Therapy for Autism is the Heart & Soul of Treatment
For autism, the “heart and soul” of treatment is one-to-one, in person, supportive, child-centered care. For adults with autism, person-centered care. The large body of scientific work in the area of autism supports this viewpoint. The whole care plan needs to be focused on the child, the person, with autism. What’s best for him and what works best in his world? There is usually remarkable and often rewarding progress. With early diagnosis, solid confirmation of the diagnosis, and a rapid move to start the progress of therapy, there is good reason for optimism.
The Therapist in the Therapy for Autism
The key individual in this care plan is then the therapist. A whole team of skilled professionals then backs up this one-on-one central therapist, each adding a specific skill set and experience. Having said all of this, it’s important to understand that no therapy we have can reliably, consistently, and effectively make the core symptoms of autism just disappear.
A Reader Asks:
Why can’t a kid just take a pill to treat autism like other problems?
Wishing For a Medication to Cure Autism
A great question, and don’t we all wish there was such a medication. One has to realize the medical situation with autism. The brain’s wiring is such that the child experiences the world in an unusual way. She’s responding to the world as best possible. It’s brain hardwiring that’s at the center of the situation. Though in computer terms, a better term might be the brain’s “firmware”. Medical neuroscience does not yet have a pill to correct brain’s firmware circuit wiring. Maybe someday. So the best we can do is modulate the circuitry with a variety of educational and therapeutic treatments. And often this approach works remarkably well. There are a few specific medications that might help for certain times in a person with autism.
Medication and Therapy for Autism
This statement of medication and therapy is an either/or. It’s not one vs. the other. The main thrust for treating autism is a therapy of one sort or another. We talk about medications and autism on our page Treating Autism with Medicine. At times specific behaviors might need some medication. Behaviors that might possibly cause injury. But medication is not center stage to treat autism, and is barely on the stage at all.
Dozens of Therapies When Discussing Therapy for Autism
Here’s a good question. Is the broad choice of therapies for autism a rich collection of help, or, is it a situation with too many cooks spoiling the broth? Autism can be very individual. It can look like many different conditions. And, there’s no one, simple, cut-and-dried way to treat it. This situation can create an absolute mess. Every Tom, Dick, and Harry, (or Jane, Mary, and Suzie) claims to have “THE magic bullet” treatment. Whether noted, famous doctors or plain money-hungry bums, they’re all in the mix. And sadly, too often, those with the loudest voices show up with the least good treatments. How does one decide? We hope the information below will help. As discussed more below, Applied Behavioral Analysis has been and remains the “gold standard” for a good treatment that works for autism.
More Emphasis on One-to-One Therapy for Autism
The idea of a one-to-one therapist with the child is important and too often overlooked. Parents of a child with autism are often anxious and upset, maybe even in crisis. So one-to-one therapy can be overlooked just because there are not enough people, not enough help, to do the best for every child. The parents seek help and those who guide them toward help often offer what’s readily available rather than what’s best. The only true way to say if a therapy works is to answer the question, does it work for this one child, the child in front of you.
Collect Information and Judge Over Time
As you need to or want to, try different therapies and therapists and keep careful records, such as you would in a diary. Which therapists helped, which therapy approaches worked, and which ones did not? Both the parents and the treatment team members can work on this diary of help, helpers, and careful notes about progress. It’s needed to have solid information on what has helped this specific child.
Therapy for Autism – Therapist Qualities
The weighing and deciding go beyond which types of therapies to try. It’s possible that a good, quality, conscientious therapist using a supposedly so-so form of therapy could provide good progress in the child’s well-being and success. On the other hand, a lackadaisical therapist, even if performing therapy in the model of the gold-standard of care, might be of little help to the child, with little progress.
Should I Wait Before Starting Therapy to See What Happens?
In a word, no. In several words, no, no, no, no, and no. Once the diagnosis is made, start with therapy absolutely as soon as possible. The sooner treatment is started after the diagnosis of autism is made, the better everything will go for the child for years to come. But, make sure the diagnosis is real and correct. That is, if there’s any question, get a second opinion that the diagnosis IS autism from a really capable doctor, and get that opinion right away.
What Therapy for Autism Can Do
Treatment can make all the difference in the world. The first step will be looking at where the child is now. What is he able to do? What can he do really well, that is, what are his strengths, strengths upon which a therapist can build? In what areas does he not do well? That is, find those areas that are not as strong. The information from this thorough look gives the therapy team the ability to reward strengths. And, to work gently on less strong areas to gradually build balance in abilities over time.
Meet the Treatment Team Around the One Central Therapist
- Most important and at the top of the list, 1 or 2 experienced, highly-trained, top-level doctors. Perhaps a psychiatrist or a neurologist, maybe a pediatrician or an internist.
An Occupational Therapist
- An occupational therapist. This individual knows play behavior, social skills, and daily living skills (like eating and personal hygiene). In an adult this therapist knows work skills.
A Speech Therapist
- Speech therapist. Some people with autism are not that great at speaking, at conversation, at getting their ideas across. A person who cannot explain to others what he needs or wants will not do well in life. Speech therapists train and improve speaking ability, practice on talking back and forth with others, and improve a child’s learning ability.
The Care Manager
- Care manager. The coach and coordinator. A central, super-necessary person. The care manager or case manager follows the treatment plan and keeps track of everything and everyone. The case manager functions like a coach on a sports team. In this situation the “sports team” consists of the person with autism, the members of the treatment team, and the friends, relatives, and other helpers for the person with autism. The case manager is like the center hub of a wheel holding the spokes of the wheel in place.
The Therapist and The Care Manager
- The child’s therapist might or might not be able to function as the care manager. Case management takes a lot of talking to people, tracking interactions, and coordinating across home, school, work, and/or social settings. That is, it takes a lot of time. The central therapist’s time might be better spent working with the child. A therapist and a case manager working in tandem as a team can put experience and skills where they’re needed.
Comments on a Few Behavioral Therapies
Applied Behavioral Analysis
Some call Applied Behavioral Analysis the “gold standard” for a treatment for autism that works. Applied Behavioral Analysis is, no surprise, based on an analysis of the child’s behavior and known treatment strategies in psychology. Behaviors that one wants to make more frequent are rewarded. Actions that one wants to make happen less often, to extinguish, are ignored. For example, reward school skills like reading and arithmetic, reward social actions like playing with others and talking to others, and reward living skills such as paying attention to calendars, days, and schedules.
Cognitive Behavioral Therapies
Cognitive behavioral therapies are learning-based treatment. That is, they’re teaching. For this approach to work the autistic child has to be able to understand and to work with the teacher/therapist. Some children can understand and work with this type of a therapist and some cannot. As therapies in other areas are put in place and progress is seen, understanding might improve over time. Changing how you yourself think and paying attention to how a you behave is hard for anyone. Truly starting to think differently and changing your behavior is even harder. (Truth is, most mature adults can’t do it.)
Therapy for Autism – Exercise Therapies
Exercise therapy is the one that most parents use with most children. It can help some autistic children. It starts with getting the child going in some form of exercise. If the child can do it, it helps with muscle movement training, coordination when active, and general physical fitness. And, as a side benefit, the time spent in a good exercise program leaves less time for a problem behavior to start.
Other Types of Therapy
Educational therapies are in a setting familiar to everyone, a classroom with a teacher. For an autistic child these classes have a fairly firm behavioral focus. The information or material to be learned must be put together to serve the needs of the one specific child. As one might imagine, doing this is hard. Even with just a few children you need a team of skilled people who really know what they’re doing. There’s a classroom with children but each individual child needs attention focused on him or her. Daycare age children and kindergarten age, if they can do it, often show good progress. They’re then better able to enter elementary school grades with the hope of success. One example of an educational therapy is called Early Intensive Behavioral Intervention, or EIBI.
Training Parents – Giving Parents Tools and Skills
Parents. They’re in trouble, too. They’re often hit with several grief-like reactions as they discover the diagnosis of autism in their child. Their internal struggle can cycle through all of the usual grief stages, early denial, realization anger, hopeful bargaining, and upset depression. Finally, they get to the acceptance stage and the desire to move forward sets in, but not usually with a calm clear-mindedness. There’s still anxiety, and overtones of a crisis. Given all of this it’s little wonder that working with the parents is helpful and needed. How to play with their child, how to talk, watch, and encourage in a way that adds to progress and growing. And one needs to let parents know that as troubled waters of new behaviors come up, they have a place to get help.
No Evidence for Complementary and Alternative Medicine Therapies
For reasons that are not clear except that the label is trendy right now, Complementary and Alternative Medicine (CAM) therapies for autism are popular. CAM treatment includes things like herbal supplements, vitamin supplements, probiotics, “chelation” therapies, acupuncture, message therapies, yoga, hyperbaric oxygen, dietary manipulations, and others. Lumped under the CAM approaches are music therapies and other auditory training, drama therapies, dance therapies, pet therapy, and “sensory integration” therapies. Even chiropractic treatment is listed in this mix. Unfortunately, based on a large expert review by the Italian researcher Dr. Natascia Brondino and her collaborators (Complementary and Alternative Therapies for Autism Spectrum Disorder) there is no conclusive evidence, none, zero, zip, that CAM therapies work for autism or autism spectrum disorder. You see, everything is tried based on hope when nothing works and a child is in distress.
Autism Society – Autism Intervention and Therapy Options
Autism Speaks – Sensory Integration Therapy
Mayo Clinic – Autism Spectrum Disorder
NIH PubMed Central – Complementary and Alternative Therapies for Autism Spectrum Disorder