What are some guiding principles for autism therapy?
At first, parents may feel confused or overwhelmed by the number of providers and types of therapy that a child with autism can receive. Zooming out, we suggest parents consider 4 higher-level guiding principles when building a therapy plan for their child:
- Child-centered goals of therapy. What does the therapy plan seek to accomplish for the child? In our view, the overarching goal is to help a child with autism reach their fullest potential and improve their long-term quality of life. This often means helping them develop skills to navigate the modern world (e.g., by supporting speech and communication skills). This is an important question to ask any provider you are considering for your child: What are the macro-level goals of your therapy? What do we hope to accomplish through therapy? How do you see us getting there or reaching these goals? By asking these questions of different providers, you may get a better feeling for their underlying care philosophies, which can vary by provider.
- Importance of early intervention. There is strong evidence for early intervention on long-term child outcomes. Parents should, in consultation with their healthcare provider based on their child, strongly consider services at a young age to support a child’s long-term growth and development. In fact, research studies have found physiologic improvements in children who receive early intervention therapy, such as changes on brain wave tests (EEG) when viewing faces and objects. For instance, 6 randomized control trials have shown the benefits of early intervention services for young children with autism.
- Multi-disciplinary and coordinated. Autism is complex and often involves multiple providers caring for your child. Specific services will vary by the child but may include speech therapy, occupational therapy, behavior therapy, and other modalities. Strong coordination across providers is important, as care coordination may improve the effectiveness, safety, and efficiency of care. As the strongest influence in your child’s life, you as the parent should be considered as part of the team as well and your input and feedback should be incorporated into the therapy plan. It’s also helpful to ask providers: How do you coordinate across the care cycle? How do you involve parents?
- Individualized and personalized. Each person with autism is unique, and the care team should work together to craft a personalized treatment plan that addresses the individual needs and strengths of the child.
What are the different therapy types for autism?
Conceptually, 3 broad categories of treatment modalities are used to support children with autism:
- Behavior and communication approaches
- Complementary and alternative medicines, including dietary approaches
Each child’s needs will vary, and treatment choices should be based on a consultation with an expert provider in autism. Here are some facts that are relevant for many children with autism:
- Particularly for young learners, most time in therapy will be spent in category #1 via programs focused on behavior therapy, speech therapy, occupational therapy, social skills training, and other approaches.
- Under category #2, no medicines have been shown to cure autism or treat its core symptoms. However, a health care provider may prescribe medication to support the well-being of a child with autism, such as medicines to help manage anxiety or support healthy sleep.
- Under category #3, families may choose to adapt their child’s lifestyle to a gluten/casein-free (GFCF) diet or include nutritional supplements. A recent review of 19 randomized clinical trials found “little evidence” to support the use of dietary therapies or nutritional supplements in children with autism. Before starting your child on these or other therapies, talk to your doctor or specialized health care professional.
- Children often respond differently to therapy, with some making steady progress while others take a bit more time.
What is ABA therapy?
ABA therapy, or applied behavioral analysis therapy, uses reinforcement to encourage new skills or increase certain positive behaviors.
For instance, for a child with delayed speech who likes cars, a therapist might ask the child to say the word “car” and then reinforce this action by offering a toy car. In the context of behavior therapy, the word “behavior” doesn’t necessarily mean bad or challenging behavior but rather any action an individual does.
As a result, behavior therapy targets the acquisition of all developmentally appropriate skills across a lifetime. There are loads of information about ABA online, and it’s easy to feel confused or overwhelmed by the sheer volume.
The following are key facts we believe that parents should know and understand when considering ABA for their child:
- ABA is a set of evidence-based therapies used for children with autism. ABA therapy has helped children with autism in multiple studies. In the past, such studies weren’t as robust, but the evidence base has grown over time, including showing effectiveness in randomized clinical trials.
- ABA is a family of overlapping therapies. Several different models may be used with your child that, while based on the same principles, in practice look quite different. (See the next section for additional details on this topic.)
- The quality of ABA depends on the person administering it. Levels of training, experience, and qualifications may vary significantly amongst frontline clinicians delivering ABA. At a minimum, your child’s therapy program should be overseen by a Board-Certified Behavior Analyst (BCBA, which we expand upon in other sections), and the staff should have completed sufficient training.
- ABA uses small steps to build larger improvements over time. For example, a macro goal for your child may be playing with peers. The first step may be to play independently with toys. Next, the goal may progress to engaging in parallel play with those toys near a few peers. Then, the goal may include greeting a peer by saying, “Hi.”
- ABA is not the only therapy used in children with autism. As we noted before, additional options such as speech therapy, occupational therapy, and social skills training may all be beneficial for a child to support their development and growth. A strong ABA program should coordinate with these other clinicians to provide consistency across therapeutic environments and expand on treatment goals during ABA therapy.
- ABA should focus on skill generalization and carryover to multiple environments. Parent support and participation are key components of treatment that promote success.
- ABA often involves multiple hours a week of therapy. Each child and each therapy plan is different, but it’s not uncommon for children to receive 20-30 hours of ABA a week or more. This high intensity model is supported by medical research and endorsed by major US medical societies.
- Starting therapy can be hard emotionally for children and families. Children with autism tend to have preferences and routines they like, and changes from these norms can lead to anxiety for the child. At the start of any therapy program, the child may cry or otherwise release emotions as their routines are disrupted. This is totally normal, and your care team should support you without judgment. Ask your provider about how they manage this transition (e.g., gradually ramping up hours) and what support they offer (e.g., parent coaching). You’re making the best choices for your child, and their feelings are valid and real.
- There can be strong opinions on ABA online and in social media discussions. See our Overview of Neurodiversity section for a more in-depth discussion on this topic.