Treatment & Intervention Options for ASDs

There is a wide variety of interventions and treatments for autism, but be aware that how effective each one is varies from person to person.  Progress with interventions such as behavioral, educational, and sensory integration interventions have proven quite promising while others such as pharmacotherapeutic management (with medications) currently is best applied to treating associated symptoms. The following is a brief description of what is currently available:

Behavioral and Educational Interventions:

Applied Behavior Analysis (ABA)

Also known as Discrete Trial (DT), ABA, developed in 1987, teaches a child how to learn by focusing on building skills in attending, imitation, receptive/expressive language, and pre-academics.  An ABA specialist, working on a 1:1 ratio, will give a child a directive, followed by a response from the child, and then a consequence based on the response (successful compliance, non-response, etc.), which can range from strong positive reinforcement to a negative “No”.  ABA has been effective in keeping children engaged for increasing lengths of time, eliciting verbal responses in some children, and is a jump start for many children. 

TEACCH

Stands for Treatment and Education of Autistic and related Communication handicapped Children.  In operation for 32 years, this method uses parents as co-therapists, with the main focus on autism rather than on behavior.  The goal of this therapy is to provide strategies that support the person through the lifespan and facilitate autonomy.  The emphasis is on visual learning, using functional contexts for teaching concepts on an individual level depending on an individual assessment.  Structure and predictability is used to promote spontaneous communication.  This model supports inclusive strategies and can potentially identify emerging skills.

PECS

Stands for Picture Exchange Communication System.  Emphasizing the difference between talking and communicating, this modality combines an understanding of speech therapy with an understanding of communication where a child does not attach meaning to words.  Often used with TEACCH, PECS’ goal is to help a child spontaneously initiate communication interaction, and to understand the function of communication.  Training on a 1:2 basis involves rewards; it begins with physically assisted exchanges and proceeds through 8 phases. PECS has helped children’s language get started and addresses both communication and social deficits of autism.

Floortime

Targets emotional development and is dependent on staff and parent observations of an autistic child to determine level of functioning.  This intervention builds from the child’s interactions and functioning and targets personal interactions as a way to facilitate developmental skills.  The child is looked at holistically, rather than focusing on distinct parts such as speech development and motor development.  All teaching is done in an interactive setting and addresses developmental delays in perceptual processing, sensory modulation, and motor sequencing.  It is usually done in 20 minute segments with 20 minute breaks.  Although there is no research to support the effectiveness of  Floortime, it does address emotional development and teaches parents how to engage an autistic child in a more relaxed manner.

Inclusion

The goal of inclusion is to educate children with disabilities with children who don’t have disabilities to the maximum extent possible.  Children with autism usually have a 1:1 aide with a modified curriculum.  Inclusion is a team approach and can provide opportunities for role modeling and social interaction; greater exposure to verbal communication; and opportunities for non-disabled peers to gain greater understanding and tolerances for differences.

Pharmacotherapeutic Management

There are no medications specifically marketed for the treatment of autism.  However, medications have been studied and researched for several years.  Some of the better-studied medications (including haloperidol and risperidone) are often effective in treating associated symptoms of autism (aggression, self-injurious behavior, severe tantrums, etc.) but can also cause unacceptable adverse effects. Early studies of serotonin re-uptake inhibitors appear promising but may not be indicated for all age groups. Small, controlled studies of methylphenidate and clonidine indicate a possible role for these medications in the treatment of hyperactivity in autism. No medications have been proven to be effective in the treatment of the core social or communication impairment seen in autism. Current pharmacological management is best aimed at targeting symptoms that can respond to medication, without adverse effects.  A child with ASD may not respond in the same way to medications as typically developing children so it is important that parents work with a health care provider who has experience with children with autism.

Dietary Interventions

Dietary interventions are based on the idea that food allergies cause symptoms of autism, and an insufficiency of a specific vitamin or mineral may cause some autistic symptoms. If parents decide to try a special diet, they should have their child's nutritional status monitored.  A diet that some parents have found helpful to autistic children is a gluten-free, casein-free diet. Gluten is a substance that is found in wheat, oat, rye, and barley. Casein is the principal protein in milk.  A supplement that some parents feel is beneficial for an autistic child is Vitamin B6 taken with magnesium (which makes the vitamin effective). The result of research studies is mixed; some children respond positively, some negatively, some not at all or very little.

Other Therapies

Multisensory Stimulation

Involves exposure to soothing and/or stimulating light, color, scents and music in carefully controlled environments. Such sensory integration therapies have been used in the therapy of patients with autism diagnoses since the 1970s.

Neurofeedback

A pilot study on 8 autistic children focused on the placement of electrodes on the scalp and the training of individuals to control their own brain waves. After ten weeks of therapy, five of the children performed better on tasks involving imitation. Individuals with autism are thought to have mu wave dysfunction, associated with mirror neurons, brain cells that play a critical role in mimicking the behaviors of others and in development of the capacity for empathy.