In a recent comment a reader asked my opinion about the best treatment options for autism. This is inherently a loaded topic because there are so many people who have aligned themselves with particular treatment approaches. Also, there are some people who have experienced significant improvement with a single approach.
I form my opinion on this question based on twenty years of clinical experience working with children and families. I don't believe that there is a single approach that works for everyone. Also, just because something works for someone at some point in time has not been an indicator that it will work for everyone else at countless other moments in time.
From an evidence-based perspective it seems that behavioral approaches have the best research to support their efficacy. However, behavioral approaches are not unitary and the concept of 'efficacy' needs to be clearly defined. Certainly, there is no overwhelming evidence that any behavioral approaches will cure autism.
Lack of evidence in other approaches is often a reflection of the approaches themselves. Behavioral interventions, with their reductionistic focus, lend themselves to measurement. It is more complex to measure 'relationships' or 'communication.' This causes some people to mistakenly believe that only behavioral approaches can be helpful - and that most certainly is not true at all.
All this being said, I believe that there are certain components that are critical in any 'best' intervention program:
1. A child who has an autistic spectrum disorder needs a family that can provide love, nurturance, and support.
2. Structure and consistency are important for all children, but this seems to be a particular need of children who have autism.
3. Given their preferences for structure and consistency, children who have autism often learn skills best with simple behavioral approaches.
4. Sensory differences need to be respected and accomodated for. Sometimes this means modifying the environment to reduce noises, or decreasing visual distractions, or allowing normative opportunities for movement or other sensory experiences that the child is driven toward.
5. Children who have autism need to have access to typical peers and need social modeling from the children and adults that they interact with.
6. Children who have autism have the right to experience typical childhood, including normal play and socialization experiences. Not everything should be part of a program.
7. Parents and caregivers need education, coaching, and support. They also need access to respite services.
For different people and for different families these basic program components may vary over time. Sometimes the most important intervention is family education on the IEP process, and sometimes the most important intervention is environmental modification, and sometimes the most important intervention includes a behavioral plan.
A lot of families ask me about gluten or casein free diets, hyperbaric oxygen, megavitamins, chelation, and swimming with dolphins - among other interventions. I have a stock answer that I provide when people ask me about these things: If my child had autism I would be swimming with dolphins too. However, I think it is important for families to measure their resources (and resources are broad, meaning time, energy, money, family needs, etc.). If there are adequate resources to support a parent flying to some distant city to sit in a hyperbaric chamber with their child, and if there are no known negative side effects - then why not?
Any practitioner who understands and can promote the seven major components listed above into a program can provide the 'best intervention.' Above all else, autism has an impact on the entire family - and the family has to be a focal point during interventions. So, an effective practitioner can council with the family to make choices about interventions over time. An effective practitioner has to evaluate the child and understand the child's skills and needs - and just as importantly, has to interact with the family in a way that provides guidance and support.
I offer no references, because this is just my opinion.