Opening doors to closed young minds: An article about an autistic child on this page last month prompted a strong response from readers. Here, Cherrill Hicks outlines the variety of treatments available

UNTIL the age of 11, Georgie Manning was autistic. She withdrew from social contact, lived in a world of her own, and seemed destined to spend her life in institutions. Yet she developed into a lively outgoing teenager who excelled at school and graduated from her US college with honours.

Georgie's mother, Annabel Stehli, believes that her daughter was transformed by a new treatment for autistic children which claims to modify their grossly distorted sense of hearing, making it possible for them to re-enter normal life. Unheard of 10 years ago, auditory integration training is already big in the US and looks likely to make a splash in Britain when a book about Georgie, written by her mother, is published here later this month. Like other 'miracle treatments' it will raise the hopes of parents of autistic children, who are often desperate for an answer.

Since her account of life with an autistic child was published on the Living page last month, Kate Rankin has received many letters of sympathy and support from other parents.

Her 14-year-old son, Gabriel, attends a school for autistic children: it has a high staff/pupil ratio and an intensive, highly structured programme of activities that includes training in social skills as well as music and movement therapy designed to help the children, who find verbal communication difficult, to express themselves. But funding for special schools is short and it can be a battle to obtain a place. And, too often, it is left to families to find out what treatments are available.

Some 80,000 people in Britain suffer from autism, and auditory training is only the latest of a bewildering array of therapies that claim to be of benefit to them. Few of these treatments have been systematically evaluated (although a comparative study is being undertaken by researchers at Nottingham University); and although many claim to achieve remarkable results, it is unlikely that any of them can cure autism, an organic disorder which most specialists now believe is caused by brain damage.

'The key thing to remember is that autism covers a wide range of conditions and what's right for one child isn't right for all,' says Christine Nickles, from the National Autistic Society. 'But we do support parental choice. People should know there is a number of approaches available.'

THERAPIES AVAILABLE

Auditory integration training was developed by Dr Guy Berard, a French physician. He invented a special electronic device which, by removing some sound frequencies and emphasising others, reconditions the hearing of autistic children so that they are no longer so acutely sensitive to ordinary sounds. To Georgie, for example, before she underwent treatment, the sounds of dishes being washed, of lavatories being flushed at the other end of the building or even of her own breath blowing out the candles on her birthday cake, were intolerable. Dr Berard has never claimed miracles, only that the therapy can help some children. A small pilot study in the US has produced 'positive' results and researchers there have begun a larger trial. Auditory training is at present available at only one centre in Britain.

Behaviour modification is widely used in schools for autistic children to teach social and language skills and to eliminate 'inappropriate' behaviour such as head-banging or making noises. In Britain, therapists tend to use rewards of sweets or food for good behaviour, such as sitting down and reading; US teachers also favour aversive therapy, with mild slaps and shouts used as 'punishments'.

Facilitated communication, already popular in the US and Canada, is beginning to attract interest in Britain. It was originally developed to help cerebral palsy sufferers but is now being used to help autistic children who do not speak. Using a 'Canon communicator', a kind of hand-held typewriter, the child presses a series of buttons; messages are either printed out on tape or interpreted by a human voice. However, the children need 'facilitators', who physically help them use the keyboard and critics of the method suspect that messages come subconsciously from the facilitator rather than the child.

Holding therapy made a big impact in Britain a few years ago, and is available at two 'Mothering Centres'. It was originally developed by a New York therapist, Martha Welch. Supporters believe that holding children against their will, forcing them to make eye contact, will help them to work through feelings of anger and upset and learn to overcome any fear of intimacy.

Researchers in Italy and Germany have claimed that three-quarters of autistic children can be helped by holding therapy, and many mothers who have used it say their children have made miraculous progress. But critics say the therapy may be harmful because

it can make children more anxious.

Higashi daily life therapy was first developed in Tokyo. Some British parents have spent their life-savings on sending their children to Japan or the Higashi school in Boston, Massachusetts. Children undergo an intense, regimented programme of physical activity as well as instruction in music and the visual arts, and group education to develop social skills. By structuring each day completely and eliminating choice, teachers hope to relieve the sense of confusion that seems to afflict many autistic children. Some elements of Higashi have been incorporated into British special schools for autistic children and a private Higashi-type school is being set up in Hampshire. But in its extreme form, Higashi regimentation and the emphasis on the group would be unacceptable to most British

parents.

Megavitamin therapy. Some studies have found that high doses of vitamin B6, taken with magnesium, lead to behavioural improvements in some children. B6 has been shown to have an effect on certain neurotransmitters in the brain that are thought to function abnormally in autistic children. Very high doses of B6 are expensive,

however, and they should be taken only under medical supervision. Claims are also being made for dimethylglycine, a chemical used by fitness enthusiasts, which is not available in Britain but can be imported from the United States, and folic acid. Norwegian therapists believe a gluten-free diet may also help.

Option Institute. In complete contrast to the regimented Higashi training is the philosophy of the Option Institute in Sheffield, Massachusetts, where the aim is to enter the child's world rather than impose any external structure. 'If the child wants to sit on the wardrobe or make mud pies you do it with him,' says Paul Shattock, director of the Autism Research Unit, University of Sunderland. The child is placed in a specially designed playroom for lengthy periods, sometimes months, and is visited by different teachers in rotation. The aim is to eliminate outside distractions. A report on the Option Institute by the National Autistic Society found some positive features; but some parents might find the idea of keeping the child in one room unacceptable.

Psychotherapy for autistic children and their parents is based on the now discredited belief that autism is the result of an early trauma, caused by the 'refrigerator mother' who fails to respond to her child's needs. Although still used in some European countries such as France, this approach has largely been abandoned in Britain.

Relaxation. Because autistic children have high anxiety levels, many therapies are now used to help them relax. These include aromatherapy and massage. One or two parents have also praised the merits of dolphin therapy and cranial osteopathy.

'The Sound of a Miracle: A Child's Triumph Over Autism', by Annabel Stehli (Fourth Estate, pounds 14.99).

Not all the specialist therapies developed for autistic children have been mentioned here. For more information, contact the National Autistic Society: 081-451 1114.