Treatments for Building Skills in Individuals with Autism Spectrum Disorder

There are dozens of treatment modalities for the treatment of ASD related symptoms. Most treatments aim to increase positive behaviors and increase positive social interactions. Some of these treatments are supported by evidence, but many of them are not. This article will highlight a handful of the treatment modalities that are evidence-based, meaning that the use of these treatments have been thoroughly studied and supported by research, and that when done according to the manual, have been shown to lead to positive growth outcomes. 

Behavioral Interventions

Comprehensive Behavioral Treatment:
Applied Behavior Analysis (ABA)
A treatment that has been around for over 60 years, Applied Behavior Analysis (ABA) is an intensive evidence-based treatment used to bring about positive changes in behavior. This treatment can be administered for 10-25 hours a week, depending on the child’s needs by a Board Certified Assistant Behavior Analyst (BCABA), who is supervised by a  Board Certified Behavior Analyst (BCBA) (Alexrod, 2012). These treatment sessions may be administered in-home, at a specialized treatment center, or at a school (Anagnostou et al., 2014). ABA treatment is most commonly used as an intervention for individuals on the autism spectrum. Individuals who have received ABA-therapy have seen gains in IQ, adaptive skills, academic skills, communication skills, and self-regulation (Anagnostou, 2014; NAC, 2015). 

Additional Behavioral Interventions
Established and emerging behavioral interventions for ASD include Pivotal Response Training (PRT®), the Early Start Denver Model (ESDM), and Social Stories^TM. Each of these modalities target specific goals and aim to help children at various developmental levels. PRT, for example, targets “‘pivotal’ areas [of a child’s development] such as motivation to interact with others, self-management, self-initiation, and responsiveness to multiple cues.” (Alexrod, 2012; NAC, 2015). ESDM is a behavioral intervention model that aims to teach behavior strategies to very young children with ASD, as young as 12 months old. Social Stories are helpful tools that can be used to teach children strategies for navigating challenging social situations. These stories can come from books, or be individually created for each child.

Behavioral Intervention Strategies
Behavioral intervention strategies are commonly used components of a behavioral intervention. Common established and emerging strategies include modeling, scripting, schedules, self-management, and the Picture Exchange Communication System (PECS)  (NAC, 2015).

Modeling- In modeling, a model will accurately demonstrate a skill that can then be imitated by the person learning the new skill. Children can learn through imitating parents, peers, and teachers.

Scripting- Scripting is another way to teach individuals how to initiate or respond to a situation. Scripts can be beneficial when social cues are hard to read and understand, or in situations that are challenging to navigate, such as bullying. In order to have scripts be an effective tool, they must be overpractived before used.

Schedules- Schedules are a great way to increase independence and allow for the planning of future activities. This can be beneficial, especially for individuals who are unsure what to do,  have difficulties with transitions, or for those who need  predictability.

Self-management- Self-management is the ability to manage one’s emotions and actions independently. Teaching self-management can be useful for increasing one’s sense of self-efficacy and for the management of social or disruptive behaviors.

Picture Exchange Communication System (PECS)- For individuals who are non-verbal or have difficulties communicating, PECS can be a valuable resource for them to communicate their needs using pictures. If a child wants to go to the park, they would provide their caregiver with the image of of the park to communicate. Through the use of a picture book, individuals trade images for the items that they desire. 

PEERS Social Skills Training
One of the main symptom domains individuals with ASD face is social communication impairments. Some examples of these social impairments include “poor social communication, impaired social cognition, and lack of understanding social cues” (Madnelberg). The Program for the Education and Enrichment of Relational Skills (PEERS) is an evidence-based, parent-assisted, treatment intervention aimed to help adolescents with autism improve their social skills. Typically administered as group treatment, this therapy is a 16 week group treatment that teaches individuals with ASD a range of friendship skills. These friendship skills include conversational skills, electronic forms of communication, how to develop and maintain friendships, appropriate humor, strategies for handling teasing and bullying, resolving arguments, managing gossip, and more. PEERS has also been adapted to work well with young adult groups and preschoolers, though the greatest evidence supports its use with teens and young adults (UCLA PEERS Clinic, 2017).

If you are interested in helping your child develop the above mentioned skills, please see the resource page on our website.

Speech and Occupational Therapy

Speech and Language 
Individuals with ASD often have difficulties with social communication. Some individuals may be non-verbal, or have language delays, while others may have well developed language skills but struggle with pragmatic language (social language skills we use in our daily interactions with others). Speech pathologists work in-home, in an office, or at school. Along with teaching your child verbal and written communication skills, a speech pathologist can also help your child with social skills and behavior (ASHA). Speech pathologists also teach individuals augmentative and alternative communication (AAC) strategies. These are alternative or complementary communication strategies for individuals with ASD who are non-verbal or have a hard time communicating, and may include pictures, sign language, or language generating devices, such as ipods, computers, or other electronic devices. An SLP can be a helpful addition to your child’s treatment team.

Occupational Therapy
Occupational therapy (OT) is client-centered therapy that helps individuals reach their goals through the use of daily activities or occupations (Tomcheck, 2015; Welch, 2016). Occupations are defined as daily life activities that are meaningful and give a sense of purpose and identity to a person (Tomchek, 2015). An occupational therapist works with clients to help them accomplish daily living activities that come less naturally to them. Common target activities for individuals with ASD include daily self-care (showering, dressing, etc.), planning and preparing healthy meals, rest and sleep disturbances, education domains, employment, and social participation. When clients are able to participate in and be socially engaged in treatment, they are able to gain personal satisfaction, increased role competence and quality of life, and perform daily living skills that may have challenged them before.

Medications for Autism Related Symptoms
In addition to the behavioral interventions that can be used to treat autism, there are also some medications that have been shown to decrease impeding autism symptoms, such as irritability, aggressive behavior, sleep disturbances or self-harm. Three of these medications include Risperdal, Abilify, and melatonin supplements. Some of these medications are FDA approved to treat symptoms of autism, but it is important to note that these are NOT cures for autism, as none exist (FDA, 2017). These medications only treat potentially harmful or disruptive symptoms of autism. Please speak with a psychiatrist or your PCP if you are considering any of these options for you or your child.

While dozens of treatments for autism exist, there are a handful which are thoroughly studied and proven to be safe and effective. When deciding what treatment modality to choose, it is important to consider your treatment goals and the evidence-base supporting your treatment, so that you get the best and safest results. It is important to talk to a professional about which options are best for you.

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FDA Approved 
For individuals with autism, it is possible that they may express irritability and aggressive symptoms. These behaviors can be challenging to manage (LeClerc, 2015). While behavioral interventions can work to address these concerns, some people have found that medications can also help to manage these symptoms. Two such medications, which have been approved by the food and drug administration (FDA), are risperidone (can be used for individuals 5-16 years) and aripiprazole (can be used for children 6-17 years) (FDA, 2017). These medications target tantrums, aggressive episodes, and self-injurious behavior (LeClerc, 2015). Though these medications are FDA approved, it is still important to discuss with your doctor and psychiatrist the costs and benefits of these medications when considering adding them to your treatment plan. 

Melatonin Supplements
Another common symptom faced by individuals with ASD is sleep disturbances, like insomnia. Melatonin is a hormone that regulates sleep, and studies have shown that individuals with autism tend to abnormally produce this hormone, leading to increased sleep problems (Complementary approaches, Levy & Hyman, 2008). In order to counteract these sleep problems, melatonin supplements have been tested and found to improve sleep for individuals with autism who also have sleep problems. Melatonin supplements are safe and have been shown to have some support for their use. Again, it is important to discuss adding medication to a treatment plan with your primary care doctor. 

References:
Anagnostou, E., Zwaigenbaum, L., Szatmari, P., Fombonne, E., Fernandez, B. A., Woodbury-Smith, M., … & Buchanan, J. A. (2014). Autism spectrum disorder: advances in evidence-based practice. Canadian Medical Association Journal, 186(7), 509-519.

ASHA (n.d.). Autism (Autism Spectrum Disorder). Retrieved from: http://www.asha.org/public/speech/disorders/Autism/

Axelrod, S., McElrath, K. K., & Wine, B. (2012). Applied behavior analysis: autism and beyond. Behavioral Interventions, 27(1), 1-15.

Complementary Approaches for Treating Autism. (n.d.).  Autism Speaks. Retrieved from https://www.autismspeaks.org/what-autism/treatment/complementary-treatments-autism

FDA. (2017). Autism: Beware of Potentially Dangerous Therapies and Products. Retrieved from: https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm394757.htm

LeClerc, S., & Easley, D. (2015). Pharmacological therapies for autism spectrum disorder: a review. Pharmacy and Therapeutics, 40(6), 389.Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450669/

Levy, S. E., & Hyman, S. L. (2008). Complementary and alternative medicine treatments for children with autism spectrum disorders. Child and adolescent psychiatric clinics of North America, 17(4), 803-820. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597185/

Mandelberg, J., Laugeson, E. A., Cunningham, T. D., Ellingsen, R., Bates, S., & Frankel, F. (2014). Long-term treatment outcomes for parent-assisted social skills training for adolescents with autism spectrum disorders: The UCLA PEERS program. Journal of Mental Health Research in Intellectual Disabilities, 7(1), 45-73.

National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. Randolph, MA: Author.

Roane, H. S., Fisher, W. W., & Carr, J. E. (2016). Applied behavior analysis as treatment for autism spectrum disorder. The Journal of pediatrics, 175, 27-32.

Tomcheck, S., LaVesser, P., Watling, R. (2015). Scope of Occupational Therapy Services for Individuals with Autism Spectrum Disorder Across the Life Course. The American Journal of Occupational Therapy, 69, 1-12.

UCLA PeersⓇ Clinic. (2017). PEERS Curriculum. Retrieved from: http://www2.semel.ucla.edu/peers/teens 

Welch, C. D., & Polatajko, H. J. (2016). Applied Behavior Analysis, Autism, and Occupational Therapy: A Search for Understanding. American Journal of Occupational Therapy, 70(4), 7004360020p1-7004360020p5.