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January 04, 2008
Study Shows Antipsychotic Drugs Offer No Benefit in Curbing Aggression
In Drugs Offer No Benefit in Curbing Aggression, Study Finds the New York Times reports the results of a study to be published today in the Lancet which tracked intellectually handicapped adults over more than a month of treatment. There was a 79 per cent reduction in aggressive behavior among those taking placebo pills. The group taking antipsychotic drugs saw a 65 percent or less reduction in aggressive behavior. The better results of the placebo group was attributed by one of the lead researchers to the extra attention the group members received during the study.
In the study, Dr. Peter J. Tyrer, a professor of psychiatry at Imperial College London, led a research team who assigned 86 people from ages 18 to 65 to one of three groups: one that received Risperdal; one that received another antipsychotic, the generic form of Haldol; and one that was given a placebo pill. Caregivers tracked the participants’ behavior. Many people with very low I.Q.’s are quick to anger and lash out at others, bang their heads or fists into the wall in frustration, or singe the air with obscenities when annoyed.
After a month, people in all three groups had settled down, losing their temper less often and causing less damage when they did. Yet unexpectedly, those in the placebo group improved the most, significantly more so than those on medication.
In an interview, Dr. Tyrer said there was no reason to believe that any other antipsychotic drug used for aggression, like Zyprexa from Eli Lilly or Seroquel from AstraZeneca, would be more effective. Being in the study, with all the extra attention it brought, was itself what apparently made the difference, he said.
The NYT notes that the study sharply challenges standard practices in mental health clinics and nursing homes around the world.
Don't be surprised if researchers for the major pharmaceutical companies come out with studies soon to contradict or minimize the Tyer group's findings. Risperdal is used to treat aggression in people with a variety of mental health conditions including autism.
Thursday, January 03, 2008
Offensive Autism Language at "Aspies for Freedom"
On December 29 I commented on the offensive language and hypocrisy demonstrated by neurodiversity blogger Do'C at Autism Street in Offensive Language On Autism Street where he referred to Donald Trump and Jenny McCarthy as "celebrity idiots". Now another neurodiversity blogger fresh off the suppression of the Ransom Notes campaign is insulting Autism Speaks with the following caption: autism speaks are retarded.
My son Conor, for first time visitors to this site, has Autism Disorder with profound developmental delays. One of the issues which has plagued Conor from his earliest years has been his inability to handle being in public places. He is beyond any doubt sensitive, overly sensitive, to environmental stimulation. At one time we could not visit a department store with Conor without him having a meltdown on the scene. We dealt with it by staying in the store and ignoring the tantrum behavior that often accompanied such visits. Conor would literally scream and kick on the floor of department stores. Other shoppers would look at us with the look that said "why are they abusing that child?" Neurodiversity bloggers will still make that accusation. But with time that behavior was eliminated and Conor, to both our benefit and his, began to be able to visit public places without engaging in tantrum behavior or having a meltdown.
In the past several months though Conor began to regress. Even in places where I took him on a regular basis it became difficult, and sometimes impossible, to visit for any time without a meltdown. I continued to take him to the most familiar places with the least environmental stimulation to try and restore his comfort level with public settings. After making some progress for awhile I pushed the envelope too far during the Christmas holidays, as I commented on previously, and Conor had one of the worst meltdowns I have ever seen.
Even more recently though Conor has again shown great progress. We ask him whether he wants to go into the grocery stores when we go there or give him the option of "stay in car with Daddy" while my wife gets the groceries. Usually Conor would say "stay in car". But he surprised us fairly recently by saying "Sobeys" the name of the grocery store we were going to visit. Last night again when going to the "Superstore" grocery store Conor expressed the wish to go in the store. Inside the store, I buy apples individually and I asked for his help in counting and placing apples in the plastic bag before I tied it up. Conor smiled and had fun in the store.
I also took Conor for a drive to a nearby community and back. Conor enjoys driving with Dad preferably with no radio or discs playing. At the end of the drive I took him to a local McDonald's expecting to have to again go through the drive through because it had been awhile since Conor would sit down in McDonald's without a tantrum. This time though I asked him and he agreed. We went inside and Conor was smiling and relaxed. It was fun.
If parents are struggling with visiting public places with their autistic child have faith that things can improve. You may have to try different approaches and you may want to consult any therapists who are working with your child but the situation can improve with time and effort.
Wednesday, January 02, 2008
An Autism Suggestion For 2008's New Autism Parents - Do Not Waste Time
TO PARENTS OF CHILDREN DIAGNOSED WITH AUTISM IN 2008 DO NOT WASTE TIME
Amongst the many events that will occur in 2008 is the certainty that many children will receive an autism disorder diagnosis. Many parents of these children will have their hands full coping with the demands of daily life and trying to understand what autism is all about. If a child receives a diagnosis at an early age, between 1-2 or even before school age, it is likely because the parent already understands that their child's behavior, or lack of development, is not a culture or way of life, not just a different form of wiring, as some neurodiversity advocates like to describe it in trivializing autism. It is that parental observation and concern which will usually have led to an autism disorder diagnosis. Parents with children newly diagnosed with autism disorder should waste no time in seeking effective help.
Autism is a serious neurological disorder that will seriously impair and restrict the lives of many who are afflicted with the disorder. At present there is no widely accepted, evidence based cure, BUT there is a treatment that is effective in significantly improving the child's potential on many fronts behavior, intellect, social skills and communication are all deficits which can be improved in an autistic child with early, effective, evidence based, intervention. While there are several variations in practice today the most effective, evidence supported, intervention for autistic children is Applied Behavior Analysis. The American Academy of Pediatrics in Management of Children With Autism Spectrum Disorders, October 29, 2007 stated with regard to ABA:
Applied Behavior Analysis
Applied behavior analysis (ABA) is the process of applying interventions that are based on the principles of learning derived from experimental psychology research to systematically change behavior and to demonstrate that the interventions used are responsible for the observable improvement in behavior. ABA methods are used to increase and maintain desirable adaptive behaviors, reduce interfering maladaptive behaviors or narrow the conditions under which they occur, teach new skills, and generalize behaviors to new environments or situations. ABA focuses on the reliable measurement and objective evaluation of observable behavior within relevant settings including the home, school, and community. The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology 21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–40
Highly structured comprehensive early intervention programs for children with ASDs, such as the Young Autism Project developed by Lovaas35,41 at the University of California Los Angeles, rely heavily on discrete trial training (DTT) methodology, but this is only one of
many techniques used within the realm of ABA. DTT methods are useful in establishing learning readiness by teaching foundation skills such as attention, compliance, imitation, and discrimination learning, as well as a variety of other skills. However, DTT has been criticized
because of problems with generalization of learned behaviors to spontaneous use in natural environments and because the highly structured teaching environment is not representative of natural adult-child interactions. Traditional ABA techniques have been modified to address
these issues. Naturalistic behavioral interventions, such as incidental teaching and natural language paradigm/pivotal response training, may enhance generalization of skills.13
Functional behavior analysis, or functional assessment, is an important aspect of behaviorally based treatment of unwanted behaviors. Most problem behaviors serve an adaptive function of some type and are reinforced by their consequences, such as attainment of (1) adult attention, (2) a desired object, activity, or sensation, or (3) escape from an undesired situation or demand. Functional assessment is a rigorous, empirically based method of gathering information that can be used to maximize the effectiveness and efficiency of behavioral
support interventions.42 It includes formulating a clear description of the problem behavior (including frequency and intensity); identifying the antecedents, consequences, and other environmental factors that maintain the behavior; developing hypotheses that specify
the motivating function of the behavior; and collecting direct observational data to test the hypothesis. Functional analysis also is useful in identifying antecedents and consequences that are associated with increased frequency of desirable behaviors so that
they can be used to evoke new adaptive behaviors.
What does all the above mean? It means that your autistic child's abilities and understanding can be enhanced most substantially with early, intensive, behavioral intervention. Do not waste time. I did not have access to intensive ABA intervention for my son when he was first diagnosed at the age of two. There were few trained personnel available and their time was divided amongst many autistic children. Ultimately ABA has been obtained for Conor and for the past few years he has received ABA based instruction in a modified learning environment within our public schools.
As the parent of a child with severe Autism Disorder who has actual experience with ABA and the benefits it has brought to my son I can tell you, parent to parent, that it has been of immense value to him even though he did not receive ABA intensively at an early age. He was toilet trained using ABA principles years before entering the school system. With ABA Conor has learned significant oral communication skills even though he is still limited in that area. Although he reads at a level well below his chronological age he does read (12 years old, reading Dr. Seuss). Behavioral issues still surface including biting and aggression against family members as I have described on this site but we have a way to deal with it and minimize it.
Conor is also himself a witness against the nonsense that ABA oppresses the personality and human rights of autistic persons who receive ABA intervention. Conor looks forward to visits from his ABA therapist at home, asking for her an hour before she arrives, pulling a chair up to the living room window looking out and waiting for her to arrive. He also asks to go to school where he receives ABA based instruction. Conor is happy with the structured learning that he receives. And it is not all academic in nature. He is taught life skills as well, including self dressing, helping in the kitchen etc. Conor is happy receiving ABA.
That is my evidence as Conor's father, the father of a severely autistic boy with profound developmental delays, a father who is involved with my son every day and who has been actively involved in his treatment and education. I have no doubt that Conor would be thriving even more if he had received ABA intensively from age 2 or earlier.
If you are the parent of a newly diagnosed child DO NOT WASTE TIME. Seek confirmation from your local professionals that ABA is suitable for your child (you will likely be told yes after the AAP report) and get him or her involved with ABA as early and as intensively as possible.
A note on Harold Doherty
Harold L Doherty
My interest in autism, and my engagement in autism advocacy, began with my son Conor's Autism Disorder diagnosis and the realization that, locally at least, no serious efforts were being made to improve the lives of persons with Autism or to address the realities of Autism Disorder. Hugs are good, but hugs are not enough. Evidence based treatment, education and residential care by properly trained service providers are required to help the 1 in 150 persons who have an autism spectrum disorder.
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