Thursday, April 21, 2005

New Autism Spectrum Disorder study

A form of therapy that focuses on parents' interactions with their children could help treat autism at a far lower cost than other strategies for the disorder, according to researchers.
Their study found that a therapy called responsive teaching, given over one year, led to gains in language and behavioral development among young children with autism or other pervasive developmental disorders -- a group of disorders marked by problems in the development of communication and social skills.
Children with autism have, to varying degrees, difficulty in using and interpreting verbal language and body language, and in interacting with other people, including their parents. Responsive teaching works on strengthening this interaction, encouraging parents to "follow their child's lead" and respond to their actions.
The approach is "child-centered," Dr. Gerald Mahoney, a co-author on the new study, told Reuters Health, and it stands in contrast to the widely held belief that education for autistic children must be highly structured and "direct" them in learning particular skills.
"We don't really focus on structured lessons," explained Mahoney, who co-directs the Center on Intervention for Children and Families at Case Western Reserve University in Cleveland.
Instead, he said, responsive teaching offers parents strategies they can use to "enhance their daily, routine interactions with their children."
Another way the tactic differs from other forms of autism therapy is in cost. Contact with therapists is limited to about once a week, and the yearly price tag for the program is about $5000 -- a fraction of the cost of many other therapies, which, Mahoney said, can run up to $50,000 a year.
Though more research is needed on the effects of responsive teaching, Mahoney noted that the more manageable cost is a potentially "huge advantage" of the approach.
For the current study, reported in the Journal of Developmental and Behavioral Pediatrics, Mahoney and colleague Frida Perales followed 50 children whose parents began responsive teaching when the children were around the age of 2. Some of the children had a pervasive developmental disorder, or PDD -- most commonly autism -- and some had other forms of developmental disabilities.
The idea behind responsive teaching is that by enhancing parents' interactions with their children, the children will "acquire and use pivotal developmental behaviors," which in turn will improve children's language skills and social and emotional development.
For instance, if stronger parent-child interactions improve the pivotal behavior of cooperation, the result could be fewer behavioral problems. Similarly, improving the pivotal behavior of "joint attention" between a parent and child could aid in the child's learning of language.
Mahoney and Perales found that while parents and children in their study met with therapists only about 32 times during the year, the parents said that they used responsive teaching strategies -- such as imitating their children, or following their lead -- about 15 hours per week, on average.
After a year, the researchers found, the children showed large gains in their cognitive development, especially when it came to communication skills. Their rate of development in terms of expressive language increased by an average of 167 percent, while their ability to understand language improved by nearly as much, according to the report.
Between 70 and 80 percent of the children showed such improvements.
Children with PDDs also showed improvements in the social and emotional problems they had at the study's outset, according to Mahoney and Perales.
Responsive teaching is one form of "relationship-focused" education for children with developmental disorders -- a theoretical approach that also includes the more widely known "Floor Time" program developed by Dr. Stanley Greenspan. Though he has reported success with that program based on a chart review of 200 children, Mahoney and Perales note in their report, the lack of rigorous research into relationship-focused education makes it too soon to recommend the approach for PDDs.
The new findings, they conclude, "provide support for the notion that relationship-focused intervention can be an effective procedure for enhancing the development of children with PDD."
However, they add, more research -- including studies that use comparison groups of children not treated with a relationship-focused approach -- is needed to "gain greater confidence" in the therapy's potential benefits.
SOURCE: Journal of Developmental and Behavioral Pediatrics, April 2005.