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Scientists agree that the earlier in life a child receives early intervention services the better the child’s prognosis. All children with autism can benefit from early intervention, and some may gain enough skills to be able to attend mainstream school. Research tells us that early intervention in an appropriate educational setting for at least two years prior to the start of school can result in significant improvements for many young children with autism spectrum disorders (ASD). As soon as autism is diagnosed, early intervention instruction should begin. Effective programs focus on developing communication, social, and cognitive skills.
Early diagnosis of ASD, coupled with swift and effective intervention, is paramount to achieving the best possible prognosis for the child. Even at ages as young as six months, diagnosis of ASD is possible. Regular screenings by pediatric psychiatrists are recommended by the Centers for Disease Control and Prevention (CDC). Even if your child is not diagnosed with an ASD before the age of 3, under the Individuals with Disabilities Education Act (IDEA), your child may be eligible for services provided by your state. In addition, many insurance companies will provide additional assistance for the coverage of proven therapies. More information on autism and insurance can be found here.
The most effective treatments available today are applied behavioral analysis (ABA), 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. In 2012, the Missouri Guidelines Initiative summarized the findings from 6 reviews on behavioral and pharmacological interventions in autism. The consensus paper includes current evidence of what interventions have been studied and shown effective, why or why not, and can be found here.
Applied Behavioral Analysis (ABA) works to systematically change behavior based on principles of learning derived from behavioral psychology. ABA encourages positive behaviors and discourages negative behaviors. In addition, ABA teaches new skills and applies those skills to new situations
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.
Pivotal Response Training is a variation of ABA that works to increase a child’s motivation to learn, monitor his 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 is a common form of ABA, in which what is being taught is broken down into smaller steps, and taught using prompts and rewards for each step. Prompts and rewards are phased out over time.
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.
The Early Start Denver Model is an early intervention program designed for infants, toddlers, and pre-schoolers ages 12-48 months with autism. Developed by Geraldine Dawson, Ph.D., and Sally Rogers, Ph.D., it is the only experimentally verified early-intervention program designed for children with autism as young as 18 months old. ESDM applies the principles of ABA to an early-intervention program. Similar to Pivotal Response Training, interventions are delivered within play-based, relationship-focused routines. Studies testing the efficacy of the treatment have found the intervention “resulted in significant improvements in IQ, language, adaptive behavior, and autism diagnosis”. To learn more about the Early Start Denver Model, read more here.
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 him 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, and 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 issues associated with ASDs. It is also used to help teach life skills that involve fine-motor movements, such as dressing, using utensils, cutting with scissors, and writing. OT 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 and increasing independence.
Physical Therapy (PT)
Physical therapy is used to improve gross motor skills and handle 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.
Pharmaceutical treatments 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, other treatments, including ABA, may be more effective. Medications should be prescribed and monitored by a qualified physician.
Risperidone is the first FDA-approved medication for the treatment of symptoms associated with of ASD in children and adolescents, including aggressive behavior, deliberate self-injury, and temper tantrums. Read the studies below.
Scahill, L. et al. Effects of risperidone and parent training on adaptive functioning in children with pervasive developmental disorders and serious behavioral problems. J Am Acad Child Adolesc Psychiatry 51, 136-146, doi:10.1016/j.jaac.2011.11.010 (2012).
Troost, P. W. et al. Long-term effects of risperidone in children with autism spectrum disorders: a placebo discontinuation study. J Am Acad Child Adolesc Psychiatry 44, 1137-1144, doi:10.1097/01.chi.0000177055.11229.76 (2005).
Shea, S. et al. Risperidone in the Treatment of Disruptive Behavioral Symptoms in Children With Autistic and Other Pervasive Developmental Disorders. Pediatrics 114, e634-e641, doi:10.1542/peds.2003-0264-F (2004).
Arnold, L. E. et al. Parent-defined target symptoms respond to risperidone in RUPP autism study: customer approach to clinical trials. J Am Acad Child Adolesc Psychiatry 42, 1443-1450, doi:10.1097/00004583-200312000-00011 (2003).
Aripriprazole is also 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, by week 8, 52% of those taking aripriprazole, in the form of Abilify, experienced a 25% or greater reduction in autism-related irritability symptoms compared with 14% of those who took the placebo. Read the studies below.
Marcus, R. N. et al. Safety and tolerability of aripiprazole for irritability in pediatric patients with autistic disorder: a 52-week, open-label, multicenter study. The Journal of Clinical Psychiatry 72, 1270-1276, doi:10.4088/JCP.09m05933 (2011).
Aman, M. G. et al. Line-item analysis of the Aberrant Behavior Checklist: results from two studies of aripiprazole in the treatment of irritability associated with autistic disorder. J Child Adolesc Psychopharmacol 20, 415-422, doi:10.1089/cap.2009.0120 (2010).
Marcus, R. N. et al. A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. J Am Acad Child Adolesc Psychiatry 48, 1110-1119, doi:10.1097/CHI.0b013e3181b76658 (2009).
Stigler, K. A. et al. Aripiprazole in pervasive developmental disorder not otherwise specified and Asperger’s disorder: a 14-week, prospective, open-label study. J Child Adolesc Psychopharmacol 19, 265-274, doi:10.1089/cap.2008.093 (2009).
There are dozens of other therapies that incorporate the practices of evidence based approaches to helping improve symptoms of ASD. Researchers have identified these core practices and reported on what they are and the evidence behind them at the National Professional Development Center (NPDC) on ASD, which can be found here. Similar efforts to summarize scientific information on autism interventions have been conducted by the Missouri Guidelines Initiative, which has reported similar findings and can be found here. The goal of periodically summarizing these practices is to not only identify additional methods, but to communicate to parents, educators, legislators and other community members what is of value. They use stringent criteria on sometimes emerging, new evidence.
There are a number of practices that have been incorporated into recreational activities or technological tools. Alternatively, most interventions come in packages that include more than one practice in more than one setting. Many interventions that have been shown to be effective in the research lab have not moved into community settings, at least yet. When examining the right behavioral intervention for yourself or your child, it is important that the intervention incorporate the practices of effective behavioral interventions, rather than have a name or a specific methodology as discussed in the reference below. As one example, the music therapies of today represent a way to deliver communication interventions in a social environment, rather than just playing music. In order to see some of these evidence-based practices in action, you can see videos of them at the Autism Focused Intervention Resources and Modules resource of the NPDC on ASD.
Schreibman, L. et al. Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder. J Autism Dev Disord 45, 2411–2428, doi:10.1007/s10803-015-2407-8 (2015).