Therapeutic Approaches

Parents of children who fall on the autistism spectrum are frequently overwhelmed when confronted with the many treatment/educational approaches suggested for their children. The following is an explanation of some of the most widely used techniques. This list is not exhaustive. Some of these techniques are comprehensive programs, while others are designed to target a specific area. This listing does not constitute an endorsement of any particular technique, but is intended to be informational only. Some of these techniques have been well researched, while others are based on very limited evidence. This guide will give you a brief description only. Please find out more about any techniques you decide to use with your child.

Discrete Trial Training (DT)

Discrete Trial Training is one type of treatment based on applied behavior analysis principles (ABA). This teaching method involves breaking tasks down into simple elements and teaching the child through repetition. An individualized program is designed for each child so that the child’s specific strengths and weaknesses are appropriately addressed. Sessions are typically highly structured and more teacher directed than child-directed.

DT Goals:
The goal of a DT program is to teach the child all that is required of a typically developing child of the same age. New students may focus on developing learning readiness skills such as sitting in a chair, responding to his/her name, establishing joint attention and learning how to focus on teaching materials. Once these skills are learned, programs may work on imitation skills, learning to follow simple commands, and increasing receptive and expressive vocabulary (labels, requests, etc). As the child progresses, the skills become more advanced, but the methodology and prompting techniques remain consistent. This method is designed to develop cognitive, play, social, and self-help skills.

DT Technique:
The instruction is most often performed one-on-one in the home or school with therapists. Specific techniques include:

Breaking a skill into smaller parts
Teaching one sub-skill at a time until mastered
Providing opportunities for repetition in concentrated periods of time
Prompting and fading prompts as necessary to reach independence
Using reinforcement procedures

Flexibility and patience are extremely necessary for DT. Language, social and play skills typically develop over months and years of intervention

Additional information: http://www.lovaas.com

DIR/Floor Time

DIR/Floor Time Theory:
People with autism, like everyone, need to be calm and regulated enough to engage in warm, emotionally connected relationships that are truly reciprocal with mutual growth and learning (e.g. between parent and child, teacher and student, employee and fellow employee, etc.). DIR/Floortime® looks at the Developmental level of the person (regulation, engagement, gestural reciprocity, etc.), often using the Functional Emotional Developmental Scale, the Individual differences of the person (with things like talking, moving, and other things), and uses our Relationships with others as the most important way to learn and grow together.

DIR/Floor Time Intervention:
In DIR/Floortime®, every time we talk, play, or teach we start by seeing if the other person is calm enough to do things with us. If not, we help the person settle down. Usually that means just waiting a bit and seeing what the person is doing (following the person’s lead). Sometimes, it means doing other things with the person to help them calm down. The next thing we do is woo the person into an interaction, usually by either joining in or playfully getting in the way of the other person. We look for the ‘gleam in the eye’ that comes when you know the other person knows that you are both being playful. When we do this, the other person usually does something different, and so we keep doing things to see what the other person does. We try to keep these circles of play going, and as we do this we build a real, growing, learning bond with the other person. We can do this with all sorts of people, from children who seem to only flap their hands to people who can talk really well but get stuck with things like making friends. We do DIR/Floortime® all day, every day. It’s fun when we play – and with young children that is often on the floor – but it can be done in the car, at the store, in class, at home, and in any situation. DIR/Floortime® helps people react better to change and to the things that bother them, from scratchy clothes or loud noise to mean kids or even mean bosses. DIR/Floortime® can help people learn how to care about other people and think about how other people feel. DIR/Floortime® is a very useful way to think about and help people with autism and autism-like problems.

DIR/Floor Time Goals:

DIR/Floortime® goals follow functional, developmental, emotional levels to assist the person in improving and mastering necessary developmental skills.

Self-Regulation and Attention – Goal: Take in sights and sounds and maintain shared attention
Engagement and Relating – Goal: Woo another and be wooed, stay engaged through emotions in warm interaction
Use Affect to Convey Intent – Two Way Communication – Goal: To do this for requests, emerging back and forth interactions
Behavioral Organization and Problem Solving – Goal: Continuous flow of affective interactions with people for shared social problem solving
Creates and Elaborates With Symbols – Goal: Represents ideas and emotional themes in play and other interactions.
Emotional Thinking: Logical –Abstract – Goal: Bridges ideas, elaborates and can reflect on actions, motives, aware of time and space

Additional information: http://www.floortime.org or http://www.icdl.com

Music Therapy

Music Therapy Theory:

Music therapy is a professional health discipline which uses music as a therapeutic stimulus to achieve nonmusical treatment goals. Findings from a recent analysis of music therapy research in the area of autism (Whipple, 2004) support the benefits of this intervention to assist in communication, on-task behavior, social development, self-care skills, and anxiety reduction. Additionally, research indicates enhanced processing and interest in musical stimuli for a subset of individuals on the autism spectrum. In combination with other evidence-based techniques, music is a strong modality to engage individuals with autism in more challenging or non-preferred tasks. For a complete research list (including the metaanalysis referenced above), visit http://coastmusictherapy.com/articles/diagnosisautism.html.

Music Therapy Goals:
As an adjunct learning support, many need areas can be targeted through music-based strategies. Techniques that are frequently utilized for individuals on the autism spectrum include:

Teaching and role play of social scripts and scenarios via song-cued format
Practice and repetition of vocal sounds, speech phrases, or conversation scripts through melodic & rhythmic techniques
Presentation of academic facts, self-help sequences, and language concepts through song or chant
Gross and fine motor exercises and motor imitation cued by rhythm or instrument play
Engagement in music performance, songwriting, or music-facilitated social groups to encourage emotional expression, creativity, and interpersonal skills
Music to assist with calming, self-regulation, and transitions

Music Therapy Credentialing & Programs:

A professional music therapist holds a minimum of a Bachelor’s Degree in Music Therapy from an accredited university in addition to completion of 1200 hours of clinical training, and national board certification. For more information on this credentialing process, visit http://www.cbmt.org. Services frequently offered by music therapists include: early intervention, adapted music lessons, educational services, individual and group therapy sessions, consultation and collaboration with other treatment providers, and development of resources for home or school carry-over.

Additional information: http://www.musictherapy.org

Picture Exchange Communication System (PECS)

PECS Theory:
The Picture Exchange Communication System offers children a unique alternative to verbally-based communication systems and is founded on applied behavior analysis and Verbal Behavior principles. It can be used in a variety of settings including the home, the classroom, and the community. According to the proponents of this system, it is more beneficial than other types of augmentative communication because natural reinforcers are used, there is no need to train prerequisite skills such as pointing or imitation, and natural use of communication is built into the program.

PECS Goals:
The goal of PECS is to teach children a form of communication that requires few prerequisite skills. PECS provides children with a functional form of communication that allows them to get needs met, make choices, engage with people socially, and form a sense of control over their environment. Research indicates that children using PECS typically also use spoken language after a period of time.

PECS Technique:
Children using PECS are taught to give a picture of a preferred item to a communicative partner in exchange for the item. The initial communicative behavior targeted is initiating a request and preferred items serve as reinforcers for communication. The communication is motivating for the child because he/she is receiving reinforcement for his/her choice. Requesting is an extremely useful skill and may facilitate the development of other communicative intents. Physical prompts are faded quickly in order to insure independent communication. Once requesting with pictures is firmly established, the child is encouraged to verbalize the request. PECS is set up in a series of phases which include training of initiations, requesting, use of sentences, commenting, and complex use of communication.

Additional information: http://www.pecs.com

Pivotal Response Training (PRT)

Pivotal Response Training Theory:
Pivotal Response Training (PRT) is a naturalistic intervention based on the principles of applied behavior analysis. PRT targets certain pivotal areas for treatment that are believed to be central to wide areas of functioning, so positive changes in pivotal behaviors should have widespread effects on many other behaviors. Important pivotal areas addressed using PRT are motivation and responsivity to multiple cues. This intervention is flexible and designed to be used in structured one-on-one teaching or a natural setting. This technique provides therapists, parents, teachers and caregivers with a method of responding to the child with ASD which provides teaching opportunities throughout the day. Integrating PRT into everyday living can facilitate generalization and maintenance of the desired behavior change.

PRT Goals:
PRT works to increase motivation in developing new skills such as language, social interaction, and play.

PRT Techniques and Components:
The question/instruction/opportunity to respond should:

Be clear, uninterrupted and appropriate to the task
Be interspersed with maintenance tasks
Be chosen by the child
Include multiple components when appropriate Other important aspects of PRT include turn taking, frequent task variation, allowing child choice, and natural consequences.

Additional information: http://education.ucsb.edu/autism

The Reinforcers should be:

Contingent upon behavior
Administered following any reasonable attempt to respond
Related to the desired behavior in a direct way

Occupational Therapy (OT)

Occupational Therapy Goals:
Occupational Therapy is concerned with the child’s ability to function and participate in desired daily life activities or “occupations”, according to their needs. Children’s occupations include self-care (dressing, eating, and personal hygiene), school activities, home chores, and play. Occupational therapy benefits children with autism by improving their skills required to participate in these activities.

Occupational Therapy Techniques:
Occupational Therapy uses a client-centered approach: the intervention is tailored to the child’s strengths, weaknesses, and the family’s needs. Interventions can take place individually or in groups. Occupational therapists routinely address:

Attention
Behavior
Social skills
Sensory processing
Motor function
Play
Self-care

Additional information:

Websites:
http://www.aota.org/Practitioners/Resources/Docs/FactSheets/Children/38517.aspx
http://www.aota.org/Pubs/OTP/Features/2004/f-062804.aspx
http://www.aota.org/Consumers/Tips/Conditions/Autism/35155.aspx
http://www.aota.org/Pubs/OTP/Features/2006/f-111306.aspx
http://www1.aota.org/ajot/getpdf.asp?doc=59619.pdf

Rapid Prompting™ Method (RPM)

Rapid Prompting™ Method Theory:
The Rapid Prompting™ Method (RPM), developed by Soma™ Mukhopadhyay, initially to teach her severely autistic son, Tito, and since used to instruct many others. RPM is a method used for teaching by eliciting responses through intensive verbal, auditory, visual and/or tactile prompts. RPM seeks to increase students’ interest, confidence and self-esteem.

Rapid Prompting™ Method Techniques:
Prompting serves to compete with each student’s self-stimulatory behavior, and is designed to keep students focused and successful. Student responses evolve from picking up answers, to pointing, to typing and writing which reveals students’ comprehension, academic abilities and eventually, conversational skills. RPM is a low-tech approach, requiring only paper and pencil.

Additional information: http://halo-soma.org

Relationship Development Intervention (RDI)

Relationship Development Intervention Theory:
Relationship Development Intervention (RDI) Program is a parent-based clinical treatment for individuals with autistic spectrum and other relationship-based disorders. The RDI™ Program is modeled after the way typical children become competent in the world of emotional relationships. The model for intervention begins with the Relational Development Assessment, a careful examination to pinpoint the specific stage of readiness and the appropriate developmental place to begin working. The RDI™ Program is founded upon the model of Experience Sharing developed by Steven Gutstein Ph.D.

RDI Goals:
The primary goal of the RDI™ Program is to systematically teach the motivation and skills of Experience Sharing interaction.

RDI Objectives:
Grouping of objectives is based on the RDI™ ‘curriculum,’ and is composed of six levels and 28 stages. Each of the stages represents a dramatic development shift in the central focus of relationships. Objectives are divided into ‘Functions’, which are the reasons why we engage in an action and ‘Skills’, which are the specific proficiencies needed to be competent. Along with social objectives, the RDI™ curriculum encompasses a number of non-social areas including flexible thinking, rapid attention shifting, reflection, planning, forethought, preparation, emotion regulation, improvisation, creativity, mistake management, and problem solving. Individuals certified in RDI use an assessment to determine level of need for the child and then use a specified curriculum, developed by the authors of the program for intervention.

Additional information: http://www.rdiconnect.com

The SCERTS Model

Social Communication, Emotional Regulation and Transactional Support

SCERTS Theory:
The SCERTS Model (Social Communication, Emotional Regulation and Transactional Support) was developed out of 25 years of research and clinical/educational practice by a multidisciplinary team of professionals trained in Communication Disorders, Special Education, Occupational Therapy, and Developmental and Behavioral Psychology. SCERTS is a comprehensive, multidisciplinary approach to enhancing communication and socioemotional abilities and supporting families. This model provides an individualized education/treatment approach based on a child‘s strengths and needs, guided by research on the development of children with and without disabilities.

SCERTS Goals:
SCERTS offers a framework to directly address social communication and emotional regulation, the core challenges of Autism Spectrum Disorders (ASD). It focuses on building a child’s capacity to communicate with a conventional, symbolic system from preverbal to conversational levels of communication. It also focuses on the development of emotional regulation (i.e., self and mutual regulatory capacities to regulate attention, arousal, and emotional state).

SCERTS Program:
The SCERTS program is designed to be comprehensive and address the following areas:

Social Communication, including joint attention and symbolic behavior.
Emotional Regulation, including self-regulation, mutual regulation and the ability to recover from dysregulation.
Transactional support including, educational supports, interpersonal supports, family support and collaboration among professionals.

Additional information: http://www.scerts.com

Sensory Integration/Sensory Processing (SI)

Sensory Integration Theory:
Sensory Integration is a neurobiological process that refers to the integration and interpretation of sensory stimulation from the environment by the brain. It is the brain’s process of organizing and interpreting information from sensory experiences that involve touch, movement, sight, sound, body awareness, and the pull of gravity. Children develop and integrate this information naturally as they grow, but children with ASD may have a dysfunctional sensory system. It is believed that a problem with an individual’s ability to process such information could manifest as learning and behavior disorders.

Distinct Behavioral Characteristics of SI Dysfunction:

Hyper, or hyposensitivity to touch, movements, sight or sound
Impulsivity
Distractibility
Inability to unwind or calm
Lack of a healthy self-concept
Physically clumsy
Socially and/or emotionally immature
Difficulty with transition
Delayed speech, language, or motor skills
Delayed academic achievement

SI Goals:
The goals of Sensory Integration are to provide the child with sensory information that helps to organize the central nervous system, to assist in modulating sensory information, and to process more organized responses to sensory stimuli.

SI Intervention:
Interventions are designed to enhance growth and development by involving children in whole body activities that provide vestibular input. SI programs can involve sports activities, fine and gross motor play, creative thinking, interactive play, and even music. Specific techniques include: brushing, deep pressure, joint compression, scooter board riding, swinging, and jumping activities among others.

Additional information: http://www.sensoryint.com

Social Stories

Social Stories Theory:
Many persons with autism have deficits in social cognition, the ability to think in ways necessary for appropriate social interaction. This deficit is addressed using social stories in which individuals with autism “read” about difficult social situations. The idea is that the child can practice and learn about social events in a structured safe format, before the event occurs.

Social Stories Goals:
The goal of using social stories is to help a person predict and understand what may occur in a social situation, thereby increasing the person’s success in that situation and reducing behavior problems.

Social Stories Intervention:
Social behaviors are presented in the form of a story. This can be done with words or pictures, be read by or to the individual, or listened to via audiotape. Once the individual successfully enacts the skills or appropriately responds to the social situation, the use of the story can be faded. Stories can be re-written to address variations in a situation and individualized to the specific needs of the person with autism.

Additional information:

http://www.thegraycenter.org/social-stories

http://www.sandbox-learning.com

Speech and Language Therapy

Speech and Language Therapy Theory:
The acquisition and effective use of communication is an integral part of daily life. Language and speech is the primary and optimal form of communication as it allows for the most detail and specification. Assisting children to communicate through speech provides more opportunity for engagement with others as well as an optimal avenue for having needs met.

Speech and Language Therapy Goals:
There are many goals for speech therapy dependent on the specific needs of the child. The treatment works to attain the best form of language or speech the child can communicate. Therapy will address all areas of receptive and expressive language. Other areas of focus may be vocabulary expansion, direction following instruction, and language organization.

Speech and Language Therapy Components:
Speech and Language therapy intervention may take place in the form of one-on-one sessions, home programs, social groups, or computerized training programs. Therapy will work to improve:

Receptive and expressive language
Word retrieval
Vocabulary development
Comprehension/auditory processing
Articulation
Oral motor disorders

Additional information: http://www.asha.org

TEACCH: Treatment and Education of Autistic Communication Handicapped Children

TEACCH Theory:
TEACCH is a state funded public health program available in North Carolina, which provides services for diagnosis, early intervention, and early counseling for parents and professionals as well as adult community based centers. A hallmark of the TEACCH program is to provide “Structured Teaching”. This technique is based upon the observation that children with autism learn and integrate information differently than other children. TEACCH proponents believe that many noncompliant behaviors of children with autism are a result of their difficulty understanding what is expected of them. TEACCH uses the children’s strength in visual processing as a cornerstone of the intervention.

TEACCH Goals:
The structured teaching technique is designed to help the children understand expectations, remain calm, focus on relevant information through visual cueing, achieve independence in tasks, and manage behavior.

TEACCH Technique:
Structured teaching places a heavy emphasis upon teaching through visual modes, due to the difficulties most children with autism have with processing verbal information. Visual structure is provided at many levels, such as organizing areas of the classroom, providing a daily schedule using pictures or written words, visual instructions, and visual organization signaling the beginning and end of tasks.

Additional information: http://www.teacch.com

Anti-Yeast Therapy

Anti Yeast Theory:
This theory is currently hotly debated in the field. Some medical professionals believe that there is a link between Candida Albicans and autism as well as other learning disabilities. Candida is a yeast-like fungus that is normally present in the body to some degree. Certain circumstances, however, may lead to an overgrowth of yeast that a normal, healthy immune system would otherwise suppress. The more severe symptoms of yeast overgrowth may include long-term immune system disturbances, depression and possibly autism.

Medical Complaints Associated with Candida Complex:

Intestinal problems (constipation, diarrhea, flatulence)
Distended stomach
Excessive genital touching in infants and young children
Cravings for carbohydrates, fruits, and sweets
Unpleasant odor of hair and feet, acetone smell from mouth
Skin rashes
Fatigue, lethargy, depression, anxiety
Insomnia
Behavior problems
Hyperactivity

Anti Yeast Treatment:
Treatment for Candida overgrowth usually includes a prescription of antifungal medication. In addition, certain herbal formulas are sometimes used. Along with antifungal medications, a diet which eliminates sugar, yeast, and many other foods is a critical part of the treatment. Symptoms may grow worse at the onset of treatment but may gradually improve if Candida overgrowth is in fact contributing to the patient’s problems. Finally, it is important to note that Candida Albicans is not the only yeast that may cause problems. Stool analysis may reveal serious problems in various functions of the body.

Dietary Interventions

Dietary Interventions Theory:
The role diet and allergies play in the life of a child or adult with autism is not yet well understood. This means that parents who wish to explore this avenue of treatment must really do their homework. There has not yet been extensive research in this area for autism. Some preliminary research studies have indicated that individuals with autism may have trouble metabolizing peptides into amino acids because of an enzyme deficit. Two sources of protein, gluten and casein, are particularly suspect. Some anecdotal success has been noted when diets were modified to exclude gluten and casein. There are ways to uncover allergies, though some tests are more effective than others at discovering intolerances to food and chemicals. Careful research and consultation with a professional who is skilled in this area are probably the best bets in determining which tests are most appropriate. Food intolerances can often be determined by beginning a rotation or an elimination diet and observing any subsequent changes in behavior.

Dietary Interventions Treatment:
Dietary changes are the treatment for gluten and casein, or other allergies. Commitment and perseverance on the part of parents are required to make dietary changes and stick with them. Although any food could be the offender, there are several foods that are considered prime suspects in relation to behavioral disturbances. Sugar is one, as some children are allergic to it, and they may also be unable to metabolize it properly. As a result the adrenal glands in the body become stressed, depleted, and over time cease to function normally. The effects may include mood swings, irrational behavior, irritability, sleep disturbances, and nervousness among other symptoms.

Other foods that cause allergic reactions are, unfortunately, foods we often consume the most. Wheat is one such food. Milk has also been linked to behavior problems. Other common food offenders include corn, chocolate, chicken, tomatoes, and certain fruits. However, any food can cause an intolerance or sensitivity. There may be more than one food that causes difficulty and other substances may also cause reactions in children, such as molds, chemicals, perfumes, food additives like phosphates and food colorings, and other substances.

Additional information: http://www.gfcfdiet.com

Vitamin/Nutritional Supplements Therapy

B6/Magnesium Supplements Theory:
The goal of vitamin therapy is to normalize metabolism and improve behavior. Studies have shown that vitamin B6 may help normalize brain waves and urine chemistry, control hyperactivity and improve overall behavior. It may also help in reducing the effects of allergic reactions by strengthening the immune system. Although improvements vary considerably among individuals, other possible improvements from B6/magnesium therapy are: speech improvements, improved sleeping patterns, lessened irritability, increased attention span, decrease in self-injury/self-stimulation, and overall improvements in general health.

Dimethyglycine (DMG) Supplements Theory:
Dimethyglycine (DMG) is a food substance. Its chemical make-up resembles that of water-soluble vitamins, specifically vitamin B 15. Anecdotal reports from parents giving their child DMG indicate improvements in areas of speech, eye contact, social behavior, and attention span. Occasionally, if too much DMG is given, the child’s activity level has been seen to increase; otherwise, there are no apparent side effects.

Additional information: http://www.autism.com

Medications

Many families wonder about the use of medications to treat autism and related disorders. For decades, doctors have been using many different medications ‘off-label’ to treat various symptoms of these disorders. In 2007, the medication risperidone (Risperdal) was given the first FDA approval for marketing a medication for autism, specifically for the control of aggression. Medication can sometimes be very helpful, making it possible to utilize other treatments more effectively. At their best, some people have remarkable improvement in social awareness. However, medication cannot make up for an inappropriate placement or poor staff training in other treatments. Also, families need to weigh the benefits of medications against side effects and work closely with the prescribing physician. Here are examples of medications and classes of medications often used in the treatment of symptoms associated with autism spectrum disorders (alphabetical order):

Antiseizure medications, also known as Antiepileptic Drugs or AED’s: These are medications used for various kinds of seizures. They are often used to help persons with ASDs attain better mood stability, however they all have different side effects and many require frequent blood level checks. A full discussion is not possible here, but it is important that your doctor knows and discusses with you the various options and ways these medications are prescribed. As a class, AEDs are often useful in the treatment of persons with ASDs when there is suspicion that part of the underlying difficulty includes subclinical seizure activity that makes the person seem unfocused and at times unruly. Often a 24 hour EEG and a neurologic evaluation are helpful in deciding whether to try these medications. Some examples of medications in this class are valproate (Depakote), carbamazepine (Tegretol), lamotragine (Lamictal), oxycarbazine (Trileptal), topiramate (Topomax), gabapentin (Neurontin), and ethosuccimide (Zarontin).

Atamoxetine (Strattera) is a non-stimulant medication for ADHD that is a lot like an norepinephrineserotonin reuptake inhibitor (NSRI, see below) and carries similar cautions. Like with all persons with ASDs, some people respond well, others have significant side effects such as agitation.

Benzodiazepine medications such as diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Ativan) are excellent anti-anxiety medications, but they tend to interfere with learning, memory, and coordination. There is also the danger that they may be addicting for both persons with ASDs and for family members who might borrow them, and their role in the safe treatment of ASDs is limited by these cautions.

Bupropion (Welbutrin) is an antidepressant that is dopaminergic and therefore in a class of its own. Like stimulants, it tends to help focus and concentration, reduces craving for carbohydrates (and also tobacco and alcohol), and may have a place for some persons with ASDs who otherwise lack energy, as this class of medications is generally activating. They also increase seizure risk in those who are susceptible (with ASDs, the more challenged the person is the higher the seizure risk, also there seems to be an increased risk in the teenage years for seizures in persons with autism).

Central Alpha Agonists such as guanfacine (Tenex, Guanfacine XR) and clonidine (Catapres) are medicines originally marketed for high blood pressure in adults. These medications can help with attention and focus, reduce tics and sensory sensitivity, and generally calm people with ASDs. They can also make people sleepy, dizzy, or cranky. Used with care, these medicines can be helpful and are often used in combination with other medications such as stimulants.

Memantine (Namenda) is a medication marketed to help persons with Alzheimer’s Disease retain cognitive function. There are now several reports of its use in persons with ASDs with scattered reports of success in improving cognitive ability. While it appears to be fairly safe, the long term effects of use, like with many medications, particularly in developing children, is unknown.

Naltrexone (Revia) is an opioid antagonist used in the treatment of alcohol and drug addiction, which has also been tried for persons with ASDs to help with self-injurious behaviors. While no good research studies have proven that this helps, there are scattered reports of success attributed to naltrexone. Liver function should be monitored with use of this medication.

Neuroleptics (Antipsychotics): These medications have the most research about their use in persons with ASDs. All are FDA approved for schizophrenia, but virtually all can help with mood stabilization and aggression in ASDs. Neuroleptics are very helpful for tic disorders and can also occasionally create significant improvement in social function, leading many doctors to recommend them as first line treatments for ASDs. Side effects can include weight gain, insulin resistance, sedation, agitation, changes in cardiac conduction, higher risk for seizure, new abnormal movements and muscle spasms (dystonias, Tardive Dyskinesia), and rarely, a dangerous fever with muscle stiffness (Neuroleptic Malignant Syndrome). These medicines are often used safely but require good follow up and good communication between family and the physician. Members of this class include chlorpromazine (Thorazine), molindone (Moban), fluphenazine (Prolixin), thioridazine (Mellaril), haloperidol (Haldol), trifluoperazine (Stelazine), etc.; and the new: clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodan), and aripiprazole (Abilify).

Norepinephrine-Serotonin Reuptakes Inhibitors (NSRI): these include venlafaxine (Effexor), mirtazapine (Remeron), duloxetine (Cymbalta), and nefazadone. They are ‘dual-action’ antidepressants and as a class they tend to be about as effective as SSRIs for depression but often have less activation associated with them. Cautions are similar to SSRIs with additional need to monitor blood pressure if there is already a concern.

Serotonin Specific Reuptake Inhibitors (SSRI): These medicines are often used with persons with ASDs to target depression, anxiety, obsessiveness/perseveration, and rigid thinking. While often helpful, they also frequently create ‘behavioral activation’, i.e., make the person more active and impulsive. Side effect might include weight gain (over many months or years), mania or hypomanic (in those at risk for mania), increased seizure risk, and in combination with other medicines (MAOIs, buspirone, etc.) can create a risk for a potentially dangerous Serotonin Syndrome. The SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine, citalopram (Celexa), and escitalopram (Lexapro).

Steroid Treatment: Some doctors prescribe courses of steroids, usually Prednisone, and usually to infants and very young children with autism or with sudden regression of development, whom they believe may have a variant of Landau-Kleffner Syndrome (LKS). LKS is a disorder typically seen in infants or very young children who have a certain type of seizures, and the steroids seem to help some of them stabilize and allow for more typical development. The treatment has potentially serious side effects which must be discussed with your doctor, although different methods of timing the steroids can help reduce side effects.

Stimulants: This is the class of medication most used for Attention Deficit Hyperactivity Disorder (ADHD). While early studies found them ineffective in autism, more recent work and clinical experience shows that while they can help with inattention and overactivity in some persons with ASDs, they tend to have troubling side effects. Side effects can include loss of appetite, sleep disturbance, irritability when the medicine is wearing off, tics, increased sensory sensitivity, increased obsessiveness/perseveration, and rigid thinking. Stimulants are a good example of a class of medication that can often be used with good effect in combination with another medicine that balances the side effects, and equally a good example of medications that are relatively safe but easy to dislike because of side effects. Names of methylphidate type stimulants include Ritalin, Metadate, Methylin, Concerta, Focalin, and Daytrana. Dextroamphetamine type stimulates include Adderall, and ‘mixed amphetamine salts’. A ‘prodrug’ called Vyvanse has recently been released. People treated with stimulants require cardiovascular screening and follow up (history, blood pressure, pulse) as well as monitoring of weight and growth as these can be affected (likely due to reduced appetite).

Tricyclic Antidepressants, such as clomipramine (Anafranil), imipramine, desipramine (Norpramin), nortriptyline (Pamelor), and amitriptyline (Elavil) are older medications that some people still use for depression, anxiety, inattention, and bedwetting. While clomipramine can be an excellent medication for obsessive-compulsive symptoms too, these medicines require careful cardiac monitoring, can be cardiotoxic in overdose, and must be used with caution.

This is by no means an exhaustive list as there are many other medications used in the treatment of ASDs. It is important to work closely your doctor, avoid rapid, large, or multiple changes in medication if possible, and to be sure to look at the entire range of interventions for the person rather than become focused on medication as the ‘answer’ to the many challenges of living with autism.

Information submitted by Dr. Joshua D. Feder, MD.

This listing does not constitute an endorsement of any particular technique, but is intended to be informational only. Please work with a qualified professional to develop an appropriate, individualized intervention plan for your child.

Abbreviations

ABA Applied Behavior Analysis O & M Orientation and mobility

AIT Auditory Integration Training OHI Other Health Impaired

APE Adapted Physical Education OI Orthopedically Impaired

CAC Community Advisory Committee OT Occupational Therapy

CCS California Children Services PECS Picture Exchange Communication System

CEC Council for Exceptional Children PH Physically Handicapped

CH Communicatively Handicapped PRT Pivotal Response Training

CLD Combined Learning Disabled PT Physical Therapy

DB Deaf/Blind RS Resource Specialist

DHH Deaf and Hard of Hearing RSP Resource Specialist Program

DIS Designated Instruction & Services SDC Special Day Class