Autism Spectrum Disorders: Current Evidence & Future Promise

By Judith Aronson-Ramos, M.D.

Medical Director, Developmental & Behavioral Pediatrics of South Florida

Research Consultant, Health Sciences of America

I have been diagnosing and treating children with Autism Spectrum Disorders for the past fifteen years. In this time there have been numerous changes in both diagnosis and treatment. This article is a summary of some key points of interest to parents and caregivers regarding new developments and standards of care which guide those of us who treat children with ASD on a regular basis.

Regarding Autism diagnosis we now have better tools to assess and diagnose children earlier and more accurately. Instruments such as the ADOS, Autism Diagnostic Observation Schedule, have become more widely available to clinicians and have standardized the assessment process. Early screening questionnaires such as the MCHAT can be quickly administered in a busy Pediatrician’s office to children as young as 15 months of age to help facilitate the process of early identification. Parents have access to numerous internet based resources with information about warning signs, red flags in their child’s development, and how to best help a child who they feel is not developing typically.

All of these developments have led to improved identification and earlier treatment for many children. However, there is unfortunately, still an unacceptable delay in many parts of the country to obtain an accurate diagnosis for many children on the spectrum at an early age.

Regarding treatment, it has become well established that ABA, applied behavioral analysis therapy is an effective treatment. Speech and Occupational therapies as well as other forms of instruction specially adapted to children with Autism such as the Teach Method, Verbal Behavior, Pivotal Response Training, Floor time, and other approaches are gaining in evidence and momentum as reasonable intervention strategies to use for children with ASD. Although there continues to be heated debate about the most effective treatment, access to different options is critical. We know there is heterogeneity amongst children in the spectrum, it is only logical that this will require a variety of approaches in the treatment of children with ASDs. We have yet to identify which subtypes of children with ASDs will respond best to specific therapeutic programs, however this may be the future.

Clinical Trial Research is another promising area which will provide families and children with ASDs more treatment options. There is a growing body of clinical trial research investigating various medications which may help improve the lives of children with ASDs. This research has focused on medications that improve symptoms, such as irritability, hyperactivity, aggression, behavioral rigidity, and self-injurious behaviors. There are also promising new studies investigating the treatment of the core deficits in autism such as socialization, and communication.

Although the biomedical aspects of ASDs are yet to be fully elucidated, there is inquiry into these mechanisms including oxidative stress, deficits in detoxification pathways, and metabolic derangements. Many treatments in these areas still lack sufficient evidence, but many parents have chose to trail some of these methods resulting in vitamin and mineral supplementation, dietary changes, use of experimental treatments such as chelation and hyperbaric oxygen therapy.

As with many fields of medicine, there can be a lag between well documented evidence based treatments and interventions that hold promise. However a principal of medicine in clinical practice and research is “primum non nocere”, first do no harm. This principal is important for parents and their team of treating professionals to always adhere to regardless of the promises and claims of individuals who may offer hope. Clinical research and evidence based medicine both emphasize the use of treatments with well researched and proven benefits. Without a guiding framework such as this we will be vulnerable to the empty promises of cures without sufficient evidence.

Parents of children with ASDs are often vulnerable and it is my duty, by the oath of my profession to make sure parents are given the most accurate information regarding effective treatments for autism. The world of clinical research, though imperfect, does set a reputable standard whereby the safety, efficacy, and reliability of a treatment must be rigorously tested and proven, for it to be offered as a reasonable therapy to patients. Clinical Trials for autism treatments are in their infancy. The hope is they will add to the current evidence based treatments, and improve the lives of children and families with Autism Spectrum Disorders.

For more information about Clinical Trial Research in Autism contact, Health Sciences of America at 561-715-7032/ 561-376-7879. For more information about Dr. Judith Aronson-Ramos, M.D, visit her website at www.draronsonramos.com.