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Therapeutic options for children with autism

Therapeutic options for children with autism

When a child is diagnosed with autism, parents have several different options to consider as they navigate the next steps in supporting their child. They may question what types of therapy and support their child will need to develop their communication and social skills and improve adaptive behaviors. Challenging behaviors such as aggression and self-harming are common in children with autism as well, so treatment aimed at reducing those behaviors is often sought by parents and caregivers. 

While there is no cure for autism, there are many different therapy options available for children with autism. Treatment is typically focused on alleviating some of the symptoms that come with an autism diagnosis including communication delays, social skill deficits, and repetitive and restrictive behavior patterns. The general goal of treatment is to help a child with autism be as independent and successful as possible, closing skill gaps and reducing interfering behaviors that may hinder their learning and growth or harm them. 

Treatment will vary based on the individual needs of each child. We’ll take an in-depth look at several of the common therapies that are available for children with autism. Oftentimes children receive a combination of two or more therapies for the best possible outcomes. Your child’s care team can help guide you through deciding which treatment options are best suited for your child’s needs.  

The following review will cover treatments that are specific for children with autism. However, every child is different, so alternative therapies may also be recommended by your child’s care team. 

The following therapeutic approaches will be covered:

  • Applied behavior analysis (ABA)
  • Speech therapy
  • Physical therapy (PT)
  • Occupational therapy (OT)
  • DIR/Floortime
  • Medications
  • Diet modifications

Applied behavior analysis (ABA) for children with autism 

ABA is a scientific approach to modifying behavior through the principles of behavior analysis. Evidence-based procedures are applied to improve socially significant behaviors. ABA therapy addresses a wide range of behaviors and skills, from basic communication to social skill development to maladaptive behaviors such as aggression and self-injurious behaviors. 

While ABA is not solely a treatment for children with autism, it is commonly known as the “gold standard” for autism treatment due to the wide range of skills and behaviors worked on in ABA, as well as the research backing it. The principles of behavior can also be applied to many different populations and settings. 

ABA therapy is typically conducted by a Behavior Technician (BT) or Registered Behavior Technician (RBT), with a supervising Board Certified Behavior Analyst (BCBA) overseeing the case. The RBT is responsible for working directly with the child, and implementing the goals and behavior intervention plan (BIP) while the BCBA is responsible for conducting assessments, creating the treatment plan and BIP, training and supervising staff, parent treatment guidance meetings, and more. There may also be a Board Certified Assistant Behavior Analyst (BCaBA) or another mid-level supervisor supporting the BCBA with treatment planning and supervision. 

Parent involvement is also a key component of ABA, especially when the therapy is provided in the home. Through treatment guidance meetings (also sometimes referred to as “parent training”) parents have an opportunity to ask questions, troubleshoot concerns, learn about ABA principles, and generalize skills from therapists to themselves. 

Some of the common procedures used in ABA include:

  • Functional behavior assessment (FBA) - An FBA is conducted to gather thorough information regarding a behavior of interest to identify the variables maintaining the behavior and identify more adaptive ways of supporting the individual. An FBA may consist of both indirect assessment such as interviews with caregivers, questionnaires, and record review, as well as descriptive assessment which includes direct observations of the individual and data collection and analysis. 
  • Data collection - ABA is highly data-driven. Because of this, data is a primary component of therapy sessions. Data may be taken on specific goals/programs, behaviors, caregiver goals, etc. The data is then analyzed on an ongoing basis by the BCBA on the case. Intervention decisions are data-driven. 
  • Preference assessments - Each child has individual preferences, and therefore what motivates one child may not motivate another. In order to identify items that are likely to be motivating and serve as reinforcers for a particular child, preference assessments may be conducted. These can be in the form of questionnaires, observations, or a structured assessment. 
  • Behavior intervention plan (BIP) - When children are struggling behaviorally, the ABA team will implement a BIP that outlines strategies for reducing interfering behaviors and teaching replacement behaviors. This will include antecedent strategies, which are ways to structure the environment to avoid the behaviors occurring in the first place, and consequence strategies, which are the ways of modifying the environment after a behavior occurs. In other words, how to respond to the behavior. A BIP is a highly individualized document and will therefore vary greatly from child to child. 

ABA may be conducted in a child’s home environment, at a center, out in the community, or sometimes even at school. ABA is often started at an intensive number of hours with children receiving 20+ hours per week of direct care, while titrating to a lower number of hours as the child makes progress in developing their social and communicative skills, and reducing problematic behaviors. 

While ABA has a significant body of research supporting its efficacy, it may not be the best fit for all families. There are several other therapies that may be used in conjunction with ABA or on their own without ABA therapy. 

Speech and language therapy for children with autism

Speech and language therapy can help children improve their ability to effectively communicate with others. Speech therapy can cover verbal, nonverbal, and social communication.

Speech and language-related challenges vary from child to child. Some children with autism are non-vocal-verbal, while others have a strong ability to communicate with others. The goals initiated in speech therapy are individualized to each child’s needs. 

Speech and language therapy is provided by a Speech Language Pathologist (SLP) by first conducting assessments to determine the needs and strengths of the child and then developing an individualized treatment plan. Speech therapy is typically conducted once or twice a week, however, the frequency will be determined based on each individual child’s needs. 

Some of the skills and goals a speech therapist may work on with children include:

  • Articulating words
  • Understanding body language
  • Using an appropriate tone of voice
  • Responding to questions and holding conversations
  • Responding to instructions
  • Strengthening muscles in the jaw, neck, and mouth
  • Using Alternative Augmentative Communication (AAC)
  • Feeding and swallowing

Speech services may take place in a variety of settings including in a clinic, at school, and in-home. Speech therapists can work on a wide range of language and communication skills, making it an important component of autism therapies, especially for those with speech and language-related delays.  

Occupational therapy (OT) for children with autism

In occupational therapy, children develop the skills needed to live independent lives by helping children develop, maintain, or recover their ability to engage in meaningful daily lives. Some skills worked on in occupational therapy include those necessary for dressing, bathing, eating, playing, etc. 

Occupational therapy is conducted by an occupational therapist starting with an assessment of the child, which is done through a parent and/or child interview as well as direct observations of and engagement with the child. Some of the areas they assess include sensory, motor, social, communication, and cognitive functioning. Occupational therapy may occur anywhere from once a month to a few times per week depending on the individual’s needs.

Some of the goals an occupational therapist may target include:

  • Sensory integration
  • Emotional development and self-regulation
  • Motor development
  • Improving self-care routines
  • Improving tolerance to delayed gratification
  • Increasing independence and confidence

Occupational therapy is typically conducted in a clinic setting or in school. The focus on increasing independent life skills makes occupational therapy a beneficial therapy approach for some children with autism. The sensory integration component is also essential, as hypersensitivity and hyposensitivity are common in some children with autism. 

DIR/Floortime for children with autism

DIR stands for developmental, individual differences, and relationship-based. It provides a framework for understanding individual differences and how each individual perceives the world around them. It emphasizes the importance of developing social and emotional skills and highlights the need for emotional connections in reaching one’s highest potential.

Floortime is the application of the DIR model in action. A main component of DIR/Floortime is first finding the child’s motivation by paying attention to what they are naturally drawn to. They avoid thinking in terms of rewards and avoid having preconceived notions. 

It is called floortime due to the focus of having the adults get on the floor and engage with the child in their interests. It is highly child-led, with parents and therapists meeting the child where they’re at, and building on their strengths. 

Some of the main goals worked on in DIR/Floortime include:

  • Self-regulation and interest in the world around them
  • Engagement in relationships
  • Two-way communication
  • Complex communication
  • Emotional ideas
  • Emotional thinking

Therapy session frequency and duration range based on individual needs, but they typically occur between 2-5 hours per day. A key component is training caregivers to interact with their child in a way that enhances learning through their natural interests. 

Unlike other therapies, DIR/Floortime is not specific to a certain provider type. Psychologists, teachers, speech therapists, social workers, daycare providers, and more, may get certified in DIR/Floortime and be qualified to provide this type of treatment. 

Physical therapy (PT) for children with autism

For some children with autism, physical therapy may be a component of their treatment. Physical therapy works on improving motor skills and building strength, posture, and balance. A literature review shows a wide range of motor delays and deficits in those with autism, noting the need for physical therapy as a component of treatment for many children with autism. 

Motor skill deficits are common in children with autism in the following domains:

  • Motor planning
  • Gait
  • Coordination
  • Posture
  • Fine motor skills
  • Gross motor skills

Physical therapy is provided by a physical therapist. A physical therapist can help a child develop stronger motor skills necessary to engage in play, daily living activities, and academic tasks. Physical therapists will perform exercises with a client and demonstrate exercises that they should do outside of therapy sessions, for optimal progress. 

Physical therapy will occur at a frequency determined by the physical therapist for each individual based on their needs but is commonly done once or twice per week for about 30-60 minutes. 

Medications for children with autism

There are no medications that are currently authorized by the FDA to treat autism. However, there are certain medications that may be able to treat specific symptoms, like ADHD, anxiety, and mood dysregulation disorders. 

Some examples of medications for treating specific symptoms in children with autism include:

  • Aripiprazole - to treat aggression and irritability
  • Risperidone - to treat social aberrant behavior
  • Methylphenidate - to treat hyperactivity and inattention
  • Venlafaxine - to treat self-injurious behaviors
  • Fluoxetine - to treat repetitive behaviors

Each medication comes with potential side effects and each work for different people. If you feel that your child may benefit from medication, this should be discussed with their primary care provider to further consider the benefits and potential risks, and determine whether or not medication is appropriate for your child’s needs. 

If your child is receiving other therapies, be sure to inform their care team of any medication changes, so they can help monitor the child’s behaviors in response to the addition of a medication. In particular, if your child is receiving ABA therapy, their BCBA can create an event change line on all behavior graphs, which can support you in identifying any behavior changes that are identified after the medication is added. 

Diet modification

Many families try diet modifications to alleviate some of the symptoms of autism. Studies are in the early stages of identifying what benefits, if any, there are to specialized diets. While there are many anecdotal reports of improved symptoms of autism when diet changes are made, there is not much scientific evidence at this time. If you are interested in pursuing a change in your child’s diet, it is recommended that you speak with their pediatrician prior to making any changes to ensure that the diet is safe for your child and that you are aware of any risks or side effects, in order to make a fully informed decision.

Some of the common diet modifications include:

  • Gluten-free casein-free diet (GFCF) - This is the most common diet modification parents consider. It consists of removing all sources of gluten and casein in one’s diet, as well as gluten found in external sources such as lip balm. As of yet, there has not been substantial evidence to scientifically link a reduction of symptoms of autism with a GFCF diet.
  • Exclusion of food additives - This involves removing additives such as aspartame, MSG, and artificial colors, typically in an effort to improve behaviors such as hyperactivity and irritability. There has been minimal quality research on this type of diet for the improvement of autism symptoms. 
  • Fish oil and other supplements high in omega 3’s - Omega 3 fats play a role in brain development and function. Research has shown that deficiencies in omega fatty acids can contribute to behavioral and learning challenges. Current scientific evidence available suggests that omega 3 supplementation can improve neurodevelopmental disorders such as mood disorders and learning disabilities, however, this has not yet been linked to those with autism diagnoses. 

There are many other diet modifications that have anecdotal support for treating symptoms of autism, though there is not quite enough scientific backing to support these as a treatment modality. If you have any questions or concerns with any aspect of your child’s diet or are interested in diet modifications, please speak with a primary care provider and dietician to explore your options further. 

Final words

Every child with autism has individual strengths and individual needs, so their treatment plan should be individualized for the best possible outcomes. With many options to choose from, it is up to you and your child’s care team to determine what therapeutic options would best fit their needs. Whichever therapies are chosen for your child, early intervention is an important component to optimal results. 

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