
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This Discussion Guide is part of Community Conversations at FOCUS St. Louis.  It is meant to initiate civil discourse around the policies that affect the St. Louis region; to hear each other’s perspective. As is the case with all public policies, this issue is complex and multi-faceted, with many stakeholders. Please keep this in mind as you discuss treatment options for Autism Spectrum Disorders (ASD) in your community. 
 
Treatment Options for Autism Spectrum Disorders (ASD)

Autism spectrum disorders (ASDs) are a group of developmental disabilities characterized by impairments in social interaction, communication and by restricted, repetitive, and stereotyped patterns of behavior. Symptoms typically are apparent before 3 years of age. The complex nature of these disorders and the lack of biological markers for diagnosis and changes in clinical definitions over time have created challenges in monitoring the prevalence of ASDs.  Treatment options for ASDs vary, from a minimalist approach to complex nutritional – and controversial – techniques.

Background 

The number of children with autism in the United States continues to rise, according to a report released in April 2012 by the Centers for Disease Control and Prevention (CDC). The latest data estimate that 1 in 88 American children has some form of autism spectrum disorder, a 78% increase compared to a decade ago, where it was estimated 1 in 150 children had autism. The rate is even higher in Missouri, where an estimated 1 in 72 children has autism. The report also shows that boys with autism continue to outnumber girls 5-to-1; one in 54 boys in the United States has autism. Research has now shown that autism can be identified in children as young as one year, and that intensive early intervention can lead to improved outcomes for these children.  Once a diagnosis of autism has been made, intensive behavioral and developmental interventions can begin.   

There are generally three approaches for the treatment of ASD. One is Applied Behavioral Analysis (ABA).

Through decades of research, the field of behavior analysis has developed many techniques for encouraging useful behaviors and reducing those that may cause harm or interfere with learning. ABA is the use of these techniques to bring about meaningful change in behavior.  They can be used in structured situations such as in a classroom as well as in everyday situations with family and friends. Some ABA therapy sessions involve one-on-one interaction between the behavior analyst and the child, although group instruction can also prove useful. Today, ABA is widely recognized as a safe and effective treatment for autism. It has been endorsed by a number of state and federal agencies, including the U.S. Surgeon General.  

A second form of treatment is physical, speech, and occupational therapies. ASD children often benefit from particular therapeutic interventions specific to areas of disability. People with ASD are often challenged by physical tasks such as walking, running, and physical coordination; speech impairments including echolalia/scripting and expressive language, and "occupational” tasks such as eating (food fixations/aversion is common), proper toileting, and self-care (i.e. teeth brushing, finger/toe nail trimming, haircuts, hand-washing, etc.), as well as handwriting/typing, and situational awareness. Intense physical, speech and occupational therapies have proven useful for many with ASD.
 
As many with ASD are food challenged, whether its fixation on one specific food, aversion to new foods, or allergic/intolerant to specific foods (as indicated by physical distress or behavioral impairment), in many cases, interventions with nutritional and/or homeopathic supplementation can be beneficial for those with ASD.  A good physical condition is a pre-requisite for recovery from any physical ailment, including ASD. If a child cannot (or will not) eat a well balanced diet, over time, the body’s basic biochemistry, which requires adequate nutrients to function properly, will become impaired.  This impairment will eventually lead to malnutrition and physical stress on the major body organs.  This form of treatment has proven quite useful in treating certain children with ASD, although its use is very controversial for some.

It is important to keep in mind the toll autism takes on a family as well as society. Raising an autistic child can take a tremendous financial toll, even when insurance helps cover some of the costs. The cost of providing care for a person with autism in the U.S. is an estimated $1.4 million over their lifetime, in addition to the $226,920 price tag to raise a child without autism from birth to age 18. Adding to the severe financial strain, families with autistic children earn 28% less compared to families whose children do not have health limitations. Also, as these children grow older, the number of "able-bodied” workers will be diminished due to this disability, negatively impacting each community’s economic viability. This will impact all areas of our nation, from business, to social services, to government and the military. Concurrently, there will be an increased community/societal burden to provide services and care for those who cannot care for themselves.

Who else is involved with this issue?

There are many organizations involved in treatment of ASD.  Autism Speaks is a well-known national organization that strives to help families of children with ASD. Crossing Back to Health is a local clinic that advocates an alternative, dietary approach to treating ASD. Every school district in the area is involved in some fashion with ASDs, as are most daycare providers, health care providers and even some churches. With the sharp increase in ASDs the past decade, a wider variety of organizations are becoming involved as autism touches nearly every part of society.

Three Possible Perspectives:

Person A advocates a minimalist intervention approach, believing the child will grow out of it on their own and/or the school based services will be adequate; and indeed some have children have "grown out of it.”
 
Person B supports a mainstream intervention method, including those covered by health insurance (ABA and/or some pharmaceuticals) and/or therapies provided by the schools.
 
Person C believes an alternate intervention is more appropriate, including those listed above in addition to   the controversial dietary, nutritional, homeopathic and alternate therapies.
 
Discussion Questions:
  1. Which of the three people in this scenario do you most closely align with A, B. or C?  Why?
  2. Why are alternative treatments for ASD so controversial?
  3. What are the societal costs of ASD as the prevalence of the condition increases?
Links for further reading:
  1. March 30, 2012 St. Louis Post Dispatch article: Autism rate rises to 1 in 88 U.S. children.
  2. April 5, 2012 St. Louis Post Dispatch article: Early recognition of autism spectrum disorder is a key.
  3. March 30, 2012 St. Louis Beacon article: One in 72 St. Louis children has an autism spectrum disorder, says CDC study.
  4. April 2, 2012 CNN.com article: With autism, no longer invisible.
  5. Center for Autism Research Technology and Education website.
  6. March 29, 2012 CNN.com article: CDC: U.S. kids with autism up 78% in past decade.
  7. April 2, 2012 CNN-Money.com article: The financial toll of autism.
  8. April 2, 2012 TIME.com article: Autism: Why Some Children ‘Bloom’ and Overcome Their Disabilities.
  9. Crossing Back to Health website. 
  10. Autism Speaks website  
  11. Special School District of St. Louis County website.
  12. Centers for Disease Control and Prevention (CDC) website.
  13. CDC’s New Data on Autism Spectrum Disorders.
  14. CDC Report: Prevalence of Autism Spectrum Disorders — Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008.
  15. Mercy Autism Center at Mercy Children's Hospital St. Louis
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