Overview
Once you receive an autism diagnosis, don’t wait. Early diagnosis of ASD, coupled with swift and effective intervention, is paramount to achieving the best possible outcomes for your child.
All states are required to provide early intervention services until children are 3 years old, at which time services are provided by their school district (see below). In some states services are provided by the Department of Health and in others by the Department of Education. When your child under 3 is diagnosed, call your state early intervention provider to begin the intake process. If your child is diagnosed at an age older than three, contact your school district, even if your child is not yet of kindergarten age.
The most effective interventions available are behavioral therapies based on applied behavioral analysis (ABA). There are many different types of ABA to choose from based on your child’s strengths and needs. Other therapeutic options to try include occupational therapy, speech therapy, physical therapy and pharmacological therapy. Treatment works to minimize the impact of the core features and associated deficits of ASD and to maximize functional independence and quality of life.
You will likely hear about a variety of non-evidence-based therapies, including horseback riding, swimming with dolphins, high-dose vitamins, electromagnet therapy and even drinking unpasteurized camel milk. These therapies have no evidence behind them and many can be harmful. While it is fine for children with autism to swim with dolphins and ride horses—just as other children do—these activities will not impact their autism (although they make some children, both with and without autism, very happy). Some but not all activities with animals or music aimed at children with autism offer opportunities to communicate and express feelings and to engage with peers. These activities should be done in conjunction with, not instead of, more evidence-based approaches. When in doubt, ask to participate in a class with your child to see what the proposed activity is all about.
Read ASF’s statement on the use of ABA for Autism here.
Treatment Options
Behavioral Interventions: Applied Behavioral Analysis (ABA)
With ABA therapies, the emphasis is put on reinforcing behaviors that form the foundation of skill development. It is done by breaking down a complex behavior into a series of smaller tasks so learning can occur. You can read about the science behind ABA here.
ABA can help promote your child’s social development, help them develop daily life skills and redirect behaviors that can be harmful, like self-injury. In addition, ABA teaches new skills and applies those skills to new situations. There are several types of evidence-based behavioral interventions that are built on ABA, including:
- Early Intensive Behavioral Intervention (EIBI) is a type of ABA for very young children with an ASD, usually younger than five, often younger than three years old. EIBI’s use a 1:1 adult to child ratio in the early stages of treatment and utilize discrete trial training methods (see below). This therapy can be implemented in the home or school, usually for an average of 20-40 hours a week.
- Naturalistic Developmental Behavioral Interventions: This is a relatively new term to describe behavioral interventions that are delivered in a child’s natural environment (rather than in a clinic), sometimes in cooperation with parents or caregivers. It utilizes different practices to promote interactions and learning and teach new skills, and emphasizes the child’s own interest and initiations. Many EIBI’s that are delivered in a naturalistic setting can also be called Naturalistic Developmental Behavioral Interventions. They include JASPR, Early Start Denver Model, and SCERTS. There are many other NDBI’s that may not be named, but are based on the principles of NDBI’s. This is a blanket term for a number of interventions.
- Pivotal Response Training: PRT utilizes principles of ABA to increase a child’s motivation to learn, monitor his/her own behavior, and initiate communication with others by focusing on behaviors that are seen as key to learning other skills, such as language, play and social skills. This training works to generalize skills across many settings with different people.
- Discrete Trial Teaching: Discrete Trial Teaching is a subset of ABA. It involves breaking down tasks into small, discrete steps, and is taught using prompts and rewards for completing each step. Prompts and rewards are phased out over time.
- Lovaas Therapy: The Lovaas Model consists of 20-40 hours of highly structured, discrete trial training, integrating ABA techniques into an early intervention program. The intervention typically begins when the child is between the ages of 2-8 years old, and no later than 12 years old. The technique utilizes child-specific reinforcers to motivate and reward success. Additionally, the use of language and imitation are crucial for the teaching model. Click here to learn more about the Lovaas Model.
Speech Therapy
Since people with ASDs have deficits in social communication, speech therapy is an important treatment option. Speech therapy with a licensed speech-language pathologist helps to improve a person’s communication skills, allowing them to better express his needs or wants. For individuals with ASD, speech therapy is often most effective when speech-language pathologists work with teachers, support personnel, families, and the child’s peers to promote functional communication in natural settings.
Some individuals with ASD are nonverbal and unable to develop verbal communication skills. The use of gestures, sign language, and picture communication programs are often useful tools to improve their abilities to communicate.
Occupational Therapy (OT)
Occupational therapy is often used as a treatment for the sensory integration and motor deficits associated with ASDs. OT can help teach life skills that involve fine-motor movements, such as dressing, using utensils, cutting with scissors, and writing. It works to improve the individual’s quality of life and ability to participate fully in daily activities. Each occupational therapy program is based on individual evaluations and goals. Occupational therapy for young children with ASD often focuses on improving sensory integration and sensorimotor issues. In older children, OT often focuses on improving social behavior, teaching motor skills (like handwriting) and increasing independence.
Physical Therapy (PT)
Physical therapy is used to improve gross motor skills and improve sensory integration issues, particularly those involving the individual’s ability to feel and be aware of his body in space. Similar to OT, physical therapy is used to improve the individual’s ability to participate in everyday activities. PT works to teach and improve skills such as walking, sitting, coordination, and balance. Physical therapy is most effective when integrated in an early intervention program.
Medications
There are no medications approved by the FDA so far that have been shown to affect the core features of ASD, though several phase 3 FDA trials are underway in this area. There are pharmaceutical treatments that can help ameliorate some of the behavioral symptoms of ASD, including irritability, aggression, and self-injurious behavior. Additionally, by medically reducing interfering or disruptive behaviors, behavioral interventions, including those supported at home by caregivers, may be more effective. Medications should be prescribed and monitored by a qualified physician. Some of the most commonly prescribed medications include:
- Risperidone was the first FDA-approved medication for the treatment of symptoms associated with ASD in children and adolescents, including aggressive behavior, deliberate self-injury, and temper tantrums.
- Aripiprazole is FDA-approved for the treatment of irritability in children and adolescents with ASD. A 2009 study published in Pediatrics found that in a group of 98 children 52% of those taking aripriprazole, in the form of Abilify, experienced a 25% or greater reduction in autism-related irritability symptoms by week 8 of the trial, compared with 14% of those who took the placebo.
- Other medications may also be used to treat behaviors associated with ASD, or seizures, which commonly occur in children with autism. There are also dozens of medications currently being studied in clinical trials which show strong promise. You can learn more about enrolling your child in a clinical trial here.