The most effective treatments for autism involve therapies that start as early as possible in life. Early interventions offer the best success rates.
Therapies for autism include:
- Applied behavior analysis (ABA).
- Cognitive behavioral analysis (CBT).
- Occupational therapy.
- Speech therapy.
- Physical therapy.
- Nutritional therapy.
These therapies are often combined into one treatment plan for a full continuum of care.
While all these therapies can benefit people with autism, ABA therapy is considered the primary therapy for autism.
Treatment is individual to each person with autism. There isn’t an approach that will work for everyone. Ultimately, each child will benefit from a specific care plan that is tailored directly to their needs and progress.
Autism is a developmental disorder, and its prevalence continues to increase in the United States. The disorder impacts about 1 out of every 54 children.
It can be diagnosed as early as 18 months, though diagnoses are considered reliable around 2 years old. Most children are diagnosed around age 3. The sooner a diagnosis is made, and interventions and treatments can begin, the better the long-term outcomes.
Symptoms of autism include communication issues, deficits in social skills, and behavioral, physical, and emotional issues. Treatments for autism aim to improve function in each of these areas.
Categories of Autism Treatment
Autism treatment can encompass a lot of different methods and modalities. Autism, or autism spectrum disorder (ASD), can bring a wide range of severity and disabilities. While some people may have only mild symptoms, others may suffer from significant disability. As a result, treatment must be specific to each person.
A child’s autism treatment team may include a variety of professionals, such as:
- Developmental pediatricians.
- Child psychologists or psychiatrists.
- Speech and language pathologists.
- Occupational therapists.
- ABA therapists.
- Physical therapists.
- Additional specialists.
Treatment for autism typically falls into four main categories:
- Behavior and communication approaches: This includes ABA therapy, cognitive behavioral therapy (CBT), assistive technology, speech therapy, occupational therapy, and social skills training.
- Medication: There are no medications designed specifically to treat autism. Medications can be effective for managing certain symptoms, but these pharmacological approaches are generally a last resort due to the potential for side effects.
- Dietary approaches: This includes nutritional therapy.
- Complementary and alternative medicine (CAM) techniques: These techniques go beyond traditional medicine. They should be used with caution as they can potentially cause more harm than good. Never begin an alternative therapy without first discussing it with your child’s doctor.
Types of Therapy
There are several specific types of therapies that aim to improve autism symptoms.
- Physical therapy develops motor skills and muscle tone.
- Occupational therapy teaches and hones basic life functioning skills.
- Speech and language therapy enhances the ability to form words and communicate with others.
- Nutritional therapy implements dietary changes to boost overall health.
- Behavioral therapies (CBT and ABA) help to modify thoughts, emotions, and actions to build skills and reinforce behaviors.
Therapies are often combined into an overall treatment plan. For example, a child who struggles with language, motor skills, and activities related to everyday functioning will benefit from a combination of speech therapy, physical therapy, and occupational therapy. ABA therapy will be part of virtually every autism treatment plan.
Applied Behavior Analysis (ABA)
Applied behavior analysis (ABA) is one of the most widely used forms of therapy to treat autism.
The therapy focuses on reinforcing positive behaviors while decreasing negative, or unwanted, behaviors. It uses positivity to help children learn new life skills, manage autism symptoms, and better understand what is expected of them.
This evidence-based therapy modality has proven effectiveness and high success rates in improving intellectual abilities, socialization, adaptive behavior, and communication skills. ABA therapy can be beneficial for people at all levels of the autism spectrum.
Part of the beauty of ABA is that it is highly flexible. It can be tailored to each client’s specific strengths and weaknesses, focusing on what behaviors need to change and which behaviors should be reinforced. Reinforcement via rewards encourages desired behaviors, thus helping these changes to stick over time.
ABA is most effective when it begins before age 4. It’s a rigorous treatment approach and generally involves more than 20 hours per week of intensive therapy. Results don’t happen overnight, but families that stay committed to the treatment plan see impressive results.
Goals of ABA
ABA targets specific skills, helping clients to reach goals that are outlined by the therapist, including:
- Enriched social skills.
- Better language and communication abilities.
- Enhanced cognitive and academic abilities.
- Improved motor skills.
- Ability to perform self-care.
- Increased independence.
Parents will work with a board certified behavior analyst (BCBA) to identify the goals for ABA. The therapist will teach parents how to practice these learned skills at home and how best to support their autistic child.
ABA is an adaptive therapy that is generally given in the home. Registered behavior technicians (RBTs) carry out the therapy plan that is designed by the BCBA. Parents solidify the lessons with regular practice. The lessons learned at home are then applied to other settings, such as school or other public environments.
Types of ABA
There are several types of ABA.
- Early intensive behavioral intervention (EIBI): EIBI therapy is given in highly structured sessions to young children (age 5 or younger) in one-on-one sessions or small group settings.
- Pivotal response training (PRT): Sessions are conducted in a child’s regular environment, such as the home. PRT focuses on improving pivotal areas of development, such as motivation, self-management, social initiations, and responses to multiple cues. The skills that are developed can then be applied to multiple settings.
- Positive behavior and support (PBS): This therapy aims to determine the root of problem behaviors and then make positive changes. The approach to change often includes switching up the environment.
- Discrete trial teaching (DTT): This teaching strategy has been shown to work particularly well for children with autism. With DTT, skills are taught in a step-by-step and controlled manner, breaking down a larger task into smaller parts. Positive feedback is given to help a child use newly learned skills.
These approaches all fall under the umbrella of ABA, and some will work better for some children than others. The therapist will assess the child’s behavior issues and then choose the approach that will work best for them. The BCBA will also regularly assess the child’s progress to determine if changes are needed in the therapy approach.
Pros of ABA Therapy:
- Focuses on positive reinforcement
- Can be used in a variety of settings
- Is highly adaptable
- Tailored specifically to each child
- Has high success rates
- Involves the entire family
- Tracks specific goals and builds new skills
- Can be used in conjunction with many other therapies to address autism symptom
Potential Cons of ABA Therapy:
- Requires long-term treatment to be effective
- Can be costly, although it’s usually covered by insurance
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is an evidence-based treatment method with proven success in managing anxiety disorders, depression, alcohol and drug abuse, severe mental illness, eating disorders, and relationship issues.
The premise of CBT is to help a person recognize patterns of negative thoughts and emotions, learn what triggers them, and how these relate to destructive actions. By learning how to become more self-aware, a person can then learn strategies for coping and tools for changing negative behaviors into more positive ones.
CBT can also be used as a form of autism therapy, helping people with autism to cope with anxiety, recognize their emotions, and better manage social situations. Like ABA, CBT for autism is tailored to focus on the specific strengths and weaknesses of the client.
When CBT is used for autism treatment, it is highly structured in specific phases with defined goals. The goals are set by the therapist, in consultation with clients and their families.
CBT doesn’t work for everyone with autism, and its utility largely depends on the severity of the disorder. It can be a useful therapy for children with high-functioning autism, helping to reduce symptoms of autism and anxiety.
Pros of CBT:
- Cost-effective therapy
- Can help with emotional regulation
- Addresses secondary issues, such as anxiety
- Aids in recognizing the connection between thoughts, emotions, and actions
Potential Cons of CBT:
- Deals with more secondary concerns than specific autism symptoms
- May not be ideal for individuals with low-functioning ASD
- Does not address social or communication skills directly
- Is sometimes delivered in groups, which can be overwhelming for children with autism
Occupational therapy (OT) can help a child acquire and refine motor, social, physical, and cognitive skills to improve daily life functioning. These skills are often taught through play.
The overall goal of occupational therapy is to improve everyday life skills to aid in self-reliance and independence. Like other forms of autism therapy, parental involvement is important to reinforce the skills learned in therapy sessions. The results of occupational therapy can be impressive as the child gains more independence, eventually becoming self-sufficient in many areas of life..
Children with autism often have difficulties with everyday tasks, such as:
- Feeding themselves.
- Getting dressed.
- Using fine motor skills, like brushing their teeth.
- Grooming, like combing or washing their hair.
- Using the bathroom independently.
Occupational therapy can greatly help with these types of tasks. If an autistic child learns to get dressed or use the bathroom on their own, it can make an immense difference in the lives of everyone in the family.
An occupational therapist can also help a child with ASD communicate by using a specialized communication device and teaching them how to use it.
A licensed occupational therapist creates the treatment plan for occupational therapy. The therapy is given by either the therapist or an occupational therapy assistant. Sessions are typically 30 to 60 minutes. The number of sessions per week will depend on the needs of the individual client.
Occupational therapy is usually covered by insurance. It is sometimes offered through schools. Based on family income levels, services may be low cost or even free.
Pros of Occupational Therapy:
- May be low-cost or even free to families in need
- Often included in early intervention programs
- Helps a child to learn skills that are essential to daily life
- Improves outcomes at school and home
Potential Cons of Occupational Therapy:
- Must be used in conjunction with other therapies
- Does not address issues related to communication, emotion, or social skills
Communication difficulties and language delays are common symptoms of autism. Speech and language therapy can help with both verbal and nonverbal communication skills.
Language issues can range greatly among people with autism, depending on the severity of their disorder. Some people with mild symptoms may only have minor communication issues, whereas people on the other end of the spectrum may be completely nonverbal. Speech therapy is commonly recommended for people across the entire autism spectrum.
- Improve speech rhythm and rate of speech.
- Teach correct names for objects and people.
- Help a child learn how to use words more effectively and put together proper sentences.
- Build vocabulary.
- Help a child to understand feelings, thoughts, and emotions better.
- Use picture symbols to communicate.
- Teach sign language or hand signals if the child is nonverbal.
- Strengthen muscles in the jaw, mouth, and neck to improve speech
- Give a better understanding of body language.
- Use assistive technology to help a child learn how to communicate.
- Aid in response to questions.
- Help a child make clearer speech sounds.
- Teach a child how to match their facial expressions with emotions.
A speech and language pathologist (SLP) will work with a child to assess their own personal communication challenges as well as their strengths. The therapist will create a personalized treatment plan, with defined goals, for each client.
Speech-language therapy can be provided in private clinics, through early intervention programs, at schools through an IEP, and in group or individual settings. This therapy is often covered by insurance plans.
Pros of Speech-Language Therapy:
- Improves verbal communication skills
- Helps with nonverbal communication and social skills
- May be free or low-cost to families in need
- Often covered by insurance and included in early interventions programs
Potential Cons of Speech-Language Therapy:
- Specific for helping with communication and language skills
- Must be used in tandem with other therapies to address additional symptoms of autism
Physical Therapy (PT)
Children who are diagnosed with autism often struggle with movement and motor control issues. These children may benefit from physical therapy, which can build strength and muscle control.
Research is ongoing regarding how physical therapy can help movement functions for people with autism, but the therapy shows particular promise for children with autism.
While there may be some overlap with occupational therapy, physical therapy focuses specifically on:
- Building muscle tone.
- Refining motor skills.
- Improving balance.
- Promoting breath control.
- Increasing fitness levels and overall stamina.
- Cultivating coordination.
Autistic children may have pronounced deficits in these areas that targeted physical therapy can improve.
Physical therapy only addresses movement issues and physical deficits. It doesn’t address other symptoms of autism, so it isn’t a sufficient therapy on its own. It can be an important part of a larger treatment plan, however.
A licensed physical therapist will work directly with the child on creative movement techniques. The therapist should have specific training and experience dealing with the autistic community, particularly children with autism.
Pros of Physical Therapy:
- Can improve motor functions
- Builds muscle strength
- Is often fun and stimulating for a child
Potential Cons of Physical Therapy:
- Can be costly and may not be covered by insurance when related to autism
- Not scientifically proven to help with autism symptoms
- Can be difficult to find a practitioner with experience treating autistic children
There is a lot of controversy surrounding diet and autism. Autistic individuals often suffer from nutritional deficiencies, but common beliefs regarding how autism and nutrition are connected are often false.
Much has been made of a potential connection between gluten or casein and worsening autism symptoms. Gluten is a protein found in wheat, and casein is a milk protein.
Despite widespread personal commentaries on the subject, the research does not support that a gluten-free and casein-free diet — often termed the “autism diet” — actually improves autism symptoms. In fact, the reverse may be true. This diet can lead to nutritional deficiencies that can worsen autism symptoms.
Children with autism frequently struggle with inadequate nutrition. Nutritional deficiencies can be linked to sensory problems and behavioral issues related to eating as well as potential gastrointestinal problems.
Autistic children may have food aversions and sensitivities. They may prefer to only eat specific foods, and this narrow diet can lead to nutritional problems. Research studies show that children with autism are most commonly deficient in protein and calcium.
Parents regularly face significant challenges in getting an autistic child to eat balanced meals. Nutritional therapy can be key to ensuring the child gets the nutrients they need in a manner they will consume.
A nutrition specialist, like a registered dietician, will create specialized meal plans. Their goal is to make nutrition easier for the family, rather than a battle for parents, so they will aim to create plans that work for the specific child.
Other members of the child’s treatment team may be involved with nutritional approaches, helping to craft ways to make food less of a struggle for parents and children dealing with autism.
Pros of Nutrition Therapy:
- Can help parents learn how to feed autistic children, who are often picky eaters
- Ensures proper nutrients are included in their diet
Potential Cons of Nutrition Therapy:
- Can be cost-prohibitive and may not be covered by insurance
- May be corrupted by scams, like “autism diets” that are deficient in nutrients
Finding the Right Treatment Approach
Each autistic person’s treatment plan should be tailored to their specific needs. There isn’t a one-size-fits-all approach that will work for everyone.
While the specifics of care plans and chosen therapies will vary, ABA therapy should be a part of every plan. ABA is considered the cornerstone treatment for ASD, and evidence continually shows that it is the most effective therapy for autism.
Your child’s doctors will weigh in on the best autism therapies for your child. The most commonly used autism therapies are ABA therapy, occupational therapy, and speech therapy, but CBT, physical therapy, and nutritional therapy may round out the treatment regime.
Parental involvement is essential to the success of all autism therapies. The lessons learned in therapy sessions are cemented in everyday interactions. Your child’s therapists will teach you how to best put the lessons into practice on a regular basis.
There isn’t a known cure for autism. And the diversity of autism is something to be celebrated. Your child will continue to live with the disorder for the rest of their life, but there is good reason to be hopeful. Effective therapies for autism can greatly reduce the problematic symptoms of the disorder, helping people to live independent, full lives.
The results of autism therapy are not immediate. It takes time and effort to see results. But those results are well worth it.
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