Treatment Options

A review of recent studies confirms the benefit of five types of behavioral therapies for children and adolescents with autism spectrum disorder (ASD).

The authors reviewed scientific reports published since January 2010 and found that a wide range of behavioral interventions improved outcomes of people with ASD.

The report appears in the December issue of the scientific journal Current Opinion in Pediatrics. It is co-authored by Autism Speaks Chief Science Officer Geraldine Dawson, Ph.D., who is also a professor of psychiatry at the University of North Carolina, in Chapel Hill; and psychologist Karen Burner, Ph.D., of the University of Washington, in Seattle.

Dawson and Burner focused on five types of behavioral therapies and found evidence of the following benefits:
• Early intensive behavioral intervention for toddlers can produce significant gains in language and mental abilities. “Intensive” is defined as 25 to 40 hours a week of therapy over at least 2 years.
• Briefer, targeted behavioral interventions can improve social communication in toddlers and young children. Here, benefits can be seen when interventions are delivered for at least 6 months.
• Parent-delivered early interventions can improve parent-child interactions. However, research in this area is relatively new. More studies are needed to determine whether parent-led therapies improve children’s overall outcomes.
• Group programs designed to enhance social skills clearly benefit grade-schoolers and adolescents with ASD
• Behavioral therapies can also reduce anxiety and aggression in children and adolescents with ASD.

The authors recommend that future research build on these results by comparing treatments, determining the common “ingredients” to successful programs and better identifying which individuals will benefit from which type of therapy. Also still needed are follow-up studies that can determine how best to maintain benefits, as well as studies on how best to train therapists, teachers and parents to deliver these therapies in various community settings.

“It is gratifying to see the accumulating evidence that supports the benefits of a wide range of behavioral interventions for improving outcomes of people with autism,” Dawson says. “It is crucial that families have access to these interventions, which can improve quality of life for not only children and adults with autism, but also their families.”

Options for Treatment Include:

Parent Education and Training
Social Skills Training and Speech-Language Therapy
Cognitive Behavior Therapy
Applied Behavioral Analysis (ABA)
Sensory Integration/Occupational Therapy

Parent Education Training
Parent training can be especially beneficial to the improvement of children with AS/HFA. If caregivers such as parents, grandparents, siblings, babysitters, etc. are fully aware of and understand the strengths and deficits of the child, they will be able to incorporate aspects of successful treatment options like social skills training into the child’s life at home. The more children with AS are exposed to social skills and behavior training, the more likely they are to improve their behavior. Parents and other caregivers can learn how to effectively implement treatment mechanisms into the child’s everyday life. Treatment then becomes consistent and routine for children with AS.

Social Skills Training and Speech-Language Therapy
Children with Asperger Syndrome/HFA can expand and improve their social skills through training and therapy. Though children with AS may have strong language skills, it is important that they learn how to express their thoughts and feelings appropriately. Their ability to interact with others can improve with lots of practice and explicit teaching. Therapists often teach social skills to children with AS/HFA using visual techniques such as social stories, or using exercises that involve the children in various social situations. Social skills groups have proved to be very beneficial to children with AS in teaching them how to interact with their peers. Speech and language therapy may also help these children to communicate better. This therapy could correct awkward methods of speaking such as monotone, and help children to better understand and interpret the speech and communication signals of others such as humor, eye contact, and hand gestures.

Cognitive Behavior Therapy
Cognitive Behavioral Therapy (CBT) is used primarily to help individuals with AS regulate their emotions, develop impulse control, and improve their behavior as a result. In addition, some individuals with AS/HFA struggle with fears and anxiety, or may become depressed. Cognitive behavior therapy has been shown to be helpful for reducing anxious and depressed feelings and behavior by making changes in thoughts and perceptions of situations through a change in cognition. The key ingredient of CBT, which distinguishes it from regular behavior therapy, is working on this change in cognition or how thinking is processed. Therapists seek to reduce challenging behaviors, such as interruptions, obsessions, meltdowns or angry outbursts, while also teaching individuals how to become familiar with and manage certain feelings that may arise.
Cognitive behavioral therapy can be individualized for each patient, and as a result, is very effective at improving very specific behaviors and challenges in each child or young adult. Stabilizing emotions and improving behavior allows those with AS to prepare for and respond more appropriately in specific situations.

Applied Behavior Analysis (ABA)
Since the early 1960’s, Applied Behavior Analysis, or ABA, has been used by hundreds of therapists to teach communication, play, social, academic, self-care, work, and community living skills, and to reduce problem behaviors in learners with autism. There now is a great deal of research literature that demonstrates that ABA is effective for improving children’s outcomes, especially their cognitive and language abilities. Over the past several decades, different treatment models using ABA have emerged, all of which use behavioral teaching. They all use strategies that are based on the work of B.F. Skinner. ABA is often difficult to understand until you see it in action. It may be helpful to start by describing what all of the different methods of ABA have in common. ABA methods use the following three step process to teach:
1. An antecedent, which is a verbal or physical stimulus such as a command or request. This may come from the environment or from another person, or be internal to the subject
2. A resulting behavior, which is the subject’s (or in this case, the child’s) response or lack of response
3. A consequence, which depends on the behavior. The consequence can include positive reinforcement of the desired behavior, or no reaction for the incorrect response.
ABA targets the learning of skills and the reduction of challenging behaviors. Most ABA programs are highly-structured. Targeted skills and behaviors are based on an established curriculum. Each skill is broken down into small steps, and taught using prompts, which are gradually eliminated as the steps are mastered. The child is given repeated opportunities to learn and practice each step in a variety of settings. Each time the child achieves the desired result, he receives positive reinforcement, such as verbal praise or something that the child finds to be highly motivating. ABA programs often include support for the child in a school setting, with a one-on-one aide to target the systemic transfer of skills to a typical school environment. Skills are broken down into manageable pieces and built upon so that a child learns how to learn in a natural environment. Facilitated play with peers is often part of the intervention. Success is measured by direct observation and data collection and analysis – all critical components of ABA. If the child isn’t making satisfactory progress, adjustments are made.

Sensory Integration Occupations
Many children with AS/HFA have problems with motor skills or issues with their senses. In sensory integration therapy, occupational therapists work with children to stabilize their senses and their reactions to external stimuli. This therapy can help children gain better control over their bodies, and thus can reduce clumsiness, instability and hand-eye coordination. SI therapy can also reduce anxiety in children with AS/HFA by improving their responses to particular sounds or touches. When children have better control of their senses, they are better able to control their movements, sounds, and emotions. This leads to reduced awkwardness and improved social skills.