Isenção de responsabilidade: qualquer informação fornecida neste artigo não se destina a diagnosticar ou tratar. Não deve substituir a consulta por um profissional qualificado para lidar com o transtorno do espectro autista (TEA).
There is no medical treatment for autism spectrum disorder (ASD). There are only a number of behavioral therapies whose scope is to reduce the symptoms of autism, improving the child’s ability to function in a better way and develop her/his social, communication, and learning skills.
Given the complexity of the disorder and the kaleidoscopic ways it surfaces, there is no one-size-fits-all treatment. Therapies shall be tailor-made to fit the specific challenges of each child or adult.
2 years old children show better responses than older children, to therapies as they can impact the brain in a more incisive way, helping the child enhance her/his critical social, communication, functional and behavioral skills.
This is why it is vital to track child development as early as possible and detect any possible autistic trait as early as possible in life. Some doctors managed to diagnose autism in 8-12 months old children and implement effective therapies that resulted in improved long-term life conditions.
If the signs and symptoms of autism are evident, parents are recommended to start therapy even before an official diagnosis is issued.
Autism treatment options
Throughout the years, a high number of alternative home or school bases therapies have been conceived and tested.
Parents should talk to experts to define the best treatment strategy for the child, and keep it updated based on the child’s changing needs. Therapies are generally multidisciplinary and involve a team of experts with different competencies and backgrounds (medical doctors, psychologists, caregivers, and others).
The key therapies for the autistic spectrum disorder can be classified as follows.
1) Medical/Biomedical treatment for autism
There is no medical treatment that can fix the autism spectrum disorder at its core however some specific medications are effective for reducing its symptoms.
There are, for instance, medications to reduce the child’s hyperactivity (attention-deficit), to relief the child from depression and anxiety (anti-depressants), to control her/his severe behavioral problems (antipsychotic), to fight sleep disorders (benzodiazepine), selective serotonin reuptake inhibitors (SSRIs), or to treat the typical neurological or physical problems experienced by autistic children (gastrointestinal and metabolic issues, seizures, obsessive-compulsive disorder, and epilepsy).
Unfortunately, antidepressants and antipsychotics are largely used for older children and adults as the only available remedy at that stage in life.
2) Nutrition-based ASD therapies (“Autism Diet”)
No special diet is prescribed to autistic children generally, however, the intake of proper nutrition is important given the known relations between the digestion system and the brain.
Sometimes, parents eliminate gluten and casein from the food of their autistic kids based on the general belief that they may make the condition worse. Unfortunately, there is no research that proves that the removal of proteins in wheat and milk products (gluten and casein) may have a positive impact on ASD. On the contrary, bone-building foods are important for autistic kids which tend to have thinner bones than the average population.
3) ASD Behavioral and communication therapies
Behavioral therapies, which can be very intensive and challenging both for the child and the family, are the most used to treat the autistic spectrum disorder today. Their goal is to address the symptoms of ASD (social, language, behavioral skills), and help children learn new competencies (especially in the social and communication areas). Of course, the type of autism (severity level) has a direct impact on the selection of the right treatment strategy.
“A.B.A.” Therapy (Applied Behavioral Analysis)
The “ABA Therapy” is the most known and practiced anti-ASD behavioral treatment: it helps children learn new skills and then generalize their application to multiple situations based on a reward & positive compensation motivational system of incentives.
The main types of ABA therapy are listed below:
- EIBI (Early Intensive Behavioral Intervention): This type of ABA targets children under 5 years old
- DTT (Discrete Trial Training): the therapy aims at breaking down the desired behavior into simple steps that the child can master progressively
- Pivotal Response Treatment (PRT): This play-based therapy is based on compensating the child with something that the child has requested, (even with a badly formulated demand that can be interpreted). Therefore, the therapy leaves the child the possibility to formulate requests and rewards her/him for being able to communicate a demand. PRT uses a similar approach of ABA and is called pivotal as the child triggers the response of the therapist (and not vice versa).
- VBI (Verbal Behavior Intervention): a therapy that improves the verbal skills of the child
The name of the therapy comes from the fact that parents get down to the floor with the child to play at her/his level and foster interaction based on what the child is doing in a specific moment. Being close to the child, and letting the child feel close to the parents, expands the openness of the child to communicate and interact. Parents play the child’s favorite games and let her/him lead the experience.
Floor-time (a therapy invented by Dr. Greenspan and Dr. Weider) is a therapy for children on the autistic spectrum, sometimes used alternatively or in conjunction with the ABA therapy.
Occupational Therapy for Autism (OT)
The scope of Occupational therapy for autism (OT) is to help autistic people develop their cognitive, physical, social, and sensorial skills to become more independent and participate in activities in multiple contexts.
The areas of focus are self-care (using the toilette, bathing, eating, drinking from glasses, using the cutlery, dressing, grooming, teeth brushing), playing abilities, learning abilities (writing, reading, painting, shaping objects), and sensory awareness.
The occupational therapy for autism (OT) is articulated in 30- or 60-minutes sessions, whose number depends on the starting level of the child (that is assessed at the beginning of the therapy by the specialist). It can be practiced at home, at school or in dedicated locations (clinic).
Social Skills Class
Social skill class therapy aims at improving how a child interacts socially and forms bonds with other children and adults. It can be executed at home, at school, or in a spontaneous community (1:1 or in groups). The technique is based on learning via role-playing or practice. Likewise ABA, parents shall be trained upfront to continue the therapy at home, and help the autistic child improve her/his social skills.
“ESDM” Therapy (Early Start Denver Model)
The ESDM therapy is used for autistic children from 12 up to 48 months and is based on a methodology similar to the ABA (therapists and family members use fun, compensation and playing attitudes to build rapport with the kid and foster learning). The scope of the therapy is to enhance the child’s social, communication and cognitive skills.
The ESDM therapy can be practiced at home, at school or at the autism clinic (multiple contexts are always beneficial). It is open both to kids with and without learning disabilities, 1 by 1 or in groups. It requires the direct involvement of the parents, to continue the therapy once they are at home with the kid.
Horseback Riding or “Hippotherapy”
The therapy is based on creating a bond between the child and a trained horse. The child rides the horse with the support of a therapist and learns to understand the movements of the animal and react to them.
The Hippotherapy has shown positive results (enhanced social and language skills) in autistic persons up to 16 years of age. It also seems to calm down the children, making her/him quieter and less hyperactive
Relationship Development Intervention (RDI)
Relationship Development Interventions (RDI) are behavioral treatments focused on building social and emotional skills in autistic kids (the ability to build relationships and connect with other people emotionally). The primary therapists are the parents, who are trained beforehand by skilled instructors.
The therapy also teaches the child how to be more flexible, evaluate multiple perspectives (instead of being single-minded), manage change in routines with lower anxiety and distress, make use of all senses in a coordinated way.
The RDI therapy, like ABA, uses positive reinforcement to help the child crystallize her/his learnings.
As the name indicates, the speech therapy goal is to improve the communication and speaking abilities of the child. The therapy exercises the verbal, nonverbal (sign, gestures, facial expressions, body language), and social communication skills (communication in groups, taking turns in a conversation) of the child.
This therapy is generally guided by a speech-language pathologist (SLP). Some physical exercises may also be included (for example mouth and tongue control to generate clear sounds).
Some Android and iOS applications are available to help autistic children improve their speech abilities (how to pronounce a word exactly, for instance). These are sometimes called “iPad therapy”.
Treatment and Education of Autistic and Related Communication-handicapped Children (TEACCH)
“TEACHH” uses visual cues, such as picture cards, to help children learn everyday skills like getting dressed and basic self-care. The inputs of this therapy are broken down into progressive steps to foster engaging and dynamic learning.
The Picture Exchange Communication System (PECS)
This is a visual-based treatment similar to TEACCH that uses symbols instead of picture cards. In brief, the child is pushed to ask questions and communicate with the therapist through special symbols.
Sensory Integration Therapy (SIT)
Most children on the autism spectrum suffer from sensory issues. This therapy is designed for autistic children that feel distressed by things like bright lights, loud sounds, or the feeling of being touched. The therapist exposes the child to the badly tolerated stimuli little by little, and in a playful way, helping her/him get acquainted with it progressively (for instance, if the child is irritated by human touch, the therapist will slowly keep on touching her/him while playing together until she/he becomes less sensible and irritated). The SIT therapy may help the child deal with sensory inputs in a more relaxed and natural way (however, no statistical data are available to prove the effectiveness of the SIT therapy for autism).
4) Hyperbaric oxygen therapy
Some studies have reported that the hyperbaric chamber therapy (letting the child breath pure oxygen in a high-pressure chamber) can improve the social and learning abilities of autistic people in a significant way (including less irritability and repetitive behaviors).
According to the promoters of the hyperbaric chamber treatment, such benefits come from the de-inflammatory action of pure oxygen on the brain and the gastrointestinal apparatus of the treated child.
Unfortunately, most autism researchers believe that these conclusions are either questionable or biased (as the study has been promoted by an organization that promotes the hyperbaric therapy (and the equipment behind it).
To draw a line on the actual effectiveness of this therapy, more rigorous and independent analysis is needed.
5) Educational therapies
Autistic children tend to respond well to structured educational programs delivered by multidisciplinary teams. This type of ASD therapy shows good success when started early in life and followed intensively. Educational programs address the typical shortcomings of the autistic spectrum, such as behavior in social contexts and communication with others.
6) Family therapies
Any home-based therapy falls under this general category: parents learn how to interact, play and communicate with their autistic children to stimulate their social, communication and behavioral skills. Essentially, parents attend courses to understand autism better, its challenges, and how to behave at home with their child.
Which are the most effective therapies for autism?
There is no objective answer to this question. Each child on the autistic spectrum has a unique set of challenges that shall be addressed with a customized intervention strategy. Hence, the right question to ask is “what is the most effective therapy for my child?”.
What is highly effective for a child may be totally ineffective for another; this is where the experience of trained specialists comes into play. Parents shall refrain from “do-it-by-yourself” approaches when treating autism but find out with the support of a recognized professional the most indicated mix of therapies starting from the assessment of the child’s unique challenges.
According to Autismspeaks.org, the 8 most effective therapies for autism according to 8.000 interviewed parents are:
- Occupational Therapy for autism – 39%
- Speech Therapy – 27%
- ABA Therapy – 15%
- Social Skills Classes – 8%
- Hippotherapy (OT through horseback riding) – 2%
- GFCF Diet – 2%
- Psychiatrist/Psychologist sessions – 2%
- (5-way tie, each with 1%): Floor Time, RDI, PECs, Swimming, PRT
Any other existing therapy for autism had a less than 1% response rate (mainstream schooling, vision therapy, aqua therapy, iPad therapy, special nutrition therapy, etc.).
These data have empiric rather than scientific nature; therefore, it is recommended to try different approaches with a specialized therapist and find out the best approach with a trial-and-error approach.
What seems undoubted, is that the earlier the treatment begins, the better the outcomes for the child (probably because the brain of younger children is more plastic and adaptable than older ones). Late diagnosis is the most common reason why therapies are ineffective.
Who can deliver the ASD therapies?
Autism therapies shall be conceived and delivered by specialized professionals only. Parents should check that the therapist in charge of their child possesses the necessary requisites. Despite these can vary country by country, authorized professionals are people that:
- Have a master’s degree or Ph.D. in psychology or behavior analysis (therapists with bachelor’s degrees shall be assisted by higher-education therapists)
- Have passed a national certification exam for the elected therapy (example ABA)
- Have a license to operate as ASD therapist (this requirement may not apply in some countries)
The typical professional qualifications involved with autism treatment are:
- (Child) Psychologists
- Behavior specialists (BCBA)
- Occupational therapists
- Speech and language pathologists (SLP) or speech therapists
- Early intervention specialists
- Developmental pediatricians
- Special education teachers with specialization on autism spectrum disorders
- Autism specialists
Parents shall contact the autism associations in their countries to get the local lists of the authorized autism clinics or centers, and therapists.
Who Pays the Treatment for Autism?
There is no easy answer to this question, as it would involve an analysis country by country (which is a massive research task beyond the scope of this article).
In general, it is safe to state that in most countries with a public health system autism therapies are (at least partly) supported by state programs and backed by autism Laws; in countries with a private health system, insurances cover, at least, some of the most accredited therapies (example ABA or OT, occupational therapy for autism).
The main point to highlight, though, is that autistic people are no longer supported by state or insurance programs as they reach the age of 18 (or 21 in some countries) and the burden comes back on the shoulder of their parents (or family members) entirely.
Most autistic adults end up in mental disease centers when their parents die or can’t support them any longer. By hitting such centers, autistic adults lose any special support, are treated like the other people that have mental issues that have nothing to do with autism and are kept under control (when hyperactive) with psychoactive medicaments.
This is one of the most tragic and dark truths of autism, a situation not acceptable for a modern society.