How Autism Is Treated

Every person with an autism spectrum disorder (ASD) has different needs, so the best treatment options will always be individual. Autism cannot be cured, so the goal is to help a person gain and hone skills, and better navigate daily life, including school, work, relationships, etc. This might include, but is certainly not limited to, physical therapy, behavioral therapy, speech therapy, and prescription medications.

This is an area where there are many unsupported treatment claims, so it can be tricky to navigate. As with everything, always consider the source of any information you're receiving and work closely with your or your child's doctor to determine what treatments should be tried, how they're working, and what changes might need to be considered.

In the U.S., children under school age who have been diagnosed with an autism spectrum disorder are eligible for early intervention services (EI). These are free, in-home and/or preschool-based programs that include supported educational programs and therapies.

If your child is older than 5 or 6, similar treatments will be offered through your school district and other agencies. If your child is not offered these services, it's up to you to ask why.

Most of the time, your child will be provided with at least the following treatments at some level (free of charge):

• Speech therapy: If your child is non-verbal, this will likely focus on basic communication skills; if they are verbal, it may focus more on speech pragmatics (the ability to use language in a social setting).
• Occupational therapy: This can range from handwriting and sensory integration to play and social skills therapy, depending on the therapist, need, and the amount of time available.
• Physical therapy: Ideally, a physical therapist will work on gross motor skills in a social setting such as gym or recess.
• Social skills therapy: Usually offered by a speech or occupational therapist, social skills therapy teaches children with autism (usually in group situations) how to interact appropriately by sharing, collaborating, taking turns, asking and answering questions, and so forth.

Your child may also receive applied behavioral analysis (ABA), either individually or in the context of an "autism classroom." It is one of the oldest and most fully researched treatments specifically developed for autism. ABA is a very intensive system of reward-based training that focuses on teaching particular skills and behaviors, such as everyday tasks. If any autism-specific therapy is offered by your school and/or covered by your insurance, this will probably be the one.

Schools and early intervention programs are very clear that, while they must provide services, they're not required to offer the best services. As such, many parents who have the means often seek additional therapy for their children. If you pursue this, you will need to check on whether any private therapy will be covered by insurance or if you will need to pay out of pocket.

Behavioral therapy usually will include ABA, but there are many other forms. Some types, such as pivotal response therapy, may not be available near you or funded by your insurance.

Developmental therapies include floortime, SCERTS, and relationship development intervention (RDI). They build from a child's own interests, strengths, and developmental level to increase emotional, social, and intellectual skills.

Developmental therapies are often contrasted to behavioral therapies, which are best used to teach specific skills such as shoe tying, tooth brushing, etc. Play therapy and recreational therapy are often grouped with developmental therapies.

Medications can help manage autism symptoms and those of related conditions. These medications are prescribed by physicians and are often covered by insurance with a formal diagnosis.

Selective serotonin reuptake inhibitors (SSRIs) are prescribed for anxiety, depression, and/or obsessive-compulsive disorder (OCD), which may accompany autism spectrum disorders. SSRIs include the following:

• Prozac (fluoxetine) has an FDA indication for both depression in children age 8 and older and OCD in children 7 and older.
• Lexapro (escitalopram) is approved by the FDA for kids with depression that are age 12 or older.
• Luvox (fluvoxamine) is FDA-approved for kids age 8 and older with OCD.
• Zoloft (sertraline) is FDA-approved for children age 6 and older with OCD.
• Anafranil (clomipramine) is FDA-approved for kids age 10 and older with OCD.

Wellbutrin (bupropion) works differently than SSRIs and may be prescribed for adults with depression and other symptoms, but is not approved for pediatric use.

Antipsychotic medications may be recommended if behaviors are dangerous or out of control. Two newer-generation antipsychotics have an indication for autistic disorders:

• Risperdal (risperidone) is FDA-approved for children age 5 and older.
• Abilify (aripiprazole) is approved for kids age 6 and up.

Both are FDA-approved to treat irritability in kids with autism.

Older, first-generation antipsychotic medications include haloperidol, thioridazine, fluphenazine, and chlorpromazine. They are sometimes used off-label for autistic symptoms and behaviors, but can have serious side effects, such as sedation, muscle stiffness, and abnormal movements.

In addition to professional treatments, some families choose to provide their autistic children with art therapies, animal therapies (e.g., horseback riding, service dogs), craniosacral massage, homeopathy, and more. Few of these are well-researched relative to the core symptoms of autism, but many families believe these therapies make a positive difference for their children.

Children with autism often have aversions to various types of foods, and people with autism are more likely to have food sensitivities, food allergies, or gastrointestinal symptoms. It is challenging to ensure your child is getting adequate nutrition, and gastrointestinal issues may exacerbate autism behaviors and symptoms. It is good to talk to your doctor, who may refer you to a dietitian for advice.

The National Center for Complementary and Integrative Health (NCCIH) summarizes the evidence of studies of various alternative therapies for ASD.

• No evidence: Secretin, hyperbaric oxygen, chelation, and antifungal agents have no evidence that they help people with ASD, and they may be dangerous.
• Some evidence: Melatonin might be of use for people with ASD who have sleep problems.
• Unclear: Omega-3 fatty acids, acupuncture, mindfulness-based practices, massage therapy, oxytocin

Special diets have been suggested for people with ASD, including a gluten-free, casein-free (GFCF) diet. No solid, replicated research suggests that autism is caused by particular foods or can be cured through nutritional changes of any kind.

A high-fat, very low carbohydrate ketogenic diet is used for some types of epilepsy. While it might be used for individuals with autism who have seizures, the person needs to be carefully monitored by a healthcare team for their nutritional status and other side effects.

There is no single road map for the journey that is treating someone with autism. Finding the right course may not be easy, and usually requires trial and error. However, knowledge is power—and perseverance matters. Advocate for your child, and yourself, as much as you can. Help is available that can improve life with autism. And remember, if you're caring for a child, teen, or adult with autism, you have needs too.