How is ASD treated?

While there's no proven cure yet for autism spectrum disorder (ASD), treating ASD early, using
school-based programs, and getting proper medical care can greatly reduce ASD symptoms and
increase your child's ability to grow and learn new skills.

Early intervention

Research has shown that intensive behavioral therapy during the toddler or preschool years can
significantly improve cognitive and language skills in young children with ASD.27,28 There is no single
best treatment for all children with ASD, but the American Academy of Pediatrics recently noted
common features of effective early intervention programs.29 These include:

Starting as soon as a child has been diagnosed with ASD

Providing focused and challenging learning activities at the proper developmental level for
the child for at least 25 hours per week and 12 months per year

Having small classes to allow each child to have one-on-one time with the therapist or
teacher and small group learning activities

Having special training for parents and family

Encouraging activities that include typically developing children, as long as such activities
help meet a specific learning goal

Measuring and recording each child's progress and adjusting the intervention program as
needed

Providing a high degree of structure, routine, and visual cues, such as posted activity
schedules and clearly defined boundaries, to reduce distractions

Guiding the child in adapting learned skills to new situations and settings and maintaining
learned skills

Using a curriculum that focuses on

Language and communication

Social skills, such as joint attention (looking at other people to draw attention to
something interesting and share in experiencing it)

Self-help and daily living skills, such as dressing and grooming

Research-based methods to reduce challenging behaviors, such as aggression and

tantrums

Cognitive skills, such as pretend play or seeing someone else's point of view

Typical school-readiness skills, such as letter recognition and counting.

One type of a widely accepted treatment is applied behavior analysis (ABA). The goals of ABA are to
shape and reinforce new behaviors, such as learning to speak and play, and reduce undesirable
ones. ABA, which can involve intensive, one-on-one child-teacher interaction for up to 40 hours a
week, has inspired the development of other, similar interventions that aim to help those with ASD
reach their full potential.30,31 ABA-based interventions include:

Verbal Behaviorfocuses on teaching language using a sequenced curriculum that guides

children from simple verbal behaviors (echoing) to more functional communication skills
through techniques such as errorless teaching and prompting32

Pivotal Response Trainingaims at identifying pivotal skills, such as initiation and self-
management, that affect a broad range of behavioral responses. This intervention
incorporates parent and family education aimed at providing skills that enable the child to
function in inclusive settings.33,34

Other types of early interventions include:

Developmental, Individual Difference, Relationship-based(DIR)/Floortime Modelaims to

build healthy and meaningful relationships and abilities by following the natural emotions
and interests of the child.35 One particular example is the Early Start Denver Model, which
fosters improvements in communication, thinking, language, and other social skills and
seeks to reduce atypical behaviors. Using developmental and relationship-based
approaches, this therapy can be delivered in natural settings such as the home or pre-
school.33,34

TEACCH (Treatment and Education of Autistic and related Communication handicapped

Children)emphasizes adapting the child's physical environment and using visual cues (for
example, having classroom materials clearly marked and located so that students can access
them independently). Using individualized plans for each student, TEACCH builds on the
child's strengths and emerging skills.34,36

Interpersonal Synchronytargets social development and imitation skills, and focuses on

teaching children how to establish and maintain engagement with others.

For children younger than age 3, these interventions usually take place at home or in a child care
center. Because parents are a child's earliest teachers, more programs are beginning to train parents
to continue the therapy at home.

Students with ASD may benefit from some type of social skills training program.37 While these
programs need more research, they generally seek to increase and improve skills necessary for
creating positive social interactions and avoiding negative responses. For example, Children's
Friendship Training focuses on improving children's conversation and interaction skills and teaches
them how to make friends, be a good sport, and respond appropriately to teasing.38

Working with your child's school

Start by speaking with your child's teacher, school counselor, or the school's student support team
to begin an evaluation. Each state has a Parent Training and Information Center and a Protection and
Advocacy Agency that can help you get an evaluation. A team of professionals conducts the
evaluation using a variety of tools and measures. The evaluation will look at all areas related to your
child's a111bilities and needs.

Once your child has been evaluated, he or she has several options, depending on the specific needs.
If your child needs special education services and is eligible under the Individuals with Disabilities
Education Act (IDEA), the school district (or the government agency administering the program)
must develop an individualized education plan, or IEP specifically for your child within 30 days.

IDEA provides free screenings and early intervention services to children from birth to age 3. IDEA
also provides special education and related services from ages 3 to 21. Information is available from
the U.S. Department of Education.

If your child is not eligible for special education servicesnot all children with ASD are eligiblehe
or she can still get free public education suited to his or her needs, which is available to all public-
school children with disabilities under Section 504 of the Rehabilitation Act of 1973, regardless of
the type or severity of the disability.

The U.S. Department of Education's Office for Civil Rights enforces Section 504 in programs and
activities that receive Federal education funds. More information on Section 504 is available on the
Department of Education website.

More information about U.S. Department of Education programs for children with disabilities is
available on their website.

During middle and high school years, your child's teachers will begin to discuss practical issues such
as work, living away from a parent or caregiver's home, and hobbies. These lessons should include
gaining work experience, using public transportation, and learning skills that will be important in
community living.29

Medications

Some medications can help reduce symptoms that cause problems for your child in school or at
home. Many other medications may be prescribed off-label, meaning they have not been approved
by the U.S. Food and Drug Administration (FDA) for a certain use or for certain people. Doctors may
prescribe medications off-label if they have been approved to treat other disorders that have similar
symptoms to ASD, or if they have been effective in treating adults or older children with ASD.
Doctors prescribe medications off-label to try to help the youngest patients, but more research is
needed to be sure that these medicines are safe and effective for children and teens with ASD.

At this time, the only medications approved by the FDA to treat aspects of ASD are the
antipsychotics risperidone (Risperdal) and aripripazole (Abilify). These medications can help reduce
irritabilitymeaning aggression, self-harming acts, or temper tantrumsin children ages 5 to 16
who have ASD.

Some medications that may be prescribed off-label for children with ASD include the following:

Antipsychotic medications are more commonly used to treat serious mental illnesses such
as schizophrenia. These medicines may help reduce aggression and other serious behavioral
 problems in children, including children with ASD. They may also help reduce repetitive
behaviors, hyperactivity, and attention problems.29

Antidepressant medications, such as fluoxetine (Prozac) or sertraline (Zoloft), are usually

prescribed to treat depression and anxiety but are sometimes prescribed to reduce
repetitive behaviors. Some antidepressants may also help control aggression and anxiety in
children with ASD.29 However, researchers still are not sure if these medications are useful; a
recent study suggested that the antidepressant citalopram (Celexa) was no more effective
than a placebo (sugar pill) at reducing repetitive behaviors in children with ASD.39

Stimulant medications, such as methylphenidate (Ritalin), are safe and effective in treating
people with attention deficit hyperactivity disorder (ADHD). Methylphenidate has been
shown to effectively treat hyperactivity in children with ASD as well. But not as many
children with ASD respond to treatment, and those who do have shown more side effects
than children with ADHD and not ASD.40

All medications carry a risk of side effects. For details on the side effects of common psychiatric
medications, see the NIMH website on "Medications".

FDA warning about antidepressants

Antidepressants are safe and popular, but some studies have suggested that they may have
unintended effects on some people, especially in teens and young adults. The FDA warning says that
patients of all ages taking antidepressants should be watched closely, especially during the first few
weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking
or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal
from normal social situations. Families and caregivers should report any changes to the doctor. The
latest information is available on the FDA website.

A child with ASD may not respond in the same way to medications as typically developing children.
You should work with a doctor who has experience treating children with ASD. The doctor will
usually start your child on the lowest dose that helps control problem symptoms. Ask the doctor
about any side effects of the medication and keep a record of how your child reacts to the
medication. The doctor should regularly check your child's response to the treatment.

You have many options for treating your child's ASD. However, not all of them have been proven to
work through scientific studies. Read the patient information that comes with your child's
medication. Some people keep these patient inserts along with their other notes for easy reference.
This is most useful when dealing with several different prescription medications. You should get all
the facts about possible risks and benefits and talk to more than one expert when possible before
trying a new treatment on your child.

http://www.nimh.nih.gov/health/publications/a-parents-guide-to-autism-spectrum-disorder/how-
is-asd-treated.shtml
Treatment
There are no medications that can cure ASDs or treat the core symptoms. However, there are
medications that can help some people with ASDs function better. For example, medication
might help manage high energy levels, inability to focus, depression, or seizures. Also, the
U.S. Food and Drug Administration has approved the use of risperidone and aripiprazole
(antipsychotic drugs) to treat at certain ages children with ASDs who experience severe
tantrums, aggression, and self-injurious behaviors. For more information, visit the Food and
Drug Administration's website .

Medications might not affect all children in the same way. It is important to work with a
health care professional who has experience in treating children with ASDs. Parents and
health care professionals must closely monitor a child's progress and reactions while he or
she is taking a medication to be sure that any negative side effects of the treatment do not
outweigh the benefits.

It is also important to remember that children with ASDs can get sick or injured just like
children without ASDs. Regular medical and dental exams should be part of a childs
treatment plan. Often it is hard to tell if a childs behavior is related to the ASD or is caused
by a separate health condition. For instance, head banging could be a symptom of the ASD,
or it could be a sign that the child is having headaches. In those cases, a thorough physical
exam is needed. Monitoring healthy development means not only paying attention to
symptoms related to ASDs, but also to the childs physical and mental health, as well.

Early Intervention Services

Research shows that early intervention

treatment services can greatly improve a childs development.[1],[2] Early intervention services
help children from birth to 3 years old (36 months) learn important skills. Services include
therapy to help the child talk, walk, and interact with others. Therefore, it is important to talk
to your childs doctor as soon as possible if you think your child has an ASD or other
developmental problem.
Even if your child has not been diagnosed with an ASD, he or she may be eligible for early
intervention treatment services. The Individuals with Disabilities Education Act (IDEA)
says that children under the age of 3 years (36 months) who are at risk of having
developmental delays may be eligible for services. These services are provided through an
early intervention system in your state. Through this system, you can ask for an evaluation.

In addition, treatment for particular symptoms, such as speech therapy for language delays,
often does not need to wait for a formal ASD diagnosis. While early intervention is extremely
important, intervention at any age can be helpful.

Learn more about early intervention

Types of Treatments

The National Institute of Mental Health and the Autism Society of America suggest a list of
questions parents can ask when planning treatments for their child.

There are many different types of treatments available. For example, auditory training,
discrete trial training, vitamin therapy, anti-yeast therapy, facilitated communication, music
therapy, occupational therapy, physical therapy, and sensory integration.

The different types of treatments can generally be broken down into the following categories:

Behavior and Communication Approaches

Dietary Approaches

Medication

Complementary and Alternative Medicine

Behavior and Communication Approaches

According to reports by the American Academy of Pediatrics and the National Research
Council, behavior and communication approaches that help children with ASDs are those that
provide structure, direction, and organization for the child in addition to family participation.

Applied Behavior Analysis (ABA)

 A notable treatment approach for
people with an ASD is called applied behavior analysis (ABA). ABA has become widely
accepted among health care professionals and used in many schools and treatment
clinics. ABA encourages positive behaviors and discourages negative behaviors in order to
improve a variety of skills. The childs progress is tracked and measured.

There are different types of ABA. Following are some examples:

Discrete Trial Training (DTT)

DTT is a style of teaching that uses a series of trials to teach each step of a desired behavior
or response. Lessons are broken down into their simplest parts and positive reinforcement is
used to reward correct answers and behaviors. Incorrect answers are ignored.

Early Intensive Behavioral Intervention (EIBI)

This is a type of ABA for very young children with an ASD, usually younger than five, and
often younger than three.

Pivotal Response Training (PRT)

PRT aims to increase a childs motivation to learn, monitor his own behavior, and initiate
communication with others. Positive changes in these behaviors should have widespread
effects on other behaviors.

Verbal Behavior Intervention (VBI)

VBI is a type of ABA that focuses on teaching verbal skills.

Other therapies that can be part of a complete treatment program for a child with an ASD
include:

Developmental, Individual Differences, Relationship-Based Approach (DIR; also called

"Floortime")
Floortime focuses on emotional and relational development (feelings, relationships with
caregivers). It also focuses on how the child deals with sights, sounds, and smells.

Treatment and Education of Autistic and related Communication-handicapped

CHildren (TEACCH)
TEAACH uses visual cues to teach skills. For example, picture cards can help teach a child
how to get dressed by breaking information down into small steps.
 Occupational Therapy
Occupational therapy teaches skills that help the person live as independently as possible.
Skills might include dressing, eating, bathing, and relating to people.

Sensory Integration Therapy

Sensory integration therapy helps the person deal with sensory information, like sights,
sounds, and smells. Sensory integration therapy could help a child who is bothered by certain
sounds or does not like to be touched.

Speech Therapy
Speech therapy helps to improve the persons communication skills. Some people are able to
learn verbal communication skills. For others, using gestures or picture boards is more
realistic.

The Picture Exchange Communication System (PECS)

PECS uses picture symbols to teach communication skills. The person is taught to use picture
symbols to ask and answer questions and have a conversation.

Visit the Autism Speaks or Easter Seals website to read more about these therapies.

Dietary Approaches

Some dietary treatments have been developed by reliable therapists. But many of these
treatments do not have the scientific support needed for widespread recommendation. An
unproven treatment might help one child, but may not help another.

Many biomedical interventions call for changes in diet. Such changes include removing
certain types of foods from a childs diet and using vitamin or mineral supplements. Dietary
treatments are based on the idea that food allergies or lack of vitamins and minerals cause
symptoms of ASDs. Some parents feel that dietary changes make a difference in how their
child acts or feels.
If you are thinking about changing your childs diet, talk to the doctor first. Or talk with a
nutritionist to be sure your child is getting important vitamins and minerals.

Medication

There are no medications that can cure ASDs or even treat the main symptoms. But there are
medications that can help some people with related symptoms. For example,
medication might help manage high energy levels, inability to focus, depression, or
seizures. Also, the U.S. Food and Drug Administration approved the use of risperidone and
aripripazole (antipsychotic drugs) to treat at certain ages children with ASDs who have
severe tantrums, aggression, and cause self-injury.

To learn more about medications and ASDs go to National Institute of Mental Health autism
website.

Complementary and Alternative Treatments

To relieve the symptoms of ASDs, some parents and health care professionals use treatments
that are outside of what is typically recommended by the pediatrician. These types of
treatments are known as complementary and alternative treatments (CAM). They might
include special diets, chelation (a treatment to remove heavy metals like lead from the body),
biologicals (e.g., secretin), or body-based systems (like deep pressure).[3]

These types of treatments are very controversial. Current research shows that as many as one
third of parents of children with an ASD may have tried complementary or alternative
medicine treatments, and up to 10% may be using a potentially dangerous treatment.[4] Before
starting such a treatment, check it out carefully, and talk to your childs doctor.

To learn more about CAM therapies, go to the National Center for Complementary and
Alternative Medicine Get the Facts webpage.

Additional Treatment Resources

The National Institute on Deafness and Other Communication Disorders has a website to
help individuals with an ASD who have communication challenges.

The National Institute of Dental and Craniofacial Research has a website to help health
professionals with the oral health care needs of patients with an ASD.
Clinical Trials.Gov lists federally funded clinical trials that are looking for participants. If
you or someone you know would like to take part in an autism study, go to the website and
search "autism."

The Autism Treatment Network (ATN) seeks to create standards of medical treatment that
will be made broadly available to physicians, researchers, parents, policy makers, and others
who want to improve the care of individuals with autism. ATN is also developing a shared
national medical database to record the results of treatments and studies at any of their five
established regional treatment centers.

References

1. Handleman, J.S., Harris, S., eds. Preschool Education Programs for Children with
Autism (2nd ed). Austin, TX: Pro-Ed. 2000.
2. National Research Council. Educating Children with Autism. Washington, DC:
National Academy Press, 2001.
3. Gupta, Vidya Bhushan. Complementary and Alternative Medicine. New York
Medical College and Columbia University, 2004. Pediatric Habilitation, volume 12.
4. Levy, S. Complementary and Alternative Medicine Among Children Recently
Diagnosed with Autistic Spectrum Disorder; Journal of Developmental and
Behavioral Pediatrics, December 2003; vol 24: pp 418-423. News release, Health
Behavior News Service.

http://www.cdc.gov/NCBDDD/autism/treatment.html