Treatment and Intervention Services for Autism Spectrum Disorder

Currently, no treatment has been shown to cure ASD, but several interventions have been developed and studied for use with young children. These interventions may reduce symptoms, improve cognitive ability and daily living skills, and maximize the ability of the child to function and participate in the community [1-6].

The differences in how ASD affects each person means that people with ASD have unique strengths and challenges in social communication, behavior, and cognitive ability. Therefore, treatment plans are usually multidisciplinary, may involve parent-mediated interventions, and target the child’s individual needs.

Behavioral intervention strategies have focused on social communication skill development—particularly at young ages when the child would naturally be gaining these skills—and reduction of restricted interests and repetitive and challenging behaviors. For some children, occupational and speech therapy may be helpful, as could social skills training and medication in older children. The best treatment or intervention can vary depending on an individual’s age, strengths, challenges, and differences [7].

It is also important to remember that children with ASD can get sick or injured just like children without ASD. Regular medical and dental exams should be part of a child’s treatment plan. Often it is hard to tell if a child’s behavior is related to the ASD or is caused by a separate health condition. For instance, head banging could be a symptom of ASD, or it could be a sign the child is having headaches or earaches. In those cases, a thorough physical examination is needed. Monitoring healthy development means not only paying attention to symptoms related to ASD, but also to the child’s physical and mental health.

Not much is known about the best interventions for older children and adults with ASD. There has been some research on social skills groups for older children, but there is not enough evidence to show that these are effective [8]. Additional research is needed to evaluate interventions designed to improve outcomes in adulthood. In addition, services are important to help individuals with ASD complete their education or job training, find employment, secure housing and transportation, take care of their health, improve daily functioning, and participate as fully as possible in their communities [9].

Types of Treatments

There are many types of treatments available. These include applied behavior analysis, social skills training, occupational therapy, physical therapy, sensory integration therapy, and the use of assistive technology.

The types of treatments generally can be broken down into the following categories:

  • Behavior and Communication Approaches
  • Dietary Approaches
  • Medication
  • Complementary and Alternative Medicine

Behavior and Communication Approaches

According to reports by the American Academy of Pediatrics and the National Research Council, behavior and communication approaches that help children with ASD are those that provide structure, direction, and organization for the child in addition to family participation [10].

Applied Behavior Analysis (ABA)
A notable treatment approach for people with ASD is called applied behavior analysis (ABA). ABA has become widely accepted among healthcare professionals and used in many schools and treatment clinics. ABA encourages positive behaviors and discourages negative behaviors to improve a variety of skills. The child’s progress is tracked and measured.

There are different types of ABA. Here are some examples:

  • Discrete Trial Training (DTT)
    DTT is a style of teaching that uses a series of trials to teach each step of a desired behavior or response. Lessons are broken down into their simplest parts, and positive reinforcement is used to reward correct answers and behaviors. Incorrect answers are ignored.
  • Early Intensive Behavioral Intervention (EIBI)
    This is a type of ABA for very young children with ASD, usually younger than 5 and often younger than 3. EIBI uses a highly structured teaching approach to build positive behaviors (such as social communication) and reduce unwanted behaviors (such as tantrums, aggression, and self-injury). EIBI takes place in a one-on-one adult-to-child environment under the supervision of a trained professional.
  • Early Start Denver Model (ESDM)

This is a type of ABA for children with ASD between the ages of 12-48 months. Through ESDM, parents and therapists use play and joint activities to help children advance their social, language, and cognitive skills.

  • Pivotal Response Training (PRT)
    PRT aims to increase a child’s motivation to learn, monitor their own behavior, and initiate communication with others. Positive changes in these behaviors are believed to have widespread effects on other behaviors.
  • Verbal Behavior Intervention (VBI)
    VBI is a type of ABA that focuses on teaching verbal skills.

There are other therapies that can be part of a complete treatment program for a child with ASD:

Assistive Technology
Assistive technology, including devices such as communication boards and electronic tablets, can help people with ASD communicate and interact with others. For example, the Picture Exchange Communication System (PECS) uses picture symbols to teach communication skills. The person is taught to use picture symbols to ask and answer questions and have a conversation. Other individuals may use a tablet as a speech-generating or communication device.

Developmental, Individual Differences, Relationship-Based Approach (also called “Floortime”)
Floortime focuses on emotional and relational development (feelings and relationships with caregivers). It also focuses on how the child deals with sights, sounds, and smells.

Treatment and Education of Autistic and related Communication-handicapped CHildren (TEACCH)external icon
TEACCH uses visual cues to teach skills. For example, picture cards can help teach a child how to get dressed by breaking information down into small steps.

Occupational Therapy
Occupational therapy teaches skills that help the person live as independently as possible. Skills may include dressing, eating, bathing, and relating to people.

Social Skills Training
Social skills training teaches children the skills they need to interact with others, including conversation and problem-solving skills.

Speech Therapy
Speech therapy helps to improve the person’s communication skills. Some people are able to learn verbal communication skills. For others, using gestures or picture boards is more realistic.

Visit the Autism Speaksexternal icon, Autism Societyexternal icon, or National Center for Child Health and Human Developmentexternal icon website to read more about these therapies.

Dietary Approaches

Some dietary treatments have been developed to address ASD symptoms. However, a 2017 systematic review of 19 randomized control trials found little evidence to support the use of dietary treatments for children with ASD [11].

Some biomedical interventions call for changes in diet. Such changes can include removing certain foods from a child’s diet and using vitamin or mineral supplements. Dietary treatments are based on the idea that food allergies or lack of vitamins and minerals cause symptoms of ASD. Some parents feel that dietary changes make a difference in how their child acts or feels.

If you are thinking about changing your child’s diet, talk to the doctor first or with a registered dietitian to be sure your child’s diet includes the necessary vitamins and minerals for their growth and development.

Medication

There are no medications that can cure ASD or treat the core symptoms. However, there are medications that can help some people with ASD function better. For example, medication might help manage high energy levels, inability to focus, anxiety and depression, behavioral reactivity, self-injury, or seizures.

Medications might not affect all children in the same way. It is important to work with a healthcare professional who has experience in treating children with ASD. Parents and healthcare professionals must closely monitor a child’s progress and reactions while he or she is taking a medication to be sure that any negative side effects of the treatment do not outweigh the benefits.

To learn more about medication and ASD, please visit the National Institute of Child Health and Human Development’s websiteexternal icon.

Complementary and Alternative Medicine Treatments

To relieve the symptoms of ASD, some parents and healthcare professionals use treatments that are outside of what is typically recommended by pediatricians. These treatments are known as complementary and alternative medicine (CAM) treatments. CAM treatments refer to products or services that are used in addition to or instead of traditional medicine. They might include special diets, dietary supplementsexternal icon, chelation (a treatment to remove heavy metals such as lead from the body), biologicals (for example, secretin), or mind-body medicine [12].

Many of these treatments have not been studied for effectiveness; moreover, a review of studies on chelation found some evidence of harm and no evidence to indicate it is effective in treating children with ASD [13]. Current research shows that as many as one-third of parents of children with ASD may have tried CAM treatments, and up to 10% may be using a potentially dangerous treatment [14-17]. Before starting such a treatment, talk to your child’s doctor.

To learn more about CAM therapies for ASD, go to the National Center for Complementary and Alternative Medicine’s Autismexternal icon webpage. The FDA has information about potentially dangerous treatments hereexternal icon.

Additional Treatment Resources

The National Institute on Deafness and Other Communication Disordersexternal icon has a website to help individuals with ASD who have communication challenges.

The National Institute of Dental and Craniofacial Researchexternal icon has resources to help caregivers and health professionals with the oral healthcare needs of individuals with ASD.

Clinical Trials.Govexternal icon lists federally funded clinical trials that are looking for participants. If you or someone you know would like to take part in an autism study, go to the website and search “autism.”

The Autism Treatment Networkexternal icon (ATN) seeks to create standards of medical treatment that will be made broadly available to physicians, researchers, parents, policymakers, and others who want to improve the care of individuals with autism. ATN is also developing a shared national medical database to record the results of treatments and studies at any of their five established regional treatment centers.

References

  1. Dawson, G., et al., Early behavioral intervention is associated with normalized brain activity in young children with autism. J Am Acad Child Adolesc Psychiatry, 2012. 51(11): p. 1150-9.
  2. Dawson, G., et al., Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics, 2010. 125(1): p. e17-23.
  3. Reaven, J., et al., Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial. J Child Psychol Psychiatry, 2012. 53(4): p. 410-9.
  4. Reichow, B., et al., Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev, 2018. 5: p. CD009260.
  5. Vivanti, G., C. Dissanayake, and A.T. Victorian, Outcome for Children Receiving the Early Start Denver Model Before and After 48 Months. J Autism Dev Disord, 2016. 46(7): p. 2441-9.
  6. Weitlauf, A., M.L. McPheeters, and B. Peters, Therapies for children with autism spectrum disorder: behavioral interventions update, in Comparative Effectiveness Review. 2014, Agency for Healthcare Research and Quality: Rockville, MD.
  7. Brookman-Frazee LI, Drahota A, Stadnick N. Training community mental health therapists to deliver a package of evidence-based practice strategies for school-age children with autism spectrum disorders: A pilot study. J Autism Dev Disord. 2012;42(8):1651–1661.
  8. Reichow, B., A.M. Steiner, and F. Volkmar, Cochrane review: social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD). Evid Based Child Health, 2013. 8(2): p. 266-315.
  9. Interagency Autism Coordinating Committee. IACC Strategic Plan for Autism Spectrum Disorder (ASD) Research—2016-2017 Update. Retrieved from the U.S. Department of Health and Human Services Interagency Autism Coordinating Committee website: https://iacc.hhs.gov/publications/strategic-plan/2017/external icon.
  10. Hyman SL, Levey SE, Myers SM, Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Peditarics. 2020 Jan;145(1).
  11. Sathe, N., et al., Nutritional and Dietary Interventions for Autism Spectrum Disorder: A Systematic Review. Pediatrics, 2017. 139(6): p. e20170346.
  12. Hofer, J., F. Hoffmann, and C. Bachmann, Use of complementary and alternative medicine in children and adolescents with autism spectrum disorder: A systematic review. Autism, 2017. 21(4): p. 387-402.
  13. James, S., et al., Chelation for autism spectrum disorder (ASD). Cochrane Database Syst Rev, 2015. 5: p. CD010766.
  14. Krishnaswami, S., M.L. McPheeters, and J. Veenstra-Vanderweele, A systematic review of secretin for children with autism spectrum disorders. Pediatrics, 2011. 127(5): p. e1322-5.
  15. Williams K, Wray JA, Wheeler DM. Intravenous secretin for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2012;(4):CD003495.
  16. Perrin, J.M., et al., Complementary and alternative medicine use in a large pediatric autism sample. Pediatrics, 2012. 130 Suppl 2: p. S77-82.
  17. Levy, S.E., et al., Use of complementary and alternative medicine among children recently diagnosed with autistic spectrum disorder. J Dev Behav Pediatr, 2003. 24(6): p. 418-23.