Autism Treatment and Therapy

It is important to understand that every person on the autism spectrum requires different intervention. A particular program or combination of programs may work for one person or period of time and not another. Often, the effectiveness of the treatment depends on the skill of the therapists, as well as their experience and style. You will have to objectively evaluate each intervention and switch to another if your child doesn't achieve the desired goals.

Autism Speaks recommends that you:

• Observe the therapy in action.
• Talk to experienced parents.
• Make sure you thoroughly understand all that a therapy involves before beginning one.
  
• Ask your pediatrician, developmental pediatrician, and/or social worker who specializes in autism treatment for advice and help prioritizing therapies based on your child's comprehensive evaluation.
• Check to see if multiple therapies can be incorporated into the same learning format, as many children with autism have related problems and can benefit from receiving therapies for several issues.

The National Institute of Mental Health (NIMH) recommends that you find treatment that:

• Offers a predictable schedule
• Builds on your child's strengths
• Teaches things as a series of simple steps
• Engages your child's attention through highly structured activities
• Reinforces good behavior
• Involves the parents

NIMH also recommends that in developing a treatment plan parents:

• Consult with trusted advisers who are specialists in the area.
• Target the child's main weaknesses.
• Take advantage of the child's strengths.
• Incorporate things the child enjoys.
• Address the most important skills your child lacks.
• Work to reduce the behaviors that cause the most problems.

Treatments for autism include Applied Behavior Analysis ABA, Floortime, Gluten Free, Casein Free Diet, occupational therapy, PECS, Relationship Development Intervention, SCERTS, Sensory Integration Therapy, Speech therapy, TEACCH, and verbal behavior intervention.

The National Institute of Mental Health (NIMH) suggests that you ask:

• Has the program been successful with other children? What percent of children who tried it found that it helped?
• How many children who tried this treatment then went on to regular school? How have they done?
• Are staff members trained and experienced at working with children and adolescents with autism?
• Is there a predictable daily schedule and routine?
• Will my child receive individual attention? If so, how much?
• How will progress be measured? Will any one observe and record my child's behavior?
• Has the environment been designed to reduce distractions?
• Will I be taught how to continue the therapy at home?
• How much will the treatment cost, where will it be located, and how much time will it take?
• What is the rationale for how activities are planned and organized?

The Autism Society of America recommends remembering that your child will need a functional curriculum, vocational life and social skills, and that you ask:

• Will the treatment cause harm to my child?
• If the treatment fails, how will it affect my child and family?
• Has the program been scientifically validated?
• Are there ways to assess progress?
• Can the treatment be integrated into my child's current program?

Special Education services are provided by local school districts beginning at age 3. This means you will stop working with the state office that has provided Early Intervention services, and start working with the Special Education department of your local school district.

Special Education has a different focus from Early Intervention. Early Intervention works with the entire family to facilitate adjustment to having a disabled child in the family and to minimize the developmental impact of the disability. Special education focuses on your child receiving an adequate education despite any disability or special need.

An Individualized Education Program (IEP) describes your child's strengths and weaknesses, establishes goals, and specifies how to meet these goals within the school system through specific services. At least once a year you will have to meet with representatives of the school department to work out an IEP for your child. In order to successfully advocate for your child, you will need to be assertive. If your child is mainstreamed in a public school classroom, the assistance of a one-on-one aide may be required, or you may have to arrange special accommodations. Any provided aides should be trained and educated in autism.

As an advocate for your child, you may determine that the services offered are inadequate, and that although no needed services currently exist, they must still be furnished.

Alternatively, you may find your child would progress best in a special education program, a special needs school, or with a home instruction program.

It's appropriate to receive recommendations for intensive services from the specialists that have evaluated your child previously. And you may also want to have an outside advocate with you to help work out an education plan.

Applied Behavior Analysis (ABA). The therapy for autism that has helped the most children and has been studied the most is ABA. ABA works by breaking desired acts into tiny components and then teaching them one by one, until the child can put them all together to complete a task. This technique uses positive reinforcement, making use of anything the child enjoys to create incentives and to make learning fun. A key component is to constantly alter the incentives as one becomes less effective as a motivator. The goal is to teach appropriate behaviors while reducing those that are problematic. Success is measured continually and the intervention is modified based on progress or lack of it. The long-range goal is for your child to function as independently as possible in different environments.

Two subtypes of ABA are:

• Verbal Behavior (VB) is often used along with ABA to teach children to develop connections between the value of a word and the word itself -- to use words for communication as opposed to babbling.
• Pivotal Response Treatment is used with ABA to target motivation, responsiveness, self-management, and social initiations, as opposed to focusing on one behavior at a time.

ABA therapy is provided by board-certified behavior analysts (BCBA) specializing in autism who will devise, implement, and monitor your child's individualized program. But behavior therapists who are not board certified can work one-on-one with your child and should be supervised by a BCBA.

Each session is two to three hours long, broken down into short periods of highly structured time spent on a particular task (usually three to five minutes each). At the end of every hour, your child has a 10 to 15 minute break. Breaks and free play are used to teach or practice in a new environment. Your child will ideally spend between 35 to 40 hours a week on ABA and your family should incorporate it into your family life.

This therapy centers around parents working with their children at the child's current development level. The central idea builds on the theory that if parents enter the children's world and activities, following the kids' lead, then the children can build on the strengths and emotions they experience during Floortime therapy. The goal is to help the child pass through six basic developmental steps using specific techniques to move the child to interact in increasingly complex ways. These steps are:

• Self regulation and interest in the world
• Intimacy or special love for human relationships
• Two-way communication
• Complex communication
• Emotional concepts
• Emotional thinking

Three different types of Floortime are:

• Play and Learning for Autistic Youth (P.L.A.Y.) -- This intervention teaches parents how to engage and interact with their child with autism. The parent tries to begin at the child's level and, with the help of a trained coach, have the child to interact in more normal ways.
• Social Skills Training -- This approach tries to teach people with autism how to recognize social cues, how to communicate in different social situations, and even how to walk.
• Social Stories -- This technique teaches appropriate social behaviors through telling stories. The goal is to help people learn empathy.

This therapy has not been scientifically proven.

While this approach has not been proven scientifically to work, many parents believe that eliminating gluten and casein has helped their children control bowel movements, sleep better, and reduce hyperactivity and self-stimulating behaviors. Careful attention must be paid to diet to insure that the child gets an adequate amount of vitamins and fiber despite the elimination of gluten and casein.

The goal of occupational therapy is to help a person function as independently as possible in life activities. The therapy addresses:

• Coping skills
• Fine motor skills
• Play skills
• Self-help skills
• Socialization skills

Specific skills taught to children with autism include:

• Dressing
• Feeding
• Toilet training
• Grooming
• Social skills
• Fine motor and visual skills (to help with writing and scissor use)
• Gross motor coordination (to help with walking and bike riding)
• Visual perception skills (for reading and writing)

PECS helps people with little or no verbal ability to communicate through the use of picture cards. This method is especially effective for visual learners and builds on a child's interests. By using photos of things children like, therapists teach them to communicate and obtain objects by using the cards. In the second phase, a child has to approach a trainer, who has moved further away and the child learns how to attract the caregiver's attention. In the third phase, the child must put visual sentences together including phrases like "I want" and color and size descriptors. This therapy can take weeks to years, depending on the specific child.

This parent-based intervention addresses the specific issue of making friends, feeling empathy, expressing love, and sharing experiences with others. It also specifically addresses the problem of adapting to changing circumstances, which may be particularly difficult for people on the autism spectrum. The goal of this therapy is to enhance the quality of life of participants. This intervention is reported to be easily begun and integrated into daily routines in ways that enrich family life.

The Social Communication, Emotional Regulation, and Transactional Support (SCERTS) model strives to enhance social communication and emotional regulation and is easily integrated with other interventions. Its goal is for a child to learn and use skills needed to function in daily life in a variety of settings with a variety of partners. It focuses on developing spontaneous communication in trusting relationships with adults and peers and sharing joyful emotional experiences. This intervention emphasizes child-initiated communication for purposes such as requesting, greeting, expressing emotions, and protesting. While ABA focuses on adult-directed activities, the SCERTS model focuses on child initiatives and applies goals to daily routines at home and at school. The child learns to imitate and observe others, and the family members and teachers learn to recognize signs of emotional dysregulation and respond with needed support to prevent the situation from escalating.