Treatment & Care

There is currently no cure for autism spectrum disorder (ASD). However a range of strategies and approaches can be effective in improving the skills of children with ASD.

Autism Spectrum Disorder

There are many different types of intervention for ASD, so it is often hard to judge which one will work best for your child.

Some types of intervention can involve hours of intensive work, and this is not always possible for many families because of the practical, emotional and financial commitments necessary.

The National Autistic Society website has information on the many different approaches, therapies and interventions available for ASD.

Intervention

Any intervention should focus on the important aspects of your child's development that are impacted by having ASD. There are 3 main areas affected, sometimes known as the 'Triad of Impairment':

  • Communication skills – such as the ability to start conversations.
  • Social interaction skills – such as the ability to understand other people's feelings and respond to them.
  • Cognitive skills – such as encouraging imaginative play.

Additionally your child may experience difficulties with:

  • Academic Skills – the "traditional" skills that a child needs to progress with their education, such as reading, writing and maths.  You may find some ideas to help with this in the Education part of this site.  Alternatively it may be worth speaking to your child's teacher or Educational Psychologist.
  • Motor Skills - these can affect your child's ability to take part in everyday activities including aspects of self care and play.  Try looking in the life skills section of this site for more information and advice on self care and play.
  • Sensory Processing - some children can be more sensitive to different sensations, whilst others can seem unaware of sensory experiences the rest of us find challenging.  For some advice and strategies try completing the appropriate sensory questionnaire for your child

Some widely used interventions for ASD are explained below.

 

Applied Behavioural Analysis (ABA)

Applied behavioural analysis (ABA) is based on:

  • Breaking down skills (such as communication and cognitive skills) into small tasks, and then teaching those tasks in a highly structured way.
  • Rewarding and reinforcing positive behaviour while discouraging and redirecting inappropriate behaviour.

ABA programmes usually take place in the home. They consist of 40 hours a week of intensive therapy over two to three years.

An ABA programme is usually delivered by a consultant, who oversees the programme, and a team consisting of at least three therapists who alternate working with your child.

The programme team will work with your child on a one-to-one basis, in sessions of two to three hours. The team will try to teach your child by breaking skills down into smaller tasks. These tasks are then taught in a repetitive and structured way, with a particular emphasis on praising your child and reinforcing positive behaviour.

An ABA programme usually begins with simple tasks. Over time, these small tasks will build up into more complex skills that will help with your child's development.

ABA is not offered on the NHS and there is a significant cost implication for families who pursue this intervention; they have to fund their own training as well as the training of the other ABA therapists who will be working with their child, plus potentially pay their salaries over the 2-3 year period that the intervention is provided.

TEACCH

 

TEACCH stands for the Treatment and Education of Autistic and related Communication handicapped Children.  This intervention was developed in America in the 1960's and is widely used in some States.  It is a type of educational intervention that places great emphasis on structured learning by using visual prompts. Research has found that children with ASD often respond better to information that is presented visually.

Some of the basic components of the TEACCH methodolgy are used in educational establishments without staff actually following the TEACCH programme.  This can vary from establishment to establishment depending on whether staff are trained in the TEACCH programme and how much awareness they have of TEACCH. 

As with all of the comprehensive treatment methods for ASD there is a cost implication if you wish to implement this programme for yourself, however you can read more about this intervention (and others) on the NAS website.

 

Social Stories

Social storiesTM were created by Carol Gray in 1991. They are short descriptions of a particular situation, event or activity, which include specific information about what to expect in that situation and why.

The terms 'social story' and 'social stories' are trademarks originated and owned by Carol Gray.

What are Social Stories for?

Social stories can be used to:

  • Develop self-care skills (eg how to clean teeth, wash hands or get dressed), social skills (eg sharing, asking for help, saying thank you, interrupting) and academic abilities.
  • Help someone to understand how others might behave or respond in a particular situation.
  • Help others understand the perspective of an autistic person and why they may respond or behave in a particular way.
  • Help a person to cope with changes to routine and unexpected or distressing events (eg absence of teacher, moving house, thunderstorms).
  • Provide positive feedback to a person about an area of strength or achievement in order to develop self-esteem.
  • As a behavioural strategy (eg what to do when angry, how to cope with obsessions).

How do Social Stories Help?

Social stories present information in a literal, 'concrete' way, which may improve a person's understanding of a previously difficult or ambiguous situation or activity. The presentation and content can be adapted to meet different people's needs.

They can help with sequencing (what comes next in a series of activities) and 'executive functioning' (planning and organising).    

By providing information about what might happen in a particular situation, and some guidelines for behaviour, you can increase structure in a person's life and thereby reduce anxiety.

Creating or using a social story can help you to understand how the autistic person perceives different situations.

Speech and Language Therapy (SLT)

Speech and Language Therapists are Allied Health Professionals with specialist skills in the field of language and communication.  They will be involved in assessing your child as part of the diagnostic process.  They may well provide intervention designed to improve your child's language skills. This in turn can improve your child's ability to interact with others socially.

The Speech & Language Therapist uses a number of strategies and techniques, such as visual aids, Picture Exchange Cards (PECS), social stories, and sometimes assistive technology to improve communications skills.

Medication

No medication is available to treat the core symptoms of ASD, but medication may be able to treat some of the related symptoms, such as:

  • Repetitive thoughts and behaviour.
  • Aggressive behaviour, such as tantrums or self-harming.

One type of medication used in the UK is the class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). These work by changing the levels of a chemical called serotonin in the brain. Serotonin is known to affect behaviour and mood.

However, SSRIs are used only extremely rarely to treat children and young people, and only by specialist consultants such as a child psychiatrist.

It is more common for specialists to use melatonin or other prescribed medication to help sleep (which is commonly disturbed in ASD). Specialist consultants may also use stimulant medication such as methylphenidate for young people who also have attention deficit hyperactivity disorder (ADHD).

It is not possible to predict how an individual will respond to SSRIs and whether they are a suitable treatment, but the clinical use of SSRIs has increased greatly in the last decade.

Examples of SSRIs include:

  • Clomipramine.
  • Fluoxetine.
  • Paroxetine.

Some children with ASD who are taking SSRIs can suddenly have a sharp rise in serotonin levels. This can trigger a group of side effects known as serotonin syndrome.

Symptoms of mild to moderate serotonin syndrome include:

  • Confusion.
  • Agitation.
  • Muscle twitching.
  • Sweating.
  • Shivering.
  • Diarrhoea.

If your child has any of the above symptoms, stop their medication and seek immediate advice from your GP. If this is not possible, call NHS 24 on 111.

Symptoms of severe serotonin syndrome include:

  • A high temperature of 39.4C (103F) or above.
  • Seizures (fits).
  • Irregular heartbeat.
  • Unconsciousness.

If your child has any of these severe symptoms, call 999 and ask for an ambulance.

Complementary and Alternative Medicines (CAM)

A number of studies have found that most parents have tried at least one type of complementary and alternative medicine (CAM) to improve their child's symptoms.

Examples of suggested CAMS to treat ASD include:

  • Special diets, such as gluten-free diets.
  • Vitamin supplements.
  • Anti-fungal medication.
  • Chelation therapy, which uses medication or other agents to remove metal, in particular mercury, from the body.

There is little or no evidence that any of these approaches are effective, and some may even be potentially dangerous.

Do not make changes to your child's diet without first consulting your GP.

It is strongly recommended that you do not try chelation therapy as there is no evidence of its effectiveness. It is based on a theory that mercury is responsible for the symptoms of ASD. But this theory is not shared by mainstream ASD experts, and it is potentially dangerous.

Risks associated with chelation therapy include kidney damage and liver failure. One child is reported to have died as a result of chelation therapy.

If you are considering a CAM, look out for certain claims and signs that suggest that the treatment may be unsound. These include claims that:

  • Are based on overly simplified scientific theories – for example, that ASD is caused by mercury in the body.
  • Promise effective treatment for a wide range of unrelated symptoms.
  • Offer dramatic results or the possibility of a cure.
  • rRely on unpublished case reports rather than carefully designed studies.
  • The treatment has no risks or side effects.