The 1990s marked a transformative period in the understanding and treatment of autism. This decade saw a significant evolution in how autism was conceptualized, moving towards a more neurologically-informed perspective. As scientific knowledge advanced, intervention strategies began to shift, leading to the emergence and refinement of various therapeutic and educational approaches. This era laid foundational groundwork for many current practices in autism support.
Prevailing Understanding of Autism
The 1990s saw a significant shift in understanding autism, moving away from psychogenic theories that attributed it to parenting styles. Autism became recognized as a neurological disorder with biological underpinnings.
A pivotal moment was the 1994 introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The DSM-IV expanded diagnostic criteria, categorizing autism under Pervasive Developmental Disorders (PDD). This manual included Autistic Disorder, Asperger’s Disorder, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), Rett’s Disorder, and Childhood Disintegrative Disorder. The inclusion of Asperger’s Disorder, often described as “high-functioning” autism, broadened the diagnostic landscape and contributed to a more inclusive view of autism as a spectrum.
Behavioral and Educational Strategies
Behavioral and educational strategies formed the core of autism treatment in the 1990s, with Applied Behavior Analysis (ABA) gaining prominence. ABA is a structured, intensive intervention focusing on how behaviors are influenced by their environment. It breaks down complex skills into smaller, teachable steps, systematically teaching them using positive reinforcement. This approach aims to increase helpful behaviors while decreasing those that might impede learning.
ABA programs in the 1990s often involved labor-intensive, one-on-one interventions, frequently providing 25 to 40 hours of therapy per week for several years. These interventions targeted improvements in communication, social interaction, daily living skills, and intellectual functioning. Emphasis was placed on observable and measurable behaviors, with careful documentation to ensure evidence-based practices.
Alongside ABA, the Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) program was another influential educational model. Developed in the 1960s and established statewide in North Carolina by 1972, TEACCH emphasizes structured teaching environments. This method leverages the visual processing strengths often observed in individuals with autism, using visual schedules and organized physical spaces to enhance understanding and independence. TEACCH also promotes parent involvement, viewing parents as co-therapists who apply structured teaching techniques at home.
Supportive Therapeutic Interventions
Beyond behavioral and educational approaches, supportive therapeutic interventions were important in 1990s autism treatment. Speech-Language Pathology (SLP) was essential for addressing communication differences. SLPs worked on verbal and non-verbal communication skills, helping individuals develop language, improve articulation, and understand social communication nuances. For non-speaking individuals, SLPs explored alternative communication methods like gestures, picture exchange systems, or electronic devices.
Occupational Therapy (OT) focused on improving daily living skills, fine and gross motor coordination, and addressing sensory processing challenges. Occupational therapists helped individuals engage in meaningful activities by adapting tasks or environments, enhancing independence in self-care, play, and social participation. This included strategies for emotional regulation and safety awareness.
Sensory Integration Therapy, often provided by occupational therapists, was a common intervention designed to help individuals process sensory information more effectively. This therapy aimed to organize sensory input from the environment, particularly focusing on tactile, vestibular, and proprioceptive senses. The goal was to help individuals regulate their responses to sensory stimuli, which could manifest as over- or under-reactivity, and improve their ability to participate in daily life.
Medical and Complementary Approaches
In the 1990s, medical interventions for autism primarily focused on managing co-occurring conditions rather than treating autism itself, as no medications were specifically approved for core autism symptoms. Medications were sometimes prescribed to address associated challenges like anxiety, hyperactivity, aggression, or seizures. Certain antipsychotics like risperidone, introduced in the early 1990s, were used off-label for irritability and aggression, though not FDA-approved for autism until later. Selective serotonin reuptake inhibitors (SSRIs) were also explored for repetitive behaviors or anxiety, though their efficacy in children with autism remained inconclusive.
The 1990s also saw growing interest in Complementary and Alternative Medicine (CAM) approaches. These included dietary interventions, vitamin and mineral supplements, and other non-conventional therapies. One prominent example was the gluten-free, casein-free (GFCF) diet, theorized to alleviate autism symptoms by eliminating certain proteins believed to cause adverse reactions. While families explored these options, often driven by anecdotal reports and a desire for solutions, robust scientific evidence supporting the widespread efficacy of many CAM treatments was limited at the time. Many approaches lacked rigorous study, and some were later found to be ineffective or even potentially hazardous.