Overview of Treatment for Core Features of Autism
Once your child receives an autism diagnosis, don’t wait. Early diagnosis of ASD, coupled with swift and effective intervention, is critical to achieving the best possible outcomes for your child.
All states are required to provide early intervention services until children turn 3, at which point services are provided by your child’s 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 after age 3, 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 chelation, hyperbaric oxygen therapy, horseback riding, swimming with dolphins, high-dose vitamins, electromagnetic therapy, nicotine patches, and even drinking unpasteurized camel milk. These therapies lack evidence, 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 can improve muscle tone). To learn more about what it means for an intervention to be “evidence-based,” watch this seminar given by ASF CSO Alycia Halladay and Professor Giacomo Vivanti.
Treatment Options
Behavioral Interventions: Applied Behavioral Analysis (ABA)
ABA (Applied Behavior Analysis) is a therapy based on the science of learning and behavior. It uses positive reinforcement to teach new, helpful skills (like communication and daily tasks) and to reduce harmful or disruptive behaviors. It is highly individualized and widely used to support individuals with autism and developmental delays. 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.
There are several types of evidence-based behavioral interventions that are built on the principles of ABA, including:
- Early Intensive Behavioral Intervention (EIBI) is a type of ABA for very young children with ASD, usually younger than five and often younger than three years old. EIBI uses a 1:1 adult-to-child ratio in the early stages of treatment and utilizes discrete trial training methods (see below). This therapy can be implemented at home or at school, typically for 20-40 hours per week.
- Naturalistic Developmental Behavioral Interventions: This is a term to describe behavioral interventions that are delivered in a child’s natural environment (school or home, rather than in a clinic), sometimes in cooperation with parents or caregivers. It utilizes different practices to promote interaction and teach new skills, and emphasizes the child’s own interests and initiations. Many EIBIs delivered in naturalistic settings are also called Naturalistic Developmental Behavioral Interventions (NDBI). Some of these NDBIs include JASPR, Early Start Denver Model, and SCERTS. There are many other NDBIs that may not be named, but are based on NDBI principles. This is a blanket term for a number of interventions.
- Pivotal Response Training: PRT uses 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 considered 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 that integrates ABA techniques into an early intervention program. The intervention typically begins when the child is between 2 and 8, and no later than 12. The technique utilizes child-specific reinforcers to motivate and reward success. Additionally, the use of language and imitation is crucial for the teaching model. Click here to learn more about the Lovaas Model.
Read ASF’s statement on the use of ABA for autism here.
Caregiver-Mediated Interventions
Since parents and caregivers spend more time with preschool infants and toddlers than anyone else, methods have been developed for involving them in delivering interventions. These interventions teach caregivers specific strategies to support their child’s behavioral development in daily life across a variety of contexts children experience. Caregiver-mediated interventions expand the time available for therapeutic intervention by employing therapeutic techniques during everyday routines, such as meals, playtime, dressing, schoolwork, and social interactions. These interventions use techniques that have been shown to be effective when delivered by trained therapists in clinical settings. Some caregiver-mediated strategies can be learned through Autism Navigator, an online platform that provides evidence-based training and video resources for families and professionals.
Speech Therapy
Speech therapy with a licensed speech-language pathologist helps to improve a person’s communication skills, allowing them to better express their needs or wants. For individuals with ASD, speech therapy is often most effective when speech-language pathologists work with teachers, 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. Gestures, sign language, and picture communication programs are often useful tools for improving communication skills.
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 their body in space. Like Occupational therapy, physical therapy is designed 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 into an early intervention program.
Medications
There are no medications approved by the FDA that target the core features of ASD (though several phase 3 FDA trials are underway). There are several pharmaceutical treatments designed to ameliorate symptoms associated with ASD, including irritability, aggression, and self-injurious behavior. Medications should be prescribed and monitored by a qualified physician. Some of the most commonly prescribed medications include:
- Risperidone: Risperidone, also called risperdal, 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: Aripiprazole, also called abilify, is FDA-approved for the treatment of irritability in children and adolescents with ASD. A 2009 study published in Pediatrics found that among 98 children, 52% of those taking aripiprazole experienced a 25% or greater reduction in autism-related irritability symptoms by week 8 of the trial, compared with 14% of those taking 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 that show strong promise for both the core features of autism and co-morbid or co-occurring symptoms like depression, anxiety, ADHD, as well as sleep and GI problems. You can learn more about enrolling your child in a clinical trial here.
