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The Utah researchers found that children receiving a combination of the two treatments (Lovaas-type training at school and TEACCH methods at home) showed three to four times greater progress on all outcome tests than did children who received only the school-based treatment. That study was reported in the Journal of Autism and Developmental Disorders (Vol. 28, No. 1, p. 2532).

Researchers in Washington, D.C., are comparing a discrete trial training approach with a "developmental, individual-difference, relationship based" (DIR) approach, says child psychiatrist Stanley Greenspan, MD, professor of psychiatry at George Washington University Medical School.

Psychologist Robert Koegel, PhD, at the University of California, Santa Barbara, and his colleagues are attempting to tailor a standard treatment to the specific needs of an autistic child and family. The standard treatment is called pivotal response training

Since most of the ways we diagnose autism are based on behavior, we can't rely on biological, structural, or chemical findings to determine if a treatment is working. We primarily measure success based on a patient's change, or lack thereof, in behavior.

The behavioral changes produced by the few effective treatments make life in social settings (including the home) possible, but we have no idea whether they have any effect on the underlying cause (or causes) of autism or whether they even make severely affected patients feel better.

One method intended to help, "facilitated communication," is based on the idea that a sensitive facilitator will hold the hand of a patient over a kind of Ouija board. She will then help the patient respond to questions by sensing his intention and helping guide his hand to spell out answers. Rigorous studies have shown that the spelled-out answers come from the unconscious (or, worse, the conscious) mind of the facilitator. Nonetheless, the practice is still in use, and I know parents who are utterly convinced that it is valid and useful. Frankly, something important did happen when facilitated communication was introduced to my patients: They improved, they brightened, they became more social and more interactive, and they seemed, somehow, happier, even though facilitated communication didn't actually translate their thoughts into words. I'll come back to "why" in a minute.

Children with autism who received hyperbaric treatment at 1.3 atm and 24% oxygen for 40 hourly sessions had significant improvements in overall functioning, receptive language, social interaction, eye contact, and sensory/cognitive awareness compared to children who received slightly pressurized room air. Trial Registration: clinicaltrials.gov NCT00335790

The selective serotonin reuptake inhibitors (SSRIs) are among the most widely used drugs for autism treatment, even though the effectiveness to date has been questionable. A new study published in the June issue of Archives of General Psychiatry reports that, not only are SSRIs ineffective, they may actually cause unintended side effects.

At the conclusion of the trial, nearly one-third (32.9%) of the patients receiving citalopram showed improvement in symptoms, but this was not significantly different from the 34.2% of patients who showed symptom improvement with placebo. Further, patients receiving citalopram were more likely to experience side effects, including nightmares, increased energy level, impulsiveness, decreased concentration, hyperactivity, diarrhea, insomnia, and dry skin than patients receiving placebo.

The NLP became synonymous with motivation and motivation is pivotal in teaching children with autism to respond to multiple questions.

1988 was the first time the word pivotal was used to describe this method. It was referred to previously as the NLP. It is considered a behavior intervention with similarities to the Lovaas method/ABA. 

Why would you say PRT is more effective than other therapies

This includes autism - there are no compelling studies showing any benefit from hyperbaric oxygen therapy in autism. The few studies that do exist are uncontrolled, which means they are mostly worthless.

Some have pointed out that the study leader, Daniel Rossignol, has a potential conflict of interest in that he offers hyperbaric oxygen therapy in his practice.

Everyone agrees, even Rossignol, that this study will not end the controversy over hyperbaric oxygen in autism. It needs to be replicated.

Children’s Hospital & Research Center Oakland scientist and pediatric emergency medicine physician, Claudia Morris, MD says she has identified a syndrome which combines apraxia (a speech disorder) with symptoms often associated with autism. Many of these symptoms are precisely the ones that are pointed to by those whose children appear to benefit from biomedical treatments -- specifically Gluten and Casein-free diets and vitamin supplements.

The data clearly demonstrated a common cluster of allergy, apraxia and malabsorption, along with low muscle tone, poor coordination and sensory integration abnormalities. In addition, Dr. Morris was able to gather laboratory analyses in 26 of the children, which revealed low carnitine levels, abnormal celiac panels, gluten sensitivity, and vitamin D deficiency among others. All children genetically screened carried an HLA gene associated with gluten sensitivity and celiac disease.

Most significantly, the data indicate that the neurologic dysfunction represented in the syndrome overlaps the symptoms of vitamin E deficiency. While low vitamin E bioavailability may occur due to a variety of different causes, neurological consequences are similar, regardless of the initiating trigger. The study suggests that vitamin E could be used as a safe nutritional intervention that may benefit some children. Growing evidence support the benefits of omega 3 fatty acid supplementation in a number of neurodevelopmental disorders.

Now a small but growing number of researchers see hope in a tool called transcranial magnetic stimulation, which lets scientists spark activity in specific areas of the brain and watch what happens to patients' behavior. The technology may illuminate some of the biology behind the disease, and some specialists speculate it may one day offer a treatment.

John Gabrieli, a neuroscientist at Massachusetts Institute of Technology. Transcranial magnetic stimulation "is fantastic for identifying brain regions that are essential for specific mental functions. . . . I think if we can start to use it more systematically with autism, one could hope we'd understand a lot more about what's going on."

Researchers at the Boston hospital's Berenson-Allen Center for Noninvasive Brain Stimulation used rapid, repetitive stimulation to simulate what happens in the brain when people learn a new task. Then they gave a single pulse of stimulation and measured minute muscle twitches that told them how long people's brains maintained connections formed by the initial stimulation.In people with no evidence of autism, changes lasted about 30 minutes, on average. But in people on the autism spectrum, the initial stimulation caused brain changes that lasted much longer - on average an hour and a half.

For example, Smith et al16 studied 10 individuals with autism specifically to investigate the effects of facilitator influence and level of assistance on the results of FC. Each subject had six sessions, two with no help, two with partial assistance, and two with full assistance. Results showed that there were no cases of correct responses from the subject unless the facilitator knew the correct response. In addition, numerous responses were typed by the subjects to stimuli that were shown only to the facilitator, and not the subject. Similar results have been found by Regal et al17 and Eberlin et al.1

One complication of the use of FC has been the allegation of abuse, particularly sexual abuse, that has been obtained from individuals through the use of FC against third persons. This has generated adverse publicity and caused severely negative consequences for families who may be unsure of the validity of the allegations. Because of legal mandates regarding reports of child abuse, this becomes a critical issue for teachers and pediatricians alike, who may find the credibility of the report highly questionable but are obligated to fulfill their legal responsibilities. Margolin20 notes that although more than 50 such allegations have resulted in legal proceedings, most have terminated before trial. The ethical dilemmas posed by FC for practitioners have been reviewed by Jacobson et al.8

It is important for the pediatrician to obtain current data on both AIT and FC as they become available. Until further information is available, the use of these treatments does not appear warranted at this time, except within research protocols.