Treatments for Autism

Posted on August 11, 2018

There is at present no cure for autism, although a very small percentage of people experience “optimal outcome,” eventually losing all symptoms of autism. The good news is that while autism is not curable, many people experience improvement with treatment.

Autism is truly a spectrum with a wide range of behaviors and symptoms at differing severity levels, and each individual experiences them differently. For this reason, people with autism may benefit from different types of treatment. There is no one type of treatment that will be effective for every person with autism. Finding the most effective combination of therapies is key.

Autism treatments include an array of behavioral, psychosocial, and educational therapies, medications, and supportive therapies.

Therapy for core autism symptoms

Early intensive behavioral intervention has been proven effective in multiple studies for improving social, communication and learning skills in children with autism. In early behavior intervention, toddlers and preschoolers spend at least 25 hours per week in structured activities with one or more specialists. School-age children may continue therapy in school or receive sessions after school.

An early behavioral intervention regimen may involve multiple specialists and providers, including pediatricians, child psychologists, specially-trained teachers, occupational therapists, and speech-language therapists. Parents may also be trained in how to keep family time consistent with what is being learned in therapy.

There are many different models of therapy for autism. Multiple approaches may be incorporated into a treatment regimen.

Applied behavior analysis (ABA)

ABA methods involve structured activities and breaking skills down into simple steps. Some techniques are led by the behavior analyst, while some are led by the child. The child will receive positive reinforcement for correct answers and responses that promote learning, and no reinforcement for incorrect answers and behaviors that distract from learning.

Discrete trial training (DTT)

Also known as discrete trial teaching, DTT is one ABA instructional method. DTT breaks down skills into discrete components and teaches them one by one. As DTT progresses, discrete skills are linked together into more complex skills.

Early start Denver model (ESDN)

ESDN focuses on relationships and the naturalistic teaching principles of applied behavior analysis. The child is motivated to learn by parental involvement, engagement in joint activities, and interpersonal exchange. ESDN activities are designed to be enjoyable for the child in order to foster motivation to learn.

Floortime

During floortime, the parent, caregiver or therapist sits on the floor with the child, joining them on their level. The play is led by the child, and the adult is responsive. The child is challenged to be creative and spontaneous in play, which also incorporates sensory stimulation, motor skills, and communication.

Pivotal response training (PRT)

PRT is play-based. In PRT, the child plays a leading role in choosing activities and objects utilized in exchanges. The therapist frequently shares control with the child. For example, the therapist may perform the first few steps in a task, then turn it over to the child to complete. Activities are varied and regularly interspersed with maintenance tasks. The therapist rewards all meaningful attempts that show the child’s intent to achieve the target behavior.

Social skills therapy

There are many approaches to social skills therapy. One technique utilizes small groups consisting of children with ASD and neurotypical children who have received some training in interacting with autistic individuals. Some social skills therapists use visual elements to promote understanding of social interactions. In social skills therapy, children may play games or watch videos of interactions.

Verbal behavior (VB) intervention

Also known as or verbal behavior therapy or applied verbal behavior, VB intervention is associated with applied behavior analysis. VB teaches children with ASD that any purposeful communication can bring positive results.

Occupational therapy (OT)

OT is focused on helping children with autism gain and improve the skills to engage in daily activities. An occupational therapist can help autistic children improve participation in self-care such as feeding and dressing, play skills, and school life. Occupational therapy can also help families of autistic children better understand sensory issues, respond to problems, and communicate more effectively with their child.

Physical therapy (PT)

PT is focused on helping children with autism improve their motor skills, coordination and sensory integration. A physical therapist can help autistic children improve posture, balance and gross motor activities such as walking, sitting and jumping. Physical therapy can also address sensory issues, helping parents better understand these problems and find better ways to cope.

Speech therapy

There are many different approaches to speech therapy depending on the child’s needs. For children who are nonverbal or have trouble producing understandable speech, the SLP may use augmentative and alternative communication (AAC). AAC is a nonverbal approach to communication by using sign language, visual cues such as photos or videos, written words, or devices like computers and tablets. Speech therapists can also help with pragmatic, or social, aspects of communication. For example, the SLP can help children develop joint attention, learn how to begin and end conversations, and take turns talking. The speech therapist may also improve the flow of a child’s communication by having him sing songs designed to mimic the rhythm of conversation.

TEACCH Autism Program

The TEACCH program is mainly a classroom-based framework for learning. Using an approach called “Structured TEACCHing”, the program focuses on specific characteristics of learners with ASD to work on social communication, maintaining attention, and improving executive function.

Relationship development integration (RDI)

RDI is a type of family-based behavioral therapy focused on building personal relationships. RDI fosters dynamic intelligence, described as the ability to think flexibly.

Social Communication/Emotional Regulation/Transactional Support (SCERTS)

SCERTS incorporates aspects of PRT, TEACCH, floortime, and RDI. SCERTS promotes child-initiated communications. Children learn largely from other children, most commonly in a classroom setting.

Medications

People with autism who experience seizures or those whose harmful behaviors are not modified by therapy may benefit from medications. Most classes of drugs prescribed for people with autism work by changing the balance of neurotransmitters in the brain.

Anti-epileptic drugs (AEDs)

Approximately one-third of people on the autism spectrum also have epilepsy. On average, AEDs will work for 70 percent of people with epilepsy. In as many as 20 to 40 percent of epilepsy cases, seizures cannot be adequately controlled with any type of anticonvulsant medication. Drug-resistant epilepsy is also known as intractable or refractory epilepsy. In cases where AEDs are ineffective, doctors may recommend a special diet, an implanted device, or surgery.

AEDs commonly prescribed for children with both autism and epilepsy include Dilantin (Phenytoin), Klonopin (Clonazepam), and Carbamazepine, which is sold under the brand names Tegretol and Carbatrol.

Antipsychotics

Antipsychotics such as Abilify (Aripiprazole), Risperdal (Risperidone), Clozaril (Clozapine), Zyprexa (Olanzapine), Seroquel (Quetiapine), and Geodon (Ziprasidone) may be prescribed to help control self-harming behavior and aggression. Common side effects include weight gain, sleepiness, drooling, tremors, and movement disorders.

Antidepressants

Antidepressants may be prescribed to treat anxiety, depression, or obsessive-compulsive behavior. Some of the most commonly prescribed antidepressants include Prozac (Fluoxetine), Zoloft (Sertraline), Paxil (Paroxetine), Celexa (Citalopram), Elavil (Amitriptyline), Effexor (Venlafaxine), and Lexapro (Escitalopram). Wellbutrin (Bupropion hydrochloride) is an antidepressant that has shown effectiveness at treating both depression and ADHD. Common side effects of antidepressants include drowsiness, nausea, and weight gain.

Stimulants

Sometimes prescribed to treat attention deficit hyperactivity disorder (ADHD), common stimulants include Ritalin (Methylphenidate), Adderall (Amphetamine and Dextroamphetamine), Focalin (Dexmethylphenidate hydrochloride), Concerta (Methylphenidate), and Dexedrine (Dextroamphetamine). Strattera (Atomoxetine hydrochloride) is a non-stimulant indicated for the treatment of ADHD. Common side effects of stimulants include loss of appetite, weight loss, tics, sleep disturbances, and abdominal pain.

Benzodiazepines

Benzodiazepines may be used to treat anxiety or seizures. Drugs in this class include Xanax (Alprazolam), Ativan (Lorazepam), and Valium (Diazepam).

People with autism who experience gastrointestinal symptoms such as chronic diarrhea or constipation may be treated with laxatives or antidiarrheals.

Diet and nutrition

Restricted diets can benefit some people with autism who experience seizures or gastrointestinal issues. Others find that identifying problematic foods can improve behavioral issues, too. Diet changes should be made with your doctor’s knowledge and guidance.

The most popular special diet for autism is the gluten-free/casein-free (GFCF) diet. Gluten is a protein found in wheat, rye, and barley and in most products made from these grains. Casein is a protein found in milk and most milk products. Some researchers believe that these substances are not broken down properly by the digestive systems of children with autism. They theorize that autistic symptoms stem in part from a build-up of one or both of these substances, which results in inflammation of the gastrointestinal system.

People with both autism and epilepsy that does not respond to medication may be recommended by a doctor to try the ketogenic diet. The ketogenic diet is an extreme diet involving fasting and monitoring by a physician and a nutritionist. The purpose of the diet is to force the body to burn fat for energy instead of carbohydrates, increasing the level of molecules called ketones in the blood. For some children, a high level of ketones reduces seizure activity. Since the ketogenic is a highly restrictive diet that can cause side effects, it should be medically supervised throughout.

You may consider having your child tested for food allergies, lactose intolerance or celiac disease. These tests can help pinpoint which foods to avoid to keep your child their healthiest.

Another way to find out which foods may cause trouble for your child is to use an elimination diet. In an elimination diet, you avoid all common allergens and problematic foods completely for a period, usually one month, then slowly reintroduce them one at a time. During this process, you keep a record of what your child eats and how they feel and behave. Elimination diets can provide valuable cues about which foods to avoid.

Trying a new diet for two or three months should give you a clear idea of whether or not it is helping your child. Keep a daily record what your child eats and how they feel and behave in order to track changes.

Some supplements, including a daily comprehensive multivitamin and nutrients such as omega-3 fatty acids, probiotics, and vitamin B-6 taken with magnesium, have shown promise in improving the health or behavior of some autistic children.

Supportive therapies

Hippotherapy (Horseback riding)

Hippotherapy involves riding and caring for horses. Horseback riding provides multisensory stimulation and increases balance and awareness of the body as it moves with the horse.

Music therapy

Music therapy uses music as an element to promote intellectual and emotional development. In autism spectrum disorders (ASD), music helps to motivate, relax, and engage children. Music therapy can help foster communication, positive social behaviors, and emotional growth.

Complementary and alternative therapies

At least one-third of families with children on the autism spectrum try one or more forms of complementary or alternative therapies, also known as natural or integrative treatments. While some families report positive results when using complementary treatments, it is important to note that most integrative approaches have not been proven safe or effective in clinical trials. Complementary treatments may include massage, acupuncture, traditional Chinese medicine, energy therapies, and biomedical approaches such as chelation therapy to remove toxic metals, probiotics, and sulfate or iodine supplements.

Supplements containing melatonin, a hormone produced in the human body that helps regulate sleep, may help some people with autism who suffer from sleep problems.

Service dog

A trained service dog can help keep a child with autism safe and calm in several ways. Dogs can be trained to track a child who wanders. A child can be “tethered” by holding the dog’s leash to prevent bolting. Dogs can also be trained to disrupt repetitive behaviors by touching or nudging the child, and to respond to meltdowns by snuggling or lying on the child to provide pressure. Dogs can also be trained to support people during seizures.

Resources

External resources

MyAutismTeam resources

FAQs

Can I get help paying for autism treatments?

Treatment for autism can be costly, and health insurance may cap or exclude costs for some services. Adults with autism or families with children who have autism may be eligible for one or more forms of government assistance. There are also private and non-profit organizations that offer grants to help cover autism therapies.

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