Treatments and Interventions for Autism Spectrum Disorders
Posted on January 8, 2019 by All In
This list was taken from Appendix C from the book “The Autism Sourcebook: Everything You Need to Know About Diagnosis, Treatment, Coping, and Healing” by Karen Siff Exkorn.
Note from All In:
Parents and caregivers should not replace mainstream interventions for pre-school children with Autism Spectrum Disorder (ASD) with Complementary and Alternative Therapies (CAT).
Based on MOH’s Clinical Practice Guidelines for Autism Spectrum Disorders in Pre-school Children (2010), some of the practices listed below are CAT and are not recommended for pre-school children with ASD because of:
(i) insufficient, conflicting or inconclusive evidence for efficacy;
(ii) evidence that they are ineffective; or
(iii) potential for harm or adverse effects.
All In has added a note for each CAT referenced in the MOH Guidelines.
All In encourages parents and caregivers to discuss possible intervention with professionals.
Note from the Author:
This is a comprehensive list of almost all of the current treatments that are available for Autism Spectrum Disorders (ASD). This list is not an endorsement. Its purpose is to provide you with information. If you see a treatment that interests you, you can do further research by reading books, articles, accessing the Internet, and speaking with parents and professionals. For the purposes of this list, the title “Treatments and Interventions’’ refers to treatment tools, methodologies, theories, and therapies.
For quicker navigation, click on the letter that the treatment begins with:
Activity Schedules are treatment tools that are used to help children with ASDs to be less dependent on adult prompting and more self-directed at home and in the classroom. Developed by Lynn McClannahan and Patricia Krantz of the Princeton Child Development Institute, Activity Schedules use a set of pictures or a simple written checklist to illustrate step-by-step how to accomplish a task or complete a social interaction. Activity Schedules can provide children with ASDs sequential cues for everything from making a sandwich to initiating a conversation with a classmate. McClannahan and Krantz’s book Activity Schedules for Children with Autism: Teaching Independent Behavior (1999) provides parents and teachers with practical advice about how to create and use activity schedules to reduce the child’s need for extensive adult supervision.
APPLIED BEHAVIOR ANALYSIS (ABA)
ABA is a treatment methodology that was pioneered by Dr. Ivar Lovaas and is based on theories of operant conditioning by B.F. Skinner. In 1987, Lovaas published a study showing that almost half of the 19 preschoolers involved in intensive behavioral intervention – 40 hours per week of one-on-one therapy – achieve “normal functioning.” ABA has more scientific research to support it than any other treatment for ASD. Hundreds of researchers have documented the effectiveness of ABA for building a wide range of important skills and reducing or eliminating problem behavior (e.g., stimming and self-injurious and disruptive behaviors) in individuals with ASD. The best known ABA procedure used for teaching now skills is Discrete Trial Training (DTT), during which tasks are broken down into small teachable steps so that they can be learned more easily (see Discrete Trial Training). A reward system is used to motivate and reinforce a child while he or she is learning new skills and behaviors. ABA programs incorporate both therapist-directed and child-directed interventions, known as incidental teachings. In addition to teaching children basic skills, ABA also teaches play skills, social skills, communication skills, and relationship-building skills through peer modeling, activity schedules, and inclusion support in the classroom. ABA progress is measured frequently, recorded in written reports, and reviewed so that treatment can be updated and customized to meet a child’s specific needs. ABA can be taught in formal one-on-one treatment sessions at home or at school and in a variety of other community settings. Parents are encouraged to take an active part in the process to support their children’s goals. One of the primary goals of ABA is to make learning fun and enjoyable for the child, by offering lots of positive reinforcement and positive interactions.
All In’s Note: There are some discussions in the community on ABA and what constitutes abuse during therapy.
ACUPUNCTURE AND ACUPRESSURE
Note: According to MOH guidelines, this complementary alternative therapy is not recommended for pre-school children with ASD.
Acupuncture, a component of traditional Chinese medicine, has been used to stimulate energy flow (Chi) and restore energetic balance to the body for over 2,000 years. Some acupuncture treatments support the maintenance of general health, while others focus on specific symptoms. For children with ASDs who are hyperactive and have problems sleeping, acupuncture treatments may promote a calming effect. Acupuncture treatments employ thin needles inserted just under the skin at specific points on energetic pathways called meridians. For young children who may have a difficult time remaining still, acupressure is more commonly used than acupuncture; therapists apply pressure with their hands or press blunted needles on (not under) the skin. Parents usually stay with the child during treatments. The child may receive treatment on a therapy table or while held in a parent’s lap.
Note: According to MOH guidelines, this complementary alternative therapy is not recommended for pre-school children with ASD.
Antifungal treatment is used to help maintain a healthy gastrointestinal (GI) tract. Allergens and yeast (candida albicans) overgrowth or “leaky gut” contribute to an unhealthy Gl tract; some believe that a leaky gut aggravates symptoms of ASDs. Because many children with ASDs have a history of ear infections, and antibiotics can cause yeast infections, it is believed that these children can benefit from a yeast-free, sugar-free diet, supplemented by antifungal drugs such as Nizoral and Diflucan (these drugs can cause liver damage and require regular testing to monitor liver function). Parents should be aware that, just as use of antibiotics can lead to bacterial resistance, there is a possibility that antifungal treatments can lead to fungal resistance.
The American Therapeutic Recreation Association recommends aquatic therapy as an effective intervention for children with ASDs. Many children with ASDs have sensory difficulties and are easily distracted; the hydrostatic pressure that surrounds a child in the water produces a calming effect, while at the same time providing sensory input. In water, body weight is reduced by 90 percent, making this an ideal environment for exercise or physical rehabilitation. For children with ASDs, aquatic activities can help to improve sensory integration, body awareness, balance, and mobility skills. Beyond being an enjoyable experience, aquatic therapy has been shown to have physical, psychosocial, and cognitive benefits.
Art therapy can help children with communication skills, relationship building, sensory integration issues, and developing a sense of self. Art therapy can be a vehicle for understanding a child’s emotional state, identifying conflicts, and solving problems and has been used to help children with ASDs express feelings and ideas. Art therapists may mirror or engage in shared drawing tasks to establish a rapport with children. It can be especially helpful for children who are nonverbal or who have difficulty with verbal expression.
Assistive technology includes the use of simple or complex technology or equipment that helps people function more fully in their homes, schools, and communities. Assistive technology can include computers, visual and auditory aids, assistive listening devices, adaptive toys, augmentative communication, daily living aids, environmental controls, and modifications for home, school, and recreation.
AUDITORY INTEGRATION TRAINING (AIT)
Note: According to MOH guidelines, this complementary alternative therapy is not recommended for pre-school children with ASD.
Dr. Guy Berard, a French ear, nose, and throat specialist, developed Audio Integration Training (AIT). Originally intended to rehabilitate hearing loss, AIT is now used for auditory and sensory processing disorders commonly found in children ASDs. The goal of AIT is to improve listening skills and language completely through the use of the Ears Education and Retraining System (EERS). During a typical AIT session, a child wears specialized earphones to listen to music with selected frequencies filtered out. Proponents claim that EERS exercises the brain and inner ear, reducing hypersensitivity to sound and improving overall auditory processing. AIT typically consists of twenty half-hour sessions for ten consecutive days. Treatment can be repeated every six months. As a result of AIT, some parents report that their children have decreased impulsivity and are less sensitive to loud noises.
A trained assistance dog can provide children who have physical or developmental disabilities with companionship and support. Working with and caring for a canine companion can help a child with an ASD establish an emotional connection, feel secure, and develop confidence and independence. The bond between the child and the dog can be a step in learning how to form positive, reciprocal relationships with others.
CHELATION OR DETOXIFICATION THERAPY
Chelation is a treatment that is administered either orally or intravenously to remove unwanted metals from the bloodstream. Some people believe that children with ASDs have extremely high levels of mercury (similar to mercury poisoning) that either occurred in utero as the result of a mother’s high mercury-content diet or infant vaccinations which contained the preservative thimerosal. Chelation therapy includes extensive lab testing for mercury toxicity.
All In’s Note: There have been deaths associated with chelation treatment. Please seek the advice of a medical professional when considering this form of treatment.
Doctors of Chiropractic adjust and manipulate the parts of the body where bones are connected, emphasizing the spinal column. Supporters contend that chiropractic adjustments can improve the behavior of children with ASDs by restoring optimal function to the nervous system. In addition to physical manipulation, chiropractic treatments may also utilize heat and ultrasound. Sessions take place in the chiropractor’s office and typically last ten to thirty minutes depending on the procedures performed.
CRANIO-SACRAL THERAPY (CST)
Developed in 1970 by John E. Upledger, an osteopathic doctor, Cranial-sacral therapy (CST) is a hands-on treatment used to improve the functioning of the cranial-sacral system, which is made up of the cerebral spinal fluid and membranes that surround and protect the brain and spinal cord. Proponents of CST believe this therapy improves the immune system and relieves restrictions or tensions impeding proper functioning of the body. In a typical hour treatment session, a practitioner applies gentle pressure to the neck, jaw, sacrum, and feet.
DAILY LIFE THERAPY
Developed by the late Japanese doctor Kiyo Kitahara, Daily Life therapy is a holistic treatment for children with ASDs. Kitahara’s approach utilizes group dynamics, sensory integration, modeling, and physical activity to help children develop intellectually and socially. In the United States, Daily Life therapy is practiced at Boston’s Higashi School, an international program providing education, physical activities, art appreciation, and vocational training for individuals with ASD, ages three to twenty-two. In addition to treating children, the Higashi School offers parent training and other family support services. The goal of Daily Life therapy is to prepare children with ASDs to lead productive, independent, and socially satisfying lives in their communities.
THE DENVER MODEL
Dr. Sally Rogers, a developmental psychologist and one of the world’s leading researchers of ASDs, developed the Denver Model in the early 1980s as a developmental treatment approach for children with ASDs. The Denver Model combines intensive teaching and intensive focus on the development of social-communicative skills. Guided by the premise that optimal development occurs when the child is able to form emotional connections, the Denver Model emphasizes relationship building and communication. This treatment includes highly focused one-on-one work in the home and support and teaching at school. In the preschool classroom, the child with an ASD is fully included with typically developing children and support is embedded within group activities. Everyone who interacts with the child, both at home and at school, is working on the same treatment objectives. The Denver Model is family-based; parents take the lead in determining their treatment objectives, participate in all team meetings, and receive support and training to help their child to meet objectives.
The most useful diet for children with ASDs is the gluten-free/casein-free (GF/CF) diet. This was developed on the observation that children with ASDs are more likely to have food allergies and higher levels of yeast, gastrointestinal problems, and an inability to break down certain proteins. There is evidence that children with ASDs have deficiencies in vitamins and minerals and cannot properly digest gluten and casein. The GF/CF diet eliminates all food containing gluten, including wheat, oats, barley, and rye, and all dairy products – a source of casein. The GF/CF diet is an important component of the DAN (Defeat Autism Now) protocol. Other diets for ASDs include the Feingold diet (to treat hyperactivity), the Ketogenic diet (for seizures), the Body Ecology diet, the Anti-yeast/Fungal diet, and the Specific Carbohydrate diet. Parents should receive nutritional counseling before beginning any dietary intervention with their child.
DISCRETE TRIAL TRAINING (DTT)
Discrete Trial Training (DTT) is a core feature of Applied Behavioral Analysis (ABA). DTT breaks down complex skills into small, manageable steps so that skills can be more easily mastered by the child with an ASD. Skills are presented in “trials’ during which the therapist gives a brief instruction or asks a question, the child responds, and the therapist provides a consequence (e.g., a reward or a guiding hand). Then the therapist records the data. DTT begins by teaching simple learning readiness skills, such as sitting in a chair, learning to respond to one’s name, imitating, and making eye contact. DTT also helps to reduce behaviors that may interfere with learning, such as stimming or throwing tantrums. As children master the basic skills, they learn more complex skills such as communication and social skills. The goal of DTT is for the child to learn to generalize the skills from the therapy sessions into the outside world. A child who learns to wave, clap, or initiate a conversation in the session should be able to do these same things at home or in school. Goals and objectives in DTT are individualized to meet your child’s specific needs. In its initial phase, DTT is an intensive treatment; children usually work for 25 to 40 hours per week in one-on-one sessions with a trained professional. The time requirement may be unrealistic or intrusive for some families. Research on ABA and the use of DTT, however, have consistently demonstrated that these techniques are highly effective in teaching new skills and behaviors to children with ASDs.
Introduced in the 1970s, Dolphin therapy has gained recognition for helping children with ASDs. Psychologist David Nathanson, dolphin expert Horace Dobbs, and Dutch therapist Richard Griffioen discovered that the gentle, intelligent, and playful disposition of dolphins help children with ASDs increase their functional skills. In Dolphin therapy, children swim and play with the dolphins; they are able to touch them, instruct them, and learn from them. Proponents claim the children also are learning how to concentrate, retain information, and learn more effective communication skills.
EAROBICS AUDITORY DEVELOPMENT AND PHONICS PROGRAMS
Earobics is a series of computer-based interactive programs that can be used at home or school to help children develop better auditory processing, phonological awareness, and phonics skills. Earobics Step 1 is designed for children ages four to seven, and includes activities and games that teach children how to match sounds to letters, decode unfamiliar words, and learn to read and spell. Earobics also develops cognitive skills such as attention and memory. Different Earobics programs are designed for different age groups, ranging from age four through adulthood.
Some energetic interventions include psychic therapy, crystal healing, feng shui, Reiki therapy, and therapeutic touch. Most of them employ noninvasive healing techniques. The goal of these treatments is to balance the child’s energy on a physical, emotional, and psychic level so the child can be more open to communicate and build relationships. The practice of feng shui includes the arrangement of furniture and objects in a manner that stimulates the Chi, or energy in the child’s physical environment that can affect him emotionally or psychologically. None of these interventions has solid scientific evidence to support them and may be criticized for being “too alternative.”
FACILITATED COMMUNICATION (FC)
Facilitated Communication is an alternative form of communication used by some individuals who have limited or no speech. With this technique, a facilitator physically supports the arm, hand, or wrist of an individual with an ASD to help him or her use a computer keyboard or typewriter or to point to symbols or letters on a picture or letter board. FC is complex and requires physical and emotional support, as well as creative problem-solving. FC has strong anecdotal support, but researchers claim that it is not scientifically valid because it is difficult to ascertain whether the FC user or the facilitator is the one communicating.
Fast ForWord is a patented program published by the Scientific Learning Corporation. It was developed in response to research indicating that individuals with ASDs and other language and learning disabilities may have a split second delay in the brain’s ability to process sensory input. Through the use of computer games that provide thousands of precise repetitions (discrete trials), the program is designed to help retrain the child’s brain to process information more efficiently.
The creators of Fast ForWord state that the success of this program is dependent upon repeated and intensive practice and recommend strict adherence to a schedule of one hundred minutes a day, five days a week, for six weeks.
Also known as the DIR (Developmental, Individual Difference, Relationship-Based)/Floortime approach, Floortime was developed by child psychiatrist Dr. Stanley Greenspan. Floortime is a one-on-one intervention that focuses on the child’s individual strengths and his or her relationship to others. Floortime is based upon the premise that individuals learn best when they are emotionally engaged. Rather than focusing solely on a child’s symptoms, Floortime focuses on helping children learn the building blocks of relating, communicating, and thinking. It creates a circle of interaction between the child and parent, professional, or peer. Parents and professionals follow the child’s lead to encourage paying attention, relatedness, and two-way communication. By capitalizing on the child’s interests and motivations, Floortime helps the child master interpersonal, emotional, and intellectual skills. In a Floortime session the parent, therapist, or teacher often gets down on the floor to interact and play with the child. The Floortime experience is a spontaneous, unstructured time that strives to create circles of communication that engage the child and gives him/her the opportunity to practice back-and-forth communication. For example, if a child is stacking red blocks, his mother may add a blue block to the tower, prompting the child to engage with her rather than remaining absorbed in a solitary activity. Back-and-forth play helps the child make the link between cause and effect and provides him/her the opportunity to engage in a personal interaction. In this intervention, parents play a particularly active and critical role. Sessions are typically 20 to 30 minutes long.
Gentle teaching, based on the writings and work of John J. McGee, is a relational approach that focuses on helping the child to feel safe, engaged, unconditionally loved, and loving toward others. In Gentle Teaching the bond between the caregiver and the child is prioritized over the teaching of specific skills. This approach encourages the child to make choices and emphasizes errorless learning, where the child cannot make a mistake. The caregiver redirects the child from inappropriate, aggressive, or self-injurious behavior; punishments and verbal reprimands are never used as a means of controlling behavior.
THE HANDLE INSTITUTE (HOLISTIC APPROACH TO NEUROLOGICAL DEVELOPMENT AND LEARNING EFFICIENCY)
The HANDLE Institute views the diagnoses for ASDs as labels for individuals whose attentional priorities are limited from infancy or early childhood, caused by irregularities in systems that support the senses and their interactions. HANDLE treatments are individualized to meet the specific needs of the child and may include reducing extraneous sounds in the environment or increasing the range of the child’s bodily movement through activities done in a specific developmental sequence.
Developed by the Monroe Institute, Hemi-sync is a patented audio technology that uses concentration and relaxation tapes to help individuals achieve desired states of either alertness or relaxation.
Hippotherapy is a treatment that literally means “treatment with the help of the horse.” Hippotherapy uses horseback riding to help children achieve specific rehabilitation goals. A trained therapist guides the horse’s movements to help the child improve motor skills, coordination, mobility, and muscle tone. Speech, occupational, and physical therapies can all be delivered in the context of a hippotherapy session.
Holding therapy, developed by child psychiatrist Dr. Martha Welch, is used with children who have ASDs or attachment disorders. This therapy seeks to create a bond between the child and parent or therapist through close physical contact. In a therapy session, a child exhibiting tantrum behavior is held close and reassured verbally. Sessions have no set time limit and end when the child relaxes and establishes eye contact. While proponents believe that holding therapy can be reassuring for a child, others contend that forced holding may be abusive and produce feelings of fear, confusion, and anger.
Homeopathic medicine has its roots in ancient Greece and was refined by Samuel Hahnemann in the nineteenth century. Homeopathy treatment is completely individualized; what works for one child may or may not work for another. An initial homeopathic consultation may take one to two hours and, depending on symptoms, two or three follow-up visits may be required. Homeopathic herbal remedies are prescribed in either pill, liquid, granule, or tablet form.
Hyperbaric-oxygen therapy (HBOT) is the treatment of the entire body with 100 percent oxygen at greater than normal atmospheric pressures. An individual receiving HBOT lies in an airtight, pressurized chamber. HBOT is used for a number of health conditions, including brain injury, stroke, cerebral palsy, multiple sclerosis, and ASD.
Some current research indicates that ASDs may be autoimmune disorders. Elevated levels of gamma interferon, alpha interferon, interleukin 6 and 12 in children with ASDs suggest excess immune activity that is directed at the self. Immunotherapies seek to restore balance in the child’s immune system. Clinical trials are being conducted on the use of immunoglobulin with children with ASDs. This therapy has been shown to benefit individuals with chronic viral, bacterial, and fungal infections, as well as other immune deficiencies. Some children treated with immunoglobulin have experienced improvements in attention span, social interaction, and communication. Other immune enhancing therapies include steroid therapy, autoantigen therapy, vitamin C, and anti-inflammatory fatty acids. A complete immune evaluation should precede any therapy, and all immunotherapy should be overseen by a physician, preferably a clinical immunologist, allergist, or hematologist.
INTEGRATED PLAY THERAPY
Dr. Pamela J. Wolfberg pioneered integrated playgroups to create an environment where children with ASDs are able to grow and learn by playing with typical kids, using toys and games that promote social interaction and imagination. The playgroup usually consists of three to five children, the majority of whom do not have ASDs. An adult facilitates the playgroup and encourages children with ASDs to expand their communication and cognitive skills through play. In addition to benefiting children with ASDs, the playgroups help other children to be more accepting of those who play and communicate differently. Integrated play works best in those environments where kids naturally play, such as homes, schools, or community settings. Integrated playgroups come together for six months to a year, typically meeting twice a week for a half hour to an hour.
INTENSIVE INTERACTION THERAPY
Intensive Interaction therapy is designed to be a practical and fun approach to developing better communication skills. In this intervention, individuals who have difficulty with communication or social interaction are paired with a communication partner. The partner, typically a caregiver, therapist, or teacher with special training in this approach, supports the person to become more confident and successful as a communicator.
THE IRLEN LENS SYSTEM
The Irlen Lens System addresses visual sensitivities and perceptual problems with prescriptions for precision tinted glasses and through the use of colored transparencies placed over written text.
LADDERS (LEARNING AND DEVELOPMENTAL DISORDERS EVALUATION AND REHABILITATION SERVICES)
Affiliated with Massachusetts General Hospital tor Children and Spaulding Rehabilitation Center, LADDERS is a comprehensive treatment and evaluation program that serves individuals with ASD and a wide variety of other conditions. Founded in 1981 by Dr. Margaret Bauman, LADDERS uses an interdisciplinary team approach for diagnosis, intervention, and referral to appropriate resources and services. The program has a strong commitment to families and provides parents with training and education to help them transfer learned skills to home, school, and community settings. Located in a teaching hospital, LADDERS involves physicians and other professionals in training to further research on the causes of ASDs and other developmental disorders and explores effective interventions for these conditions.
The clinical staff at the Linwood Center in Maryland uses the Linwood Method to treat children with ASDs and provide consultation to school systems. Founded by Jeanne Simons and Sabine Oishi, the Linwood Method focuses on the child’s strengths and interests with the goal of positively motivating students to learn. The staff act as models for students and create learning activities that are fun and exciting. This teaching method is designed to develop behaviors and skills that can be translated into more varied and functional activities. Teachers use whatever the child is interested in (string, keys, cartoon characters, etc.) to build an individualized educational and communication program. For example if a student is fascinated by string and has few other interests, string would be incorporated into his or her programs. The child would learn colors by using different colored strings and numbers by counting strings, and string would be used to reinforce the child’s communication program.
While there is no medication that “cures” ASDs, there are a number of medications that can be prescribed to alleviate specific symptoms associated with ASDs. Medication may be used to treat behavioral problems, attention disorders, anxiety, and depression. It can play an important role in helping improve social and communication skills for individuals with ASDs. Research shows that medication can help reduce hyperactivity, impulsivity, aggression, and obsessive preoccupations. In addition to targeting symptoms that interfere with a child’s ability to participate in educational, social, and family settings, medications can also help increase the benefits of other interventions.
Medications most frequently used for children with ASDs include selective serotonin reuptake inhibitors (SSRIs), neuroleptics, stimulants, mood stabilizers, and antipsychotics (particularly the newer atypical forms which have fewer side effects). Sedatives may be used in rare situations for occasional sleep problems. Because children with ASDs do not always respond to medications in the same way that typically developing children do, it is critical that parents consult with a physician who treats children with ASDs. Any treatment plan should be regularly monitored to assess a medication’s effectiveness and toxicity.
Children with ASDs often present other medical conditions and may be seen by more than one physician and treated with multiple medications. As all medications have side effects and interact with other medications, the child’s doctor(s) must be well informed about all treatments. Parents should keep written records of all the medications that their children are taking, their reactions to these medications, and objective data about their symptoms (e.g., number of tantrums per day, sleep patterns, ability to focus, self-injurious behaviors, and so on).
THE MILLER METHOD
Developed by Arnold Miller and Eileen Eller-Miller, the Miller Method theorizes that some children with autism have “system-forming disorders,” which impair the child’s ability to organize, understand, and engage in their environment, and “closed system disorders,” which allow the child to only interact with the environment in a repetitive and ritualistic manner. Using special equipment, such as a platform called the Miller square, large swinging balls, and Swiss cheese boards, children may learn to be more focused and convert stereotypic behaviors into functional ones. Assessments and treatment sessions also can be administered via satellite, over the Internet, or by telephone with the Millers and their staff.
Music therapy encompasses a variety of performance and listening experiences. In clinical settings, music therapy has been shown to reduce blood pressure, alleviate pain, ease muscle tension, and promote movement during physical rehabilitation. Music can promote feelings of security and calmness and counteract depression. Music therapy can improve a child’s physical, menial, and social functioning. Sessions can be both instructional and child-directed. For example, if a child begins banging on a drum, the therapist may also bang on the drum and create a rhythm for the child to follow. Music therapy can help to improve coordination skills, attention and focus, and relatedness skills.
Neurofeedback, also referred to as EEG Biofeedback, can be described as exercise for the brain. It is a direct training of brain function by which the brain learns to perform more efficiently. Neurofeedback sessions utilize sensors affixed with gel to the child’s scalp and ears to monitor and provide feedback that can help a child with an ASD self-regulate and control brain waves. During a session, a child is seated in front of a video game; to play the game, the child must increase the activity of frequency bands displayed on the screen. This requires the child to be in an alert and attentive state; when the child loses focus, the video game slows down. Neurofeedback is a noninvasive treatment that supporters claim can alter brainwave activity of children with ASDs, so they become more like typically developing children of the same age and gender. An evaluation for neurofeedback takes approximately two hours. Typical neurofeedback sessions are 40 to 60 minutes long and take place one to five times per week. A therapist monitors treatment and remains in the room with the child during the session.
OCCUPATIONAL THERAPY (OT)
Occupational therapy, or OT, does not have to do with job skills, as its name may imply. Rather, OT is used to help children with ASDs achieve competence in all areas of their lives, including self-help, play, socialization, and communication. OT provides support for children who have difficulty with sensory, motor, neuromuscular, and/or visual skills. Through OT, children can learn such skills as how to balance their body weight, respond to touch, communicate with others, and accomplish daily tasks. OT sessions are usually held in a clinician’s office or in a school setting with the aid of special equipment. Occupational therapists may use swings, trampolines, climbing walls, and slides to help a child with gross motor coordination and sensory issues. OT also addresses fine motor skills, such as writing and drawing. Depending on the child’s needs, therapists may use a variety of treatments. Many OT techniques used in therapy sessions – such as brushing, wearing a weighted vest, deep pressure, and joint compressions – can be reinforced at home or in other settings. OT may also incorporate sensory integration techniques (Sensory Integration therapy is described in more detail in this section).
PEER MEDIATED INTERVENTIONS
Peer Mediated Interventions help children with ASDs gain social skills and make positive connections with their peers. Participation in small playgroups and partnering with another child provide opportunities for the child with an ASD to learn from peer modeling. A teacher or other adult helps facilitate interactions and encourages the children to work through any problems. Research studies with preschoolers found that Peer Mediated Interventions increased social interactions for children with ASDs; those who learned to initiate social interaction demonstrated a decrease in disruptive behaviors. Schools report that Peer Mediated Interventions not only build up social competence in children with ASDs, but help children without disabilities to be more tolerant and accepting of others.
Any children with ASDs do not naturally observe, imitate, and interact with their peers. Peer modeling provides a structured setting where children can improve play and social skills. A behavioral therapist or trained adult facilitates play sterns that engage children in age-appropriate games and activities and incorporate typical peers as models. Initially the activities are tailored around the Interests of the child with an ASD to increase his or her motivation to participate, per example, if a child likes to jump on the trampoline, the therapist may create a game where the children take turns copying each other’s actions while jumping, this helps to increase the child’s attention span and observational skills. The length of the sessions depends on the age and cognitive level of the children involved. Peer modeling is also used in schools to help the child with an ASD learn classrooms routines and tasks. The child’s teacher, school psychologist, or guidance counselor usually facilitates peer modeling in school.
PICTURE EXCHANGE COMMUNICATION SYSTEMS (PECS)
The Picture Exchange Communication System, or PECS, helps children acquire and initiate functional communication skills. Developed in 1985 and first used at the Delaware Autistic Program, PECS is an augmented communication system that uses pictures and ABA methods to teach children with ASDs or other communication disorders. Pictures are used to help children learn colors, numbers, and specific words. PECS can be used to help children form sentences, regulate behavior, and learn scheduled activities. For example, posting pictures next to the bathroom mirror of a child brushing his or her teeth and combing his or her hair can help a child with an ASD remember the morning routine. A child can hand his or her mother a picture of an apple to indicate what he or she wants to eat. PECS is helpful in laying a foundation for language, as well as providing a means for nonverbal children to communicate.
Physical therapy (PT) is prescribed for children with ASDs to enhance their physical abilities by treating impairments of movement that interfere with developmental appropriate functioning. Some children with ASDs have low muscle tone, as well as poor posture, balance, and coordination. Physical therapists help children increase endurance and develop motor control and motor planning. PT sessions include training in functional skills, as well as passive, active, resistive, or aerobic exercises. Therapeutic exercises are often used in combination with equipment such as weights, exercise balls, and balance boards to increase muscle strength and endurance and to facilitate body awareness and coordination. Aquatic exercises, whirlpools, and orthotics may also be part of a child’s treatment. A physical therapy session, in which the therapist works one-on-one with the child, typically lasts 45 minutes. PT can take place in a therapist’s office, at home, or in school. Physical therapists are professionally trained and licensed.
PIVOTAL RESPONSE TRAINING (PRT)
Doctors Robert and Lynn Koegel, cofounders of the Autism Research Center at the University of California, Santa Barbara, have expanded upon the principles of Applied Behavioral Analysis to develop PRT. In Pivotal Response Training, specific behaviors known as pivotal behaviors are seen as central in affecting general areas of functioning. By changing these pivotal behaviors, it is believed that other associated behaviors will change without specifically targeting the associated behaviors. Pivotal response techniques include positive reinforcement, changing and correcting behaviors, and child choice. PRT focuses on teaching children communication and language skills, and how to have effective social interactions. Most significantly, PRT helps children learn the skills they need to enjoy positive social interactions and to make friends. Unlike more clinical treatments, PRT is designed to fit into the child’s everyday life. It is an intervention that uses natural learning opportunities at home, in school, or in any inclusive setting. Because PRT encompasses the child’s whole world, parent involvement is critical to the success of this treatment. As partners in the process, parents learn PRT strategies and train teachers, family members, and others on how to use this approach with their child.
Play Therapy, facilitated by a child psychiatrist or psychologist, can promote emotional growth and help children acquire and practice specific play skills. Some children with ASDs have rigid and ritualistic behaviors that make it difficult to form positive, reciprocal relationships. Play therapy helps these children develop the skills they need to engage in interactive play. During the session, the therapist uses toys and activities as a springboard to more appropriate play. Play therapy can also help children to better understand and express their emotions. The therapist and the child discuss and act out ways to cope with emotions and create better outcomes in social situations. For example, a therapist may use puppets to act out a bullying situation, allowing the child to express his or her feelings about bullies and the therapist to introduce effective strategies for dealing with them. The therapist works one-on-one with the child in sessions that usually last 45 minutes.
In its 2002 National Health Survey, the Centers for Disease Control and Prevention found prayer to be Americans’ most commonly used “alternative medicine.” Numerous scientific studies have documented the effects of prayer or spiritual healing. Prayer has been shown to inhibit the growth of cancer cells, protect red blood cells, and promote healing. Additional studies have found that individuals who participate in organized religion have lower blood pressure, fewer incidences of heart disease, stroke, and depression, and are less likely to be substance abusers or commit suicide. Increasingly, modern medicine is recognizing a link between spirituality and health.
PROMPT SPEECH THERAPY
Prompt Speech Therapy is an intervention provided by speech therapists specially trained in this technique. During a Prompt Speech Therapy session, the therapist uses his or her fingers to elicit the correct sound. For example, to help a child generate an “m” sound, the therapist places an index and middle finger on top of the child’s lips and presses the lips to make the shape needed for the “m” sound. Each time a sound is practiced, the placement of the therapist’s fingers reminds the child where the sound is made. The therapist also works with the child to strengthen the muscles needed for speech.
Soma Mukhopadhyay developed the Rapid Prompting method as a tool to expand vocabulary and eventually teach conversational skills to nonverbal children with ASDs. Mukhopadhyay created rapid prompting as a way to help her son Tito who was diagnosed with a severe ASD; today Tito is a published poet and writer. This low tech method teaches children with ASDs, who either do not speak or whose speech is difficult to understand, to communicate by pointing to letters on a piece of paper arranged either in alphabetical order or in the same order as a typing keyboard. Initially, the teacher sits with the child and asks yes or no questions. Over time, more detailed questions are introduced and the child, with assistance from the teacher, spells out the answers by pointing to the letters. As the child becomes proficient, he or she independently responds to questions.
RELATIONSHIP DEVELOPMENT INTERVENTION (RDI)
Relationship Development Intervention (RDI) is a developmental program that employs specific exercises and activities to teach relationship skills. The program provides clear objectives and follows a step-by-step curriculum to help children systematically master skills. At the novice level, a coach (typically a teacher, therapist, or parent) works directly with the child. As the child progresses, the coach is replaced by a peer partner who facilitates the exercises. Guided by the principle of joyful collaboration, the child is invited – not forced – to interact. While the use of fun activities and engaging coaches are effective motivators for participation, supporters believe that is the shared enjoyment and collaborative aspect of the program that help children learn how to develop meaningful relationships.
RHYTHMIC ENTRAINMENT INTERVENTION (REI)
Founded by Jeff Strong in the 1980s, Rhythmic Entrainment Intervention (REI) claims that music can be used to stimulate the central nervous systems and improve brain functioning for children with ASDs. Parents are interviewed and complete a detailed survey about their child’s functional level. Based on this information, Strong creates two individually tailored compact disks with percussion rhythms; one designed to have a calming effect and the other to help the child focus. Parents are advised to play the appropriate CD once a day for approximately ten weeks.
SAMONAS (SPECTRAL ACTIVATED MUSIC OF OPTIMAL NATURAL STRUCTURE METHOD)
Spectral Activated Music of Optimal Natural Structure, or SAMONAS, is an intervention designed to help individuals with a variety of disabilities (including ASDs) develop their auditory processing skills, lessen hypersensitivity to sound, and improve neurological functions. The SAMONAS method uses compact discs with electronically tailored classical music and nature sounds. This treatment takes place in the home, with the child listening to the SAMONAS compact discs 15 to 60 minutes a day, 5 days a week, for 4 to 7 months.
SCERTS (SOCIAL COMMUNICATION, EMOTIONAL REGULATION AND TRANSACTIONAL SUPPORT) MODEL
The Social Communication, Emotional Regulation, and Transactional Support, or SCERTS Model, is an eclectic approach made up of three components: social communication, emotional regulation, and transactional support. Social communication seeks to enhance spontaneous language and social interactions for children with ASDs. Using everyday activities and daily routines, such as teaching opportunities, a communication partner helps the child with an ASD express emotions and encourages communication about those things that interest the child. To help these children learn to regulate their emotions, SCRETS employs a variety of strategies including deep pressure, music, opportunities for activity and movement, and a calm soothing environment. Interfering behaviors are prevented or lessened by supporting a child’s emotional regulation across all settings. Finally, SCRETS provides transactional support to families and staff to assure a smooth team process and reduce stress. SCERTS supports the child to meet goals across home, school, and community settings.
Secretin, a hormone produced by the small intestines, is used in the diagnosis of gastrointestinal problems. In 1996, a young boy with an ASD who received Secretin for an endoscopy showed improvements in some of his autistic symptoms. Other parents whose children have received Secretin have reported improvements in eye contact, attention, language skills, and sleeping problems. The NICHD has studied this phenomenon and found no statistically significant improvements in autistic symptoms for children who received Secretin when compared to children who received a placebo. In addition, FDA approves Secretin only in a single dose; no research has been done on the safety of repeated doses.
SENSORY INTEGRATION THERAPY
The goal of Sensory Integration Therapy is to help the child better absorb and process sensory information. Sensory integration involves taking in information through the senses and organizing and integrating this information in the brain. Sensory integration therapy focuses on the basic senses; tactile (touch), auditory (hearing), vestibular (sense of movement), and proprioceptive (body position). A child can have a dysfunctional sensory system in which one or more senses is overly responsive or under-responsive to stimulation from the environment. For example, a child may overreact to certain sounds, textures, or visual stimuli, or underreact to pain. Sensory dysfunction can affect a child’s posture or coordination skills. Therapy for sensory integration dysfunction is usually done by an occupational therapy physical therapist, or speech therapist who provides sensory and motor activity often in the form of games, exercises, and play. One popular form of sensory integration is called auditory integration training (AIT).
SOCIAL SKILLS GROUPS
Social Skills Groups provide direct instruction, practice, and generalization of interpersonal skills with age-appropriate peers. Children with ASDs may have difficulty reading social cues and need extensive training in social interactions. Social Skills Groups provide a structured, supportive environment where children can practice friendship skills and problem-solving strategies. Social groups are led by a trained facilitator, often a psychologist or behavioral therapist. Role-playing, discussion, and cooperative games and activities help children develop empathy and improve interpersonal skills. Social Skills Groups meet in a variety of settings and may include community outings. Some schools provide social skills groups as a way to help children with ASDs interact better with their classmates. The school psychologist or guidance counselor usually run these groups.
In 1991, Carol Gray created Social Stories as a vehicle to teach social skills to children with ASDs. A story is developed about a specific situation or event, and the child is given as much information as possible to help him or her understand and figure out the expected or appropriate response. Social Stories usually have three sentence types: descriptive sentences (which address who, what, where, when, and why); perspective sentences (which teach the child how to take another person’s point of view in order to read and understand others’ thoughts and emotions); and directive sentences (which suggest a response). The Social Story is a short narrative presented in the first person that helps the child to learn to respond appropriately to a specific event or situation. For example, a story can teach children when to say thank you, when to wash their hands, how to share toys, or how to participate in classroom routines. Social Stories can be written by anyone – a parent, teacher, or even a child – and are customized to meet the individual needs of the child. Social Stories may be accompanied by pictures, photographs, or music.
THE SON-RISE PROGRAM
The Son-Rise Program, part of the Autism Treatment Center of America, uses a loving and nonjudgmental educational approach to help parents and caregivers make a connection with children with ASDs. The emphasis of the program is not to leach the child to master pre-determined skills, but to join in a child’s repetitive, ritualistic behaviors and engage in interactive play in order to establish a rapport with the child. The Son-Rise Program believes that parents are their child’s best resource and, therefore, teaches parents educational and altitudinal tools and techniques to help them become their child’s teachers.
SPEECH AND LANGUAGE THERAPY
Speech and Language Therapy helps a child to communicate more effectively both verbally and nonverbally, using words and/or body language. The speech/language pathologist (SLP) provides appropriate interventions that help the child form words or communication systems, process information, and express him or herself. The SLP also teaches the child the pragmatics of language, such as how to initiate and sustain a conversation. Children may be taught to read body language and facial expressions, as well as how to organize their thinking. In a speech therapy session, the child is taught in individual and/or small group sessions, depending on the child’s skill level. Sessions usually last 30 to 45 minutes and are run by a speech pathologist in his or her office, your home, or your child’s school. Sessions may incorporate language-based exercises, games, and activities. For nonverbal children, the therapist may use prompted speech therapy or augmentative treatments such as American Sign Language, communication boards, voice output communication devices or Picture Exchange Communication Systems (PECS).
THERAPEUTIC HORSEBACK RIDING
Therapeutic Horseback Riding provides an enjoyable and beneficial experience for children with ASDs. Physical benefits include improved posture, balance, motor skills, and muscle tone. Therapeutic riding can help those with learning or emotional disabilities develop better concentration, patience, and interpersonal skills. Children can gain confidence and experience a sense of freedom through Therapeutic Horseback Riding. Even though Hippotherapy also uses horses, Therapeutic Horseback Riding differs from it in that its primary goal is to encourage children to ride independently.
Therapeutic massage involves manipulation of the body’s soft tissue (muscle tendons, and ligaments), which can improve blood and lymph circulation. Bodywork therapies like therapeutic massage may help children with ASDs by reducing anxiety, hyperactivity, self-stimulatory behaviors, sleeping problems, and improving overall motor and sensory functioning.
Developed by Dr. Alfred Tomatis, a French ear, nose, and throat specialist, the Tomatis Method is a form of auditory therapy similar to AIT. The Tomatis approach focuses on improving a child’s listening and communication skills, while Bernard’s AIT focuses on reducing hypersensitivity to sound. The Tomatis Method uses modified auditory feedback in a broad range of frequencies and vocal exercises to develop self-listening skills. This treatment has been used for children with ASDs who have auditory processing disorders, expressive and receptive speech and language difficulties, impaired social skills, and organizational problems. Parents report their children experience better listening skills, reduced tactile defensiveness, and improved language skills.
TEACCH (TREATMENT AND EDUCATION OF AUTISTIC AND RELATED COMMUNICATION HANDICAPPED CHILDREN)
TEACCH was developed in the 1970s at the University of North Carolina’s School of Medicine; it is now used widely across the United States and internationally for the assessment and treatment of people with ASDs. Incorporating a variety of interventions including Applied Behavioral Analysis and developmental approaches, programs are developed to meet an individual’s specific communication, social, and educational needs. TEACCH utilizes a highly structured physical environment and a thorough, ongoing assessment of skills to provide treatment that enables individuals to succeed at home, in the classroom, and in the greater community. Family involvement in treatment is encouraged and parents are considered partners on the treatment team. TEACCH has been replicated in different schools and classrooms in the United States and internationally (in Denmark, France, Norway, Sweden, and Switzerland).
In the 1950s, behaviorist B. F. Skinner developed an approach for parents to use in helping their children with ASDs develop better communication skills. His technique, Verbal Behavior, emphasizes repetition and the use of rewards to reinforce desired behavior. Verbal Behavior focuses on functional units of language, what Skinner termed echoics, mands, tacts, and intraverbals. Skinner believed that, in order to communicate, children need to learn imitative speech (echoics), how to request or obtain what they want (mands), to develop a vocabulary for what is in their environment (tact), and how to engage in conversational language (intraverbals). Skinner’s work, along with the work done by Ivar Lovaas, provides the foundation for Applied Behavioral Analysis.
Video Modeling is used to teach specific skills, play sequences, and social exchanges. It also can be used to help an individual with an ASD gain perspective on a given situation. Children with ASDs often need repeated exposure and practice to acquire new skills. In this approach, a peer or adult is videotaped performing a specific task or engaging in social interaction. The child repeatedly views a video illustrating a specific skill that the child is attempting to learn. A behavioral therapist or trained caregiver, using the same gestures and language from the script of the video, teaches the child to perform the task or interaction. Videos can be homemade. For example, a child with an ASD who is learning to select clothes for school can watch a video of a peer or sibling going to the closet and picking out clothes, while talking about how to decide what to wear. Video Modeling can be used for teaching basic skills, such as how to wash hands or more complex skills such as how to hold a conversation. Studies have shown that Video Modeling is an efficient and effective teaching technique that helps children with ASDs to learn and generalize skills.
In Vision Therapy, a behavioral optometrist prescribes special tenses and eye movement exercises to improve a child’s visual system. Many children with ASDs have fleeting eye contact, poor spatial organization, and sensitivity to light. During the eye evaluation, children try on different lenses while performing a variety of activities like standing on a balance beam or catching a ball that is swinging on a string. Different lenses are prescribed to address specific problems. For example, ambient lenses are used to improve spatial organization related to the child’s body posture and movement through space. Eye movement exercises, to be practiced at home on a daily basis, are used in combination with prescribed lenses.
VITAMINS AND MINERALS
The megavitamin approach is based on evidence that some children with ASDs have metabolic errors that may be overcome by larger amounts of certain vitamins. The most popular supplement for children with ASDs is a vitamin B6 and magnesium mixture that proponents believe increases concentration and eye contact, while decreasing interfering behaviors. Other recommended vitamins and minerals include cod liver oil supplements, calcium, and vitamins A, B1, B5, B12, and C. Children vary enormously in their needs for various nutrients. Parents considering the use of vitamin and mineral supplements should speak first with a nutritionist or nutritionally informed physician.
The ancient practice of Yoga may help some children with ASDs to improve motor, communication, and social skills. Success of this intervention is dependent upon a positive relationship between the child and the Yoga teacher, who may use music, dance, and stories to establish a connection with the child. Once there is a trusting relationship, the teacher can introduce Yoga poses (asana), breathing exercises (pranayama), and deep relaxation techniques. Yoga has been shown to strengthen the nervous system, develop body awareness, increase concentration, and improve overall health.
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