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Understanding Autism Part 3: Treatment Options
This is the third in a three-part series on the symptoms of autism, its diagnosis and treatment.

Early intervention and treatment is crucial for children with Autism Spectrum Disorders (ASDs) to help them learn, play, communicate, interact with others and care for themselves. Although each child’s symptoms and needs are unique, and there are many different approaches to treatment, there are several basic principles:
  • Start as early as possible. The earlier intensive treatment is started, the better the outcome for your child’s development and well-being.
  • Provide comprehensive services. Children with ASD benefit from a variety of developmental, behavioral, social, speech/language and physical/occupational therapy.
  • Do intensive treatment. Experts recommend 20 to 40 hours per week of individualized intervention, year round, with parents reinforcing the interventions at home.
  • Have clear goals, monitor your child’s progress frequently and revise the plan as needed.

According to the Individuals with Disabilities Education Act (IDEA), children with disabilities such as autism are eligible for free assessment, special education and related services. For children under 3 years of age, an Individualized Family Service Plan (IFSP) and early intervention services are coordinated through your state’s local Regional Center for Developmental Disabilities or other designated service providers. For children 3 to 21 years of age, an Individualized Education Program (IEP) and special education services are coordinated through the local public school district. Parents may have to advocate strongly to receive public services for their child. Depending on resources, parents may also choose to enroll their child in private therapy through hospitals or clinics.

Treatment for children with ASD usually involves several components including a range of therapy—developmental, behavioral, speech/communication, social skills and sensory-motor—as well as medication. Effective therapy builds on the child’s strengths and interests and provides consistent routines, individualized attention and positive reinforcement for progress. Therapy may be provided at home, in childcare, in school in a regular or special education class or at a clinic. The basic types of therapy for children with ASD are described below.

Developmental and behavioral interventions
Developmental and behavioral interventions are central to therapy for children with autism. Developmental therapy tends to focus on basic skills for attention, visual and auditory processing, communication, social skills and problem solving. Behavioral therapy tends to focus on improving skills for communication and play and reducing problematic behaviors such as self-injury and tantrums. Common programs include:
  • Applied Behavioral Analysis (ABA): This is widely accepted as an effective treatment. It involves a trained therapist working individually with the child 20 to 40 hours a week. The therapist teaches the child skills in a series of simple steps, such as teaching colors one at a time. The sessions usually begin with structured drills, such as learning to point to a color when its name is given, with positive reinforcement for desired behaviors. Later there is a shift toward generalizing the skills to other situations and environments. Parents work with the therapist to identify skills to be taught and problematic behavior to be changed, and to reinforce the learning at home.
  • Treatment and Education of Autistic and Related Communication-handicapped Children program (TEACCH): This program involves parents and teachers working together to develop a structured program to build on the child’s interests and learning strengths. For example, if a child is fascinated by trains, this will be used to focus the child’s attention, provide motivation and learn language and communication skills. Visual cues are used to maintain a consistent daily routine and help build new skills.

Speech and communication interventions
Children with ASD can have a wide range of communication difficulties. Some children may have a normal vocabulary but need help with social conversation, some have significant delays in speech, some cannot speak but can learn non-verbal communication techniques and a small proportion are unable to express themselves verbally and non-verbally. A speech pathologist can work with the child, family and teachers to facilitate therapy to help communication, including:
  • Speech therapy beginning with increasing eye contact, vocalizing, building vocabulary, enunciating words and promoting back-and-forth conversation.
  • Teaching non-verbal communication with natural gestures, sign language and picture exchange communication, which involves pointing to pictures or symbols.

Social skill interventions
Many children with ASD can learn to engage in conversation and play with others. In addition to gaining social skills through developmental/behavioral therapy, family members can do many things to promote social skills:
  • Learning “joint attention” to observe, play and talk together:
    • Throughout the day, point at things to get your child to look at them with you. Begin with things you know he likes, such as a favorite pet or toy. If he doesn’t follow your point, try tapping him on the shoulder or turning his head.
    • Encourage your child to point to what he wants. If he won’t point, you can take his hand and make it into a point. Point to items he doesn’t want in order to encourage him to respond “no,” then help him point to what he wants and praise him for showing you.
    • When your child is playing alone, join in the play. Point at and make comments about the object. If your child looks at you, smile back and encourage him with words. Try to become part of the play. For example, make a hill with your hand and let him drive the toy car over it.
  • Learning to understand how others feel: Encourage your child to observe other children when they are laughing, shouting, crying or showing another emotion. Discuss how those children are feeling.
  • Developing friendships: Although young children with ASD may seem to prefer to be alone, friendships can help them learn social skills. Invite other children to your home to play. Advocate for your childcare or school teacher to facilitate play time for your child with typically-developing peers. Encourage your child in activities he can share with others such as computers, music or sports.

Sensory-motor interventions
Many children with ASD have delays in their large and small muscle skills. In addition, they may have increased sensitivity (to touch, hugging, loud sounds, textures of clothes or food), decreased sensitivity or self-stimulating behaviors (rocking, spinning, head banging, skin picking or self-biting). Sensory-motor therapy includes:
  • Physical and occupational therapy: Trained physical and occupational therapists can help improve children’s movement, strength and self-help skills, such as feeding and dressing. They may also include sensory integration therapy, which uses procedures such as deep pressure, skin brushing and swinging to stimulate the child’s sense of motion and touch, which can be calming.
  • Auditory and vision interventions: Auditory integration programs expose children to music and other sounds in order to improve their auditory processing, decrease sound sensitivity and reduce behavioral problems. Vision training programs use prism lenses, and vision exercises aim to decrease children’s sensitivity to light and color and improve their attention and reading. Their effectiveness is still being studied.

Medications
Although there are no medications that are specifically approved to treat ASD, some psychiatric medications have been found helpful for treating specific symptoms such as self-injury, aggression, attention deficit/hyperactivity, anxiety and depression. Antidepressants, atypical antipsychotics and anticonvulsants can reduce symptoms by altering the levels of certain neurotransmitters (chemical messengers) in the brain. Parents should work with their child’s doctor to find the right medications and the right doses for the best effects.

Complementary and alternative medical treatment
There are additional treatments that are widely advertised on the Internet and through support groups. Many of them have not yet been scientifically studied and proven to be effective. Some of these treatments may work or they may not work. We just don’t know yet. Also, some of these treatments may have dangerous side effects. Be sure to discuss these with your child’s doctor.
  • Nutritional supplements, including certain vitamins, minerals, amino acids and essential fatty acids. Although these may appear “natural” and safe, in high doses some supplements (including vitamins A, B6 and magnesium) can have toxic effects.
  • Special diets eliminating gluten—which is found in wheat, barley, rye and oats—and casein, found in milk products. The effectiveness of these diets in ASD is being studied. Any diet should be done in coordination with your child’s doctor and nutritionist to ensure an adequate intake of nutrients such as protein, calcium and vitamin D.
  • Other prescription medications for gastrointestinal symptoms, treatment of bacteria or yeast or chelation to extract heavy metals. These have not been proven to be effective for ASD and may have harmful side effects.

Family support services
Many parents with children with disabilities get emotional support and practical advice in parent support groups. You can find a local group through the Autism Society of America (www.autism-society.org), Family Voices (www.familyvoices.org) or other disabilities support services. In addition, many families find it helpful to get occasional respite services with trained caregivers to assist in the care of their child at home. Funding for respite services may be available through Medicaid waiver funds. Also, depending on the family’s finances and child’s condition, financial assistance may be available through Supplemental Security Income.

In all, you need to continually ask questions, track down information and advocate for services for your child. Also remember to take care of yourself. For more information, visit the Cure Autism Now site at www.autismspeaks.org and the National Dissemination Center for Children with Disabilities at www.nichcy.org.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician