**4. Interventions**

while recent neurological studies have shown physical differences in early brain growth and functioning. Sibling and twin studies point to the possibility of genetic links. Ultimately, it is likely that ASD is caused by a combination of genetic and environmental risk factors [11]. In fact, it is to be expected that one day we will be able to differentiate symptomatology along the spectrum much more precisely and different 'causes' will be linked with different mani‐

General Practitioners (GP) are the first port of call for most parents who are concerned about their children's behaviour. A referral is made to an assessment team, commonly lead by a pediatrician working in collaboration with a team of allied health professionals. A full diagnosisis based on behavioural observations and caregiver reports of their behavioural observations [19]. Although presently, there are no medical tests, ASD remains a medical

The Vice President for State Government Affairs of Autism Speaks, the world's largest autism

Of course not everyone agrees. Proponents of the neurodiversity movement [48, 58, 66] argue that autism represents a neurological difference that should be celebrated rather than treated with interventions. [44] maintain that these arguments are valid with regards to rights, recognition and acceptance, however, they rightly argue that 'only a narrow conception of neurodiversity, referring exclusively to high-functioning autists, is reasonable' (p. 20).

For 'low-functioning' individuals with ASD, the lifetime cost to society is estimated to bein excess of £1. 4 million and these figures are similar internationally [7]. Of course, the cost for quality of life for the individual and their family is much higher. For example, 86% of parents of children with disabilities have to pay above average childcare costs and 72% of these families have given up work or reduced their working hours, because of childcare problems [9] and only about 15% of adults with ASD are in gainful employment [79]. The potential positive

It is not surprising, therefore, that the intervention market is booming [17, 32]. As governmental investments into ASD services are increasing, fad treatments abound. In fact, the struggle for a slice of the market has been called the 'Autism Wars' [31]. Primary care, allied health, social

Autism is diagnosed by a doctor, not a school principal. Treatment is prescribed by a doctor, not a teacher. Here are some things autism families deal with daily: swallowing aggression, teeth grinding, feces eating, depression, tantrum, drooling, elective mutism, food refusal, food theft, genital stimulation, hallucinations, hyperactive behaviour, hyperventilation, inappropriate vocalizations, insomnia, public disrobing, rectal digging, seizure behaviour, self-injurious behaviour, tongue protrusion and vomiting. Does anyone think these should be treated in our

charity, Professor Lorri [87] made this point clearly when arguing for health cover:

diagnosis that requires a medical as well as educational response.

festations along the autism spectrum.

248 Autism Spectrum Disorder - Recent Advances

school classrooms? (p. 1)

impact of effective interventions is enormous.

**3. Economic impact**

Given that there are no medical indicators for ASD, it is not surprising that currently there are no pharmacological treatments for the core symptoms of autism. There are, however, phar‐ macological treatments for some of the co-occurring symptoms, but due to lack of evidence of effectiveness and potentially serious side effects, the National Institute for Clinical Excellence [64] advises against the use of pharmacological interventions.

There are some commercially available intervention packages. However, commonly they are very expensive and make unsubstantiated claims and promises of recovery or 'cure' for autism. These claims are predatory on vulnerable parents, especially since there is generally very little evidence of effectiveness. The very few studies that exist for some of these commercial packages are usually not very rigorous and/or conducted by people who have a financial interest [38].

Some interventions have been developed and are frequently used or recommended by allied health professionals despite the fact that, after a thorough review of all available research evidence was carried out by the large team of multidisciplinary professionals for National Autism Centre [63], these interventions have been categorised as *unestablished*. For example, Sensory Integration Therapy is recommended widely by occupational therapists [9], yet there is evidence that it has very little or no effects and can even be counterproductive or detrimental [55]. Sensory Integration Therapy is classed as not recommended also by the Australian Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) [74].

Facilitated Communication is another *unestablished* treatment [63] that is still in use, despite the fact that it is highly controversial and has been exposed as being based on deception [57] and has the potential of causing harm [56].

Virtually all interventions that have been categorised as *established* are based on knowl‐ edge and applications of the scientific discipline of behaviour analysis [63, 89]. Even some of the most ardent doubters or opponents of applied behaviour analysis (ABA) have come to the realisation that behavioural interventions are the key to enhancing quality of life for individuals on the autism spectrum and their families across the lifespan [40, 41, 47, 60, 95].

It is important to know that the term 'behaviour' when used by behaviour analysts refers to anything we do and therefore includes feeling and thinking [16].
