Tokyo psychiatrist, Dr. Douglas Berger, comments on “Autism Spectrum Disorders and Psychiatry: Update on Diagnostic and Treatment Considerations” by Jennifer Foss-Feig, PhD and James Mcpartland, PhD, June 20th, 2016 issue of the Psychiatric Times.

The author describes various behavioral interventions for autism. They state the ABA approach has been effective and provide reference #5 by Smith. Besides the fact that the article by Smith is not exactly about ABA, these approaches are all studied with neither subjects nor treaters blind to the therapy given. Even if raters are masked, that is far from the same rigor as a double-blind treatment which is necessary when endpoints are subjective.

It’s not clear if these modalities would make a difference over 10 or 20 years compared to a good educational system supported by extra-curricular activities such as music, sports, language, math etc.,especially for moderate or less seriously impaired.

A more recent article by the same Smith does articulate some of the limitations involved. It is hard for me to understand why the authors did not reference his article from 2012, and instead reference the one from 2001.
Evolution of Research on Interventions for Individuals with Autism Spectrum Disorder: Implications for Behavior Analysts, by Tristram Smith.

He states, “No published RCTs or other group studies are available for any comprehensive ABA intervention for school-age children, youth, or adults with ASD. After decades of ABA research involving these individuals, one might hope and expect that more ABA interventions would be ready for the last type of investigation”.

This PT article needs to be more tempered in its enthusiasm for modalities as yet unvalidated and costly.

Doug Berger, M.D., Ph.D.
US Board Certified Psychiatrist
Tokyo, Japan

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