Autism Spectrum Disorder (ASD) has two main hallmarks: difficulty with communication and social interactions and a tendency toward restricted, repetitive patterns of behavior and interests. But no two children on the spectrum are alike, which can make an ASD diagnosis particularly overwhelming. It can be hard to understand which aspects of your child's behavior and development are part of her ASD and which are typical for her age or just idiosyncratic parts of her personality. You may also worry that your child's issues are too severe or ingrained for treatment to make much difference, but it's important not to lose hope. "With good treatment, many and increasingly more children will get better," says Parents advisor Fred Volkmar, M.D., director of the Child Study Center at Yale University School of Medicine. "By that I mean they will grow up to be self-sufficient adults who can live independently. They may never be problem-free, but we see many children do very well."
If your child has been diagnosed with ASD, you'll need to find an autism specialist who can partner with you in your child's care. That specialist may be a neuropsychologist or neuropsychiatrist, a clinical psychologist or psychiatrist, or a developmental pediatrician. "The key is that he or she has special training in understanding the needs of kids on the spectrum," says Michael Rosenthal, Ph.D., a pediatric neuropsychologist who specializes in autism at the Child Mind Institute in New York City. Your pediatrician should be able to make referrals; you can also contact the Autism Response Team at Autism Speaks for help finding a qualified specialist in your area. Once you find the right therapist, he or she will work with you and your child to devise a treatment program that will look something like this:
"When we see a newly diagnosed 2- or 3-year-old, our first goal is to get him into pretty aggressive early intervention known as applied behavioral analysis [ABA]," Dr. Rosenthal says. "There is a tremendous amount of research to show that this is the way to go." An ABA-trained therapist will work with your child for 25 or more hours per week, systematically encouraging desired social and communication behaviors and actively teaching the kind of social interactions that other children learn intuitively. The list of goals may include improving attention span, building social interaction skills, and developing verbal and nonverbal communication skills.
Depending on your child's specific needs and progress, other evidence-based approaches might be used. These include pivotal response therapy (PRT), which is derived from applied behavioral analysis; the Early Start Denver Model approach, known for its developmental curriculum of skills; or the TEACCH approach (Training and Education of Autistic and Related Communication Handicapped Children). Many children with ASD also benefit from occupational, physical and speech-language therapies, and others need a kind of hybrid approach, in which therapists choose from a variety of methods to meet their needs. "With children on the milder end of the spectrum, we often find that all they need is a little bit of speech-language therapy to help with social skills," Dr. Rosenthal notes. "Other kids really need the total treatment package."
It's important to understand that most public school systems offer only one kind of autism program. "It varies tremendously by school district whether your child can be in an ABA-based classroom or one with a developmental approach," Dr. Volkmar says. "We run into problems when a kid is diagnosed but the only program available isn't a good match with his needs." If you think your child's current therapeutic approach isn't working, talk to your specialist about the best strategy for switching to something different.
"Medication can't fix autism itself but it can be useful if a child has some associated problems," Dr. Rosenthal says. For example, some children with ASD also experience high levels of anxiety, inattention, or hyperactivity; medications are often prescribed to help with those issues, which can otherwise interfere with their social and behavioral progress. "When medication can help get the symptoms of the associated problem under control, we often see a big jump in a child's progress," Dr. Rosenthal notes.
Diets, vitamins, and chelation (a process that is said to remove mercury or other heavy metals from the body) have all been touted as treatments for ASD. But "none of these have any reliable science behind them," Dr. Rosenthal says. And some (particularly chelation, which can cause kidney or liver damage) can be very dangerous. If you want to pursue an alternative therapy for your child, be sure to consult a qualified physician first.
It's important for parents to understand that autism is often a lifelong condition, without any known cure. But good behavioral therapy is extremely effective, especially when it's started as early as possible. "It's not a question of whether a child with ASD can make progress--it's a question of how much progress," Dr. Rosenthal says. In 2013, researchers at the University of Connecticut co-authored a landmark study published in the Journal of Child Psychology and Psychiatry, which showed that some children with ASD can achieve "optimal outcomes." "The 34 children identified in this study were making friends, doing well in school, and generally functioning well," says Dr. Rosenthal, one of the study's co-authors. "They had effectively moved off the spectrum. It's too soon for us to say why these children did so well, but early behavioral intervention does appear to be key." Further research is needed to replicate the results in a bigger population and understand more about what worked so well for these children. Dr. Volkmar, who was not involved in the study, notes that the term "optimal outcome" is subjective: "I know one college-aged boy who by many definitions has 'moved off the spectrum,'" he explains. "But he also can't do his laundry, so we have a long way to go before he's fully functional in all areas of life." But Dr. Volkmar, too, wants parents to stay optimistic. "I have seen many young children make tremendous progress," he says. "There are so many reasons to be hopeful."
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