Current treatments for autism spectrum disorder (ASD) seek to reduce symptoms that interfere with daily functioning and quality of life.1 ASD affects each person differently, meaning that people with ASD have unique strengths and challenges and different treatment needs.1 Therefore, treatment plans usually involve multiple professionals and are catered toward the individual.
Treatments can be given in education, health, community, or home settings, or a combination of settings. It is important that providers communicate with each other and the person with ASD and their family to ensure that treatment goals and progress are meeting expectations.
As individuals with ASD exit from high school and grow into adulthood, additional services can help improve health and daily functioning, and facilitate social and community engagement. For some, supports to continue education, complete job training, find employment, and secure housing and transportation may be needed.
Types of Treatments
There are many types of treatments available. These treatments generally can be broken down into the following categories, although some treatments involve more than one approach:
Behavioral Approaches
Behavioral approaches focus on changing behaviors by understanding what happens before and after the behavior. Behavioral approaches have the most evidence for treating symptoms of ASD. They have become widely accepted among educators and healthcare professionals and are used in many schools and treatment clinics. A notable behavioral treatment for people with ASD is called Applied Behavior Analysis (ABA). ABA encourages desired behaviors and discourages undesired behaviors to improve a variety of skills. Progress is tracked and measured.
Two ABA teaching styles are Discrete Trial Training (DTT) and Pivotal Response Training (PRT).
- DTT uses step-by-step instructions to teach a desired behavior or response. Lessons are broken down into their simplest parts, and desired answers and behaviors are rewarded. Undesired answers and behaviors are ignored.
- PRT takes place in a natural setting rather than clinic setting. The goal of PRT is to improve a few “pivotal skills” that will help the person learn many other skills. One example of a pivotal skill is to initiate communication with others.
Developmental Approaches
Developmental approaches focus on improving specific developmental skills, such as language skills or physical skills, or a broader range of interconnected developmental abilities. Developmental approaches are often combined with behavioral approaches.
The most common developmental therapy for people with ASD is Speech and Language Therapy. Speech and Language Therapy helps to improve the person’s understanding and use of speech and language. Some people with ASD communicate verbally. Others may communicate through the use of signs, gestures, pictures, or an electronic communication device.
Occupational Therapy teaches skills that help the person live as independently as possible. Skills may include dressing, eating, bathing, and relating to people. Occupational therapy can also include:
- Sensory Integration Therapy to help improve responses to sensory input that may be restrictive or overwhelming.
- Physical Therapy can help improve physical skills, such as fine movements of the fingers or larger movements of the trunk and body.
The Early Start Denver Model (ESDM) is a broad developmental approach based on the principles of Applied Behavior Analysis. It is used with children 12-48 months of age. Parents and therapists use play, social exchanges, and shared attention in natural settings to improve language, social, and learning skills.
Educational Approaches
Educational treatments are given in a classroom setting. One type of educational approach is the Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH) approach. TEACCH is based on the idea that people with autism thrive on consistency and visual learning. It provides teachers with ways to adjust the classroom structure and improve academic and other outcomes. For example, daily routines can be written or drawn and placed in clear sight. Boundaries can be set around learning stations. Verbal instructions can be complimented with visual instructions or physical demonstrations.
Social-Relational Approaches
Social-relational treatments focus on improving social skills and building emotional bonds. Some social-relational approaches involve parents or peer mentors.
- The Developmental, Individual Differences, Relationship-Based model (also called “Floor time”) encourages parents and therapists to follow the interests of the individual to expand opportunities for communication.
- The Relationship Development Intervention (RDI) model involves activities that increase motivation, interest, and abilities to participate in shared social interactions.
- Social Stories provide simple descriptions of what to expect in a social situation.
- Social Skills Groups provide opportunities for people with ASD to practice social skills in a structured environment.
Pharmacological Approaches
There are no medications that treat the core symptoms of ASD. Some medications treat co-occurring symptoms that can help people with ASD function better. For example, medication might help manage high energy levels, inability to focus, or self-harming behavior, such as head banging or hand biting. Medication can also help manage co-occurring psychological conditions, such as anxiety or depression, in addition to medical conditions such as seizures, sleep problems, or stomach or other gastrointestinal problems.
It is important to work with a doctor who has experience in treating people with ASD when considering the use of medication. This applies to both prescription medication and over-the-counter medication. Individuals, families, and doctors must work together to monitor progress and reactions to be sure that negative side effects of the medication do not outweigh the benefits.
Psychological Approaches
Psychological approaches can help people with ASD cope with anxiety, depression, and other mental health issues. Cognitive-Behavior Therapy (CBT) is one psychological approach that focuses on learning the connections between thoughts, feelings, and behaviors. During CBT, a therapist and the individual work together to identify goals and then change how the person thinks about a situation to change how they react to the situation.
Complementary and Alternative Treatments
Some individuals and parents use treatments that do not fit into any of the other categories. These treatments are known as Complementary and Alternative treatments. Complementary and alternative treatments are often used to supplement more traditional approaches. They might include special diets, herbal supplements, chiropractic care, animal therapy, arts therapy, mindfulness, or relaxation therapies. Individuals and families should always talk to their doctor before starting a complementary and alternative treatment.
There may be other treatments available for individuals with ASD. Talk to a doctor or healthcare provider to learn more.
For more information you can visit:
American Academy of Pediatrics Council on Children with Disabilities: https://pediatrics.aappublications.org/content/145/1/e20193447external icon
Autism Society: https://www.autism-society.org/living-with-autism/treatment-options/external icon
Autism Speaks: https://www.autismspeaks.org/treatments-autismexternal icon
Interagency Autism Coordinating Committee: https://iacc.hhs.gov/publications/publications-analysis/2012/treatments.shtmlexternal icon
National Institute on Child Health and Human Development: https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatmentsexternal icon
References
- Hyman, S.L., Levy, S.E., Myers, S.M., & AAP Council on Children with Disabilities, Section on developmental and behavioral pediatrics. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1), e20193447.
Mental health crises are serious and potentially life-threatening events that frequently affect children, adolescents and adults on the autism spectrum. Beyond the danger of injury or death, these emergencies often result in lost education, employment and residential opportunities, as well as isolation, exhaustion and financial strain on parents and other caregivers.
An Autism Speaks treatment research grant enabled researchers at Baltimore’s Kennedy Krieger Institute to address the urgent need to:
- Better identify mental health crisis – and the risk for it – among young people on the autism spectrum, and
- Better understand how psychiatrists can help these highly vulnerable young people.
The study team, led by mental health researcher Luther Kalb, PhD, and psychiatrist Roma Vasa, MD, recently published the results of their investigations in the Journal of Child Psychology and Psychiatry and Psychiatric Services. Their reports provide mental health providers and policy makers with important new guidance.
Autism Speaks asked Dr. Kalb to answer related questions of interest to the autism community.
Autism Speaks: What is a mental health crisis?
Dr. Kalb: It involves two things. One, an acute psychiatric event – such as attempted suicide, elopement (or wandering), self-injury and/or dangerous impulsivity – that requires immediate intervention. Second, it involves a lack of resources to immediately manage the event. By resources, we mean a parent or other caregiver’s ability to handle the child’s dangerous behavior.
Autism Speaks: Why are young people with autism at high risk for mental health crisis?
Dr. Kalb: From research and clinical experience, we know that many young people with autism have significant behavioral challenges that include self-injurious behavior, aggression and wandering. And recent research has made clear that suicidal behavior is particularly common among those who without an intellectual disability. These young people also have high rates of psychiatric disorders including anxiety, ADHD and mood disorders.
In addition to these issues, other autism-related health conditions can contribute to crisis episodes. These include disrupted sleep cycles and painful GI disorders.
There is also evidence of unmet needs among young people with autism. We see this in high rates of emergency room visits and inpatient psychiatric hospitalization among youth with autism.
Autism Speaks: Are there autism-specific treatments for these crises? What are psychologists and psychiatrists doing to address the special needs of people with autism?
Dr. Kalb: Naturally, there is no one treatment for a mental health crisis in any group of people – including those who have autism. Mental health professionals draw from many types of treatments to address each patient’s needs.
At the same time, experts agree that youth with autism likely have special needs in this area. Unfortunately, there are only a few evidenced-based mental health treatments for patients who have autism. These include atypical antipsychotic medications such as risperidone for aggression, cognitive behavioral therapy for anxiety and applied behavior analysis for aggressive, disruptive and self-injurious behaviors. Each of these approaches has limitations, and medications can have severe side-effects.
There is also emerging evidence for the effectiveness of what we call “wrap-around services.” This is where a team, which may include a physician, psychologist and service coordinator, works together to make sure the person’s needs are met in all areas of life, from the home to school or work setting. One related approach is the START program. The acronym stands for Systemic, Therapeutic, Assessment, Resources, Treatment.
Personally, I think we urgently need more accessible, on-call services for families and children in crisis. And we need strategies to prevent a mental health crisis.
As part of our Autism Speaks-funded research, we surveyed 866 psychiatrists across the U.S. about how they managed crises in youth with autism.
We found that psychiatrists who saw youth with autism felt they lacked the professional support they needed when these young patients were in crisis – for example, support from other mental health professionals with special expertise in crisis management or a crisis-evaluation center.
They also had low confidence in the ability of emergency first responders and hospital emergency room staff to manage youth with autism in crisis. I think psychiatrists were telling us exactly what we’ve been hearing from parents: “We need more autism-tailored support services, especially urgent on-the-spot care!”
Autism Speaks: As part of your research, you created the Mental Health Crisis Assessment Scale (MCAS). What need does it address? How well did it work in your evaluation?
We reviewed the scientific literature to see if a mental health crisis measure had been developed for people who have autism. These measures, or assessments, are important tools for helping professionals and caregivers recognize when someone is at high risk for a mental health crisis – or is even in the middle of a hidden one – for example, a depression that involves thoughts of suicide.
We found nothing out there that reflected what we were seeking. So, Dr. Vasa and I decided to develop one ourselves.
First, we gathered a panel of experts from the fields of pediatrics, social work, public health, psychology and psychiatry, to discuss our concept of crisis and develop the questions that should be in the assessment scale.
Behavioral psychologist Louis Hagopian, an expert in self-injurious behaviors, played a crucial role in developing the assessment questionnaire.
We also invited a group of parent reviewers to help us improve its readability and usability. We then gathered data on the MCAS through the Interactive Autism Network (IAN). [Editor’s note: IAN is an online research project at Kennedy Krieger, originally launched with the support of Autism Speaks in 2006 and now operated in partnership with the Simons Foundation.]
The MCAS asks parents to rate the severity of a range of emotional symptoms and behaviors, as well as their ability to manage their child’s most dangerous behavior. Health care providers also interviewed some of those parents by telephone, to determine if their children were experiencing a mental health crisis.
Next, we analyzed the results of the parent-completed MCAS and the phone interviews. Our analysis found the MCAS to be a “promising tool” to measure mental health crises in children, teenagers and young adults with autism. It worked well and we are excited about its future potential.
Autism Speaks: What advice do you have for parents and other caregivers?
Dr. Kalb: Autism Speaks has several excellent tool kits for families that I recommend. I recommend the Crisis Intervention Resources page.
[Editor’s note: The Autism Speaks Autism Response Team can help people with autism, families and caregivers connect to local resources and information. Trained staff members are available Monday through Friday from 9 am to 1 pm local times. Call 888-288-4762; en Español 888-772-9050; or email [email protected].]
Autism Speaks: What are your next steps for this work?
Dr. Kalb: We are working on a study that will identify the proportion of youth with autism who are in crisis and examine what child and family characteristics increase risk for crisis. We also hope to provide evidence that the MCAS can be used as a screening tool. Right now, the MCAS is only a research tool. We will need to make sure the MCAS can improve clinical care before it is ready for use among providers and caregivers.
We would like to thank Autism Speaks. Without their funding, this study would not have happened. We would also like to thank the families in IAN. We surely could have never developed this measure without their help.
