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“If a parent comes to me and asks me which therapies she should use, I have no way to answer that question,” says Paul J. Yoder, Ph.D., professor of Special Education and an investigator in the Vanderbilt Kennedy Center. “It would be useful to know which treatments might be counterproductive to use together, or which ones might be synergistic. And we’re not just talking about educational treatments, it’s pharmacological treatments too.” About 50 percent of children with autism take medication to lessen anxiety or control serious behavioral disturbances like self-injury, aggression and hyperactivity.
Yoder and fellow Kennedy Center investigator Wendy L. Stone, Ph.D., professor of Pediatrics and Psychology, are collaborating on a study to compare two behavioral treatments. Complicating this kind of research, Yoder says, is the fact that children are often involved in multiple types of educational intervention in addition to the research study, making it difficult to control all the variables. “We don’t have good measures of the quality of those other treatments,” he says.
Despite the uncertainty about which treatments might work best, educational and behavioral interventions are effective, and the sooner they’re started, the better. “The brain is more plastic at young ages,” Stone says, “and I think there has been enough intervention research to suggest that young children who get intervention early have better outcomes than when the intervention is started later.”
To that end, Stone and collaborators have developed and are studying the STAT, Screening Tool for Autism in Two-year-olds, and they’re attempting to make it work for even younger children. The advantage of the STAT over traditional diagnostic tests, Stone says, is that it takes less time and doesn’t require advanced psychological training to administer. Because it can be more available to people in the community, “it promotes an awareness of what the early signs of autism are—the early social communicative deficits that everybody should be looking for.”
The STAT also offers the advantage of guiding treatment decisions by allowing the tester to directly interact with children and observe their strengths and weaknesses. “You can go right from the information on the STAT to designing appropriate educational activities for these children,” Stone says.
Eventually, treatment guidance may come from genetic and neuroimaging profiles, Yoder says, but those days are a long way off. “It’s exciting to me that as a nation, we’re finally spending serious money on learning how to treat children with autism, how to educate them, what to do with their day-to-day moments,” he says. “There are no easy solutions to this problem.”