Autism Treatment: Children
There’s an array of evidence-based treatments for children with autism spectrum disorder (ASD). And there isn’t a single best treatment because children with ASD have different needs, abilities, and levels of severity.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) divides autism into three levels of severity, which is based on several factors: the kind of support a person needs; the extent of their social communication difficulties; and the degree of rigid behavior. More specifically, level 1 includes high-functioning individuals who need “support.” Level 2 includes individuals who require “substantial support,” and level 3 includes individuals who need “very substantial support.”
In other words, no two children with autism are alike, which means that their treatment plans will also vary.
In general, the consensus is that early intervention is important, and most kids with autism respond well to highly structured, specialized programs. The goal with any treatment is to match a child’s specific needs and abilities with strategies that will help them reach their greatest potential.
Applied behavior analysis (ABA) is a widely used and thoroughly researched approach for treating autism. ABA focuses on reinforcing positive, helpful behaviors and minimizing or stopping negative or harmful behaviors (such as self-injury). Today, there’s an assortment of ABA-based interventions.
Early and intensive behavioral intervention (EIBI) is the oldest of these interventions, which is used with children under 5 years old and is based on the work of O. Ivar Lovaas. EIBI is an intensive, structured, highly individual treatment. It may take 20 to 40 hours a week and last for several years.
Discrete trial training (DTT) is used in EIBI to teach a variety of skills. Each skill is divided into discrete, simple steps, which the child learns one-on-one with a therapist. Kids receive positive reinforcement for correct responses, which might be anything they enjoy (e.g., praise, listening to music, watching a video for a minute). DTT is typically used with incidental teaching for more natural situations.
Practice guidelines from the American Academy of Child and Adolescent Psychiatry, published in 2014, recommend ABA programs, including EIBI. In 2018, The Cochrane Database of Systematic Reviews concluded that evidence supports the use of EIBI for some children with autism. But the results should be interpreted with caution because the quality of the evidence is low: “Only a small number of children were involved in the studies, and only one study had an optimum design in which children were randomly assigned to treatment groups.”
Also, some autistic adults and autism advocacy groups question the use of ABA, believing it makes autistic individuals hide their true nature and change who they are. This article on Spectrumnews.org and this one from the Child Mind Institute highlight the varying perspectives.
Other ABA-based interventions are more naturalistic and use play (see below). Several of these, including the Early Start Denver Model (ESDM) and Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER), have been tested in randomized controlled trials.
- Early Start Denver Model (ESDM) helps kids from 12 to 48 months old, and parents are a significant part of treatment. ESDM uses play to strengthen language, social, and cognitive skills, and promote positive relationships. You can search for a provider at this link.
- Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER) focuses on the foundations of social communication (such as joint attention, imitation, and play) and emphasizes emotional and behavioral regulation. It helps kids ages 18 months to 6 years old and also involves parents. You can learn more about JASPER in this interview with its founder Connie Kasari.
- Pivotal Response Training (PRT) strives to stimulate a child’s motivation to learn, monitor their own behavior, and communicate with others. It focuses on pivotal areas of development instead of on specific skills. Improvements in these areas should have positive effects on other behaviors, too. PRT was developed by Robert and Lynn Koegel at the Koegel Autism Center at the University of California.
Additional interventions, which can be used in conjunction with ABA-based approaches, include:
- Developmental, Individual Differences, Relationship-Based Approach (DIR), also known as “Floortime,” involves parents playing and interacting with their kids on the floor. Parents meet their kids where they’re at—engaging in activities that their child enjoys and letting them lead—and help them bolster their strengths. DIR teaches six developmental capacities, including self-regulation, two-way communication, shared problem solving, and logical thinking. You can learn more about the treatment and find a provider at this link.
- Treatment and Education of Autistic and related Communication-handicapped Children (TEACCH) helps anyone with autism, from toddlers to adolescents to adults. Based on the idea that autistic individuals are visual learners, TEACCH uses images to teach various skills. The program is based at the University of North Carolina – Chapel Hill.
Overall, well-designed studies on treatment options for autism are still needed. As a 2018 review concluded, “Improved quality and co-ordination of research are major challenges to be overcome if future research is to better investigate the effects of early intervention for ASD.”
The biggest takeaway from the American Academy of Child and Adolescent Psychiatry guidelines is that a multidisciplinary treatment plan is critical. This includes considering communication, socialization, and behavioral challenges, along with co-occurring conditions and occupational needs. For instance, the above interventions might be combined with occupational or speech therapy.
Ultimately, the treatments you choose really depend on your child’s abilities, needs, and challenges, because there’s no one-size-fits-all intervention or superior treatment.
Research on treatments for autistic teens has been very limited with most studies focusing on childhood interventions. (Fortunately, interesting research is currently being conducted.)
Treatment options vary widely by city and state. For instance, the Program for the Education and Enrichment of Relational Skills (PEERS) at UCLA is a 16-week evidence-based social skills intervention for autistic individuals in middle school or high school.
The TEACCH® School Transition to Employment and Postsecondary Education Program (T-STEP) is a free intervention for 16- to 21-year-olds with autism at the University of North Carolina. It targets various transition skills, including goal setting, executive function, emotion regulation, and social skills.
Currently, there are no medications on the market for treating the core symptoms of autism: communication difficulties, social interaction challenges, and repetitive behavior. Behavioral therapy remains the best approach for addressing these symptoms.
The U.S. Food and Drug Administration has approved two atypical antipsychotics for treating autism-related irritability (e.g., physical aggression, self-injury, and severe tantrums). In 2006 risperidone (Risperdal) was approved for kids 5 to 17 years old. Three years later, aripiprazole (Abilify) was approved for kids 6 to 17. Other atypical antipsychotics may be prescribed, but research is limited on their effectiveness.
Atypical antipsychotics can have significant side effects, such as sedation, weight gain, increased risk for developing diabetes, tremors, and movement disorders.
Because autism commonly co-occurs with other conditions, doctors might prescribe medication to treat those symptoms. For instance, almost half of kids with autism also have symptoms of attention deficit hyperactivity disorder. A doctor might prescribe a stimulant or non-stimulant to reduce impulsivity and hyperactivity and to increase focus.
Anxiety and depression also are common in autism. Selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed to treat these symptoms, but the research on their efficacy is limited. In 2013 The Cochrane Database of Systematic Reviews concluded that “There is no evidence of effect of SSRIs in children and emerging evidence of harm.” A 2018 journal article noted that autistic people taking SSRIs might be at an increased risk for adverse reactions. An example is behavioral activation, which the authors define as: “a hyperarousal event characterized by impulsivity, restlessness and/or insomnia.”
Autism Speaks offers a tool kit for deciding whether your child should take medication, which includes a list of side effects, questions to ask your doctor, and stories from other families. They also offer another tool kit that helps you if your child is taking medication and includes keeping track of progress, managing side effects, and other tools and resources.
Connect with other families. There are various online options for connecting with families of autistic kids. For example, Wrong Planet—the largest online community for people with autism, ADHD, and other neurological differences—has forums for parents. You also can join the community of families at Autism Support Network and Autism Moms Support Group on Facebook. MyAutismTeam is a free social network for parents, as well.
Check out a variety of resources. Learn as much as you can about autism by reading a wide array of materials. For instance, The Thinking Person’s Guide to Autism offers a comprehensive list of resources (including information on books, communities, parenting, and research). The site also features articles on autism, and the editors have published a book called The Thinking Person’s Guide to Autism: What You Really Need to Know About Autism: From Autistics, Parents, and Professionals.
Spectrum is an online publication that features the latest news, research, and articles on autism.
TheAutismDad.com is a blog written by a full-time single father to three boys on the autism spectrum.
The Organization for Autism Research (OAR) features a blog written by many different writers.
Autism Speaks features a variety of tool kits and guides that you can download on everything from dental care to haircuts to sleep strategies to toilet training.
These books also might be helpful:
- The Real Experts: Readings for Parents of Autistic Children, a collection of writings from autistic authors
- What Every Autistic Girl Wishes Her Parents Knew by the Autism Women’s Network
- Autism Adulthood: Insights and Creative Strategies for a Fulfilling Life by Susan Senator, an activist and mom of an adult son with autism
- Living Independently on the Autism Spectrum by Lynne Soraya, an autistic adult and disability advocate
Healthline features nine recently published books on autism.
Know your child’s rights. The Autism Society features a thorough list of resources, information, and guides for navigating the educational system.
Keep your child safe. The Organization for Autism Research OAR) offers a guide you can download called Life Journey Through Autism: A Guide to Safety. It outlines major safety risks for autistic kids, teens, and adults, and offers tips and resources.
Learn about transitioning your child to adulthood. Currently, services for adults with autism are scarce. However, starting your research early can help. The Interactive Autism Network offers insights in this 4-part series. The Child Mind Institute also offers a series on navigating college, finding living options, and working.
The Organization for Autism Research (OAR) includes an 86-page guide for parents on helping their kids transition into adulthood, including information on early planning, employment, postsecondary education, and independent living skills.
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Williams K, Brignell A, Randall M, Silove N, Hazell P. (2013). Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews, 8, 1-51. DOI: 10.1002/14651858.CD004677.pub3.
Centers for Disease Control and Prevention. (2018, April 26). Treatment for autism spectrum disorder. Retrieved from https://www.cdc.gov/ncbddd/autism/treatment.html.
French, L., Kennedy, E.M.M. (2018). Annual Research Review: Early intervention for infants and young children with, or at-risk of, autism spectrum disorder: a systematic review. Journal of Child Psychology and Psychiatry 59, 4, 444–456. DOI: 10.1111/jcpp.12828.
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Lamy, M., Erickson, C.A. (2018). Pharmacological management of behavioral disturbances in children and adolescents with autism spectrum disorders. Current Problems in Pediatric and Adolescent Health Care, 48, 10, 250-264. DOI: https://doi.org/10.1016/j.cppeds.2018.08.015.
Monnier, J. (2018, October 4). Early interventions, explained. Spectrum. Retrieved from https://www.spectrumnews.org/news/early-interventions-explained.
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Tartakovsky, M. (2019). Autism Treatment: Children. Psych Central. Retrieved on April 2, 2020, from https://psychcentral.com/autism/autism-treatment-children/