Treatment for autism: Is there a best type?

Today's guest blogger is Laura Dewey, Ph.D., a pediatric psychologist at Nemours/A.I. duPont Hospital for Children, and an assistant professor of pediatrics at Jefferson Medical College.

So your child has received a diagnosis of Autism Spectrum Disorder – now what? This is often the most pressing and distressing questions faced by families, especially since research shows that early and often intervention makes the greatest impact on improving outcomes.

It's important to remember that, at its core, ASD is a social disorder. For individuals who are severely affected this could mean minimal eye contact and almost complete avoidance of interactions, but for individuals who are less severely affected (and are now making up the largest pool of new diagnosis!), this could be subtle differences in social perspective-taking or flexibility.

Regardless, supporting social development is the ultimate goal of treatments for ASD. Unfortunately, there is no "one" treatment, and ASD is considered to be lifelong. But if families can remember that slow and steady pressure to support and improve social interactions is the primary goal, they can work with their teams to come up with an individualized treatment plan.

Applied Behavior Analysis was developed in the 1970s and was traditionally geared toward severely affected children. Often, ABA used a "discrete trial" approach and took place one-on-one in a clinic setting. For example, every time a child correctly points to a picture, they are immediately rewarded with a reinforcer, such as a piece of candy.

However, over the past few decades, the scope of ABA has widened dramatically to include considerations such as providing interventions in a child's natural environment (home instead of clinic), following a child's lead (such as prompting labeling while playing with bubbles), and emphasizing natural and social reinforcers (such as a tickle game with caregivers). These types of behavior-based interventions go by many names; research has started to refer to them as Naturalistic, Behavioral, and Developmental Interventions. Overall, it is most important to ensure that children are receiving behavior therapies that are based on ABA, even if they go by different names.

Luckily, most providers with specialty in ASD are using behavior-based approaches. This means that preschool classrooms, psychologists, occupational therapists, speech therapists, and the whole spectrum of treatment providers are already using the appropriate interventions. And the more that parents can learn how to use behavior strategies, the more they can apply these principles in the home setting to increase frequency of intervention and support generalizing skills. Research shows that 25 to 40 hours a week of intervention is most effective before age five. This includes all of the therapeutic learning opportunities that occur throughout the day in all settings.

There are many simple strategies based on ABA that parents can learn and begin using immediately to support their child's development.

1. Use of "first, then" statements. These should be kept simple and concrete and presented to the child in the same way every time. For example, a parent can say "first table, than food" to indicate that once the child sits, food will come next. This strategy is successful because it helps children to learn a pattern that can be used in a variety of settings.

2. Use of visual schedules. It is often easy to search online for pictures of basic routines, such as a bedtime routine. The schedule might depict a bathtub, pajamas, toothbrush, and a book to indicate the order of events. These schedules are helpful because it reduces uncertainty and language requirements to understand what is expected.

3. Use of a child's unique motivators. If a child loves to carry a favorite stuffed animal, require the child to engage in a basic task before using the stuffed animal as a reinforcer. For example, the child could attempt to point to the stuffed animal while making eye contact to request. After this behavior is observed, the child could be rewarded with a tickle game involving the stuffed animal and their caregiver.

Learning and using behavior strategies is the ultimate goal and the active ingredient in treatment for ASD. So the , such as ABA, is less important than the strategies used.

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