children s health issues
Autism Spectrum Disorders
Treatment of Autism Spectrum Disorders
Applied behavior analysis Educational programs Speech and language therapy Sometimes drug therapy 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 (for example, showering and grooming), daily-living skills, punctuality, and job competence. This therapy is also used to help children minimize behaviors (for example, 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 United States, ABA may be available as part of an Individualized Educational Plan (IEP) through schools and in some states is covered by health insurance. Another intensive behaviorally based intervention is the Developmental, Individual-differences, and Relationship-based (DIR®) model, also called Floortime. 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 DIRFloortime®than ABA, but both therapies can be effective. Educational programsfor school-aged children with an ASD should address social skills development and speech and language delays and help prepare children for education after high school or for employment. The federalIndividuals with Disabilities Education Act (IDEA)requires public schools to provide free and appropriate education to children and adolescents with an ASD. Education must be provided in the least restrictive, most inclusive setting possible—that is, a setting where the children have every opportunity to interact with nondisabled peers and have equal access to community resources. TheAmericans with Disability ActandSection 504 of the Rehabilitation Actalso provide for accommodations in schools and other public settings. Drug therapycannot change the underlying disorder. However, the selective serotonin reuptake inhibitors (SSRIs), such asfluoxetine,paroxetine, andfluvoxamine, are often effective in reducing ritualistic behaviors of people with an ASD. Antipsychotic drugs, such asrisperidone, may be used to reduce self-injurious behavior, although the risk of side effects (such as weight gain and movement disorders) must be considered. Mood stabilizers and psychostimulants may be helpful for people who are inattentive or impulsive or who have hyperactivity. Although some parents try special diets, gastrointestinal therapies, or immunologic therapies, currently there is no good evidence that any of these therapies are helpful in children with an autism spectrum disorder. Other complementary therapies, such as facilitated communication, chelation therapy, auditory integration training, and hyperbaric oxygen therapy, have not been proved effective. In considering such treatments, families should consult with the child's primary care physician regarding benefits and risks. 