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The first three years are critical to a child's development.
Guest Column                 
After the Diagnosis:                    
Moving Forward with Confidence          

The following guest column was written for First Signs by Mitzi Waltz, ©2001. Mitzi is the author of several Patient Centered Guides that provide comprehensive coverage on a variety of developmental and behavioral disorders, including Autism Spectrum Disorders: Understanding the Diagnosis and Getting Help.

Usually, a medical diagnosis automatically leads to treatment. Unfortunately, thatís often not the case for autistic spectrum disorders. As of this writing, the FDA has approved no medications to treat ASDs. Your insurance company or HMO will probably tell you no treatments are covered. Books and Web sites do present options, but how can you make wise decisions when every day counts?

Start with the basics.

Some doctors still deliver the diagnosis of autism as if it were an incurable cancer. True, we donít have a cure, but we do have therapies that can help most children with ASDs. Like epilepsy, asthma, and other “incurable” medical conditions, ASDs are eminently treatable. Begin with your childís basic physical health. Many children with ASDs have health problems, such as severe diarrhea or constipation, allergies or food intolerances, or immune-system dysfunction. These may be clues about the actual cause of ASDs, but that’s a question for the researchers. Right now, your job is to ensure that your child is not suffering from pain, illness, or poor nutrition. A healthy, comfortable child can benefit most from the other kinds of help that are available.

Next, make sure your child gets a complete multidisciplinary evaluation.

Find out about his strengths and weaknesses and how he learns.

Evaluating therapies.

Autism is a group of symptoms, not a single medical condition. Just as there may be several reasons for these symptoms to occur, there may be several roads to improvement.

When facing treatment decisions:

  • Make sure the interventions you choose are as safe as possible.
  • Check the credentials of all healthcare providers, and make sure they are knowledgeable about the latest research.
  • Tell your childís primary healthcare provider about everything you try.
  • Keep good notes.

I strongly believe, based on both evidence from clinical studies and from talking to many experienced parents, that all young children with ASDs can benefit from a program of intensive, daily, structured, one-to-one interaction. The best-known system is Applied Behavior Analysis (ABA), originally developed at UCLA by Dr. Ivar Lovaas. Floor-time play therapy, an approach developed by Dr. Stanley Greenspan, is also effective for many children. These methods can be tailored to meet each childĻs individual needs.

Speech therapy, occupational therapy for children with fine motor problems, sensory integration for those under- or over-sensitive to sensory information, and physical therapy for delayed gross motor development are also well-tested.

Medication for specific symptoms, such as obsessive-compulsive behavior, severe anxiety, or self-injurious behavior, may be helpful. At this time, the most important role for medication is reducing symptoms that prevent the use of interventions like ABA, floor-time play therapy, and speech therapy. Some children also need anti-epilepsy medication, as up to one-fourth of children with autism also have a seizure disorder. A few doctors are experimenting with medications that target the immune or gastrointestinal systems. Always start with the lowest dose possible, make any increases gradually, and communicate regularly with your doctor.

Biological interventions.

Biological interventions seek to address metabolic or immune-system problems. They include special diets, vitamins, and dietary supplements. Eliminating the proteins gluten and casein may help with digestive and bowel problems, and may also prevent opiate-like peptides from reaching the brain. Many parents have reported positive benefits from putting their autistic-spectrum child on a gluten-free, casein-free diet. If youíre interested, work with a licensed dietitian, and join a diet-focused support group in your area or online.

Supplementation with B vitamins and magnesium has been extensively researched. Itís not universally effective, but it does seem to help some. If you want to try vitamins, familiarize yourself with their effects and side effects.

Research on essential fatty acids in autism has just begun. They have shown promise in clinical trials targeting other brain disorders. Other supplements may also be valuable.

Check out alternative healthcare practitioners carefully. Sadly, some are untrained or use false credentials, and some make potentially harmful suggestions. Be especially wary of anyone who both recommends and sells supplements.

Evaluating new therapies.

The history of autism has been marked by a series of failed “breakthroughs,” including dangerous drugs like fenfluramine and even LSD. It seems like every year thereís something new, and plenty of families desperate enough to pay thousands for it.

Autism is a complex condition, so miracle cures are unlikely. Like diabetes and asthma, it involves both genetics and environment, and affects multiple systems within the body. Treatment plans must address that complexity. Comprehensive treatment should start as early as possible to help each child achieve her greatest potential.

So donít wait for a cure. Get going right away with therapies that have scientific backing, and evaluate other options based on your childís individual needs and symptoms. This generation of children will be the first to benefit from time-tested treatments. There may even be some real breakthroughs! With wise choices and hard work, the chance of a good outcome is excellent.

© First Signs, Inc., May 2001


Mitzi Waltz Ä

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