Treating Autism

Those who have read my new book, The Last Psychoanalyst, will recall the role autism played in the debate over psychoanalysis in France. Psychoanalysts in that country were appalled to see that autistic children were being treated with cognitive behavioral therapies in America. They set themselves the task of protecting autistic French children from what they saw as an invasive cultural scourge.

To some extent they have succeeded. The new behavioral techniques for treating autism are barely available in France.

As I mentioned in my book, these new therapies are hopeful and promising. They affect cures in a small number of cases but they do offer improvement in more cases. In some cases they are ineffective.

The New York Times has an important survey of the current work in the field. Those who are interested in the topic will enjoy reading the article.

The Times explains:

… researchers did find that early, intensive behavioral therapy could improve language, cognition and social functioning at least somewhat in most autistic children, and a lot in some. A few studies claimed that occasionally children actually stopped being autistic, but these were waved off: Surely, either the child received a misdiagnosis to begin with or the recovery wasn’t as complete as claimed.

In the last 18 months, however, two research groups have released rigorous, systematic studies, providing the best evidence yet that in fact a small but reliable subset of children really do overcome autism. The first, led by Deborah Fein, a clinical neuropsychologist who teaches at the University of Connecticut, looked at 34 young people, including B. She confirmed that all had early medical records solidly documenting autism and that they now no longer met autism’s criteria, a trajectory she called “optimal outcome.” She compared them with 44 young people who still had autism and were evaluated as “high functioning,” as well as 34 typically developing peers.

New studies have shown that behavioral techniques can also modify brain structure in autistic toddlers:

But recent research on autistic toddlers by Geraldine Dawson of Duke reveals just how malleable the autistic brain can be. Prior studies determined that autistic children show more brain engagement when they look at color photos of toys than at color photos of women’s faces — even if the photo is of the child’s mother. Typically developing children show the reverse, and the parts of their brain responsible for language and social interaction are more developed than those of autistic children.

Dawson wondered whether steering autistic children’s attention to voices, gestures and facial expressions could alter their brain development. So in a randomized clinical trial published in 2012, she tracked two groups of autistic toddlers: one that received 25 hours a week of a behavioral therapy designed to increase social engagement, and a control group that received whatever treatments their community offered (some behavioral, some not). After two years, electroencephalograms showed that brain activity in the control group still strongly favored nonsocial stimuli, but the EEGs of the social-engagement group were now similar to those of typically developing children. It appeared that their brains had, in fact, changed. Though the children were still autistic, their I.Q.s had also increased and their language, social-engagement and daily-living skills had improved, while the children in the control group had progressed noticeably less.

Again, the work is still in progress:

Though many studies show that early intensive behavioral therapy significantly eases autism symptoms, most children who receive such therapy nevertheless remain autistic — and some who don’t get it nevertheless stop being autistic. 

And also:

In Fein’s study, children who lost the diagnosis were twice as likely to have received behavioral therapy as those who remained autistic; they also began therapy at a younger age and received more hours of it each week. But roughly one-quarter of Fein’s formerly autistic participants did not get any behavioral therapy….

The treatments produce some benefits. They are certainly far more effective than Freudian psychoanalysis. No serious researcher believes that psychoanalysis is a viable treatment for autism. 

Evidently, much more work is required.