From the Guidelines
Management of high functioning autism should prioritize a comprehensive approach combining behavioral therapies, social skills training, and educational accommodations tailored to the individual's specific needs and strengths, as supported by the most recent and highest quality study 1.
Key Components of Management
- Behavioral therapies: Applied Behavior Analysis (ABA), cognitive behavioral therapy, and social skills groups to develop communication abilities, reduce challenging behaviors, and navigate social interactions.
- Educational accommodations: Structured environments, visual schedules, clear communication, and accommodations for sensory sensitivities to support learning and daily functioning.
- Family involvement: Active participation of families and caregivers in intervention, including goal setting, teaching, and reinforcing skills, as emphasized in 1.
- Occupational therapy: Addressing sensory processing challenges and developing daily living skills to enhance independence.
- Speech therapy: Supporting communication difficulties and promoting effective communication strategies.
- Vocational training: Fostering workplace success and leveraging individual strengths.
Medication Use
While medications are not used to treat autism itself, they may be prescribed for co-occurring conditions such as anxiety, depression, ADHD, or sleep problems, with examples including SSRIs, stimulants, or melatonin, as noted in 1.
Goal of Management
The primary goal is to support individuals with autism in developing independence, leveraging their unique strengths, and addressing specific challenges, recognizing autism as a neurological difference requiring support rather than a condition to be cured, as highlighted in 1 and 1.
Importance of Recent and High-Quality Evidence
The management approach should be guided by the most recent and highest quality studies, such as 1, which provides strong recommendations for practice and research in early intervention for children with autism spectrum disorder under 3 years of age. This ensures that interventions are evidence-based and tailored to the individual's needs, maximizing outcomes in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
The efficacy and safety of RISPERIDONE in the treatment of irritability associated with autistic disorder were established in two 8 week, doubleblind, placebo-controlled trials in 156 children and adolescent patients, aged 5 to 16 years A third trial was a 6 week, multicenter, randomized, doubleblind, placebo-controlled, fixeddose study to evaluate the efficacy and safety of a lower than recommended dose of risperidone in subjects 5 to 17 years of age with autistic disorder and associated irritability, and related behavioral symptoms
The management approach for high functioning autism involves the use of risperidone to treat irritability associated with autistic disorder. The recommended dosage is based on weight, with a starting dose of 0.25 mg/day or 0.5 mg/day, depending on baseline weight, and titrated to clinical response.
- Key considerations:
- The efficacy of risperidone in treating irritability associated with autistic disorder has been established in two 8-week, double-blind, placebo-controlled trials.
- A third trial demonstrated the efficacy of high-dose risperidone, but not low-dose risperidone, in subjects 5 to 17 years of age with autistic disorder and associated irritability.
- Adverse reactions in pediatric patients, including tardive dyskinesia, weight gain, and somnolence, should be monitored during treatment 2 2.
From the Research
Management Approach for High Functioning Autism
The management approach for high functioning autism involves a combination of therapeutic interventions and strategies to improve social functioning, communication skills, and behavioral problems.
- Psychosocial Therapeutic Approaches: Studies have shown that psychosocial therapeutic approaches, such as group social skills interventions, can be effective in improving social knowledge and understanding, social functioning, and reducing loneliness and co-morbid psychiatric symptoms in adults with high-functioning autism spectrum disorders (hf-ASD) 3, 4.
- Social Skills Training: Social skills training programs have been found to be effective in improving social skills and quality of life in children and adolescents with high-functioning autism (HFA) 5.
- Targeted Interventions: Research suggests that targeted interventions, such as those focusing on social motivation, social anxiety, social cognition, and social skills, can be effective in improving social functioning in adults with autism spectrum disorder (ASD) 6.
- Medications: Selective serotonin reuptake inhibitors (SSRIs) have been prescribed for the treatment of conditions comorbid with ASD, such as depression, anxiety, and obsessive-compulsive behaviors. However, the evidence for their effectiveness in improving core features of autism is limited, and there is emerging evidence of harm in children 7.
- Multidimensional Treatments: The lack of correlations between many categories of social functioning suggests the potential importance of multidimensional treatments that target the particular components of social functioning most in need of improvement in individuals 6.
Key Considerations
When developing a management approach for high functioning autism, it is essential to consider the individual's specific needs and circumstances. This may involve:
- Assessing the individual's social motivation, social anxiety, social cognition, and social skills to identify areas for improvement 6.
- Providing support to manage core symptoms, as well as co-occurring anxiety and depression 3.
- Using evidence-based psychosocial therapeutic options, such as group social skills interventions and social skills training programs 3, 4, 5.
- Monitoring the individual's response to treatment and adjusting the approach as needed 7, 6.