Autism Therapies and Research

Someone asked me if I oppose all behavioral therapy for children with autism. No, I don't. In fact, I support more research so we can better refine whatever treatments and supports do work for people with autism. I just despise, truly despise, some fringe groups and dangerous ideas about the nature of autism.

This week, a social work student from New York brought to my attention a teacher who cited Autism and Childhood Psychosis by Frances Tustin. The book, first published in the early 1970s, embraces the "narcissistic" view of autism. The book calls for therapies that, sadly, I've witnessed within the last few years: holding a child against her will, for example. The book also links emotionally detached mothers to autism. So, I will continue to remind people that such out-dated nonsense should be challenged. Thankfully, I believe most people will recognize Tustin's text is more a historical artifact than valid information on autism.

I wasn't familiar with the Tustin book, I admit. Apparently, it was reissued in 1995 and some very old-fashioned instructors and practitioners still embrace the theories mentioned. The text seems "Freudian" to me, for lack of a better description. If anyone knows the text, correct me if I'm mistaken.

It's no secret that I dislike people misusing the term "ABA" (Applied Behavioral Analysis, which is not a single therapy technically) and the practices that some people engage in under the guise of "therapy" for children with autism. Fringe groups like NARTH and some people still attached to out-dated notions of mental health use generally abandoned, discredited methods that are not endorsed by the APA or any respected organization. I definitely have no respect for the Lovaas name -- and it doesn't take a lot of research to find out why someone dedicated to equal rights for all people would be troubled by the Lovaas history. (Read the 1974 Lovaas text, Perspectives in Behaviour Modification with Deviant Children for a sad history lesson.)

However, my disgust with a fringe of therapists and "practitioners" respected by almost no one in academia or the research community should not be taken as opposition to any well-designed and monitored research into early intervention therapies for autism.

My mother does not have a college degree and was dealing with my disabilities years before Prof. Lovaas' research at UCLA. Yet, anyone familiar with her efforts would call them "early intervention" and a form of observation-based support. I have no doubt that my mother, working with my physical and neurological development from birth, played a major role in my later success in life. I know, with complete certainty, that my parents being actively engaged in my early years ensured I reached my full potential.

I do not and cannot agree with some "neurodiversity" activists that we should not research "ABA" therapies. First, this assumes all ABA is still dependent on the out-dated and discredited early Lovaas work. Second, we cannot ignore the fact that the brain is more adaptable at early ages.

We know children do learn languages easier than adults, and I don't believe it is a stretch to theorize that young minds are more likely to respond to any behavioral therapies.

I'm not convinced that ABA therapies, sensory integration therapies, or many other therapies for autism have a sufficiently high rate of success. I also believe some therapies are so discredited that they should be abandoned entirely, as research has found no credible evidence of success. Facilitated communication falls into the category of "Abandon it, already!"

I'm definitely opinionated on treatments and therapies. But I also want much more research. I don't believe the evidence for "social stories" is compelling, for example, but I'm more than willing to have research continue. Maybe we can determine when a therapy with a low success rate works and why. If something is working 50 to 60 percent of the time, is the therapy working or is this a side effect of interactions? We should explore such questions.

I'm never going to celebrate the Lovaas name. I want people to know what horrible biases Lovaas represents, especially his anti-homosexuality theories. I don't want people to forget that history. Reputable researchers, clinicians, and professional organizations must work to end discredited practices as quickly and completely as possible. Groups like NARTH are small, pretenders to legitimacy.

At the same time, if we dump all research into everything with a checkered past, not much research will be conducted at all. We cannot stop all behavioral therapy research. It simply isn't logical to stop asking how we can help the most impaired individuals.