Title: Autism: Early Intervention

Abstract: Autism is a neurological disorder that disrupts development and normal functioning.
There is currently no cure and the exact cause is not yet known. Early intervention therapies and
techniques are available, but because autism is a spectrum disorder, each case is different and
what works in one instance may have no effect in another. However, significant benefits were
derived in many cases as a result of intervening therapy. Some popular methods include the
Lovaas behavioral method, diet restrictions, and various forms of sensory integration.

Course: ENGL 2017: Introduction to Research

Semester/Year: Spring 2007

Instructor: Dr. Deborah Spangler Koelling

Autism 1
Autism is an incurable disorder that affects 1 in 150 births, making it the fastest-growing
developmental disability1. According to the Autism Society of America,
Autism is a complex developmental disability that typically appears during the first three years of
life and is the result of a neurological disorder that affects the normal functioning of the brain,
impacting development in the areas of social interaction and communication skills.1

Autism can be a devastating disorder, with many degrees of severity. Because of autisms wide
range, it is known as a spectrum disorder which includes high functioning individuals, low
functioning cases, and everything in between. While the number of diagnosed cases is increasing
by a startling 10-17%1 each year, experts still are unsure as to its cause; however, they do believe
that environment and genetics play important roles. Many therapy methods and intervention
techniques have been developed over the years to help those suffering with autism make
substantial social gains. Recently, awareness of autism has gained momentum, but the disorder
itself is not new. As noted by the Center for Disease Control (CDC), it was Dr. Leo Kanner who
named the disorder in 19432. While there is still no cure for autism, early interventions such as
behavior modification, diet restriction, and sensory integration can reduce the effects of the
disorder significantly.
For interventions to have a positive effect, early detection of autism is critical. Because of
the spectrum in which it can occur, each case is unique. The CDC lists some warning signs
commonly seen in autistic children which include the following:
Not point at objects to show interest . . . Not look at objects when another person points at them. . .
Avoid eye contact and want to be alone. . . Prefer not to be held or cuddled or might cuddle only
then they want to. . . Appear to be unaware when other people talk to them but respond to other
sounds. . . Repeat or echo words or phrases said to them, or repeat words or phrases in place of

Autism 2
normal language. . . Repeat actions over and over again. . . Have trouble adapting to changes in
routine. . . Lose skills they once had (for instance, stop saying words they were once using).2

Children with this disorder will appear to be in their own world, which can be hard for others to
understand. If any signs of these autistic behaviors arise, the CDC recommends that parents
request a referral to see a developmental pediatrician or other specialist2 from their doctor.
There are screening methods to assist doctors in diagnosing multiple developmental disorders;
however, there is no test that will yield positive or negative results. Diagnosis of this disease is
strictly based on the evaluation of development and behaviors of the child which are confirmed
by parental observation. Immediately upon diagnosis, intervention should begin in order to help
children reach their fullest potential. Though many of the early intervention methods have not
been carried out in formal scientific studies, there are recorded cases in which benefits have been
achieved.
Dr. O. Ivar Lovaas is the creator of one method of early intervention known as the
Lovaas method.3 According to the National Autistic Society,
The Lovaas method is an early intensive behaviour therapy approach for children with autism and
other related disorders. . . It is based on extensive clinical experience and research carried out over
more that 30 years by psychologist Dr. O. Ivar Lovaas, in the USA.3

The length and intensity of the Lovaas study produced positive results on the outcomes of
behavioral changes. The approach is one that uses a reward and punishment system to alter
behavior. This intense program requires the involvement not only of the therapist, but also of the
parents. The National Autistic Society reports that the Lovaas method is conducted on a one-toone basis for six to eight hours per day, five to seven days per week, for two or more years.3
Requiring 35 to 56 hours per week, this approach can be extremely demanding. According to

Autism 3
Pediatrics, [t]he most efficacious psychosocial treatment for autism is applied behavior
analysis, which focuses on positively reinforcing and shaping selected target behaviors such as
appropriate interpersonal interactions and use of correct language.4, p762 This research would
seem to support the theory behind the Lovaas system.
During the extensive therapy time when applying the Lovaas method, the National
Autistic Society also notes that
All skills are broken down into small tasks that are achievable and taught in a very structured
manner and accompanied by lots of praise and reinforcement. Examples of reinforcers are small
bites of food, play with a favorite toy, social rewards such as verbal praise and hugs and tickles.
Gradually food and other artificial reinforcers are replaced, if possible, by more social and
everyday reinforcers. Aggressive or self-stimulatory behaviours are reduced or replaced by
ignoring them or by introducing more socially acceptable forms of behaviour.3

It is the ultimate goal that as the negative behaviors are ignored the child will begin to replace
them with more acceptable ones. This popular method has produced positive results. The
National Autistic Society also explains that a . . . sizeable minority of children with autism. . .
are able to achieve normal educational and intellectual functioning by the age of seven.3 Those
not included in that group are said to have seen . . . substantial decreases in inappropriate
behaviours and acquisition of basic language. . .3 Though not all who undergo this form of
therapy are able to reach a fully normal level of functioning, many benefits can be gained from
this intense treatment.
For the Lovaas method to succeed,
. . . treatment should begin as early as possible, preferably before the child is five years old and,
ideally, before the child reaches three and-a-half years. This is necessary in order to teach basic

Autism 4
social, educational and daily life skills. It can also reduce stereotypical and disruptive behaviours
before they become established.3

It is before the child has a chance to form habits and rituals that are unchangeable that most
success is noted. Negatively, this method requires intense one-on-one time, which can also
generate a large expense. Though this may place a burden on the families, certain programs are
available to provide assistance. The American Academy of Pediatrics states,
Any child with a suspected delay or symptoms of ASD [autism spectrum disorder] should be
given the opportunity to enroll in an age-appropriate early intervention program or school program
immediately, even before a definitive diagnosis is available. Because these programs are federally
mandated (and fully implemented in most states), children with delayed or deviant development
are entitled to them. Although criteria may vary slightly among states, eligibility for these
programs is based on the presence of a delay, not on a categoric diagnosis.5, p1221

Intervention plans are available through schools and other health and educational organizations
to ensure the successful management of developmental disorders.
In a second method of early intervention for autism, strict diets are implemented, a
method which also produces some degree of known success. There are multiple limitations that
can be placed on the diet, and parents should consult with a doctor and/or dietician before
altering the childs intake. Some methods may work well for certain individuals but not as well
for others due to the spectrum of the disorder.
Increasing the amount of vitamin C in the diet has proven beneficial in some cases of
autism. According to the National Autistic Society,
Vitamin C helps us all [by] enabling our brains to function properly although how it does this is
still unknown. The symptoms of vitamin C deficiency include depression and confusion, both of

Autism 5
which are symptoms common in people with autism. Therefore, the idea is that people with autism
would in some cases benefit from vitamin C supplements.6

Following one study involving twenty autistic children, parents were surveyed and the results
found that the supplement group reported statistically significant improvements in sleep and
gastrointestinal problems. . .6
Vitamin B6 is another dietary supplementation that can be helpful. The National Autistic
Society reports that
There have been around 20 published studies since 1965 and vitamin B6 has proved beneficial to
around 50% of those involved. It is not fully understood why vitamin B6 is useful in this way. If
the treatment is going to be useful then it should have an effect within a few days but if there is no
change in three to four weeks it should be stopped. . . . magnesium . . . should always be used
when taking such high doses of vitamin B6 so as to prevent side-effects due to vitaminotherapy
such as irritability, sound sensitivity, and enuresis.6

Vitamin fluctuation in the diet is relatively harmless, producing few, if any, negative side-effects.
Dimethylglycine (DMG) is another element of the diet that can have a positive affect on
autistic behavior when the intake is increased. The National Autistic Society notes:
DMG is a good supplement and therefore a prescription is not required. It is naturally found in
some foods such as rice and liver, although only in small amounts. It has appeared to be helpful to
children with communication problems, particularly those with minimal speech development.
. . . improvements [were found] in the speech of 12 out of 15 children with learning disabilities
following the use of calcium pangamate (also known as pangamic acid, and whose essential factor
is DMG).6

Increasing the amount of foods containing DMG (such as bananas) is a change that can be made
easily without the need for a prescription. It has been proven with DMG as well, that the effects
will be noticeable within a short period of time if any improvements will be made.6

Autism 6
Serotonin, a chemical within the brain, can have varying degrees of impact when levels
are adjusted. As reported by the National Autistic Society, serotonin impacts motivation and
mood6, and though there have been many drugs created to supplement the diet, the best source
is found in foods.6 An article by the National Autistic Society claims that there are a number of
foods that contain high levels [of serotonin]. The most common foods are tomatoes, bananas,
plums, pecan nuts (among others) and pineapples.6 Serotonin is another supplement that works
best when consumed naturally through foods.
Perhaps the most popular of the diet intervention methods is the Gluten and casein-free
diet.6 Though it can be extremely restrictive in nature, the diet eliminates a number of triggers
leading to disruptive behaviors. Once again, the National Autistic Society provides information
concerning this intervention:
. . . dietary interventions yielding positive results have been reported in surveys, case studies, and
studies of groups of children with autism. Researchers have also noted positive feedback from
parents who have tried the gluten and casein-free diet on their children. . . . They report that
urinary peptide abnormalities, partly attributable to gluten (present in grains and cereals) and
casein (present in milk and milk products) have been detected in some individuals with autism. . . .
these abnormalities reflecting opioid effect processes may explain behaviours displayed by people
with autism. The research comprising two sets of observations and tests carried out on a diet group
and a control group at a one-year interval reported a significant reduction of autistic behaviours for
participants in the diet group.6

Certain triggers and abnormalities caused by the presence of gluten and/or casein have been
reduced in several cases in which this diet has been implemented. Though dramatic positive
results vary, this diet intervention has potential to produce benefits. As diet changes become one
of the more popular forms of intervention, it is important to note that any alteration of the diet

Autism 7
should be discussed with a doctor or pediatrician before implementation.6 Additional
supplements and/or vitamins are essential when eliminating food groups in order to achieve
proper nutrition. Diet regulation can be used in addition to behavioral modification and many of
the other treatment methods.
The third and final early intervention which has shown successsensory integrationis
a form of therapy that helps those with autism become aware of their own bodies. In the world of
an autistic individual, environmental stimuli are perceived in a manner unlike that of others
living without the disorder. Sensations of all kinds may be more painful and much stronger than
normal. In trying to explain this sensory processing difficulty, the National Autistic Society uses
this scenario:
Imagine what happens when just one or all of your senses are intensified or are not present at all,
often referred to as sensory integration dysfunction. This is the case for many individuals on the
autistic spectrum. . . . Everyday functions, which the majority of individuals take for granted, can
for autistic individuals be negative and upsetting experiences. Behaviours presented by someone
with autism will often be a direct reaction of their sensory experience. It is therefore
understandable why they create rituals, or have self-stimulatory behaviours such as spinning,
flapping and tapping, because this makes them feel they are in control and feel safe in their unique
world.7

Such a difficulty with sensory processing can be of major distraction, creating an obstacle which
gets in the way of improvements educationally and developmentally.
A wide variety of therapeutic techniques are used to release anxiety and tension and to
help individuals to become aware of their bodies. Dr. A. Jean Ayres was quoted by the Sensory
Integration Global Network saying that, Sensory integration theory proposes that sensory
integration is a neurobiological process that organizes sensation from ones own body and from

Autism 8
the environment and makes it possible to use the body effectively within the environment.8
When body awareness is achieved, simple activities, such as holding a pencil, become possible.
Other techniques help children to release bottled energy and tension, allowing them to calm
down to a point at which it becomes much easier to concentrate. The National Autistic Society
also notes that,
Sensory Integration therapy involves the gentle exposure to various sensory stimuli. The aim of
this therapy is to strengthen, balance and develop the central nervous systems processing of
sensory stimuli. Delacato (1974), who introduced the concept of Sensory Integration Therapy,
focused the therapy on the five core sensory systems- vision, taste, smell, auditory and tactility.
Today, occupational therapists continue to focus on these areas, as well as incorporating the
vestibular and proprioception systems, when creating and planning a schedule of activities for an
individual.7

There are a substantial variety of bodily systems that can be individually targeted using sensory
therapy. In a handbook titled Tool Chest: For Teachers, Parents & Students put out by Henry
Occupational Therapy Services, Inc., Diana Henry breaks down examples of many techniques
that can be used in a therapy setting.9 The National Autistic Society provides information
concerning many of the systems, including the vestibular or balance system which is situated in
the inner ear, [and] provides information on where our body is in space and speed, direction and
movement, all in relation to the pull of gravity.7 Many children with autism have difficulties
with speed and agility in physical activities due to problems with this system. One example
activity to improve balance, provided by the Tools handbook, is called the Fragile Egg9. In this
activity, children lie on the floor, fold knees to chest and begin a rocking motion that uses
multiple muscles to continue back and forth in a claming motion.9

Autism 9
The body awareness or proprioception system is one that, according to the National
Autistic Society is situated in the muscles and joints [and] it tells us where our bodies are. It also
informs us where our body parts are and how they are moving.7 A therapy activity for the body
awareness system provided by the Tools handbook, is known as the Wheelbarrow Walk9.
Walking on the arms while a partner holds the legs, helps the child to increase arm awareness
and strength as they pick up each arm one at a time.9
Another common sensory processing problem occurs within the touch or tactile system.
The National Autistic Society claims that,
situated on the skin, the largest organ of the body, it relates to touch, type of pressure, level of pain
and helps us distinguish temperature (hot and cold). Touch is a significant component in social
development. It helps us to assess the environment we are in and enables us to react accordingly.7

A recommended activity provided in the Tools handbook to help with tactile issues is called
Hand Fidgets9. Because fidgeting often times helps increase concentration, it can be useful to
provide tactile children with an object to fidget with, such as a balloon filled with rice. It is noted
that the object should not be used to play with, but rather as a tool.9 Many other useful sensory
therapy methods are available and currently being practiced with autistic children.
The support of the use of this method would benefit from additional research and data.
The Sensory Integration Global Network asserts that
The need for ongoing research and development [for] this theory is great, driven by the scores of
children and families who live with these difficulties. The possibilities for improving their quality
of life now and in the future through the application of these principles demand that additional
efforts be made.8

Research studies will continue to open the doors for additional therapy techniques that will bring
hope to those struggling with autism.

Autism 10
Early intervention practices for autismsuch as behavior modification, diet restriction,
and sensory integrationcan provide hope and relief to those experiencing the effects of this
devastating disorder. It is important that any signs of the behavior be diagnosed by a physician as
soon as possible and for intervening therapies begins immediately following the diagnosis.
Because no cure has been discovered, and no cause is yet known, it is important to take whatever
steps possible in the direction of helping children achieve normal functioning behaviors.

Autism 11
References
1. Autism society of America: what is autism? [Internet]. [cited 6 May 2007]. Available from:
http://www.autism-society.org/site/PageServer?pagename=about_whatis_home
2. Autism information center [Internet]. Atlanta (GA): Centers for Disease Control and
Prevention; c2007 [cited 6 May 2007]. Available from:
http://www.cdc.gov/ncbddd/autism/overview.htm
3. National autistic society- Lovaas [Internet]. London (UK): National Autistic Society; [updated
Oct 2006; cited 4 May 2007]. Available from:
http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=297&a=3345
4. Lilienfeld SO. Scientifically unsupported and supported interventions for childhood
psychopathology: a summary. Pediatrics. 2005;115(3):761-764.
5. The pediatricians role in the diagnosis and management of autistic spectrum disorder in
children. Pediatrics. 2001;107(5):1221,6p.
6. The national autistic society- the use of diet and vitamins in the treatment of autism [Internet].
London (UK): The National Autistic Society; c2005 [updated Aug 2005; cited 4 May
2007]. Available from:
http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=297&a=3368&view=print
7. The national autistic society- the sensory world of the autistic spectrum [Internet]. London
(UK): The National Autistic Society; [updated 2006; cited 4 May 2007]. Available from:
http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=1070&a=3766
8. Ayres sensory integration [Internet]. Sensory Integration Global Network; c2007 [cited 6 May
2007]. Available from: http://www.siglobalnetwork.org/asi.htm

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9. Tool chest: for teachers, parents & students. United States: Henry Occupational Therapy
Services, Inc.; 2001.