Psychoanalysis Effective for Some Autistic Children
> 1/30/2008 8:40:26 AM

Autism Spectrum Disorder's (ASD) broad and often puzzling range of symptomatic variations allows for an extremely flexible field of potential treatments, and a considerable myriad of approaches has taken shape in response to the recent boom in ASD diagnoses. Ranging from private schools and one-on-one speech therapists to specialized diets and entire family dynamics shaped by the condition's influence, these approaches draw on an overabundance of inconclusive research and subsequent pop trends that has created a subgroup that some specialists call "therapy moms" (in a jab at the ubiquitous "soccer moms" tag). These parents are so dedicated to trying various treatments until reaching an acceptable equation that they cannot be fully present in the lives of their children; autistic kids may have trouble speaking their minds and telling others what they want, but they still need the affection of their parents to better their own development.

Some treatment approaches are, inevitably, more successful and more generally accepted than others. And while the concept of psychotherapy to benefit autistic children is not absolutely new, it has drawn greater attention following an announcement by the American Psychoanalytic Association that calls for comprehensive screenings for all children by the age of two and recommends regular psychotherapy as an essential part of a treatment regime. The idea may seem, at first glance, unconventional, but the fact that professionals who specialize in reason and emotional expression can prove helpful to a child whose major disorder creates a disconnect between experience and the act of communication makes perfect sense.

Autism advocates of all stripes continue to stress the importance of early intervention; this guiding principle also applies to a therapy approach where experts believe they can mold the behaviors and perceptions of these children as they age. Some go so far as to call autism "reversible," claiming that this early treatment can all but eliminate irregularities in the autistic brain and demeanor, but such statements cannot be qualified in any way. We've simply come to believe, in the face of building evidence, that the condition is more malleable than previously thought. The therapy theory contradicts the long-held assumption that the developing brain is effectively held hostage by the disorder and that affected patients are lifelong victims whose symptoms must be accomodated rather than improved. The recommended course of psychoanalysis for autistic children is very intensive, with kids (and, most often, their parents) meeting a therapist three to four times a week. The idea driving this approach is that the therapist can translate the patient's behaviors, emotions and desires in order to help both parent and child understand them better and further more effective methods of communication. A very imprecise science to be sure, but interpersonal contact and reinforcement is what autistic children need more than anything else (even though they often fail to respond to it in conventional ways).

Also relevant is a treatment known as applied behavioral analysis (ABA), a very carefully organized approach with more extensive evidential backing than psychotherapy. ABA is a basic training framework that may be applied to many specific treatment plans; it gradually reinforces positive behaviors through rewards, foregoing the idea of punishment because it so rarely proves effective for autistic children. Under successful ABA plans children will slowly learn, via the granting and withholding of various rewards, how best to behave to the satisfaction of their parents and therapists. Many of these behavioral issues are extremely difficult for young autistic children to fully comprehend, and ABA essentially encourages them to act in acceptable ways through reinforcement rather than reason. Children should, with time, learn to better understand what makes certain behaviors more desirable than others and put these principles into play in their daily lives.

Dietary changes and special classes alone will most likely not lead to significant improvements among autistic children; their care is a heavy long-term investment. And behavioral analysis or regular personal therapy treatments may prove extremely frustrating. But they both aim at the root of the problem in its real-world incarnation, and skeptical parents may overcome their misgivings and attempt to apply these approaches to the ongoing treatment of their own children. In a still-largely-unexplored field, any novel proposals should be considered.

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