Treatment of Autism Spectrum Disorder
Evidence-based, structured educational and behavioral interventions are the cornerstone of effective treatment for autism spectrum disorder (ASD) and should be implemented as early as possible to improve outcomes. 1
Behavioral Interventions
Applied Behavior Analysis (ABA): Most robust evidence supporting efficacy for improving cognitive and language outcomes
- Early Intensive Behavioral Intervention: Up to 40 hours/week of one-to-one direct teaching
- Starts with discrete trials to teach simple skills, progressing to more complex skills
- Particularly effective for specific problem behaviors, academic tasks, social skills, and adaptive living skills 1
Functional Analysis Approach:
- Identifies patterns of reinforcement
- Uses behavioral techniques to promote desired behavioral alternatives
- Explicit focus on generalization of skills (critical as children with ASD tend to learn tasks in isolation) 1
Communication Interventions
For Non-verbal or Minimally Verbal Children:
- Picture Exchange Communication System (PECS)
- Sign language
- Communication boards
- Visual supports
- Activity schedules
- Voice output communication aids 1
For Children with Fluent Speech:
- Pragmatic language skills training
- Social reciprocity enhancement programs 1
Structured Educational Approaches
Evidence-based Educational Models:
- Early Start Denver Model
- Treatment and Education of Autism and related Communication handicapped Children (TEACCH) program 1
Key Components:
- Planned, intensive, individualized intervention
- Experienced, interdisciplinary team
- Family involvement to ensure generalization of skills
- Explicit teaching with structured approach
- Goals focused on enhancing verbal/nonverbal communication, academic skills, and social/motor/behavioral capabilities 1
Pharmacological Interventions
Used primarily to address specific symptoms rather than core ASD features:
- Aggression
- Self-injurious behavior
- Hyperactivity
- Inattention
- Compulsive-like behaviors
- Repetitive or stereotypic behaviors
- Sleep disturbances 1
Important Note: Combining medication with parent training is moderately more efficacious than medication alone for decreasing serious behavioral disturbance 1
Multidisciplinary Assessment and Management
Comprehensive diagnostic evaluation should include:
- Standardized assessment tools (ADOS-2, ADI-R)
- Hearing evaluation (mandatory to rule out hearing loss)
- Physical examination with attention to dysmorphic features
- Genetic testing when indicated 2
Regular screening for comorbidities:
- Depression
- Anxiety
- Sleep difficulties
- Epilepsy 2
Long-term Treatment Planning
Treatment needs change over time:
- Very young children: Focus on diagnosis and treatment program identification
- School-age children: Behavioral and psychopharmacologic issues become prominent
- Adolescents: Vocational/prevocational training and planning for independence 1
Maintain active role in family support and individual support throughout development 1
Alternative/Complementary Treatments
Clinicians should inquire about and discuss alternative/complementary treatments
Most have limited empirical support but are commonly pursued by families
Some treatments have been shown not to work:
- Intravenous infusion of secretin
- Oral vitamin B6 and magnesium
- Gluten-free, casein-free diet
- Omega-3 fatty acids
- Oral human immunoglobulin 1
Some treatments pose potential risks:
- Chelation (associated with mortality and morbidity)
- "Natural" compounds with contaminants 1
Common Pitfalls to Avoid
- Delaying intervention while waiting for formal diagnosis
- Failing to rule out hearing loss before diagnosing ASD
- Missing co-occurring conditions
- Not considering cultural factors
- Overlooking genetic testing 2
Resources for Families
- Parent support organizations:
- Autism Society of America
- Autism Speaks
- TEACCH
- OASIS (Online Asperger Syndrome Information and Support) 1
Early detection and intervention significantly improve outcomes, with about one-third of autistic persons achieving some degree of independent living 3. The goal of treatment should be to facilitate the child's adjustment and engagement with educational intervention while supporting families through this lifelong journey.