Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Overview of Mental Disorders in Children
Autism
Treatment
Because autism is a severe, chronic developmental disorder, which results in
significant lifelong disability, the goal of treatment is to promote the child’s
social and language development and minimize behaviors that interfere with the
child’s functioning and learning. Intensive, sustained special education
programs and behavior therapy early in life can increase the ability of the
child with autism to acquire language and ability to learn. Special education
programs in highly structured environments appear to help the child acquire
self-care, social, and job skills. Only in the past decade have studies shown
positive outcomes for very young children with autism. Given the severity of the
impairment, high intensity of service needs, and costs (both human and
financial), there has been an ongoing search for effective treatment.
Thirty years of research demonstrated the efficacy of applied behavioral methods
in reducing inappropriate behavior and in increasing communication, learning,
and appropriate social behavior. A well-designed study of a psychosocial
intervention was carried out by Lovaas and colleagues (Lovaas, 1987; McEachin et
al., 1993). Nineteen children with autism were treated intensively with behavior
therapy for 2 years and compared with two control groups. Followup of the
experimental group in first grade, in late childhood, and in adolescence found
that nearly half the experimental group but almost none of the children in the
matched control group were able to participate in regular schooling. Up to this
point, a number of other research groups have provided at least a partial
replication of the Lovaas model (see Rogers, 1998).
Several uncontrolled studies of comprehensive center-based programs have been
conducted, focusing on language development and other developmental skills. A
comprehensive model, Treatment and Education of Autistic and Related
Communication Handicapped Children (TEACCH), demonstrated short-term gains for
preschoolers with autism who received daily TEACCH home-teaching sessions,
compared with a matched control group (Ozonoff & Cathcart, 1998). A review of
other comprehensive, center-based programs has been conducted, focusing on
elements considered critical to school-based programs, including minimum hours
of service and necessary curricular components (Dawson & Osterling, 1997).
The antipsychotic drug, haloperidol, has been shown to be superior to placebo in
the treatment of autism (Perry et al., 1989; Locascio et al., 1991), although a
significant number of children develop dyskinesias as a side effect (Campbell et
al., 1997). Two of the SSRIs, clomipramine (Gordon et al., 1993) and fluoxetine
(McDougle et al., 1996), have been tested, with positive results, except in
young autistic children, in whom clomipramine was not found to be therapeutic,
and who experienced untoward side effects (Sanchez et al., 1996). Of note,
preliminary studies of some of the newer antipsychotic drugs suggest that they
may have fewer side effects than conventional antipsychotics such as
haloperidol, but controlled studies are needed before firm conclusions can be
drawn about any possible advantages in safety and efficacy over traditional
agents.
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