SAN FRANCISCO, March 12 (UPI) -- When it comes to treating autism, timing is everything, or at least a major part, specialists say.
Children with the neurodevelopmental disorder must be taught what comes naturally to their peers, and while the brain is still pliable enough to absorb the lesson, experts said.
Because the immature nervous system has a great deal of plasticity, many neuroscientists think early treatment may enrich neural growth.
"If you have a child with autism who's not wired correctly, and we allow that to continue without intervention, those neuropathways will become fixed, and it becomes far more difficult to undo that tangled mess," said Dr. David Holmes, president of the Eden Institute, a non-profit autism center in Princeton, N.J.
Early, aggressive intervention already is starting to show its mettle, for example, upending the long-held notion that half of all autistic children will never talk, specialists said.
Instead, in her study sample of children diagnosed and treated at age 2, University of Michigan psychology professor Catherine Lord found only 14 percent remained non-verbal by age 9, and between 35 percent and 45 percent could speak fluently.
Her long-term survey of the youngsters, many of whom are now in their teens, also showed 5 percent no longer had autistic symptoms at age 9, and an additional 20 percent exhibited signs of the disorder but could attend regular school.
Based on such reports, experts recommend children begin therapy -- which may involve 40 or even more hours a week -- as soon as they are diagnosed to optimize results and minimize the damage the disorder can cause.
"What we see when we meet an individual with autism is not just the autism that they were born with or that they developed fairly early, but the consequences of that autism on the experiences that they have. We know kids with autism, for example, spend less time looking at people, particularly looking at people in social interactions, than other kids," said Lord, director of the UM Autism and Communications Disorders Center in Ann Arbor, Mich.
Lord helped develop the autism diagnostic interview, a gold-standard tool for researching and identifying the disorder.
"Think about what you would know if you spent one-hundredth of the time doing a particular behavior, how different you would be from other people," she said at a recent autism conference.
"If we can prevent some of the things that don't have to happen for individuals with autism by giving them experiences that more closely mean to them the kinds of experiences typical children have, we really may be able to change those trajectories."
One typical experience lost on autistic children is learning through observation -- a lesson behavioral therapy tries to duplicate. Teaching an autistic child to wave goodbye, for instance, can take 40 hours of repetition -- and cost more than $1,000, doctors said.
Most of that likely will be paid out of pocket since, with the exception of a few companies that offer reimbursement as part of their health benefits, the majority of insurers do not cover therapy for developmental disorders like autism.
That's despite a government endorsement of such treatments, which can set parents back in the neighborhood of $25,000 to $60,000 annually -- and run up to as much as $80,000 to $100,000 a year for care in a residential school.
For many children, intensive behavioral intervention is but part of a treatment package that also includes some combination of speech and language training and special education in public schools.
Here, more than 163,000 autistic students are served at an annual cost that in 1999 to 2000 was estimated at $18,790 per pupil, significantly higher than for educating a child with emotional disorders, mental retardation and other disabilities.
Although the effects of therapy vary widely -- from dramatic improvement to none -- research suggests at least two years of intensive early intervention are needed to reduce symptoms and boost a preschooler's learning ability.
A National Academy of Sciences panel convened by the U.S. government to evaluate existing research urged all autistic children, regardless of the severity of their impairment, be made eligible for special-education services.
It also recommended a minimum of 25 hours per week of intensive, year-round training for tots as young as 2.
But the panel stopped short of endorsing any particular treatment beyond education and support for parents, noting the specific type of therapy required might differ, depending on the child.
"No two children are the same ... they're not peas in a pod that are going to pop out identically, and that affects what we need to do for them," said Lord, who chaired the panel and co-edited the report.
(Note: In this multi-part installment, based on dozens of reports, conferences and interviews, Ped Med is keeping an eye on autism, taking a backward glance at its history and surrounding controversies, facing facts revealed by research and looking forward to treatment enhancements and expansions. Wasowicz is the author of the new book, "Suffer the Child: How the Healthcare System Is Failing Our Future," published by Capital Books.)
Next: Behavioral therapy tops treatment list.
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