2 treatments for autism catch scientific interest Early therapy, drug are hailed

July 13, 1993|By New York Times News Service

Scientific debates about new ways of treating autism, one of the most disabling and perplexing of mental disorders, are fanning both hope and skepticism.

Without much fanfare, recent studies have pointed to two treatments: one a drug commonly used to treat obsessive-compulsive disorder, the other an intensive program of behavior therapy.

Autism, the first signs of which emerge in a child's preschool years, is marked by an indifference to other people, repeating words over and over or other problems in speaking, such bizarre movements as hand flapping or rocking back and forth, and fixation on specific objects or daily routines. People with autism vary widely in intelligence, with some being mentally retarded and others measuring above average on standard intelligence tests. While some can speak clearly, many others do not speak at all.

There is no sure cure for the disorder, though a few autistic children -- perhaps 1 or 2 percent at best -- recover from most symptoms by adulthood.

Over the years there have been a number of treatments for autism touted as breakthroughs which, after more objective inspection, have proven disappointing. Still, recent findings suggest some hope for at least small gains against autism.

A report in the June issue of Archives of General Psychiatry showed that clomipramine, a medication effective in treating obsessive-compulsive disorder, reduced or stopped a range of symptoms in three-quarters of 24 autistic children tested.

The improvements were seen most strongly in symptoms that resemble compulsions, such as hand flapping. But in many children the medication also improved their ability to make eye contact and begin interactions, reduced hyperactivity and stopped temper tantrums that had led children to bite or hit themselves.

"An indirect benefit may be that this helps kids communicate because they are less anxious, frustrated and preoccupied with repetitive movements that can consume hours of their day," said Dr. Charles T. Gordon, a researcher at the Child Psychiatry Branch of the National Institute of Mental Health who led the study.

Dr. Gordon said that clomipramine might be most useful with autistic people who suffer from particular symptoms: compulsions such as the ritualistic lining up of objects or such elaborate habits as walking a fixed number of steps backward and forward when going through doors, endlessly repeating certain movements like twirling, injuring themselves when frustrated and being easily overwhelmed by new settings. But Dr. Gordon cautioned that the findings were preliminary and that the medication may not work in all cases.

There has also been quiet progress with intensive behavior therapy in treating autism. A team of psychologists headed by Dr. Ivar Lovaas at the University of California at Los Angeles reported in the April issue of the Journal of Mental Retardation on the progress of 19 children with autism who at age 2 or 3 had received at least 40 hours a week of behavioral treatment designed to encourage normal behavior and discourage the symptoms of autism.

By age 11, most of those who received the treatment were doing far better than those in a comparison group.

"If you can get autistic children into this treatment as preschoolers and give them round-the-clock teaching of language and social skills, a large proportion end up substantially improved," said Dr. Gina Green, director of research at the New England Center for Autism in Southboro, Mass. "The things that really work take a lot of time and energy."

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