Autism Spectrum Disorder Treatments & Therapies for Children

Autism spectrum disorder (ASD) is a developmental condition that significantly impacts communication, social interaction, and behavior. Its severity varies among individuals, with symptoms typically manifesting in early childhood and persisting throughout life.

Notably, the prevalence of ASD is on the rise, with 2.8% of 8-year-old children in 11 areas of the US identified with the disorder in 2020, up from 2.3% in 2018. Boys are disproportionately affected, with ASD being 3.8 times more prevalent compared to girls.

Despite the growing awareness, families of children with ASD often struggle with uncertainty. The broad spectrum of symptoms makes it challenging to navigate treatment options, leading to trial-and-error approaches and financial strain.

To address this, this article provides a comprehensive overview of autism spectrum disorder treatments. Through practical insights and tips, it aims to empower families to make well-informed decisions regarding their child's care.

1. Behavioral Therapies

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These programs focus on social skills, attention, sleep, play, anxiety, parent interaction, and challenging behaviors to help a child's overall development. Trained providers usually work closely with parents and children, sometimes up to 40 hours a week. These programs can last 12 weeks to 3 years and are held in homes, schools, and clinics.

Applied Behavior Analysis (ABA)

Autism behavioral therapy focuses on improving specific behaviors and skills through structured techniques based on behavioral psychology, particularly Applied Behavior Analysis (ABA).

ABA helps children reach positive goals and reduce negative behaviors. Ideally, a trained therapist works one-on-one with the child for 40 or more hours per week. The process begins with observation and goal setting.

The therapist rewards desired behaviors and ignores undesirable ones. Involving parents or caregivers in ABA can reduce the therapist's time and help the child in real social situations.

Different types of ABA techniques for autism spectrum disorder treatment include:

Discrete Trial Training (DTT)

Discrete Trial Training is an ABA technique that breaks skills into small, manageable steps. Each step is taught individually, with correct responses being rewarded. A discrete trial involves five key steps:

• Instruction: The instructor gives a clear task, such as "touch your head."
• Prompt: The instructor might point to the child's head to guide them.
• Response: The child performs the task by touching their head.
• Consequence: The instructor provides positive reinforcement, like praise, for completing the task.
• Pause: The instructor waits a few seconds before beginning the next trial.

DTT is particularly effective for teaching complex skills, such as dressing themselves or preparing a simple meal.

Although some researchers have criticized DTT for its rigidity, a recent study found that combining DTT with mass trials and naturalistic training led to significant behavior improvements, especially in 13-16-year-olds.

Pivotal Response Training (PRT)

Pivotal Response Treatment (PRT) is a play-based form of ABA used by doctors and specialists to teach language and improve social, communication, and academic skills in autistic children. This autism spectrum disorder treatment focuses on pivotal behaviors like:

• Motivation
• Self-management
• Social interactions
• Response to multiple cues

During a PRT session, if a child makes a meaningful attempt to say "ball" while reaching for it, they are given the ball. The immediate reward reinforces their communication effort.

A 2021 study assessed the effectiveness of PRT in teaching question-asking initiations to four children with ASD. The findings indicate that PRT was highly effective, with children not only learning to ask questions but also maintaining these skills long-term and generalizing them to natural settings. Additionally, PRT led to positive collateral improvements in language development and other developmental areas.

Early Intensive Behavioral Intervention (EIBI)

EIBI is a form of ABA therapy designed for autistic preschoolers (children under the age of 5). This autism therapy aims to accelerate learning to prevent and narrow developmental gaps. By teaching appropriate behavior early, EIBI sets a foundation for lifelong skills in children with autism.

Through EIBI, children can acquire the following skills:

• Enhance attention span
• Develop imitation skills
• Improve language comprehension and usage
• Increase daily living skills

Studies on the efficacy of EIBI are mixed. One systematic review found weak evidence of EIBI’s effectiveness as an autism spectrum disorder treatment. Another review indicated that EIBI may benefit some, but not all, with the greatest gains occurring in the first 12 months of treatment.

On the other hand, an older study showed improvements in adaptive behavior, IQ, communication skills (both expressive and receptive), daily communication, socialization, and daily living skills, favoring EIBI.

Early State Denver Model (ESDM)

The ESDM is designed for very young children with autism, ranging from 12 months to four years old. It aims to enhance progress in several critical areas, including:

• Social skills
• Emotional skills
• Cognitive skills
• Language skills

This evidence-based therapy has been extensively researched and has shown positive results for autism spectrum disorder treatment. One study suggests that ESDM intervention can reduce the severity of key clinical features of ASD, including impairments in social interaction and communication.

Incidental Training

In incidental teaching, the teacher or parent follows the child's lead in choosing activities, using natural situations to encourage the child's responses and promote motivation and generalization.

Unlike DTT, incidental teaching occurs in natural environments like home, school, or the community, helping generalize skills to real-life situations.

University research on incidental teaching, which discussed two studies, concluded that this autism spectrum disorder treatment is valuable for helping children of all ages and disabilities improve their social interactions. The first study found that incidental teaching significantly improved social interactions in three preschool-aged boys with autism, even surpassing their typically developing peers.

The second study, involving 61 preschoolers with various disabilities in 31 early childhood classrooms, also found that incidental teaching effectively enhanced communication and social participation.

Positive Behavioral and Support (PBS)

Interfering student behaviors presents a significant challenge in schools. About 25% of students experience them, leading to poor academic performance, reduced instructional time, low attendance, and social-emotional difficulties. Unfortunately, these issues are often addressed with punitive procedures, raising ethical and empirical concerns globally.

In response to these concerns, Positive Behavior Support (PBS) emerged to promote inclusive environments for individuals with disabilities across various settings. PBS integrates evidence-based practices to address behavioral challenges and enhance independence and participation.

A 2022 study in Saudi Arabia demonstrated the immediate effectiveness of a virtual school-wide PBS program for students with ASD, highlighting the feasibility and efficacy of such interventions across diverse educational settings.

Cognitive Behavior Therapy (CBT)

Source: Medium

In the 1960s, Aaron Beck developed CBT, which has since been extensively researched and found effective for various psychiatric disorders, including depression, anxiety, eating disorders, substance abuse, and personality disorders.

Research on CBT interventions as an autism spectrum disorder treatment began in the mid-2000s, with approaches now regarded as evidence-based. CBT is now an ASD treatment option for children who have coexisting mental health conditions like anxiety, depression, or attention deficit hyperactivity disorder (ADHD). It aims to teach them how to change beliefs or behaviors to avoid negative emotions.

A 2021 study evaluated CBT's effectiveness on ASD symptoms and social-emotional problems in children or adolescents through a meta-analytic approach. Findings showed significant improvements in ASD symptoms across various measures (informant-reported, clinician-rated, and task-based outcomes).

In another trial, 78.5% of the CBT group met the criteria for positive treatment response, compared to 8.7% in the waitlist group. CBT also outperformed the waitlist in diagnostic outcomes and parent reports of child anxiety. These treatment gains were sustained at a 3-month follow-up.

Techniques Used in Cognitive Behavior Therapy

Each child's CBT treatment plan typically involves 12-16 weekly sessions lasting 30-60 minutes each. This autism spectrum disorder treatment offers multiple benefits, such as:

• It assists them in managing stress, worry, and other emotional challenges.
• It aids in overcoming fear, making it easier to confront frightening situations.
• It enables them to replace negative and unrealistic thoughts with positive ones.
• It helps older children enhance their communication and social skills.

These benefits are achievable through various CBT techniques, including:

• Cognitive Restructuring: It involves recognizing and changing negative thoughts into positive ones, helping to challenge automatic beliefs that trigger negative emotions.
• Guided Discovery: A technique where therapists challenge patients' beliefs by questioning their assumptions about a problem, helping them see things from another viewpoint.
• Exposure Therapy: This gradually exposes patients to feared situations, teaching coping skills to boost confidence.
• Relaxation Techniques: Exercises like deep breathing and visualization aid in overcoming phobias and social anxieties.
• Journaling: Involves recording negative thoughts alongside positive alternatives to replace them.
• Behavioral Experiments: These experiments challenge catastrophic thinking in anxiety disorders by testing the accuracy of beliefs.
• Activity Scheduling: This reduces stress by listing and organizing tasks.
• Role Play: Helps patients practice handling difficult situations, enhancing social skills and confidence.
• Successive Approximation: A technique that breaks overwhelming tasks into smaller, manageable steps to tackle difficult situations.

Difference Between ABA and CBT

CBT and ABA are both recognized by the American Psychological Association as treatments for ASD. ABA is typically started in early childhood, while CBT is more suitable for school-aged children, teens, and adults with autism.

ABA is effective for severe symptoms and low-functioning autism, while CBT is better for milder forms and high-functioning autism. Additionally, ABA targets specific behavioral issues, while CBT addresses co-occurring mental health problems.

2. Education and Learning Programs

Educational programs for autism spectrum disorder treatment are typically conducted in classroom settings. One such approach is the Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH) program.

TEACCH is based on the understanding that autism stems from neuropsychological differences, affecting how individuals' brains function. The program enhances various skills, including communication, social interaction, independence, and daily tasks. Its application varies based on the individual's age, ranging from early intervention for young children to supported employment for adults.

A 2023 study investigated the effectiveness of the TEACCH method in improving executive function abilities among children with ASD. The findings suggested that combining the TEACCH method with other behavior modification strategies aligned with teaching principles effectively enhanced executive function, particularly flexibility, in children with ASD.

3. Other Child Autism Therapies

These autism spectrum disorder treatments usually target one specific skill, depending on the child's needs. These include:

Joint Attention Therapy

Children with autism spectrum disorder (ASD) often show delays in joint attention, such as not tracking moving objects or directing their gaze toward shown objects. Mastering joint attention is essential before teaching other forms of communication due to its role in social and language development.

Nutritional Therapy

Numerous studies indicate that individuals with ASD frequently experience nutritional deficiencies, metabolic imbalances, and digestive issues. A 2018 study highlighted the effectiveness of addressing these concerns through precise dietary and nutritional interventions.

Correcting these deficiencies leads to enhanced nutritional status, non-verbal IQ, and improvements in autism symptoms. Among the strategies, parents found vitamin/mineral supplements and a healthy gluten-free, casein-free, soy-free (HGCSF) diet particularly beneficial.

Occupational Therapy

Occupational therapy is one of the three primary autism spectrum disorder treatments offered in schools, alongside speech therapy and behavioral therapy. It focuses on enhancing a child’s everyday skills, including tasks like dressing, eating, and personal hygiene, as well as emotional regulation and social engagement.

Occupational therapists aim to support students in functioning effectively both in school and beyond by addressing their individual needs, which may vary based on mood, environment, and intervention.

Physical Therapy

While motor challenges are not explicitly included in the present diagnostic criteria for ASD, approximately 87% of individuals diagnosed with ASD experience difficulties with movement.

A study showed that children with ASD showed considerable delays in gross motor skills (large muscle movements) and fine motor skills (small, precise movements). Specifically, 6.7% of children with ASD had delays in gross motor skills, while 38.5% had delays in fine motor skills.

Autism spectrum disorder treatments like physical therapy can assist children with ASD in learning and improving these skills, benefiting their overall development. Physical therapists help children with ASD develop movement skills to promote physical activity and improve their physical and mental well-being.

Social Skills Training

Social skills deficits are a common characteristic of ASD, though they may differ in each child and depend on factors like age and level of functioning. Social skills training helps children recognize expressions and emotions, teaching them appropriate interaction behaviors. They learn about the importance of eye contact during conversations and understanding social cues.

Speech-Language Therapy

Language development in children with ASD varies widely. Some are early talkers, while others start speaking later. However, social communication differences are central to ASD. Many children with ASD benefit from speech-language therapy as an additional autism spectrum disorder treatment to improve their communication skills.

Additionally, speech therapy for autism enhances nonverbal communication skills. Some children with ASD may become frustrated with verbal communication challenges and benefit from augmentative communication methods like gestures, sign language, or picture communication programs. For instance, the Picture Exchange Communication System helps children with limited verbal abilities communicate using pictures.

4. Pharmacological Therapies

Although no medication can improve the core symptoms of ASD, medications are often used alongside behavioral therapy to help patients function better. Currently, there are only two FDA-approved medications for ASD. These medications help alleviate symptoms such as irritability and aggression. They are:

Risperidone (Risperdal)

Source: Medical News Today

Risperidone was the first FDA-approved drug to treat autism-related irritability in children aged 5 and older, approved in 2006.

A study conducted in 2002 involved 101 children aged 5 to 17 years in an eight-week randomized trial. Results showed significant improvements in tantrums, aggressive episodes, and self-injurious behaviors in children treated with risperidone compared to placebo. Common adverse effects included increased appetite, dizziness, drooling, drowsiness, and fatigue.

Additionally, a 32-week trial studied the long-term efficacy and safety of risperidone in children with ASD. Risperidone showed a decrease in irritability, social withdrawal, stereotypy, hyperactivity, and inappropriate speech compared to placebo. It was also effective in preventing the relapse of ASD symptoms. Common adverse effects included weight gain, increased appetite, anxiety, and fatigue.

Aripiprazole (Abilify)

Source: Clinical Trials Arena

Aripiprazole was FDA-approved in 2009 for treating irritability in children aged 6 to 17 with ASD. It is also indicated for schizophrenia, bipolar I disorder, major depressive disorder, and Tourette’s syndrome.

A post hoc analysis of clinical studies examined aripiprazole's impact on health-related quality of life in children with ASD. It showed significantly greater improvement in Pediatric Quality of Life Inventory scores compared to placebo. Common side effects included fatigue, somnolence, sedation, extrapyramidal symptoms, and weight gain.

In certain cases, doctors may prescribe other medications such as selective serotonin reuptake inhibitors (SSRIs), anti-anxiety drugs, or stimulants, though these are not FDA-approved specifically for autism spectrum disorder. Families should work closely with healthcare providers to ensure the safe use of any medication.

Takeaway

Autism spectrum disorder treatments involve a combination of therapies and interventions tailored to each child's unique needs. Behavioral therapies are fundamental, focusing on enhancing social skills, attention, and managing challenging behaviors.

Educational programs like the TEACCH help children develop communication, social interaction, and daily living skills. In addition, other therapies, such as joint attention, nutritional, occupational, and physical therapy, address specific deficits, enhancing overall development and quality of life.

Pharmacological therapies, while not addressing core symptoms of ASD, are used to manage irritability and aggression, with FDA-approved medications like risperidone and aripiprazole.

A comprehensive and individualized approach combining behavioral, educational, and pharmacological therapies is essential for helping children with ASD reach their full potential.

FAQs on Autism Spectrum Disorder Treatment

What is the role of parent training in ASD treatment?

Parent training programs teach parents strategies to support their child's development and manage behaviors. Research shows that when parents are actively involved in their child's therapy, it can enhance the effectiveness of the treatment and improve the child's skills and behaviors.

Can technology-based interventions help in autism spectrum disorder treatment?

Yes, technology-based interventions, such as computer-assisted learning programs and mobile apps, can support education and communication for individuals with ASD. These tools can be particularly engaging and provide personalized learning experiences.

What is the importance of a multidisciplinary approach in autism spectrum disorder treatment?

A multidisciplinary approach involving various specialists (e.g., pediatricians, psychologists, speech therapists, occupational therapists) ensures comprehensive care that addresses the diverse needs of individuals with ASD. This collaborative approach can lead to more effective and holistic treatment plans.

Can mindfulness and relaxation techniques help in autism spectrum disorder treatment?

Mindfulness and relaxation techniques can help individuals with ASD manage stress and anxiety. Practices such as meditation, yoga, and deep-breathing exercises can improve their overall well-being and emotional regulation.