Autism: Treatments

Treatments

While there's no proven cure yet for autism spectrum disorder (ASD), treating ASD early, using school-based programs, and getting proper medical care can greatly reduce ASD symptoms and increase your child's ability to grow and learn new skills.

Early intervention

Research has shown that intensive behavioral therapy during the toddler or preschool years can significantly improve cognitive and language skills in young children with ASD. There is no single best treatment for all children with ASD, but the American Academy of Pediatrics recently noted common features of effective early intervention programs. These include:

  • Starting as soon as a child has been diagnosed with ASD
  • Providing focused and challenging learning activities at the proper developmental level for the child for at least 25 hours per week and 12 months per year
  • Having small classes to allow each child to have one-on-one time with the therapist or teacher and small group learning activities
  • Having special training for parents and family
  • Encouraging activities that include typically developing children, as long as such activities help meet a specific learning goal
  • Measuring and recording each child's progress and adjusting the intervention program as needed
  • Providing a high degree of structure, routine, and visual cues, such as posted activity schedules and clearly defined boundaries, to reduce distractions
  • Guiding the child in adapting learned skills to new situations and settings and maintaining learned skills
  • Using a curriculum that focuses on
    • Language and communication
    • Social skills, such as joint attention (looking at other people to draw attention to something interesting and share in experiencing it)
    • Self-help and daily living skills, such as dressing and grooming
    • Research-based methods to reduce challenging behaviors, such as aggression and tantrums
    • Cognitive skills, such as pretend play or seeing someone else's point of view
    • Typical school-readiness skills, such as letter recognition and counting

One type of a widely accepted treatment is applied behavior analysis (ABA). The goals of ABA are to shape and reinforce new behaviors, such as learning to speak and play, and reduce undesirable ones. ABA, which can involve intensive, one-on-one child-teacher interaction for up to 40 hours a week, has inspired the development of other, similar interventions that aim to help those with ASD reach their full potential. ABA-based interventions include:

  • Verbal Behavior—focuses on teaching language using a sequenced curriculum that guides children from simple verbal behaviors (echoing) to more functional communication skills through techniques such as errorless teaching and prompting

  • Pivotal Response Training—aims at identifying pivotal skills, such as initiation and self-management, that affect a broad range of behavioral responses. This intervention incorporates parent and family education aimed at providing skills that enable the child to function in inclusive settings.

Other types of early interventions include:

  • Developmental, Individual Difference, Relationship-based(DIR)/Floortime Model—aims to build healthy and meaningful relationships and abilities by following the natural emotions and interests of the child. One particular example is the Early Start Denver Model, which fosters improvements in communication, thinking, language, and other social skills and seeks to reduce atypical behaviors. Using developmental and relationship-based approaches, this therapy can be delivered in natural settings such as the home or pre-school.
  • TEACCH (Treatment and Education of Autistic and related Communication handicapped Children)—emphasizes adapting the child's physical environment and using visual cues (for example, having classroom materials clearly marked and located so that students can access them independently). Using individualized plans for each student, TEACCH builds on the child's strengths and emerging skills.
  • Interpersonal Synchrony—targets social development and imitation skills, and focuses on teaching children how to establish and maintain engagement with others.

For children younger than age 3, these interventions usually take place at home or in a child care center. Because parents are a child's earliest teachers, more programs are beginning to train parents to continue the therapy at home.

Students with ASD may benefit from some type of social skills training program. While these programs need more research, they generally seek to increase and improve skills necessary for creating positive social interactions and avoiding negative responses. For example, Children's Friendship Training focuses on improving children's conversation and interaction skills and teaches them how to make friends, be a good sport, and respond appropriately to teasing.

Working with your child's school

Start by speaking with your child's teacher, school counselor, or the school's student support team to begin an evaluation. Each state has a Parent Training and Information Center and a Protection and Advocacy Agency that can help you get an evaluation. A team of professionals conducts the evaluation using a variety of tools and measures. The evaluation will look at all areas related to your child's abilities and needs.

Once your child has been evaluated, he or she has several options, depending on the specific needs. If your child needs special education services and is eligible under the Individuals with Disabilities Education Act (IDEA), the school district (or the government agency administering the program) must develop an individualized education plan, or IEP specifically for your child within 30 days.

IDEA provides free screenings and early intervention services to children from birth to age 3. IDEA also provides special education and related services from ages 3 to 21. Information is available from the U.S. Department of Education .

If your child is not eligible for special education services—not all children with ASD are eligible—he or she can still get free public education suited to his or her needs, which is available to all public-school children with disabilities under Section 504 of the Rehabilitation Act of 1973, regardless of the type or severity of the disability.

The U.S. Department of Education's Office for Civil Rights enforces Section 504 in programs and activities that receive Federal education funds. More information on Section 504 is available on the Department of Education website .

More information about U.S. Department of Education programs for children with disabilities is available on their website .

During middle and high school years, your child's teachers will begin to discuss practical issues such as work, living away from a parent or caregiver's home, and hobbies. These lessons should include gaining work experience, using public transportation, and learning skills that will be important in community living.

Medications

Some medications can help reduce symptoms that cause problems for your child in school or at home. Many other medications may be prescribed off-label, meaning they have not been approved by the U.S. Food and Drug Administration (FDA) for a certain use or for certain people. Doctors may prescribe medications off-label if they have been approved to treat other disorders that have similar symptoms to ASD, or if they have been effective in treating adults or older children with ASD. Doctors prescribe medications off-label to try to help the youngest patients, but more research is needed to be sure that these medicines are safe and effective for children and teens with ASD.

At this time, the only medications approved by the FDA to treat aspects of ASD are the antipsychotics risperidone (Risperdal) and aripripazole (Abilify). These medications can help reduce irritability—meaning aggression, self-harming acts, or temper tantrums—in children ages 5 to 16 who have ASD.

Some medications that may be prescribed off-label for children with ASD include the following:

  • Antipsychotic medications are more commonly used to treat serious mental illnesses such as schizophrenia. These medicines may help reduce aggression and other serious behavioral problems in children, including children with ASD. They may also help reduce repetitive behaviors, hyperactivity, and attention problems.
  • Antidepressant medications, such as fluoxetine (Prozac) or sertraline (Zoloft), are usually prescribed to treat depression and anxiety but are sometimes prescribed to reduce repetitive behaviors. Some antidepressants may also help control aggression and anxiety in children with ASD. However, researchers still are not sure if these medications are useful; a recent study suggested that the antidepressant citalopram (Celexa) was no more effective than a placebo (sugar pill) at reducing repetitive behaviors in children with ASD.
  • Stimulant medications, such as methylphenidate (Ritalin), are safe and effective in treating people with attention deficit hyperactivity disorder (ADHD). Methylphenidate has been shown to effectively treat hyperactivity in children with ASD as well. But not as many children with ASD respond to treatment, and those who do have shown more side effects than children with ADHD and not ASD.

All medications carry a risk of side effects. For details on the side effects of common psychiatric medications, see the NIMH website on "Mental Health Medications."

FDA warning about antidepressants

Antidepressants are safe and popular, but some studies have suggested that they may have unintended effects on some people, especially in teens and young adults. The FDA warning says that patients of all ages taking anti-depressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor. The latest information is available on the FDA website .

A child with ASD may not respond in the same way to medications as typically developing children. You should work with a doctor who has experience treating children with ASD. The doctor will usually start your child on the lowest dose that helps control problem symptoms. Ask the doctor about any side effects of the medication and keep a record of how your child reacts to the medication. The doctor should regularly check your child's response to the treatment.

You have many options for treating your child's ASD. However, not all of them have been proven to work through scientific studies. Read the patient information that comes with your child's medication. Some people keep these patient inserts along with their other notes for easy reference. This is most useful when dealing with several different prescription medications. You should get all the facts about possible risks and benefits and talk to more than one expert when possible before trying a new treatment on your child.