By Dr. Susan Izeman
A study published this month in the Journal of the American Academy of Child and Adolescent Psychiatry looked at the role of medication and parent training in reducing serious problem behaviors of children with autism spectrum disorders. Investigators wanted to know if parent training, when used in combination with medication, had a significant benefit above the benefit of the medication alone.
Their findings were interesting, but not surprising to anyone who has a child on the autism spectrum — or to anyone working in the field of autism.
According to the study, children of parents who participated in an intense, multi-week training program were given lower doses of medication and experienced fewer side effects. Even more compelling, however, was that the behavior of these children was significantly better, and that children maintained those changes in behavior, even after the medication dose was reduced.
Parent involvement long has been acknowledged as a key component of successful interventions for children with autism. In high-quality programs, parents are taught to be familiar with intervention strategies, implement instructional strategies at home, teach their children new skills, and help their children use those skills in many different situations. When this happens, research shows children gain more skills overall, keep new skills over time, and use these skills in a wider variety of settings. This concept of family involvement and parent training has been built into statewide guidelines for the education of children on the autism spectrum in New York and Connecticut.
With support from professionals, most parents can learn to use specific strategies to teach their child new skills. Many families, however, are less familiar with strategies for reducing challenging behaviors. The persistence of these behaviors can have a significant impact on family life. Families who have a child with autism say they want the same things as other families have: to be able to eat a meal as a family; go on outings in the community with their children; sleep through the night uninterrupted — in short, to have a child whose behavior is relatively manageable and predictable.
Some parents turn to medications for help. While no medication treats “autism” specifically, several have been successful in addressing the most serious behaviors. The study used risperidone. All medications, however, have their limitations; they can be difficult to calibrate, with side effects for many children. Most disappointing is that if medication is used in isolation, positive behavioral changes diminish when dosages are reduced.
Parents often turn to professionals to provide “behavior support” at home to get an impact beyond that of medication. Parents, schools districts and a variety of state agencies contract with private agencies to put behavior plans in place, teach children daily living skills, and go with families into a variety of community settings. This approach has had some exciting outcomes, enabling families to see significant progress in their children’s behavior. However, to bring about long-term change, something is needed that goes beyond.
In the journal study and related work by the study authors, intensive, office-based training provides families with the knowledge and skills needed to address their child’s most pressing behavioral and daily living needs.
The Abilis Autism Program (formerly GAP) has been providing behavioral consultation and support for families who have a child with an Autism Spectrum Disorder in Fairfield County for more than 10 years. We work with families at home, support schools that include children with autism spectrum disorders, and provide a wide variety of community-based supports. Throughout this time, we’ve seen the positive impact on families when a child’s most serious problem behaviors are reduced, and we’ve seen the positive effects on children’s behavior when parents learn key strategies.
Our new “Independence at Home” program, supported by the work in the journal student and behavioral intervention articles, is an office-based intensive program in which parents learn the principles and strategies that are part of successful behavior change programs. Structured office-based sessions are followed by time to practice skills at home. Follow-up sessions provide opportunities to review successes and challenges, and plan program improvements
Having a child with an autism spectrum disorder can be very challenging for families. With a wide variety of services and supports available in Fairfield County, parents do not need to feel isolated or helpless. And, as current research is showing us, parents are not powerless. Parents can learn a variety of tools to teach their child new skills and reduce problem behaviors, to gradually achieve the family life they want.
Dr. Susan Izeman, a board-certified behavior analyst and director of the Abilis Autism Program, has more than 25 years’ experience in the field of autism. She wrote this for Hearst Newspapers. Abilis serves children and adults in the Greenwich-Stamford area with developmental disabilities.