Autism Independent UK (SFTAH)

Amphetamines sometimes reduce the hyperactivity accompanying autism; they can improve attention spans and reduce activity in these youngsters. Although reports of improvement with amphetamines are encouraging, several published studies show deterioration of behaviour in certain children being treated with these medications.

Phenothiazines have been used, though unpredictable, in reducing anxiety, severe aggressions, and self-injurious behaviours. Haldol is the most thoroughly researched of these drugs, although Mellaril is also commonly used. Unfortunately, phenothiazines have been shown to increase learning deficits and must be carefully monitored for several possible side effects: tardive dyskinesia, reduced seizure thresholds and excessive weight gain.

Lithium, generally prescribed for manic-depressive patients, has recently been used with autistic children, especially those exhibiting epidosic aggressive behaviours and who have not been responsive to other forms of drug treatment. Lithium has been effective with some of these youngsters, especially those showing family histories of cyclical affective illness. Lithium is especially difficult to monitor because there is a narrow range between therapeutic and toxic levels.

A 1982 study on fenfluramine sparked considerable interest by claiming to produce remarkable improvements in 2 autistic youngsters. Although designed to facilitate weight loss in non-handicapped adults, fenfluramine also reduces blood serotonin levels in the brain leading many investigators to believe it might be helpful for people with autism. The 1982 study led to a large multicentre trial of fenfluramine which was unable to replicate earlier positive results. Subsequent studies have also shown serious side effects associated with this medication. Although fenfluramine might produce positive changes in isolated cases, its lack of general effectiveness and serious side effects make it a less desirable treatment than most other alternatives.

Naltrexone, an opiate receptor blocker, is also receiving considerable interest among investigators. Based on the theory that a major problem in autism is elevated brain opioid activity, this intervention has only been used on an experimental basis. Although reports on its effectiveness have been mixed, the most enthusiastic accounts are from those using opiate receptor blockers with children who are severely self-injurious. More research is definitely needed with this exciting new biological intervention.

Though less potent than other medications, megavitamins have also been administered and evaluated in several studies. Although the evidence on the effectiveness of megavitamins is mixed, several studies show modest improvements. It appears that some autistic children - though clearly not all and probably not even the majority - benefit from these interventions. The improvement rate with megavitamins is similar to the other biological interventions, which makes this approach preferable according to some professionals because there are fewer side effects.

Operant approaches have been effective in developing communicative and social behaviours in children with autism and related developmental handicaps. Finding appropriate rewards is often a challenge with non-responsive autistic youngsters, but investigators able to build them up have been effective in improving behaviours. Operant behavioural techniques have been effective in decreasing some of the most troublesome severe behaviour problems accompanying autism such as aggression and self-injurious behaviour. Successful techniques for reducing behaviours have been withdrawal of reinforcements like attention, time-out procedures requiring isolation, and overcorrection (following an undesirable behaviour with activities designed to correct the damage). Although many of these procedures for reducing inappropriate behaviours have been effective and are common practice, many professionals are now discouraging their use in favour of more positive approaches.

Structured teaching techniques, based on cognitive theory, have been widely used with autistic people. These techniques are similar to operant approaches in emphasizing behaviour rather than underlying psychodynamic processes. Structured teaching differs from the operant techniques, however, in stressing the autistic person's understanding of what is expected, rather than the principle of positive reward. The focus is on how well an autistic person can understand the environment and its expectations for him. To the extent that rewards and punishments clarify what is expected - and in many cases they do- these are useful and important for structured teaching. Nevertheless, several other techniques are considered to be equally important: organising the physical environment to help clarify tasks and boundaries, establishing developmentally appropriate schedules, doing careful individualized assessments, and establishing positive routines.

Relaxation training is another cognitive approach that has been helpful for autistic clients. Because anxiety is so frequently associated with autism, helping autistic people to stay calm and in control has been and important priority. Relaxation training focuses on an autistic person's cognitions, using deep breathing, muscle relaxation, and visual imagery to neutralize anxiety. Biofeedback is sometimes used with those who cannot understand the basic aspects of relaxation training.

Social learning approaches have emphasized the importance of social skills training. Targetting specific skills for remediation and practicing those skills in natural settings are important aspects of this approach. Techniques like modelling, role playing, and rehearsal are frequently used to highlight and teach more appropriate social behaviours.

Several new trends are emerging in special education programmes for students with autism and related disabilities. First there is a movement toward community-based instruction, which involves instruction outside of the classroom in community settings to teach skills necessary for effective adult functioning. Examples are teaching shopping skills in an actual grocery store or teaching mobility skills by learning to ride the neighbourhood bus. Because the goal for autistic children is to function as adults in their own communities, community-based instruction has become an important way to prepare them.

Another new trend is to provide opportunities for autistic children to be with non-handicapped peers for portions of the day. Recent investigations have demonstrated the effectiveness of non-handicapped peers in teaching social and play skills to autistic children. Exposure to non-handicapped peers also provides autistic students with more appropriate models of acceptable behaviour. Progressive and potentially helpful, programmes providing contacts with non-handicapped peers are only effective to the extent they are carefully planned and well organised.

Although there is a general agreement about the value of interactions with non-handicapped peers, there is some disagreement as to the best way wo implement programmes. Some argue for special classes in main-stream schools where autistic children can get the specialized instruction they need but still be exposed to non-handicapped students. Others believe in main-streaming for part or all of the school day. Mainstreaming refers to the placement of autistic students in regular classes for those activities that are most appropriate: lunch, recess, or physical education. Others believe that mainstreaming can be effective for academic subjects as well if the autistic students have adequate support services in the regular classrooms.

Another current trend is the the emphasis on vocational training with less attention to traditional academic subjects. This change from former practice is a direct result of experiences with autistic adults. Many successful graduates of special education programmes are now working at competitive jobs when given adequate support and training. Their success has been a major source of pride. These graduates have changed prevailing educational practices because their successes have resulted from strong vocational training and not from traditional academic school programmes.