What are the treatment options for a non-verbal autistic 9-year-old?

Treatment Options for a Non-Verbal Autistic 9-Year-Old

For a non-verbal autistic 9-year-old, a comprehensive treatment approach should include structured educational and behavioral interventions such as Applied Behavioral Analysis (ABA), speech/language therapy with augmentative and alternative communication (AAC) systems, and occupational therapy to address sensory and motor challenges. 1, 2

Core Interventions

Communication Interventions

• Speech/Language Therapy: Essential for children with significant language and communication challenges 1
  • Augmentative and Alternative Communication (AAC) systems such as:
    • Picture Exchange Communication System (PECS)
    • Sign language
    • Communication boards
    • Visual supports
    • Voice output communication aids 1
  • For minimally verbal children, evaluation for an appropriate AAC device is critical 1
  • Focus on both receptive and expressive communication skills 1

Behavioral Interventions

• Applied Behavioral Analysis (ABA): Evidence-based approach for teaching skills and reducing problematic behaviors 1
  • Early Intensive Behavioral Intervention: Highly individualized program with up to 40 hours per week of one-to-one teaching 1
  • Functional behavioral assessment for challenging behaviors 1
  • Teaching chains of behaviors using forward or backward chaining with reinforcement 1

Sensory and Motor Interventions

• Occupational Therapy: Addresses fine and gross motor challenges 1
  • Should be sustained even when difficulties appear to improve, as patterns of improvement and worsening have been observed 1
  • Sensory integration activities to address sensory processing differences 2
• Physical Therapy: May be needed for gross motor difficulties 1

Educational Approaches

• Structured Educational Programs: Should be evidence-based and tailored to the child's needs 1
  • Visual schedules and supports to aid comprehension and organization 1, 2
  • Concrete, explicit language when discussing appropriate behaviors 2
  • Assistive technology to support learning and organization 1
  • Joint attention training and reciprocal imitation training 2

Medication Considerations

• Behavioral medications: Should be considered only after behavioral interventions have been tried 2
  • Risperidone: FDA-approved for treating irritability associated with autism in children 5 years and older 3
    • Indicated for symptoms of aggression, self-injury, temper tantrums, and rapidly changing moods 3
    • Requires careful monitoring for side effects including weight gain, somnolence, and extrapyramidal symptoms 3

Implementation Strategies

• Multidisciplinary Evaluation: Should include a psychologist, physician, and speech/language pathologist 1

  • Assessment of cognitive abilities, language skills, adaptive functioning, and autism symptoms 1
  • Regular monitoring of progress using standardized measures 2

• Accommodations for Processing Challenges:

  • Ensure attention is gained before giving instructions 1
  • Speak slowly and clearly 1
  • Use repetition and attention questions 1
  • Keep directives to a reasonable length 1
  • Use visual supports to enhance comprehension 1, 2

Important Considerations

• Early intervention is critical, but at age 9, intensive intervention is still beneficial 2
• Family involvement as co-therapists increases intervention effectiveness 2
• Focus on generalization of skills across different settings and with different people 1
• Regular assessment of developmental progress and adjustment of interventions as needed 2

Pitfalls to Avoid

• Assuming a child who is non-verbal cannot understand language
• Discontinuing therapies prematurely when improvements are seen 1
• Relying solely on medication without behavioral interventions 2
• Failing to address comorbid conditions like anxiety, ADHD, or sleep difficulties that may exacerbate symptoms 2
• Using treatments without evidence of efficacy (e.g., chelation therapy) 2

By implementing these evidence-based interventions with consistency and coordination among providers, a non-verbal autistic 9-year-old can make significant gains in communication, social skills, and adaptive functioning, improving their quality of life and long-term outcomes.