pediatrics
Autism Spectrum Disorders
Treatment of Autism Spectrum Disorders
Applied behavior analysis Speech and language therapy Sometimes physical and occupational therapy Drug therapy Treatment of autism spectrum disorders is usually multidisciplinary, and research shows measurable benefits from intensive, behaviorally based approaches that encourage interaction and meaningful communication. Psychologists and educators typically focus on behavioral analysis and then match behavioral management strategies to specific behavioral problems at home and at school. See also the American Academy of Pediatrics'2020 clinical report Identification, Evaluation, and Management of Children with Autism Spectrum Disorder. Applied behavior analysis (ABA)is an approach to therapy in which children are taught specific cognitive, social, or behavioral skills in a stepwise fashion. Small improvements are reinforced and progressively built upon to improve, change, or develop specific behaviors in children who have an ASD. These behaviors include social skills, language and communication skills, reading, and academics as well as learned skills such as self-care (eg, showering, grooming), daily-living skills, punctuality, and job competence. This therapy is also used to help children minimize behaviors (eg, aggression) that may interfere with their progress. Applied behavior analysis therapy is tailored to meet the needs of each child and is typically designed and supervised by professionals certified in behavior analysis. In the US, ABA may be available as part of an Individualized Educational Plan (IEP) through schools and in some states is covered by health insurance. The Developmental, Individual-differences, Relationship-based (DIR®) model, also called Floortime, is another intensive behaviorally based approach. DIR® draws on the child's interests and preferred activities to help build social interaction skills and other skills. At present, there is less evidence to support DIR/Floortime than ABA, but both therapies can be effective. Speech and language therapyshould begin early and use a range of media, including signing, picture exchange, and augmentative communication devices such as those that generate speech based on symbols children select on a tablet or other handheld device, as well as speech. Physical and occupational therapists plan and implement strategies to help affected children compensate for specific deficits in motor function, motor planning, and sensory processing. Drug treatmentmay help relieve symptoms. There is evidence that atypical antipsychotic drugs (eg,risperidone,aripiprazole) help relieve behavioral problems, such as ritualistic, self-injurious, and aggressive behaviors. Other drugs are sometimes used to control specific symptoms, including selective serotonin reuptake inhibitors (SSRIs) for ritualistic behaviors, mood stabilizers (eg, valproate) for self-injury and outburst behaviors, and stimulants and other ADHD drugs for inattention, impulsivity, and hyperactivity. Dietary interventions, including some vitamin supplements and a gluten-free and casein-free diet, are not helpful enough to be recommended; however, many families choose to use them, leading to the need to monitor for dietary insufficiencies and excesses. Other complementary and investigational approaches to therapy (eg, facilitated communication, chelation therapy, auditory integration training, hyperbaric oxygen therapy) have not shown efficacy. 