Parents who receive an autism diagnosis for their child begin what Gloria Laxer has called a "tragic pilgrimage": "They will move from one public service to another, from one doctor to the next, for years, without getting a clear answer about what causes their child's episodes or which methods might work best."
The therapeutic and educational approaches most widely used in Europe fall into two broad categories: those rooted in psychoanalysis and those based on "behavioral" treatment.
The psychoanalytic approach was championed from the 1940s onward by Bruno Bettelheim. He understood autism as a mental illness probably stemming from a "difficult interaction" between the child and his parents.
The fundamental goal of this method is to help the child "build a coherent personal story" and "open him to relationships with others." Psychoanalysts do not rush to diagnosis, which might create false hopes about the future. Schooling is approached cautiously, only when the child is ready to express his deepest wishes.
This form of care, which flourished in the 1960s and 70s, typically ended at age twenty.
Until we understand what causes autism, these efforts will at least improve some symptoms and support the development of communication.
Recent Experience with Educational Methods
Educational methods also have Anglo-Saxon roots and aim to stabilize the child's behavior through "learning basic skills."
The best-known is the TEACCH method. Unlike the psychoanalytic approach, it calls for precise and early diagnosis: assessing the child's abilities in perception, motor control, imitation, and coordination; understanding his cognitive and verbal performance; and identifying strengths to build on.
Working from this assessment, educators—always in dialogue with the parents—create an individualized educational program. "The idea is to give him a tool for communication (perhaps an object that represents an action), to structure the environment and time so information becomes concrete (going to a specific place to do a specific thing), and to teach him to move from one image or action to another (ranging from a very concrete symbol to a spoken word). The TEACCH method uses 'reinforcement'—first positive, then negative. (Critics call these 'rewards' and 'punishments'). The child is regularly tested to see if he is making progress.
Other methods draw on similar "behavioral" approaches, though they aim to support specific skills rather than provide comprehensive care. They function as "tools" for learning motor control or communication.
Facilitated communication works in much the same way, offering the autistic person a "communication support": usually a board with pictures or letters, a typewriter, or a computer. A trained "facilitator" provides physical support at the wrist to compensate for neuromotor difficulties.
Until We Find the Answers
What results should families expect from these methods?
"The lack of comparative studies makes it impossible to draw firm conclusions about whether one approach is superior to another." Many parents and professionals, of course, do not share this view—they pursue one method or the other with hope and conviction. But the fact remains: until we understand what causes autism, these efforts will "at least improve some symptoms and support the development of communication."
What parents want most is for their children to benefit from what is genuinely helpful in each approach, whatever the debates between them.
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Jacques Labrousse 1996
O. et L. n. 113
