※ [本文轉錄自 tmlu 信箱]
作者: tm@bbs.sob.com.tw
標題: ◇ [參考]Autism FAQ (7):Treatment
時間: Mon Oct 14 21:53:14 2002
作者: Jf (寫給往事的一封匿名信) 看板: NTUStar_rain
標題: [參考]Autism FAQ (7):Treatment
時間: Thu Sep 27 19:45:19 2001
_________________________________________________________________
Autism FAQ - Treatment
_________________________________________________________________
See also the comments below under "Controversies".
There is no standard, universally accepted treatment of autism; in
fact, every single method has its detractors. General approaches may
be summarized as follows:
* Biochemical (food allergies, medication, food and vitamin
supplements)
* Neurosensory (sensorial integration, over stimulation and
patterning, auditory training, facilitated communication, daily
life therapy)
* Psycho-dynamic (holding therapy, psychotherapy and psychoanalysis,
option institute(which also falls in behavioral))
* Behavioral (Discrete trials (Lovaas and others), behavior
modification with and without aversives, TEACCH)
Note: Many of the programs mentioned above also use other approaches
to some degree and an attempt was made to place them in the most
appropriate category.
The literature seems to show that food allergies and the possibility
of candida should be checked immediately because a significant number
of children may be autistic because of these problems which can be
controlled through drugs or diet. As far as other kinds of drug
therapy are concerned, there is no drug that is universally successful
in treating autistic symptoms and that in some cases usually useful
drugs may produce negative results and vice-versa. Vitamin B6 with
magnesium and some other vitamins and DMG produce positive results in
many cases.
Any educational program (SI,AIT, psychotherapy, behavioral, etc), if
done intensively, produces some positive results. There are rare cases
of recovery claimed by every educational method. In addition, some
methods have been reported by parents as producing negative results.
Behavioral approaches are backed by scientific studies as well as
anecdotal evidence. The best known, because of the amount of related
scientific literature, are Lovaas' version of discrete trial and the
North Carolina TEACCH programs. Both are very structured programs with
a lot of positive reinforcement, two factors which seem to important.
Clearly, it is important to have centers of expertise for PDD, autism,
and related disorders in order to help families and school boards in
experimenting and choosing the right therapy for each child.
Note: this list is far from complete at this time and misses some
well-known treatments.
Vitamin B6
Some have attributed some success in reducing the
characteristic symptoms of autistics through the ingestion of
large amounts of Vitamin B6. Bernard Rimland pursued this line
of investigation. Magnesium is given with it. I think the
reason is that high vitamin B6 tends to deplete the body's
magnesium. Suggestions have been that it reduces hyperactivity
and obsessive/compulsive behaviors. To make it usable with
small children, at least one company provides it in powder
form.
dimethylglycine (DMG)
Bernard Rimland pursued this line of investigation. Suggestions
are that it sometimes helps autistics with speech & with their
attention span. DMG does not require a prescription in the US,
being considered a food supplement (once called vitamin B-16,
but it was ruled not a vitamin because no specific medical
problem is associated with a deficiency of it.) The health food
store people say that it is supposed to increase "oxygen
uptake" by the blood stream and athletes sometimes take it for
that reason.
Eliminating dietary gluten/casein
For some children, the effects of this intervention are obvious
to their parents within hours or days. Children who seem to
respond most dramatically to the removal of dairy have a
history of ear infections, inconsolable crying, poor sleeping
patterns, and excessive craving of milk and dairy foods. Gluten
intolerance is generally indicated by loose stools and/or a
craving for bread and pasta. This is a relatively harmless
intervention and should be attempted as soon as possible, to
see if a child does respond. If so, further exploration into
biochemical treatment is recommended.
Fenfluramine
A drug that decreases blood serotonin concentrations. Some
autistics have abnormally high blood serotonin concentrations
so experiments were carried out to see if this drug affected
the behavior of such autistics (or other autistics). Some
success was reported. Dr. Edward R. Ritvo pursued this line of
research.
Periactin (AKA cyproheptadine)
Another drug that decreases serotonin concentrations. This drug
is normally used as an antihistamine but because of its
additional affect on serotonin, has been tried on autistics.
Piracetam
Has shown promise in helping autistic children become more
talkative, sociable, less aggressive and have an increased
attention span. Available without prescription.
Auditory Integration Training (AIT)
A method of changing a person's sensitivity to sound at
different frequencies. It was originally developed to combat
the onset of some kinds of deafness, but was tried on an
autistic child and cured her. Since then it has not produced
any cures, but has been credited with success in reducing some
of the symptoms of some children. In particular, some autistic
children show a strong aversion to some sounds, and with
Auditory Integration Training have lost their aversion and
exhibited other reductions in the symptoms of autism. There are
two methods of AIT, the Tomatis and the Berrard. They are
different enough that they should perhaps be considered
different therapies.
Tomatis Method
A kind of AIT developed by Alfred Tomatis. Over several weeks,
the person listens to classical music with the low frequencies
filtered out. Over time, voices (also filtered) are introduced,
then the missing frequencies. Treatment requires weeks,
typically 2 hours of listening a day.
Sensory Integration Therapy (SIT)
A method of helping people who are her oversensitive to the 5
senses by overwhelming them with sensory experiences, e.g.
swing them, roll them, get them jumping and spinning. Usually
provided by occupational therapists who have learned the
method.
Holding Therapy
Martha Welch is the primary proponent who argues that autism
results from a failure to bond with the child. The child is
forcibly held by the mother. Both Temple Grandin and Bernard
Rimland have argued that it provides sensory stimulation and
the psychogenic basis is erroneous. Temple Grandin has stated
that forced holding is not necessary. under such a theory,
Holding Therapy can be classified as a kind of sensory
stimulation.
Behavioral Therapy
(also "Lovaas Method", "Behavioral Intervention", "Applied
Behavioral Analysis" (ABA), "Discrete Trial Training" (DTT))
Use of behavior modification (a.k.a. operant conditioning)
which was originally developed by B.F. Skinner (a prime
developer of Behavioral Psychology) outside the purvue of
autism. Lovaas and other psychologists adapted it as a
therapy/educational method for autistic children, and it is his
adaptation which is known as The Lovaas Method or DTT.
Catherine Maurice's book Let Me Hear Your Voice is an account
of two children recovering from Autism through use of this
method, and Lovaas's The Me Book and Maurice's Behavioral
Intervention for Young Children With Autism are a widely used
handbooks for this type of method. Behavioral Therapy now has a
lot of adherents who are vociferous in their claims that it is
the only method with a study (complete with control group)
documenting its success rate. The study is documented in
Lovaas's paper "Behavioral Treatment of Normal Educational and
Intellectual Functioning in Young Autistic Children".
Detractors of the method claim that participants of the study
were not truly autistic, that the children are turned into
robots, and that the method is dehumanizing and severe. The
method also arouses controversy in cases where adherents use of
punishment & aversives to decrease self-destructive behaviors.
(See more complete citations to the above-mentioned books and
paper in the section below: "Bibliography").
Aversives
Term for employment of punishment. One class of aversive would
be physical pain though the term is not specific to that. Use
of aversives in the treatment of autistic or any children is a
very controversial topic (see "Controversies".). Many condemn
all use (or probably more specifically, all use of pain as an
aversive) and some say there are alternatives that are always
equally or more effective. Proponents say selected employment
has produced immediate positive results that has saved the
lives of autistic children inclined to continuous
self-injurious behavior who have resisted all the non-aversive
alternatives. They also say experience has shown that the
degree of pain required is often so little as to defy logic: a
very slight pain or something not painful can often stop a
child from engaging in very painful self-injury.
Natural Language Paradigm (NLP)
A behavior intervention, thus could be classed with the Lovaas
method, though there are differences. A source of information
on it is Koegel & Koegel's book. A newer name for this is
"Pivotal Response Training".
Pivotal Response Training (PRT)
Newer name for "Natural Language Paradigm".
Irlen Lenses
Developed to treat dyslexia and other learning disabilities,
the use of coloured lenses to treat the visual processing
difficulties of people with autism is relatively new (1994). It
has been popularized by Donna Williams (author of Nobody
Nowhere and Somebody Somewhere).
Prism Lenses
Lenses in glasses that are prisms: thicker at one edge than the
opposite edge.
Social skills training and social stories
Teaching verbal individuals (including those called "high
functioning" and "Asperger's") many of the unwritten social
rules and body language signals that people use in social
interaction and conversation. Carol Gray uses a technique
called "social stories" to help illustrate these social rules
in a variety of situations and appropriate responses. Social
stories and "scripting" are also used with nonverbal
individuals to teach appropriate responses and prepare the
individual for transitions. In very young child, they may be in
the form of photographs or pictures.
Anafranil (cloripramine)
a tricyclic antidepressant which may relieve some symptoms of
autism.
Desipramine
a tricyclic antidepressant.
Zoloft (sertraline)
Second-generation antidepressant (SSRI, or selective serotonin
reuptake inhibitor). Studies on SSRIs reveal significant
improvement in perseverative behaviors and some other autistic
spectrum symptoms (social withdrawal, behavioral rigidity,
etc.).
Ritalin (methylphenidate)
one of a group of stimulants which include amphetamine,
amantidine and fenfluramine. it can sometimes be very effective
for certain hyperactive children (so much so that it gets
overused for others). See also "Dexedrine".
Dexadrine
?
Ritalin SR
?
Dexedrine
used to treat ADD and ADHD in the same way as Ritalin. Likely
used less than Ritalin because its name is associated with drug
abuse. One develops a tolerance for both drugs so that
increases in dosage over time are often necessary to maintain
their effect.
Psychology
a lot of treatments on this list come under the general heading
of psychology (in its most general sense, perhaps all do).
There are parents of autistic children for whom "psychology" is
a dirty word because they associate it with theories and
treatments of autism which hypothesize bad parenting, e.g. lack
of bonding between mother and child (see "History" section
below). Treatments associated with such theories include
Psychotherapy and Holding Therapy. Other therapies in this list
(such as Behavioral Therapy) clearly fall under the heading of
Psychology, yet are certainly not predicated on any "bad
parenting" theory.
Psychotherapy
See "Psychology" above, and "History" section below.
Psychodynamic Therapy/Psycho-dynamic Therapy
I'm not certain whether this term is used for a specific
therapy, but I've seen it used for what might be termed
Psychotherapy and related kinds of therapy. (see "Psychology"
above and "History" section below).
SRRI "Selective Serotonin Reuptake Inhibitor"
A class of psychoactive drugs that includes Prozac, Zoloft,
Luvox, and Paxil (paroxetine), part of a larger class of such
drugs that also includes non-selective serotonin reuptake
inhibitors. Serotonin is a brain chemical released by neurons
and "reuptaken" by neurons.
Prozac (fluoxetine)
Also an SRRI (see Zoloft). Studies have been done.
Clomipramine
From American Health October, 1993: Washington: Psychiatrists
at the National Institute of Mental Health have found that
clomipramine, an antidepressant, also relieves many of the
symptoms of autism, a severe developmental disorder. Patients'
ability to interact with others is much improved.
Clonidine
Normally used to regulate blood pressure and perhaps other
purposes. It is used for ADD children at suppertime or bedtime
to help them attend to evening activities and to settle down
sufficiently to get enough sleep.
Dilantin (phenytoin)
an anti-convulsant used for seizures when others do not work.
It is usually avoided in children due to possible serious side
effects during development.
Lithium
a salt used primarily to treat bipolar disorder, also used in
other, possibly related conditions including autism.
Naltrexone
? (oral version of naloxone) a narcotic antagonist reported by
Lensing & Panksepp to have a dramatic and global effect on
autism. Hypothesis: In the late 70's and early 80's several of
scientists suggested that the behavior of some autistic
individuals sometimes resembles the behavior of people stoned
on hard drugs (heroin, morphine, etc): little sociability,
fixes on strange objects, little or no pain sensation, no
interest in life, states of euphoria, etc. It was suggested
that perhaps these autistic individuals have, for whatever
reason, an excess of pleasure, painkilling hormones in the
brain such as endorphines to which they are addicted (like
joggers to joggers' high which is produced by endorphines). As
a result they may require/desire a minimum dose every day and
that the self-stim and/or auto-aggression may be ways to
produce these hormones and satisfy the craving. Naltrexone's
effect: Naltrexone blocks the effects of drugs such as heroin
and morphine on the brain and has been used since the early
70's for drug addicts. Therefore, naltrexone should also block
the effects of the natural hormones such as endorphines.
(Morphine apparently is very close in structure to and
simulates the endorphines.). A number of very well controlled
studies on the effect of naltrexone on autistic traits and
deficiencies have been published. Nearly all indicate some
positive results for many of the test subjects: less
auto-aggression, less hyperactivity, more sociability, more
communication, etc. Not all the studies report all of these
effects but most report some positives.
Play Therapy
Roughly consists of therapist playing with child while talking
to the child and trying to induce the child to talk. The goal
is to help the child acquire language and the working knowledge
of every day life we all require. The method is to use play,
which is a component of a typical child's language acquisition,
in conjunction with constant interaction with a therapist. Play
therapy has been used for autistic children and children with
emotional disturbances.
Melatonin
A hormone that has a role in the immune system and in
controlling ones sleepcycle. It is sometimes given to children
who have trouble sleeping at night. For that reason and others,
it has been tried on Autistic children. Lately a lot of claims
have been made about the benefits of melatonin for a variety
things.
Haldol (haloperidol)
a neuroleptic which is used to abate symptoms of psychosis.
Trexan
the trade name for Naltrexone.
Vision Integration Therapy
?
Craniel Sacral Therapy
a form of myofacial release performed by physical therapists
and osteopaths.
Cognative approaches
?
Luvox (fluxovamine)
Antidepressant which is being used for obsessive compulsive
disorder and in some cases autism.
Prednisone
a steroid. It and other steroids are used when Landau Kleffner
Syndrome is suspected, but there have been reports of children
responding to steroids even though they don't have the classic
EEG findings of LKS and their language disability was always
present.
EPD (Enzyme Potentiated Desensitization) shots
Sort of homeopathic brew of stuff that your allegric/sensitive
to and it is given in shot form once every 6-8 weeks. It is
being used for people with multiple chemical/environmental
sensitivities/ADD/ADHD/Autism.
Doman-Delacatto
brain stimulation activities for brain-injured children
developed by Glenn Doman and Carl Delacatto. It involves
cross-patterning, patterning and sensory exercises developed to
enhance memory and processing.
Dolphin Therapy (or Dolphin-Assisted Therapy)
I can't give details, but involves being in a tank with a
dolphin or dolphins. Used for Autism, Down's Syndrome, ADD,
Muscular Dystrophy and spinal cord injuries among other
disabilities. Researchers in the field include Dr. Betsy Smith
(Florida International University) and Dr. John Lilly.
Therapy Dogs
experimental therapy to see if teaching children with
disabilities to learn typical human/pet interaction is of use.
Risperdol (risperidone)
(Risperdal?) anti-dopanine agent which also works against
serotonin. A neuroleptic.
Epsom Salt Baths
see Phenolsulphertransferase (PST) deficiency in section
"Theories and Causes".
Dimethyl Amino Ethanol (DMAE)
A food substance (abundant in fish) said to effect mood,
memory, and learning. Sold as a nutritional supplement by some
health-food outfits.
Ginko Bilboa supplements
?
Cranio-Scaral Therapy
Involves unlocking certain areas in the body that are blocked
in order for the cerebral spinal fluid to flow correctly. Among
the practicioners are some chiropractors.
Tegretol
Drug used to prevent seizures, also sometimes used for autistic
symptoms.
Nizoral (ketoconazole)
Anitfungal medication used in the treatment of candida and
other yeast infections.
Nystatin
Anitfungal medication used in the treatment of candida and
other yeast infections.
Folic Acid
?
Eliminating dietary yeast
?
Music Therapy
?
Intravenous Immunoglobulin (IGIV, IgIV, or IVIG)
IV solution something like a blood transfusion, but uses only a
solution made from donated blood rather than whole blood. Used
to address certain immune-system problems.
Intravenous Gamma Globulin (IVIgG)
A treatment for autism based upon the theory that autism can be
caused by an autoimmune condition in the brain. The treatment
is generally confined to patients who show a positive response
to Myelin Basic Protein, a protein component of brain myelin.
Adderall
?
Imipramine
?
Desyrel
?
Clonazepam (Klonopin)
?
Dipiperon
Drug used to treat hyperactivity.
MST Surgery
Surgery typically done for LKS children, but has been used with
autistic children for whom intractible seizures appear to be a
cause.
Secretin infusion
Experimental treatment reported to have helped autistic
children. Secretin is a hormone involved in digestion.
Floortime
Intervention method developed by Stanley Greenspan for
developmentally disabled children including autistic children.
Stanley Greenspan has a series of books including The
Challenging Child and The Child With Special Needs. (See more
complete citations to the above-mentioned books and paper in
the section below: "Bibliography").
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