When it comes to treating autism spectrum disorder (ASD), the developmental disorder that can cause problems with communication, social skills, and other behaviors, there is no one-size-fits-all solution. That’s because, as the name implies, cases of autism fall across a spectrum. In some cases, symptoms are mild and in others symptoms are severe; in some cases, individuals have more impairment when it comes to social skills and communication, while in other cases behavioral challenges are more problematic.
For all of these reasons, autism treatment needs to be tailored to the individual, explains Thomas Frazier II, PhD, chief scientist at Autism Speaks, an autism advocacy organization. Plus, people with autism are still people, and just because two people have the same behavioral problems doesn’t mean they will both respond to the same therapy.
“Everybody’s different. You need to talk to the person and try to understand them for who they are,” he says. And then you can find the right treatment, or combination of therapies in most cases, that are right for that individual.
Dr. Frazier gives this advice as clinician and advocate, as well as a parent of a son with autism. When it comes to treating the condition, caregivers need to be empathetic and patient, he says.
Treatment for autism typically includes a combination of behavioral therapies, dietary approaches, medication, and complementary and alternative medicine approaches that best meet the needs of the individual. It’s important to point out that there are no drugs that cure autism — or make all of its symptoms disappear. But in some instances, medication can help manage symptoms, such as irregular energy levels, inability to focus, depression, or seizures. (1)
Earlier Childhood Intervention Improves Autism Outcomes
Frazier stresses that for children, early attentive intervention is crucial. And that’s why if you notice symptoms in your child that you suspect might be autism, talking to your child’s doctor as soon as possible is important to get an accurate diagnosis and to get help for your child.
Children with autism will have some combination of difficulty with normal learning and development when it comes to social skills, communication and language, and behavior. Treatments designed for children from birth to 36 months specifically help with talking, walking, and interacting with others.
In the United States, the Individuals with Disabilities Education Act (IDEA) helps ensure there are resources for all children in need of developmental interventions — in some cases even if a child has not received a diagnosis of autism. (2)
For some individuals with autism who are diagnosed very young, going to preschool or other early education programs could be helpful, he says. Children can help other children develop new skills and avoid inappropriate or strange “nonsocial behaviors.” But in other cases, being exposed to the school setting at a young age may be overwhelming.
What should be standard for children with autism is that they get educational services specifically tailored to meet their needs. In 2001, the National Academy of Science’s National Research Council issued a guideline recommending that all educational services begin as soon as possible when a child is suspected of having autism, and those services, at minimum, should be 25 hours per week, 12 months a year, where the child receives systematically planned and developmentally appropriate educational activity. (3)
Most Children With Autism Benefit From Some Type of (or Combination of) Behavioral Therapy
It’s important for anyone with an autism diagnosis, or who is the caregiver of someone with autism, to know that for most people, no one therapy alone will likely be the solution, says Jeremy Veenstra-Vanderweele, MD, director of child and adolescent psychiatry at Columbia University College of Physicians and Surgeons in New York City. This goes for adults and kids on the spectrum. Also, you can expect to have good days, when symptoms are manageable or not bothersome at all, and bad days, when symptoms are much more severe. Life won’t always be perfect, he says.
Behavioral therapies for autism provide structure, direction, and organization for the child, to help them learn behavioral, social, and communication skills, according to the Centers for Disease Control and Prevention (CDC). (1) Behavioral therapy is usually provided in a one-on-one setting by a psychologist, special education teacher, speech therapist, or other providers who are trained in the technique.
Some such therapies are: (4)
Applied Behavioral Analysis (ABA) ABA is a treatment approach that has been in wide use since the 1960s. It is based on encouraging good behaviors and discouraging negative behaviors to help teach communication, social interaction, and community living skills.
ABA is a three-step process. First there’s a verbal or physical stimulus (like a command) to carry out an action; second, the individual either responds or ignores the stimulus (the “resulting behavior"); and third, there is a “consequence,” which could be positive reinforcement of the reaction to the initial command or no response if the individual ignores the stimulus or command. The strategy is used to break down and eventually help a child learn skills in a manageable way.
ABA therapy sessions typically are two to three hours in length, with some structured time, as well as some free “play” time and breaks. Because the intervention utilizes a one-on-one approach with the therapist or aid, the entire intervention is tailored to the individual receiving treatment and customized to that individual’s skills, needs, preferences, and family environment.
Pivotal Response Treatment (PRT) PRT is a behavioral intervention model that uses ABA principles. It is used specifically to teach language skills and improve social interactions. In some cases, PRT is used to focus on minimizing a person’s impulse to interject in conversation, while in other cases it could be used to help improve play skills that could help with other social interactions down the line. What makes PRT distinct is that is a child-directed therapy, meaning that a child will play a direct role in deciding which objects or activities will be used during a therapy session. If a kid asks for a certain toy to interact with, he or she will be given the object.
Verbal Behavior (VB) Therapy VB is a language-based therapy that focuses on communication skills. If a child asks for a cracker, for instance, they learn to say “cracker,” are then given the cracker, and are then asked to repeat the word, reinforcing the language association with the object in front of them. The therapy may also involve a child being shown an image of the same object and being prompted to repeat the word, associating the object with the language they are using. The point is for the child to learn how to label certain objects and remember and use those labels.
Relationship Development Intervention (RDI) RDI is a behavior modification technique that is mainly used for improving the long-term quality of life for a person with ASD. This treatment has six main objectives: social coordination (the ability to observe and regulate one’s own behavior); declarative language (using language and nonverbal communication to show curiosity or interact with others); flexible thinking (being able to rapidly adapt to changing circumstances that are going on around a person in real time); relational information processing (deriving meaning based on the larger context of a conversation, for instance, or solving problems that have no clear “right” or “wrong” answers); and finally, foresight and hindsight (a person’s ability to think on past experience and then respond to similar future events).
Occupational Therapy (OT) When used for autism therapy, OT simultaneously helps individuals with physical, motor, and cognitive skills. The goal of OT is for someone to gain more independence from caregivers and educators. For children, OT may help an individual learn how to play in safe and appropriate ways, as well as with learning of basic life skills.
Sensory Integration (SI) The goal of SI is to identify irregularities in how an individual with autism processes certain movements, sights, sounds, or other sensory inputs, and help the individual comprehend those signals in a more productive way. Does someone respond in a visceral way to certain sights and sounds over others? The therapist then creates an individualized program of treatment.
Other therapy methods used to help manage autism symptoms and encourage healthy development include: physical therapy, discrete trial teaching, the Picture Exchange Communication System, auditory integration therapy (or sound therapy), the Early Start Denver Model, and more.
Sometimes Medication and Drugs Can Be Helpful for Autism
Not everyone with autism requires medication, but in some cases it can be helpful, explains Dr. Veenstra-Vanderweele. Some children can exhibit a lot of aggression and self-injury, as well as “tantrums and other disruptive behavior,” which antidepressants can help manage.
These are some of the drugs that may be used to help manage autism symptoms: (5)
- Selective Serotonin Reuptake Inhibitors (SSRIs) SSRIs are antidepressants that can reduce the frequency of repetitive behaviors and can help decrease anxiety, aggression, or tantrums. A person on an SSRI may also show improved eye contact.
- Tricyclics Another kind of antidepressant, tricyclics are used to target depression and obsessive-compulsive behaviors that people with autism can sometimes exhibit.
- Psychoactive or Anti-Psychotic Medication These drugs can help reduce hyperactivity, reduce stereotyped behaviors, and minimize social withdrawal and aggression.
- Stimulants These drugs help with focus and help reduce hyperactivity. They are more helpful for people who have milder symptoms.
- Anti-Anxiety Drugs These medicines help with anxiety or panic disorders, which can be linked to ASD.
- Anti-Convulsants These drugs treat seizures or seizure disorders, including epilepsy.
What Lies Ahead for Autism Treatment
Clinicians do not have a crystal ball that will predict the next breakthrough in autism treatment. But according to Frazier, a better understanding of genetics and how genetics and environmental factors combine to play a role in the development of autism will lead to better treatments down the line.
“We need to understand all this better and we need the funding to do that,” Frazier says.
One such preliminary study was published in October 2017 in the journal Neuropsychopharmacology. (6) Researchers investigated whether a drug treatment was helpful in reversing some of the signs of cognitive deficit and social abnormality in mice specifically engineered with a human genetic mutation linked to autism. Though the research is early, being that it was evaluated in mice, it was found to work.
“If the preclinical mouse data prove consistently promising, our translational studies may encourage a new clinical trial [in people],” the study’s senior author Jacqueline Crawley, PhD, a professor in the department of psychiatry and behavioral sciences at University of California Davis MIND Institute, said in a press release when the study was published. (7)
Is this a proven therapy for autism in humans? Not yet, but this and studies like it point to a greater emphasis on genetics and its role in understanding autism and treating it down the line.
“Organizations like Autism Speaks are looking to move forward to better understand these genetic causes and potential treatments that can impact them, but more awareness needs to be drawn to better understand all of this. We need this so we can do even better,” Frazier says.