And psychoanalysis may be a valuable addition to the mix, researchers said at the annual meeting of the American Psychoanalytic Association in New York City.
The CDC estimates that one in 150 individuals has autism, a disorder that begins in early childhood and is marked by developmental delays and lagging social and communication skills.
Autism is part of a larger group of disorders that is referred to as autism spectrum disorders. The symptoms of autism can range from very mild to quite severe. Children who are diagnosed with autism often see numerous specialists several times a week for various types of speech and behavioral therapy.
Psychoanalysts see autistic children four times a week, typically with a parent in the room. They also counsel parents once a week separately to keep them abreast of progress. In a nutshell, the analyst serves as a sensitive translator who attempts to decode what the child is thinking, feeling and doing.
"A major piece is to make sense of what the child is trying to communicate, translate it to the mother, and give her the confidence that she can do it, too," explains Susan P. Sherkow, MD, a New York City psychoanalyst who works with autistic children and their families.
"The therapist focuses on the behavior, mood, or emotion of the child and then translates it to the child and waits for a sign that the child feels understood, such as a furtive glance. And from there, the therapist enters the child's world," she explains. Sometimes this translation is putting the child's actions into words, such as saying "you are picking up a cup."
"Psychoanalysis should be part of the package because unless you have a really gifted specialist, you are not going to get at the meaning of what these children are trying to convey," she says.
Another therapy known as applied behavior analysis (ABA) is aimed at supporting the behaviors that you want in the child and extinguishing those you don't, while psychoanalysis works at trying to understand the child.
Is Autism Reversible?
Sherkow and others believe that autism may be reversible with early intervention - including psychoanalysis. The theory is that the brain is more malleable than previously believed and can be reconfigured with proper therapy.
To that end, the American Academy of Pediatrics (AAP) is now urging pediatricians to screen every child for autism twice by age 2. Some early red flags include: not turning when a parent calls the baby's name; not turning to look when the parent says, "Look at me!" and not pointing themselves to show parents an interesting object or event; a lack of back-and-forth babbling; smiling late; and failure to make eye contact with people.
"Autism was considered a brain condition that can't be changed, and I think that is now dated and not right," says Martha Herbert, MD, a pediatric neurologist at Massachusetts General Hospital in Boston.
And this is just not the case anymore.
"I have seen enough kids do substantially better than when they came in, and I think we can no longer assume that autism is not reversible, but we don't know whether it is reversible for everyone or subgroups," she says. "The real gauntlet it throws down is that if some kids can get a lot better and you don't know which ones it will be, how do you justify limited care?"
Now if a definitive diagnosis is made, the child should be in intensive intervention at least 25 hours per week, 12 months per year, according to the AAP.
"We used to have soccer moms and now we have therapy moms," Herbert tells WebMD. "Moms are running themselves into the ground and yet they are not really present, so they become part of the process and not part of solution."
Parents of children with autism need to relate to the child in whatever state they are in - and this is where psychoanalysis may be helpful, she says.
Psychoanalysts can be sensitive to the inner world of the child. "It's a skill you can't package, but it's wonderful," Herbert says.
Many Approaches To Autism Treatment
"Very little is known about effective treatments for autism," says Andy Shih, PhD, vice president of scientific affairs at Autism Speaks, a New York City-based nonprofit group aimed at increasing awareness of autism spectrum disorders and funding research into its causes, prevention, and treatments.
"The only approach that has evidence behind it is ABA," he tells WebMD. "In many cases, this approach has been helpful in allowing children to lead a healthy and more normal life."
There are things that parents are trying today that may lack solid evidence such as diet changes, he says. "One of the major challenges is that this population is so [diverse] that what works for one parent may not work for your children. There is a lot of confusion and lack of clarity about what works or doesn't work."
Shih doesn't discount any treatments including psychoanalysis. "All are possibilities, but what we really need is more research assessing how interventions work and what children they work for," he says. While he is not sure whether or not the disorder is reversible, "I think that it is certainly a possibility."
By Denise Mann
Reviewed by Louise Chang
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