Your child has received a diagnosis of autism. You are faced with many choices that can seem overwhelming. What kind of facility can support your child’s needs? What kinds of treatments or interventions are best suited to your child? How do you learn how the different treatment approaches work?
It may be comforting to know that The American Academy of Pediatricians advises that “early and intensive behavioral and educational intervention can make a significant positive impact on long-term outcomes.” You’ve taken an important first step by seeking out information. If you learn as much as you can, visit schools and facilities offering care, and consider all your options, you’ll be ready to make a decision about the treatment options that most suit your child’s needs.
Children with autism are unique individuals: their diagnoses can range from mild to severe, and they can have a wide variety of behaviors. Because of this, a combination of therapies and/or treatments may be recommended and specifically tailored to each child. These therapies may improve specific behavioral skills of people with autism and help their families lead more normal lives. Be sure to inform your child's healthcare provider of any changes in treatment or therapy.
Treatment therapies include developmental, behavioral, and educational intervention strategies, and are widely available. We’ll discuss some of those strategies, as well as some of the nontraditional therapies that your pediatrician or other healthcare professional can advise you about.
Your Health Care Team
The American Academy of Child and Adolescent Psychiatry (AACAP) recommends that several types of healthcare professionals and services be involved in taking care of a child with autism. This team should be under the direction of one healthcare professional that will develop, organize, advocate for, and watch over your child’s specific program.
The team may include some or all of the following healthcare professionals:
- Developmental Pediatrician: Specializes in treating children with developmental delays and certain handicaps.
- Child Psychiatrist: Helps with diagnosis, social interaction, behavior, and emotional adjustment. Can prescribe medications.
- Child Psychologist: Helps parents better understand the scope of a child’s condition and how it affects daily life.
- Neuropsychologist: A psychologist with specialized training in the evaluation of cognitive functions.
- Behavior Analyst: A psychologist or related professional with specialized training in applied behavior analysis (ABA).
- Occupational Therapist: Focuses on teaching everyday skills such as getting dressed and eating, as well as addressing sensory issues and fine motor skill development.
- Physical Therapist: Helps improve body coordination, muscle strength, and motor skills through various exercises and body positioning.
- Speech/Language Therapist: Specializes in developing better verbal communication skills through various exercises, techniques and play.
- Social Worker: Provides counseling and other services to families in need.
Your team leader will help you get the care your child needs by:
- Finding the right services and educational programs
- Helping you find additional resources to care for your child
- Working with other healthcare professionals on behavior management programs and medications
How Do I Choose a Treatment Program?
The National Autism Center recently published the National Standards Report, a comprehensive analysis of the effectiveness of available treatment options for autism. It is a good place to start when trying to understand treatment options. The Report quantifies the level of scientific evidence supporting various educational and behavioral treatments that target the core characteristics of autism spectrum disorders and rates them in four categories: established/effective, emerging, unestablished, and ineffective/harmful. The Report utilizes research from 775 different studies and ranks a total of 38 treatments.
Below are the 11 treatments the National Standards Project identified as effective based on compelling scientific evidence:
- Antecedent Package: the modification of situational events that typically precede the occurrence of a target behavior. Examples: cueing and prompting; environmental enrichment; habit reversal; incorporating echolalia, special interests, thematic activities, or ritualistic/obsessional activities into tasks; and stimulus variation.
- Behavioral Package: reduces problem behavior and teaches functional alternative behaviors or skills through the application of basic principles of behavior change.Examples: behavioral toilet training/dry bed training; contingency mapping; differential reinforcement strategies; functional communication training; and progressive relaxation.
- Comprehensive Behavioral Treatment for Young Children: reflects research from comprehensive treatment programs that involve a combination of applied behavior analytic procedures which are delivered to young children (generally under the age of 8.) Examples: discrete trial and incidental teaching.
- Joint Attention Intervention: involves building foundational skills involved in regulating the behaviors of others; often involves teaching a child to respond to the nonverbal social bids of others or to initiate joint attention interactions. Examples: pointing to objects, showing items/activities to another person, and following eye gaze.
- Modeling: relies on an adult or peer providing a demonstration of the target behavior that should result in an imitation of the target behavior by the individual with ASD. Modeling can include simple and complex behaviors and is often combined with other strategies such as prompting and reinforcement. Examples: live modeling and video modeling.
- Naturalistic Teaching Strategies: use primarily child-directed interactions to teach functional skills in the natural environment; often involve providing a stimulating environment, modeling how to play, encouraging conversation, providing choices and reinforcers, and rewarding reasonable attempts. Examples: focused stimulation, incidental teaching, milieu teaching, embedded teaching, and responsive education and prelinguistic milieu teaching.
- Peer Training Package: teaching children without disabilities strategies for facilitating play and social interactions with children on the autism spectrum. Peers may often include classmates or siblings. Examples: peer networks, circle of friends, buddy skills package, Integrated Play Groups™, peer initiation training, and peer-mediated social interactions.
- Pivotal Response Treatment: focuses on targeting “pivotal” behavioral areas — such as motivation to engage in social communication, self-initiation, self-management, and responsiveness to multiple cues, with the development of these areas having the goal of very widespread and fluently integrated collateral improvements. Key aspects also focus on parent involvement in the intervention delivery, and on intervention in the natural environment such as homes and schools with the goal of producing naturalized behavioral improvements.
- Schedules: the presentation of a task list that communicates a series of activities or steps required to complete a specific activity; often supplemented by other interventions such as reinforcement. Examples: written words, pictures or photographs, or work stations.
- Self-management: promoting independence by teaching individuals with ASD to regulate their behavior by recording the occurrence/non-occurrence of the target behavior, and securing reinforcement for doing so. Initial skills development may involve other strategies and may include the task of setting one’s own goals. Examples: use of checklists, wrist counters, visual prompts, and tokens.
- Story-based Intervention Package: involves a written description of the situations under which specific behaviors are expected to occur. Example: Social Stories™ are the most well-known story-based interventions. They seek to answer the “who,” “what,” “when,” “where,” and “why” in order to improve perspective-taking.
Of note, 22 treatments were rated as "emerging", meaning that they have some evidence of efficacy but have not yet been proven to be beneficial, and five treatments were rated as "unestablished", meaning that their effectiveness is not supported by current research.
The American Academy of Pediatrics (AAP) also found the following things to be important to the success of a treatment program:
- Initiation of early intervention
- Involvement and cooperation with a child’s family
- Treatment designed specifically for each individual child
The Importance of Collaboration & Communication
Whichever treatment program you choose, it’s important that you work together with your child’s treatment team. This may increase your child’s success in learning new behavioral and communication skills, as well as keeping your family informed.
It’s important to make sure that the treatment team has at least a basic understanding of your child’s skill set at home and knows your expectations for your child at school. Two-way communication can lead to a better evaluation of your child’s progress. It’s also a good idea to record as much information as possible about your child’s progress at home and at school. This information can be shared with your healthcare team and enable them to more accurately assess your child’s treatment plan on an ongoing basis.