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Autism spectrum disorder therapies: why the controversy?

Controversy seems to surround therapies and interventions for autism spectrum disorder (ASD). Different people will tell you different things about what works. Knowing where the confusion comes from can help you learn about and choose therapies for your child.

Why do you get conflicting advice about autism spectrum disorder interventions?

You might expect to get the same advice about a therapy or intervention for autism spectrum disorder (ASD), no matter who you ask. But this isn’t always the case. Parents often find they’re given contradictory advice.

This happens for several reasons:

  • There might not be enough reliable evidence about an intervention to give you a clear message.
  • Even if the evidence about an intervention is reliable, people can interpret the evidence differently.
  • Advice, reliable and otherwise, comes from all kinds of sources – for example, doctors, researchers, other parents, naturopaths. These people might not agree with each other so their ideas about what you should do will differ.
  • Professionals might not be familiar with some interventions and prefer to keep using the ones they already know.
  • Different people use different definitions of ‘evidence’. For example, some people rely on results from scientific studies for evidence. Other people feel that personal testimony or anecdotes are good evidence. Someone might be trying to sell or promote an intervention. The information you get might be biased as a result. 

Why do professionals have different opinions about interventions?

Sometimes health professionals, therapists, service providers or institutions disagree on the effectiveness of therapies for autism spectrum disorder (ASD).

This might be because they:

  • have different definitions of ‘effective’ or ‘successful’, based on the different approaches they take – for example, speech pathologists and psychologists might look for improvements in different areas
  • disagree on the theory behind a therapy, regardless of its track record
  • use different research tools, methods or techniques to reach their conclusions
  • use different terms to describe what interventions do – the advice they give you might sound different but mean the same thing
  • have different ideas about how therapies should be tested or evaluated.

Why can’t we just list the interventions that work?

At raisingchildren.net.au, we can usually say which interventions for autism spectrum disorder (ASD) are better supported by research. But in most cases, more research is needed to say whether an intervention really ‘works’.

Also, because children with ASD are different from each other, an intervention that ‘works’ for one child might not be suitable for another child. For example, a child who doesn’t use speech and a child who can talk in sentences will benefit from different communication interventions.

And ‘it works’ can mean different things, which makes it difficult to compare interventions. For example, one intervention might claim that ‘it works’, meaning that it ‘improves communication’. Another might make the same claim and mean that it ‘cures ASD’.

How scientific studies can help you find answers
Scientific studies are carried out to answer questions about what therapies are effective.

These studies help you find out whether an intervention has been classified as:

  • established – the research shows positive effects
  • promising – some studies show positive effects but more research is needed, or there might be mixed results
  • yet to be determined – there’s not enough research available
  • ineffective or harmful – the research shows that the intervention has no effect, there are negative outcomes, or it might be harmful. 
Our Parent Guide to Therapies summarises the current research on ASD therapies. It can help you understand the therapies and make informed choices about them. The ‘research rating’ for interventions isn’t all you need to know. When you’re choosing a therapy, your decision will also be based on other factors – for example, costs, availability and what suits your family.

Why is it hard to prove interventions work?

When people test interventions, the testing has to meet a range of scientific standards. It’s a bit like the quality standards used for food – if the standards are met, you can feel confident that the testing has been done carefully, and that the evidence is reliable.

But there are obstacles to testing interventions, including the following:

  • Good research costs time and money, and often proper testing has to wait until someone funds the research. Still, it can be useful to know if the ‘jury is out’ on an intervention.
  • Tests aren’t always designed to the highest standards. For example, the best testing usually involves designs based on randomised controlled trials, or several single-subject design trials, but there are various reasons why this might be difficult. For example, using a controlled trial might be hard because of the way an intervention is set up, or how participants feel about being in a control group.
  • Comparing different tests can be difficult. They might measure outcomes in different ways, or even have different ways of describing the same ASD condition.

Obstacles aside, new tests are being carried out all the time, so it’s always worth asking professionals about what the evidence says.

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Last updated or reviewed
01-05-2017

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Raising Children Network is supported by the Australian Government. Member organisations are the Parenting Research Centre and the Murdoch Childrens Research Institute with The Royal Children’s Hospital Centre for Community Child Health.

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