Evidence-based Treatment Options for Autism
Published on in Children's Doctor
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Published on in Children's Doctor
If there is one clear take-away from 2 decades worth of autism research, it is this: Early diagnosis of autism spectrum disorder (ASD) coupled with prompt, evidence-based and effective intervention will result in the best possible prognosis for the child.
All children with ASD — or even a suspected diagnosis — can benefit from early intervention (EI). Research shows that in an appropriate educational setting, EI for at least 2 years prior to the start of school can result in significant improvements, and some may gain enough skills to successfully enter a regular education elementary school setting. Effective programs focus on developing communication, social and cognitive skills. Physicians should suggest patients begin EI services as soon as the diagnosis is made. If patients have a long wait between a positive screen and a diagnostic evaluation, it’s best to initiate EI even before a formal diagnosis is made.
The most effective treatments available today are applied behavioral analysis, occupational therapy, speech therapy, physical therapy, and pharmacological therapy. Treatment works to minimize the impact of the core features and associated deficits of ASD and to maximize functional independence and quality of life. In 2012, the Missouri Autism Guidelines Initiative summarized the findings from 6 reviews on behavioral and pharmacological interventions in autism. The consensus paper includes current evidence of what interventions have been studied and shown effective.
ABA uses behavioral psychology principles to systematically change behavior by encouraging positive behaviors and discouraging negative ones. In addition, ABA teaches new skills and applies those skills to new situations.
RPT is a form of incidental or naturalistic ABA aimed at increasing a child’s motivation to learn, monitor their own behavior, and initiate communication with others by focusing on behaviors that are seen as key to learning other skills, such as language, play and social skills. PRT works to generalize skills across many settings with different people.
Is a common form of ABA in which what is being taught is broken down into smaller steps, then using prompts and rewards for each step. Prompts and rewards are phased out over time.
ESDM is a comprehensive ABA program for infants, toddlers and preschoolers ages 12 to 48 months with ASD. ESDM includes naturalistic ABA, interpersonal exchange, shared enjoyment in joint activities, and promotion of language and communication. The emphasis is on having fun within a developmental framework. Parent involvement is key to the success of the intervention. ESDM has been shown to be effective in a randomized clinical trial. Children who received 20 hours of ESDM per week (5 of the hours provided by parents) over 2 years showed more improvement in cognitive testing (IQ), adaptive skills, and autism symptoms than those who received typical community treatment.
The Lovaas Model consists of 20 to 40 hours of highly structured, discrete trial teachings, integrating ABA techniques into an early intervention (EI) program for children between the ages of 2 and 8 years, and no later than age 12. The technique utilizes child-specific reinforcers to motivate and reward success. Additionally, the use of language and imitation are crucial in this teaching model.
Since people with ASD have deficits in social communication, speech therapy is an important component of treatment. A licensed speech-language pathologist (SLP) helps to improve a child’s communication skills, allowing them to better express their needs or wants. Speech therapy is often most effective when SLPs work with teachers, support personnel, families, and the child’s peers to promote functional communication in natural settings.
If a child is nonverbal and unable to develop verbal communication skill, the use of gestures, sign language, and picture communication programs are often useful tools to improve their abilities to communicate.
OT is often used as a treatment for the sensory integration issues associated with ASD. It is also used to help teach life skills that involve fine-motor movements, such as dressing, using utensils, cutting with scissors and writing. OT works to improve quality of life and the ability to participate fully in daily activities. Each OT program is based on individual evaluations and goals. OT for young children with ASD often focuses on improving sensory integration and sensorimotor issues. In older children, OT often focuses on improving social behavior and increasing independence.
PT is used to improve gross motor skills and handle sensory integration issues, particularly those involving the individual’s ability to feel and be aware of their body in space. Similar to OT, physical therapy is used to improve the child’s ability to participate in everyday activities. PT works to teach and improve skills such as walking, sitting, coordination, and balance. PT is most effective when integrated in an EI program.
Pharmaceutical treatments can ameliorate some of the behavioral symptoms of ASD, including irritability, aggression and self-injurious behavior. By medically reducing interfering or disruptive behaviors, other treatments, including ABA, may be more effective. Medications should be prescribed and monitored by a qualified physician.
The Missouri Autism Guidelines Initiative. Autism Spectrum Disorders: Guide to Evidence-based Interventions: a 2012 Consensus Publication. The Missouri Autism Guidelines Initiative. www.autismguidelines.dmh.mo.gov. Accessed June 5, 2917.
Zwaigenbaum L, Bauman ML, Choueiri R, et al. Early intervention for children with autism spectrum disorder under 3 years of age: recommendations for practice and research. Pediatrics. 2015;136 Suppl 1:S60-S81.
Makrygianni MK, Reed P. A meta-analytic review of the effectiveness of behavioural early intervention programs for children with autistic spectrum disorders. Research in Autism Spectrum Disorders. 2010;4(4);577-593.
The Lovaas Model. The Lovaas Institute website. http://www.lovaas.com. Accessed June 5, 2017.
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Contributed by: Amanda E. Bennett, MD, MPH
Categories: Children’s Doctor Summer 2017, Autism Spectrum Disorder