What is Treatment?
When you hear the word “treatment,” what does it mean to you? Something medical or, more specifically, biomedical? Or do you see “treatment” in reference to autism as a word that encompasses the full range of approaches that can be tried to help an autistic child develop and learn? “Treatment” might then refer to education and different educational methodologies to teach kids who need different learning styles. Or to behavioral and psychosocial therapies?
Or do you prefer not to use the word “treatment” at all?
At last Friday, 30 November’s IACC meeting, “treatment” was one of four research domains to be considered in developing a Strategic Plan for research for autism. Developing the plan involves the creation of workgroups to consider four different research domains:
- treatment
- diagnosis (how to best describe and identify autism spectrum disorders?)
- risk factors (genetic? environmental? other?)
- biology (what underlying processes lead to the biology of autism?)
A number of questions were asked at the IACC meeting about what constitutes “treatment.” In my own statement, I referred specifically to education. In hindsight, some of the discussions here led me to wonder about research about
- best practices for helping autistic persons learn to manage challenging and/or aggressive behavior, and that do not involve the use of physical restraints
- the use of “timeout” rooms, padded rooms, and so forth
- more and different ways to integrate autistic children into educational and other settings with typical peers
- how to train teachers and therapists in such practices
I guess it could be said, treatment for me calls for treating autistic children in ways that always acknowledge and respect their dignity and that we would at least hesitate to apply to any child or person.
10 opinions for What is Treatment?
Regan
Dec 3, 2007 at 1:21 pm
“Treatment” is a tricky word to me, because I believe that it is highly suggestive of the medical model, and that fits if what is applied might be construed as therapeutic and worthy of insurance coverage. However to term, at least the educational/non-drug/non-biomed portion into “teaching”, also frames it incorrectly–autism is a neurologic difference, and has a habilitative component above and beyond what is commonly thought of as teaching (although I think that informally to think of it as teaching takes the clinical edge off of the enterprise and puts the focus on the child/person who is “learning” and needs to be “taught” effectively).
I think if some additional focus could be done on effective information transfer to administrators, teachers and therapists (and the news media and legislators for that matter), that a lot could be done right there, since the best basic and applied research will quickly be rendered useless or a buzz-word attached to bad practice, if not integrated as developed into real first-hand situations.
Seriously, there are literally hundreds, if not thousands of papers already out there on some of those topics–and some reviews to boot, but the things that I read in the news tell me that too many direct service providers and administrators are either not reading or assimilating the material, or choosing to ignore it or cut corners.
(Sorry for the long post. I have been musing on this for a long time).
Kristina Chew, PhD
Dec 3, 2007 at 1:42 pm
So what needs to be done is to how to figure out how to educate and train those service providers and administrators, to implement the practices in those research studies—to link research studies and actually doing something. This is a big concern of my own—how to get research out of the databases and academic conferences and applied to actually helping kids and teachers and families.
Autismville
Dec 3, 2007 at 2:13 pm
I’m writing this prior to reading any comments. I’m easily influenced and I just want to be genuine in my answer.
For me treatment means any program/approach (preferably evidence-based) designed to help Jack communicate, remain healthy and strong, develop independence, reach his full potential, and just be a happy guy. (He’s only 4, so the treatment definition I’m sure will evolve over time.)
Our treatment approaches consist of various forms of ABA, OT, ST … oh and lots of TLC. :)
So far we haven’t had to turn to medication, although I certainly am not going to rule that out.
mommy~dearest
Dec 3, 2007 at 3:04 pm
“Treatment” to me, is all encompassing. It’s holistic. You can treat a particular symptom with a particular treatment, but as far as just the word, it encompasses a lot in our house.
Eleanor
Dec 3, 2007 at 3:41 pm
Another aspect of the “treatment” versus “education” debate concerns who is responsible for providing these services. Many insurers, for example, exclude (or try to exclude) services such as speech and occupational therapy for people with autism on the ground that it is really “education” and should be addressed by the schools rather than “treatment” that should be covered by a health plan. (Note some states have passed laws to stop insurers from doing this.)
Cliff
Dec 3, 2007 at 7:00 pm
It’s a broad term, and it depends on the circumstances. Personally, I don’t actually like the word in all of its uses, because of its association with the medical model (where it remains completely appropriate to autism). I do understand that this isn’t always considered the case, but the word “treatment” then becomes this broad, all-encompassing term which applies to any self-improvement, with specifics to well-being and skills. It’s the shorthand, though, and so I’ll hesitantly use it, but wherever I can I use education. It’s particularly useful because it really does put the situation; it takes away that precept of relieving the subject from themselves, and puts the focus on skills and knowledge.
Cliff
Regan
Dec 4, 2007 at 7:03 am
Oh no doubt at all Eleanor.
Our state is in a flurry of responsibility passing right now–the insurers want to get it off their plate by saying autism is “untreatable”, “has insufficiently evidenced treatments”, or is “educational”.
The educators want to be in charge but argue that it is not their fault that they can’t implement best practice because they don’t get enough money and need a medicaid waiver (which is for medical services) to do so. One currently broached legislative solution is to appoint a several year committee to “look into” the question and, I guess, hope the whole thing will go away.
(Personally my thought in these back and forths is that if my daughter had a broken arm, someone would be expected to do something and that it is not usual practice to go to the school to get it x-rayed and set.)
$10,000 raised
Dec 5, 2007 at 12:33 pm
[…] have been raised in the name of, is indeed “experimental” as far as treatments for autistic children […]
Julie O'Connell
Dec 6, 2007 at 12:34 am
Dear Kristina Chew, PhD,
I would like to get in touch with Dr. Curran because my daughter, who is 10 and has Asperger’s, has consistently done much better (if not all better) when she has a fever, and this is from when she was very young–and I think our experience might help the research. Thank you for your help.
Kristina Chew, PhD
Dec 6, 2007 at 7:31 pm
Hi—-this is the webpage for the Dr. Curran’s thesis. Dr. Craig Newschaffer was her advisor.
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