Apples and Tuna Fish

I recently watched from afar as a group of people on a message board argued vehemently back and forth over the merits of various autism treatments, particularly ABA and RDI®. There were strong sentiments on both sides and the battle became quite heated at times. Statistics were thrown around as evidence that ABA methodologies (discrete trial, pivotal response training, verbal behavior, etc.) are “proven” treatments for autism. Those on the RDI® / other therapy side of things went for the quality of life argument and gave testimony to their experience of ABA treatments not working for them.

I always find it interesting, if not a bit absurd, to listen to these kinds of arguments because it’s the equivalent of comparing two totally different things. It’s not even comparing apples to oranges, it’s like comparing apples and tuna fish! To engage in a discussion of the merits of any treatment (for any disorder), we need to start by examining what is being treated. In order to determine whether or not a treatment is appropriate and may be successful, we need to know what it is we are treating and what we want the outcome to be. Here is an oversimplified example: If I get a cold I may want to take cold medicine to help me feel better. When I go to the pharmacy there are 50 different kinds of cold medicine on the shelf for me to choose from. In order to make a good choice I need to know what my symptoms are and what I want the desired outcome to be. If I have a stuffy nose and sinus pain I will probably choose a different medicine than if I have a runny nose and a bad cough. I wouldn’t take cough medicine and then wonder why it didn’t take care of my stuffy nose – that wouldn’t make sense!

Now let's take this and apply the same line of thinking to autism treatment. If I have a child with autism I will most likely want to do something to help them make improvements in areas of deficit for them. As a parent we all want the best quality of life possible for our children! There is an array of options out there as far as autism “treatments”, and just like the cold medicine example we need to make a choice. In order to make a sound choice we need to know what the issues are that we are trying to treat and then choose the treatment that addresses those problems.

ABA-type therapies (insert your choice of specific method) have been shown to accomplish things such as improving academic skills, teaching self-care skills, and reducing inappropriate or maladaptive behaviors. There is a solid amount of research to show that this type of teaching / treatment is effective at addressing these skills areas. If a parent were interested in treating those areas, then ABA-type therapies would be a logical choice for them to make as a treatment for their child.

RDI® focuses on the developmental foundations for abilities such as flexible thinking, self-awareness, and reciprocal relationships with others, which begin to form in neurotypical children from birth. The goal is to help parents learn to guide their child through a developmental sequence that leads to the child becoming competent in the areas that they currently are not due to their autism. If a parent wants to address these developmental foundations for their child then RDI is the logical choice in terms of treatment.

When you look at treatment through this lens – what needs to be treated and what each treatment addresses – we see that comparisons need to be made very carefully. Once we know that two treatments, such as ABA and RDI, address totally different things, to compare them to each other doesn’t make sense. It’s the equivalent of comparing a cold medicine that reduces coughing to a cold medicine that clears a stuffy nose – they don’t do the same thing so you can’t begin to compare them on outcomes. It’s the equivalent of comparing apples to tuna fish!

There are obviously other factors that impact the process of making treatment decisions, and I plan to explore them in upcoming posts as I think this is an important issue that deserves attention. My main point here, though, is that it is critical to understand the goals of various treatments in order to best align them with a child’s needs. As parents we need to critically analyze any treatment for any problem by comparing what our child needs to the outcome goals for various treatments. It’s not necessarily about one being better or worse than another, it’s about knowing what obstacles autism creates for your child’s development and then determining which treatment outcomes best address them. Next week I am going to focus on the process of prioritizing a child’s needs in relation to treatment and how this plays a major role in treatment selection. In relation to this discussion on treatment outcomes and aligning needs with treatment, I would encourage readers to review Michelle’s ongoing discussion of the core deficits of autism. Check back in the blog archives to see her posts on this topic that goes hand in hand with making treatment decisions.

Until next week,
Nicole