Autism and Treatment

Since autism is on the rise, parents and professionals have become more aware of the early symptoms of autism and more children are being identified at younger ages. (While most children are identified after age 4 years, autism can be diagnosed at younger ages.) This is good news because early treatment can significantly improve outcome. Autism is a spectrum disorder from severe to mild. Not surprisingly, those with milder symptoms tend to have better outcomes, especially if their intellectual functioning is average or above. Moreover children with autism may have other risks and diagnoses that co-occur with the autism (called “comorbidities”). For this reason it is important that parents seek evaluation from a professional that will provide a comprehensive assessment of development. (A developmental psychologist, developmental pediatrician, or a clinical psychologist with expertise in early childhood is recommended. The Autism Diagnostic Observation System, or ADOS, along with a cognitive assessment, observation in multiple settings and inquiry via checklists from parents and other caregivers is the recommended evaluation protocol.) While early identification is important, treatment also predicts outcome success.

Temperament and personality traits of people with autism are as varied as they are in typical folks. However, in general people on the spectrum may have sensory sensitivity, speech and communication challenges, and social cognitive difficulties (including rigidity, restricted range of interest, and social skill deficits). These deficits may be severe enough to disrupt functioning in multiple environments.  There is no one treatment approach for autism and no treatment cures autism. Therapies are designed to target specific autism symptoms. Multi disciplinary approaches including occupational and speech therapy, and applied behavior analysis (ABA therapy) are the cornerstones of early intervention (but are not the only treatments that may be helpful). Medicine to treat some of the symptoms of autism (including psychiatry and gastro intestinal medicine) may or may not be warranted.

In addition to professional intervention, parents must understand the unique behavior and learning needs of children on the spectrum. Holistic and healthy lifestyle approaches such as diet, sleep, and exercise are important, as is a predictable schedule and consistent discipline. Allergies and gastro intestinal problems are sometimes part of the presentation of autism. Some parents have reported great success with eliminating casein and gluten from their child’s diet even though there is limited clinical evidence of the effectiveness of these diets. This should be done under the guidance of a pediatrician or licensed dietitian. Occupational therapists are effective at treating sensory sensitivities. This is important because behavioral difficulties and withdrawal seen in children on the spectrum may be related to avoiding overstimulation. Early and intensive speech therapy is indicated for most but not all people on the spectrum. Finally, educators are gradually adjusting their curriculum to accommodate kids on the spectrum – relieving them of overstimulation and working in groups. While we are not accustomed to referring to teachers as therapists, the impact of their efforts in the classroom can be substantial.

Applied Behavior Analysis or ABA therapy as a treatment for autism has garnered the most research evidence of effectiveness. ABA is an umbrella term for various types of intervention (the Autism Speaks website provides a list of ABA therapists in your area). At its core it is based on reinforcement schedules to increase desirable and decrease undesirable behaviors. While ABA is historically a strict behavioral approach, types of ABA interventions such as pivotal response treatment can be used as a component of more humanistic or relationship based therapies (such as Floor Time, Relationship Development Intervention, and Affinity Therapy). Pivotal response treatment uses a system of rewards to increase interaction, eye contact, and shared interest between a child and an adult (usually a therapist trained in ABA).

An autism diagnosis is no longer a specter of doom. People with autism graduate from high school and many go to college, have successful careers and build families. Successful outcome is becoming more common as early identification and treatment, along with understanding of the condition advances. However, for some individuals with more severe forms of autism, successful outcomes may be limited even with treatment. Long term outcome is best when symptoms are mild and treatment is comprehensive and provided early. In some cases early symptoms of autism may diminish so significantly that the person no longer meets diagnostic criteria for the condition. However, it must be emphasized that this is rare and if one looks closely enough, neurological differences may still be apparent, so this should not be referred to a cure (in all documented cases this was with comprehensive, intensive treatment). As autism diagnosis increases, understanding about treatment also improves. But while some treatment approaches boast miraculous outcomes, they are merely the latest form of “snake oil.”  Parents must research treatments carefully, expediently respond to their child’s needs with early identification, and assemble an effective multi disciplinary team including active collaboration with educators. With help, people with autism are thriving.

Recently the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was altered regarding autism. In the past autism spectrum disorders were classified under various diagnoses including Asperger’s Syndrome and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). Asperger’s Syndrome and PDD-NOS were milder forms of Autistic Disorder or classical Autism. In the DSM-5 all cases of Autism will be diagnosed as Autism and the degree of severity will be indicated. Asperger’s syndrome and PDD-NOS will not be diagnosed.