فرایند انتخاب عجیب برای درمان اختلالات طیف اوتیسم

Treatments for Autism Spectrum Disorder (ASD) vary widely. The disorder is now considered treatable, but some interventions have extensive empirical support, while other interventions have none. Despite these stark differences in the evidence base for interventions, and efforts to educate the public, little correlation exists between what treatments work and what treatments parents choose. This review covers treatments, what people choose, and possible reasons choices are made, plus what factors may influence these choices. Data of this sort are important for clinicians and researchers, since multiple issues dictate treatment selection.

Autism Spectrum Disorders (ASD) are common, and present with life-long symptoms (Matson et al., 2009a and Matson et al., 2008b). Core symptoms include social and communication deficits, and the presence of rituals and stereotypies (Ben-Sasson and Carter, 2013, Brooks and Ploog, 2013, Horovitz and Matson, 2010, Matson et al., 2010a, Matson and Dempsey, 2008 and Matson et al., 2009c). More than perhaps any other problem in the field of mental health, the ASD literature is fraught with controversy (Matson & LoVullo, 2009). Issues such as how core symptoms should be defined have received a great deal of attention (Matson and Boisjoli, 2008, Matson et al., 2012, Matson et al., 2005, Rivet and Matson, 2011 and Worley and Matson, 2012). The type of comorbid symptoms and what causes them is also among these topics (Matson and Boisjoli, 2007, Matson et al., 2009b, Matson et al., 2010b, Matson et al., 2009e and Mazzone et al., 2013). For example, intellectual disabilities are known to occur at high rates among persons with ASD (Cherry et al., 1997, Matson et al., 2008c and Paclawskyj et al., 1997). They can exacerbate a variety of problems such as feeding behaviors, self-injury, and other maladaptive behaviors (Kuhn and Matson, 2002, Matson et al., 2008a and Matson and Kuhn, 2001). These comorbid conditions can also further exacerbate core symptoms such as social skills (Matson et al., 1999a and Matson et al., 1998b) and emotional disorders (Matson et al., 1999b, Matson and Smiroldo, 1997 and Wu et al., 2013). Challenging behaviors are also reported at high rates, and can markedly complicate the treatments used (Lane, Paynter, & Sharman, 2013).

Parents tend to be the arbiters of their child's treatment, often well into adulthood. Efforts to explore why and how parents select interventions are beginning to pick up steam, but much more research on the topic is needed. What is very clear at this point is that how parents select treatment is vastly different from how researchers in the field rank treatments by evaluation of effectiveness. Cost, availability, child and family characteristics, and many other factors do not have to be confronted by researchers in determining treatments that should be used. What is needed is a better understanding of the complex process parents face. Professionals could then address these factors, providing a more comprehensive and client/parent specific strategy. The goal should be to guide parents toward optimal, comprehensive treatment selection. Ultimately these choices belong to parents. However, it is the professional's responsibility to provide systematic versus haphazard information in treatment selection. This will require professionals as a group to become much more well-versed on treatments in general and parent treatment selection strategies.