Autism in a new light

Intensive therapies are making it possible for many autistic children to get the same schooling as other children. Just a few years ago, most had no independence and could not even speak.

Some autistic children gain the equivalent of 15 IQ points using the Early Start Denver Model method, which allows them to get standard schooling.

“Autism needs to be diagnosed as early as possible.” Hilary Wood, head of the Centre for Early Intervention in Autism in Geneva, insists on the early detection of autism spectrum disorders (ASD) – a banner term used to refer to the range of conditions described as autistic – because scientific studies now widely support the effectiveness of care for very young children. “Most of the time, we can now detect a potential disorder in toddlers as early as 12 to 18 months of age,” the psychologist says.

“Regardless of the method used, research shows that the two keys for successfully treating autistic children are early care and intensive therapy, i.e. between 15 and 40 hours per week,” says Hilary Wood. The advances in neuroscience and genetics now prove that autistic children are born with a number of genetic abnormalities. Their brain functions differently from that of other babies, which is especially prevalent in social interactions. These children then slip into a vicious circle. During the first two years of life, most children acquire skills through social contact, by imitating, playing and communicating. From the earliest stages of childhood, young autistic children cannot progress normally and fall further and further behind.

Research shows that the two keys for successfully treating autistic children are early care and intensive therapy

Since the 1980s, several therapeutic methods to deal with autism disorders have been developed in the United States. They aim specifically to stimulate babies’ brains early, focusing on social interaction and language. If autistic children develop in these areas, they can make headway in other skills. The oldest and most widely known therapy is Applied Behavior Analysis (ABA). Created by the Norwegian psychologist Ivar Lovaas in 1987, this technique analyses the child’s behaviour and aims to increase or decrease the frequency of a given behaviour through repetition and reinforcement.

The Treatment and Education of Autistic and related Communication Handicapped Children (TEACCH) programme is based on a structured teaching model that uses the strengths and preferences of autistic children to help them develop, for example through detailed visuals to reinforce verbal language and help them learn to communicate. This method was developed in the 1960s by Eric Schopler, a psychologist from the University of North Carolina at Chapel Hill. Another programme is the Early Start Denver Model (ESDM), which mainly draws on ABA and was developed in 2003 by American psychologists Geraldine Dawson and Sally Rogers. This method focuses more on stimulating the toddler’s social motivation. When children’s desire to make contact with others grows, they become more independent and communicate more easily.

Since 2010, the Centre for Early Intervention in Autism in Geneva has been applying the Denver method with a small group of children age 1 to 3. “The results are spectacular,” says Stéphane Eliez, psychiatrist and director of the Geneva Medical Learning Office (Office médico-pédagogique). “Some children have gained the equivalent of 15 IQ points using this method, which radically transforms the outlook for their future. Seventy-five percent of the children who leave our centre can get standard schooling.” This success rate is impressive, but requires costly resources. Each child benefits from individual care from a psychologist for fifteen hours a week. The parents also have to learn the therapy and continue it at home. The teaching plan is personalised and reviewed every quarter by a multidisciplinary team to adapt the method as closely as possible to the child’s progress and abilities. Care at the centre costs between 70,000 and 80,000 Swiss francs per year.

But Stéphane Eliez has no doubt that the investment is worth it. “A disabled person who lives in an institution also costs 80,000 Swiss francs a year, but for the rest of their life. You do the maths,” he says. “The investment that the government should provide in the first years of an autistic child’s life is, in time, largely offset. And the benefits for families are incomparable.”

In the United States, care is free for all autistic children under age 3, quite different from the situation in Switzerland. The Geneva centre is a test project of the Federal Social Insurance Office, which has begun looking into the subject. “The government is starting to understand the need to invest in autism very early,” says Hilary Wood. And if the public authorities don’t act now, they could set off a time bomb. Autism now affects about one in 100 children, but official statistics are not yet available in Switzerland. Its prevalence has increased sharply in recent years, identified in one in every 68 births in the United States.

“I’ve noted in recent years that care has improved immensely, and attitudes have changed in Switzerland regarding autistic children. But we’re still far behind Anglo-Saxon and Scandinavian countries and need to catch up,” she says. “Many parents are angry and desperate. And it’s their fight that has brought us where we are today.”

Yves Crausaz, president of the organisation Autisme Romandie (Autism in French-speaking Switzerland), is one of these parents. The father of an autistic child, he says that he is satisfied with the recent advances. “But we’ve had to fight for years against the psychoanalytic view that blamed parents and forced our children to live a life of disability. I praise early care for children,” he says, “but I’d also like to sound an alarm. The lack of adequate structures for the many autistic teenagers and adults out there is doing them harm. And for them, the ABA and Denver methods come too late.”