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Read the following 3 articles and synthesize (Combine the ideas of all three sources into one overall point – DO NOT SUMMARIZE)  them into 1 and half page word document. Also, write a well elaborated question from each reading. Keep in mind the following points when working on this task:

*Questions must be original, thought and not easily found in the articles.

*Follow APA Rules

*Use proper citations

*Use  PAST TENSE when discussing the articles  (Research already took place)

*DO NOT USE the following words: Me, you, I, we.

*Refer to the articles by their AUTHORS (year of publication) 

*DO NOT the article name or  words first, second, or third.

*DO NOT SUMMARIZE!!!

***MUST FOLLOW ATTACHED SAMPLE

Two Factor Model of ASD Symptoms

One of the key factors in determining whether an individual has Autism Spectrum Disorder (ASD) is in their social and communication skills. Individuals who are diagnosed with ASD have delayed joint attention, eye gazing, and other social interactions such as pointing (Swain et al., 2014).

Joint attention is an important social skill to master because it is a building block for developing theory of mind which, helps us to understand other’s perspectives. Korhonen et al. (2014) found that individuals with autism have impaired joint attention. However, some did not show impairment in joint attention, which lead to evidence that suggests there are different trajectories for joint attention. One suggestion as to why Korhonen et al. (2014) found mixed results, is that there is evidence that joint attention may not be directly linked to individuals with ASD since they were unable to find a difference in joint attention between ASD and developmentally delayed (DD) individuals. Another suggestion for the mixed results, is individual interest in the task vary. Research has found that while individualized studies are beneficial in detecting personal potential and abilities, it would be difficult to generalize the study in order to further research to ASD as a whole (Korhonen et al., 2014). In addition to joint attention, atypical gaze shifts is a distinguishing factor in individuals with ASD. Swain et al. (2014) found the main difference between typically developing (TD) and ASD individuals in the first 12 months of life is in gaze shifts. Individuals that were diagnosed with ASD earlier had lower scores on positive affect, joint attention, and gaze shifts, however those diagnosed later differed from typically developing (TD) only in gaze shifts. It is not until 24 months that later onset ASD individuals significantly differ from their TD peers, by displaying lower positive affect and gestures (Swain et al., 2014). These findings may lead to other ASD trajectories.

Another defining characteristic of ASD is the excess of restrictive patterns of interest and repetitive motor movements. These patterns and movements often impaired the individual from completing daily tasks. Like joint attention and gaze shifts, these repetitive movements and patterns of interest have different trajectories (Joseph et al., 2013). Joseph et al. (2013) found that individuals with high cognitive functioning ASD engage in more distinct and specific interests and less in repetitive motor movements than individuals with lower cognitive functioning ASD. Another finding showed that at the age of two, repetitive motor and play patterns were more common than compulsion. By the age of four all these behaviors increased however, repetitive use of specific objects was found to be less frequent in older children than younger children. This finding suggests that the ritualistic behaviors and motor movements may present themselves differently based on the age of the individual (Joseph et al., 2013).

Joseph et al. (2013), Korhornen et al. (2014), and Swain et al. (2014) all defined key characteristics of an ASD individual and explains the different trajectories of each characteristic. The difficulty with the trajectories is that it is specific to each individual, some symptoms may worsen while others remain stable. It is also difficult to generalize finding with small sample sizes (Joseph et al., 2013).

Discussion Questions:

1. Korhonen et al. (2014) did not use preference-based stimuli to look for joint attention and did not separate high- from low-functioning ASD individuals. Do you think that there could be a difference in level of motivation from each group? If so, how do you think this could change the results?

2. Swain et al. (2014) found that early and late onset of ASD did not differ in their social skills scores at the age of 12 months. If we know that their social skills do not differ then, is there another factor that would allow diagnosis of late onset ASD to be diagnosed at an earlier point in development?

3. Joseph et al. (2013) explains that it is difficult to assess the trajectories of ASD with a small sample size however, how do you think that their findings still help advance the research on ASD?

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Child & Family Behavior Therapy

ISSN: 0731-7107 (Print) 1545-228X (Online) Journal homepage: http://www.tandfonline.com/loi/wcfb20

Critical Issues in Causation and Treatment of
Autism: Why Fads Continue to Flourish

Mary E. McDonald PhD , Darra Pace EdD , Elfreda Blue PhD & Diane Schwartz
EdD

To cite this article: Mary E. McDonald PhD , Darra Pace EdD , Elfreda Blue PhD & Diane
Schwartz EdD (2012) Critical Issues in Causation and Treatment of Autism: Why Fads Continue to
Flourish, Child & Family Behavior Therapy, 34:4, 290-304, DOI: 10.1080/07317107.2012.732849

To link to this article: https://doi.org/10.1080/07317107.2012.732849

Published online: 06 Nov 2012.

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290

Child & Family Behavior Therapy, 34:290–304, 2012
Copyright © Taylor & Francis Group, LLC
ISSN: 0731-7107 print/1545-228X online
DOI: 10.1080/07317107.2012.732849

Critical Issues in Causation and Treatment
of Autism: Why Fads Continue to Flourish

MARY E. McDONALD, PhD, DARRA PACE, EdD,
ELFREDA BLUE, PhD, and DIANE SCHWARTZ, EdD

Department of Counseling, Research, Special Education, and Rehabilitation,
Hofstra University, Hempstead, New York, USA

The increasing incidence of autism and the lack of specific answers
regarding causation have given rise to unproven educational
interventions and medical treatments. Parents of a newly diagnosed
child can easily fall prey to interventions that promise cures. These
interventions may be harmful and, thus, pose one of the critical
issues in special education today. This article will discuss some of
the suspect interventions that have been popularized through the
media (i.e., celebrities, journalists, and professional organizations).
The authors argue that using the scientific method is clearly the
antidote for pseudoscience; the need for accurate research-based
decision making is apparent.

KEYWORDS autism spectrum disorders, evidence-based practice,
diet, intervention, parent

The ever-increasing prevalence of autism highlights a major reason for
public concern. Worldwide, this disorder affects children, regardless of
race, religion, and socioeconomic status. Currently, autism occurs in 1 in
110 live births (Centers for Disease Control and Prevention [CDC], 2010).
This rate of incidence represents a dramatic rise over the past 15 years.
According to the CDC, between 1993 and 2003 there was a startling 800%
increase in the incidence of autism spectrum disorders (ASD). Such epi-
demic escalation in the diagnosis of autism invites speculation about the
cause of the disorder.

Received 1 October 2010; revised 26 February 2011; accepted 7 March 2011.
Address correspondence to Mary E. McDonald, PhD, CRSR Department, Hofstra

University, Hempstead, NY 11549, USA. E-mail: [email protected]

Critical Issues in Autism 291

Food additives, pesticides, and other teratogenic agents, have been put
forth as one possible explanation for the etiology of ASD. Particular attention
has been paid to thimerosol (mercury), which has been present in vaccines
given to young children.  Parents and others have pointed out that as the
number of vaccinations has increased, so has the incidence of autism. To
date, however, no research supports a link between autism and the mercury
in vaccines (Nelson & Bauman, 2003; Stehr-Green, Tull, Stellfeld, Mortenson,
& Simpson, 2003).

The belief that vaccines cause autism generates fierce differences in
opinion among parents, researchers, and the medical community. Over the
past two decades, the number of vaccines given to children has increased
greatly.  In the  early 1950s, there were four vaccines: diphtheria, tetanus,
pertussis, and smallpox. Because three of these vaccines were combined into
a single shot (DTP), children received five shots by the time they were 2
years old and not more than one shot at a single visit. Today, children could
receive as many as 24 shots by 2 years of age and five shots in a single visit
(Children’s Hospital of Philadelphia, 2010).

In 1998, British research led by Dr. Andrew Wakefield suggested some
link between autism and vaccines (Nicoll, Elliman, & Ross, 1998). His research
findings, published in Lancet, a prestigious medical journal, linked the
measles-mumps-rubella (MMR) vaccine to autism. In spite of overwhelming
scientific evidence that vaccines were safe, refuting Wakefield’s findings
(Offit & Jew, 2003), concern about the safety of vaccines persists and a
worldwide scare has been launched.  As a result, the number of children
vaccinated in the United Kingdom plummeted with cases of childhood
measles rising significantly (Wang, 2010). In the United States, more than 2.1
million children (20%) enter preschool without vaccines for measles,
whooping cough, and Hepatitis B (Smith, Chu, & Barker, 2004).  

Now after all these years of consumer campaigns against the use of vac-
cines, evidence has emerged that Wakefield was both unethical and untruth-
ful about his study. Lancet has issued a full retraction of his 1998 study and
the General Medical Council, Britain’s professional medical regulatory orga-
nization, ruled that Dr. Wakefield acted “dishonestly and irresponsibly”
(Wang, 2010). Yet, in the face of all this evidence, “die-hard believers in the
theory that vaccines cause autism are already denouncing the British medical
establishment for smearing one of their heroes” (Dachel, 2010). Metz, Mulick,
and Butler (2005) find it is ironic that unsupported concern about a possible
cause of autism may actually lead to an increase in maternal rubella, one of
the known causes of autism and other developmental disabilities.

THE PERSISTENCE OF INVALIDATED INTERVENTIONS

The Wakefield episode illustrates how some parents of children with autism
find themselves desperate for answers and vulnerable to fads and

292 M. E. McDonald et al.

pseudo-science.  They will continue exposing their children to risks by
depriving them of protection from dangerous diseases and spend all of their
resources to provide unproven and unsound treatment protocols. The popu-
larity of unproven educational interventions and medical treatments, which
in some cases may be harmful, is one of the critical issues in special educa-
tion. According to Metz et al. (2005), “Fads in the treatment of autism tend to
be harmful, fruitlessly expending limited time and monetary resources,
falsely raising hopes and expectations, and distracting and detracting from
efficacious efforts” (p. 238). They identified the following reasons why par-
ents gravitate toward such interventions and treatments:

• The nature of autism is perceived as a severe, life-long condition, resulting
in a poor prognosis.

• Parents, new to the diagnosis, lack knowledge about the disorder, and
maybe minimally trained in scientific inquiry.

• Parents must deal with conflicting information and competing perspectives
from professionals.

• The fads are often presented as quick fixes or cures.
• There is inadequate information about the cause of autism.
• Medications don’t provide a cure; they can only alleviate certain symptoms.

Parents of a newly diagnosed child can easily fall prey to alternative
interventions that promise cures. Despite the lack of scientific evidence to
support many of these alternative therapies, parents frantic to help their chil-
dren frequently go to the Internet to find a successful treatment for their
child with autism. In 2005, when Metz et  al. conducted an online Google
search for “autism and treatment,” their search resulted in 65 treatments and
interventions, the majority of which have not undergone rigorous scientific
study (p. 237). Everyday the Internet yields millions of links related to autism
treatment, including personal stories of amazing improvement in functioning
written by parents of children with autism spectrum disorders. While such
stories have great appeal, Heward (2009) recommends “healthy skepticism”
when evaluating fantastic claims. Many times critical scrutiny of new expla-
nations of causations and interventions lag behind the media’s introduction
of this information to the public. This can result in ideas and practices taking
root, which lack effectiveness, waste time and money, and do not benefit
children with autism. Therefore, parents need to carefully consider highly
touted interventions that are unsubstantiated by the U.S. Food and Drug
Administration and the scientific community.

ROLE OF THE MEDIA

Members of the media are always on the lookout for sensational news—
stories that will sell. This is evident in a CBS News (2003) report on autism:

Critical Issues in Autism 293

Although substantial and well substantiated progress seen across the
decades in dimensions such as the teaching of adaptive skills, treatment
of behavior problems, and the overall quality of life of individuals with
developmental disabilities, these well-grounded, positive developments
have often been eclipsed by the steady appearance of “breakthroughs,”
“new models,” “cures,” and “revolutionary strategies,” that typically prom-
ise results that are more rapid, more beneficial, and easier to achieve
than any seen before. (Favell, 2005, p. 19)

Unfortunately, the promise of new and better mousetraps often include
strident denunciation of all that had gone before (Favell, 2005). Information
regarding autism and autism intervention is readily available through multi-
ple media sources (i.e., newspapers, television, publications, film, Internet
blogs), providing novel ideas and approaches for a very receptive audi-
ence. The easy access to undocumented information is compounded by a
phenomenon first identified by Pierce in 1877 who posits that individuals
grant others the power to change their beliefs if they think that person has
higher social status or special knowledge (Vyse, 2005). In our media-driven
society, celebrities often promote political and social agendas with great suc-
cess, regardless of the validity of what they are saying.

For example, Jenny McCarthy, a well-known actress, touted the use of
diet to help her son Evan to “recover” from autism and was an ardent
campaigner against the use of vaccinations. She believed that a variety of
biomedical interventions (a gluten and casein-free diet, vitamin
supplementation, detoxification of metals, and anti-fungal) recovered her
son’s neurological function and enabled him to benefit from educational
interventions (speech therapy and applied behavior analysis). She told the
public, “He could not learn while he was frozen in autism” (McCarthy &
Carrey, 2008). Her story has received enormous media attention with many
parents believing that if they follow her regimen, they too will recover their
child. Unfortunately, these biomedical interventions do not have scientific
support and may offer families false hope for recovery.

OTHER INFLUENCES

Professionals, with what may be well-intentioned motives, further the use of
unproven interventions by offering parents the option of using approaches
that have no documented research to support their effectiveness or success.
When a credentialed professional utilizes such an intervention, he or she
instantly lends credibility to the treatment protocol. In addition, many inter-
ventions depend on personnel who have limited training or experience to
provide the service. Despite these facts, professional organizations are often
reluctant to denounce such treatments, thereby tolerating practitioners with

294 M. E. McDonald et al.

uncertain expertise who use questionable interventions. This reluctance may
contribute to the proliferation of pseudoscience treatment fads (Newsom &
Hovanitz, 2005).  

The combined impact of the media, celebrity endorsements, and pro-
fessional tolerance create a climate that opens the door for all types of theo-
ries and applications. Some of the most popular and suspect interventions
and therapies fall into one of the following categories: biomedical, therapeu-
tic, behavioral and educational.

BIOMEDICAL APPROACHES

Individuals who believe the cause of autism is physiological in nature may
seek biomedical interventions (i.e., nutrition, diet, vitamin and hormone
therapy, even the refusal to give vaccines to children). The success of
dietary regimens for children with disabilities is particularly attractive to
parents in view of the fact that this approach has shown positive results for
some disabilities (Huijbregts, DeSonneville, Licht, Van Spronsen, & Sergeant,
2002).

Dietary intervention has been proven effective for treating
phenylketonuria (PKU)  and diabetes. However, the generalization of the
treatments of PKU and diabetes to autism are examples of pseudoscience,
not evidence-based research. Still parents cling to the possibilities of a gluten-
and casein-free diet, despite lack of any supporting research (Elder et  al.,
2006; Mulloy et al., 2011). In addition, the idea of natural therapy such as
removing preservatives and additives from food is appealing, perceived as
one that is safer than a manufactured or chemical one. “But natural does not
mean safe or effective” (Smith, 2005, p. 51).

 Another biomedical approach involves the use of secretin. Horvath and
colleagues (1998) reported improvement in the functioning of three children
with autism after intravenous infusions of purified porcine secretin, an amino
acid hormone, used in the treatment of gastrointestinal problems. Following
the publication of the results of Horvath et al.’s study, an explosion of interest
in using secretin as a treatment found its way to the Internet. However,
numerous scientific studies have found no significant benefit from the use of
secretin as compared to the use of a placebo (Coniglio et al., 2001; Coplan
et al., 2003; Dunn-Geier et al., 2000; Molloy et al., 2002; Sandler et al., 1999).

Chelation therapy treatment aims at lowering the levels of mercury,
lead, or other heavy metals in the body. Available information about current
use of chelation therapy in autism is scant, and what exists implies that inap-
propriate agents, routes, or dosage schedules of administration are being
used as autism treatments.

It is doubtful that individuals with ASDs have high levels of heavy metals
or that chelating agents would be effective in reversing neurological damage

Critical Issues in Autism 295

from metal exposure (Levy & Hyman, 2005). There is no compelling evidence
to suggest that chelation therapy is an effective treatment for autism. A review
of Medline (1966 to April 2006) and Premedline did not yield any relevant
reviews or randomized controlled trials of chelation therapy for autism spec-
trum disorder (Sinha, Silove, & Williams, 2006). Perhaps most significant is the
danger involved with some forms of chelation therapy as it may cause severe
side effects or even death (Kane & Linn, 2005). A number of professional
organizations have also expressed growing concern regarding the use of che-
lation as an intervention for individuals with autism (National Institute of
Mental Health, 2008). Additionally, the FDA recently stated that chelators that
are sold over the counter as treatments for autism, are dangerous and illegal.
They stated that they are potent drugs that carry serious risks—including
kidney damage, dehydration, and even death (Tsouderos, 2010).

ANIMAL THERAPEUTIC APPROACHES

Some therapeutic treatment approaches involve children interacting with
animals (i.e., therapeutic horseback riding, dolphin therapy, or pet therapy). In
Dolphin Assisted Therapy (DAT), children with autism swim with the
dolphins. Parents have reported that after their children experience swimming
with dolphins, their ability to communicate increased, and they “opened up.”
For a single treatment in a series of sessions, the costs range from $75 to a
few hundred dollars. Two reviews of DAT (Marino & Lilienfeld, 1998;
Humphries, 2003) concluded that there is no credible scientific evidence for
the effectiveness of this intervention. Marino and Lilienfeld (2007) examined
the methodological status of DAT by reviewing five peer-reviewed DAT
studies published in the last 8 years. The authors found that all five studies
were methodologically flawed and plagued by several threats to both internal
and construct validity. They concluded that nearly a decade following their
initial review, there remains no compelling evidence that DAT is a legitimate
therapy or that it affords any more than fleeting improvements in mood. In
spite of the expense and lack of any research to support the claims associated
with this therapy, parents continue to seek out DAT. 

FACILITATED COMMUNICATION

Facilitated communication (FC) is a method by which a communication facil-
itator gives physical support to enable an individual with limited or no
speech to type on a keyboard or point to items on a communication board
(Biklen, 1990). Initially, FC met with great excitement and expectations.
However, the underlying theory of FC is that individuals with autism have
motor planning problems, known as apraxia, and therefore cannot use a

296 M. E. McDonald et al.

keyboard to communicate. For many parents the belief that their child merely
has a physical disability, not a developmental disability, is extremely appeal-
ing. Overwhelming scientific evidence (Mostert, 2001; Eberlin, McConnachie,
Ibel, & Volpe, 1993; Gorman, 1998) demonstrates that with FC, the commu-
nication comes from the facilitator, not the child.

This scientific evidence prompted professional organizations to speak
out against the use of this unproven method. The American Psychiatric
Association (1994) made a resolution that “facilitated communication is a con-
troversial and unproven communicative procedure with no scientifically dem-
onstrated support.” The American Association on Mental Retardation (1994)
stated that “facilitated communication has not been shown to result in valid
messages from the person being facilitated.” The association supports the use
of validated augmentative and alternative communication techniques.

Despite the lack of endorsement for FC from national professional orga-
nizations, FC continues to be used in various programs today often at great
cost to parents and children with autism spectrum disorders. This is charac-
teristic of fad treatments as “they are never completely abandoned; they
persist in small groups of professionals and resurface through the activities
of these professionals, or advocates who are unaware of the history of simi-
lar therapies and their disuse and believe the treatment they have discovered
to be novel” ( Jacobson, Foxx, & Mulick, 2005, p. xiv). 

UNINTENDED CONSEQUENCES

In a climate with parents and professionals desperate for answers, it is under-
standable that the prevalence of simple and hopeful solutions would take
hold, even without scientific evidence to support the claims made about
them. However, in many cases these seemingly benign treatments can pose
dangerous unintended consequences. The claims of sexual abuse generated
from facilitated communication and the recurrence of measles and other
childhood communicable diseases as a manifestation of Wakefield’s research
illustrate what happens when fad treatments become popular in spite of no
scientifically demonstrated support for its efficacy.

Facilitated communication offered the promise that people with autism
had normal intelligence and undiscovered language. What evolved from this
was an outpouring of abuse claims supposedly from individuals who could
not speak about it before but with FC could now accuse their abusers.
Multiple law suits followed. In spite of overwhelming legal verdicts depicting
FC claims of abuse as having no credibility (Prieto v. County of Orange,
1997), the lives and reputations of loving and caring parents were destroyed.
Further, scientifically based studies found that the typed language output
that was attributed to individuals with disabilities was really the voice of the
paraprofessional or professional who provided the facilitated assistance

Critical Issues in Autism 297

(Bligh & Kupperman, 1993; Eberline et al., 1993; Hudson, Melita, & Arnold,
1993; Klewe, 1993).

Similarly, Wakefield’s claims set in motion enduring questions about the
link between childhood vaccinations and autism. In 2001, mercury-based
preservatives were removed from childhood vaccines, but the fear about
vaccines continued. Despite the recommendations of the Centers for Disease
Control and Prevention (CDC) and assurances from the medical and health
community that vaccines are safe, a growing number of parents have requested
exemption from the vaccine requirement for children entering school.
According to health officials, requests for vaccine exemptions in the
metropolitan area (New York, New Jersey, Connecticut) have risen continuously
over the past 5 years (Rockoff, 2010). This has led to many more unvaccinated
children entering school posing a danger to themselves and other children.
The New England Journal of Medicine (Omer, Salmon, Orenstein, deHart, &
Halsey, 2009) reports that the chance of unvaccinated children getting measles
is 22 to 35 times the rate of vaccinated children. While Wakefield’s studies
have been retracted from the research literature and his claims totally
repudiated by the scientific community, there continues to some parents who
hold on to the connection between autism and vaccines.

SCIENTIFIC METHOD AND LEVELS OF EVIDENCE

Perhaps, the “last line of defense against fad treatments is that professionals
have to be trained in the scientific method. They need to use their training
and knowledge to critically evaluate new treatments and apply rigorous
criteria before adopting them in use” (Zane, 2005, p. 186). The use of the
scientific method is clearly the antidote for pseudoscience; however,
evaluation of the current research literature may not be easily accessible for
most people. To address this concern and meet the needs of the professional
community and parents for accurate appraisal of interventions for ASD, many
in the professional community have generated user-friendly resources. 

Two examples are the report by the Maine Department of Education, &
Maine Department of Health and Human Services (2009) and the work of
Reichow, Volkmar, and Cicchetti (2008). The Maine Department of Health
and Education in 2009 published a state of the evidence report. The purpose
of their report was to review the research literature to disseminate extent of
empirical evidence for treatments commonly used for children with autism.
The guide provides professionals, policy makers, and parents the most
current, efficacious treatments. Reichow et al.’s (2008) validated rubric is a
valuable resource which assigns evidence for interventions across six levels,
ranging from Level 1—proven and effective and Level 6—evidence of harm.
This rubric was used by the Maine Department of Health and Education in
2009 to assign interventions to specific levels (see Table 1).

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