Autism Management

By Dr. Ananya Mandal, MDReviewed by April Cashin-Garbutt, MA (Editor)

Autism has no cure at present. Autism spectrum disorder (ASD) is a complex disorder with various manifestations. The aim of treatment is to lessen associated difficulties and deficits and to improve quality of life and functional independence. No single treatment is best and management needs to be tailored to the child's needs. 

Interventions are usually a range of specialist education and behavioural programmes. These work towards improving the skills of children with ASD. Some of the interventions include those that take hours of intensive work while others work in short therapy sessions. What works best depends on the severity of the child’s condition and the type of autism.

Aims of interventions

Interventions target improvement of:

• Social interaction skills of the child so that he or she can understand other people's feelings and respond to them.
• Communication and language development skills to develop ability to start and maintain conversations.
• Cognitive skills to improve on imaginative play.
• Academic skills that helps the child develop learning skills in reading, writing, drawing and maths.

Common interventions

Commonly used interventions for autism include:

Applied behavioural analysis (ABA)

This intervention works by breaking down skills like communication and cognitive skills into smaller and simpler tasks. The tasks are then taught in a highly structured way. The simple tasks over time coalesce into more complex skills that help in development.

Every task completed is rewarded and reinforced in a positive way and inappropriate behaviour as discouraged and redirected. This intervention can be applied at home and is applied by a consultant, who oversees the programme, and a team consisting of at least three therapists. They consist of 40 hours a week of intensive therapy over two to three years.

• Early Intensive Behavioral Intervention (EIBI) 
• This is a type of ABA for very young children with an ASD. The patients are usually younger than five, and often younger than three. 
• TEACCH

This is another form of educational intervention that places great emphasis on structured learning by using visual prompts. Children with ASD often respond better to visual cues. This is delivered at special day centres and can be continued at home as well.

Early start Denver model

This is yet another behavioural intervention that combines applied behavioural analysis with developmental and relationship based approaches. The child is brought into interactive social relationships, using positive emotional exchanges and joint play activities. It improves cognitive, language and adaptive behavioural skills.

Discrete Trial Training (DTT)

This is a style of teaching that uses a series of trials and efforts to teach each step of a desired behavior or response.

Pivotal Response Training (PRT) 

This is intended to increase the child’s motivation to learn and monitor his or her own behaviour and begin communication.

Verbal Behavior Intervention (VBI)

VBI is a type of ABA that focuses on teaching verbal skills. 

Speech and language therapy (SLT)

This therapy aims at improving communication and language skills. This can improve their ability to interact with others socially. This intervention may use visual aids, stories and toys and other aids to develop language skills.

Occupational therapy

This focuses on development and maintenance of fine motor and adaptive skills.

Medications

There are no medications that can cure or reduce the symptoms of autism. Medications may however help in reduction of repetitive thoughts and behaviour and aggressive behaviour. For repetitive thoughts the class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) are often prescribed. These work by altering levels of serotonin in brain. Serotonin is known to affect behaviour and mood. Children who have addition behavioural problems like Attention deficit hyperactivity disorder may benefit from drugs like Methylphenidate. Melatonin may be considered for treatment of sleep problems associated with ASD.

Alternative and complementary treatments

These include special diets, vitamin supplements, chelation therapy etc. There is little or no evidence that any of these approaches are effective, and some may even be potentially dangerous.

Further Reading

• All Autism Content
• What is Autism?
• Autism Causes
• Autism Mechanism
• Autism Classification