How to Treat Autism Spectrum Disorder
Non-medical interventions are the treatment of choice for ASD, but medication may also help to get symptoms under control.
Roughly three million American children and adults have Autism Spectrum Disorder (ASD), a complex disorder of brain development caused by rare gene mutations and pre- or post-natal environmental stresses. ASD is a lifelong condition that causes difficulties with social interaction, verbal and non-verbal communication, and repetitive behaviors.
It cannot be cured, but ASD may be managed effectively with three main types of treatment: educational/behavioral interventions, medication, and alternative therapies. Most clinicians prefer to begin with non-medical therapies designed to manage the symptoms that hinder social and academic success and lead to a turbulent home life.
Treating ASD with Educational/Behavioral Interventions
Behavioral therapy is the mainstay treatment for children with autism. Even when a child’s behavior is “good,” this type of therapy can help to teach her new skills, and improve her language and social abilities. Social skills training, for example, can teach individuals with ASD how to interpret gestures, eye contact, tone of voice, humor, and sarcasm. Cognitive behavioral therapy can help to manage obsessive behavior and anxiety. Ongoing behavioral therapy is linked with better long-term health outcomes, even when symptoms of ASD are mild.
In early-intervention therapy, the entire family works with professionals to improve social, learning, and communication skills. Parent-training programs teach families how to best cope with ASD, and teach parents how to administer therapy at home. Among the most highly trusted parent-training programs are Floortime (derived from the Developmental Individual-difference relationship-based model), TEACCH autism program, the Lovaas Model (based on the Applied Behavior Analysis (ABA)), and the Early Start Denver Model (ESDM).
Parents of children with autism say that posting lists, rules, and schedules helps to keep the household organized. Checking off checklists can give people with ASD a sense of accomplishment. Physical exercise is also a good intervention for children on the autism spectrum who seem to have boundless energy. Channeling excess energy into an independent physical activity, such as swimming or karate, allows them to burn it off without the pressures of socializing. Schools with friendship groups or lunch bunches can help kids to learn the basics of social interaction.
Treating ASD with Medication
If behavioral and educational interventions aren’t sufficient, medication may help an individual with ASD to better manage his symptoms. Three main classes of medication are used with ASD patients: stimulants, antidepressant and anxiety medications, and atypical antipsychotics.
Stimulants are the most common class of medications used to treat ADHD. ADHD and ASD commonly co-occur, and it’s important to get ADHD symptoms under control when treating a child with both conditions. Children with ASD can be more sensitive to side effects, and should be monitored carefully when prescribed stimulants. A pediatrician may refer a child with ASD to a psychiatrist or a psycho-pharmacologist as the dose is increased.
Antidepressant and anxiety medications can help people with ASD deal with the common challenges of persistent anxiety and obsessive behaviors. Symptoms like running away from new situations, compulsive checking or washing, or anxiety from strict black-and-white thinking can present big obstacles in day-to-day life. Selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft) or fluoxetine (Prozac) can sometimes help with mood, anxiety, obsessive thoughts, and compulsive behaviors1. They are used off-label.
A class of medicines called atypical antipsychotics is often effective for addressing motor restlessness, repetitive behaviors, and sleep disturbance in children with autism. These medications include aripiprazole (Abilify), quetiapine fumarate (Seroquel), and risperidone (Risperdal). The latter medication is the only one of the three that is FDA-approved for treating behaviors associated with autism. A good response to an atypical neuroleptic may eliminate the need for a stimulant.
Every child with autism will benefit from the support of a developmental and behavioral pediatrician or a child psychiatrist with training in the autism spectrum. Seeing a specialist who understands what it’s like to live with an active autistic child is a bonus for parents, as well. Teens with autism can improve using transitional services that will guide them into independence and employment during adulthood with decreased parental support. Many people significantly improve with intensive early intervention and treatment. A small percentage improves so much it is no longer considered “on the spectrum.” Others become able to score in normal test ranges, and can function socially but still have mild symptoms. Many live independent lives, develop fulfilling relationships, and work with the appropriate supports.
1National Institute of Mental Health. “Medications for Autism.” PsychCentral. (2013). Web. (http://psychcentral.com/lib/medications-for-autism/)
Treating ASD with Alternative Therapies
Many people with chronic conditions like ASD use therapy and medication in tandem with alternative treatments, though their effectiveness and safety are not as well researched. Parents of children with ASD and adults with the condition should consult with a physician before taking any supplements or trying alternative methods.
Amino acids, which can act as neurotransmitters, may help regulate serotonin levels of people with ASD. Taurine may improve visual learning and L-Carnosine may help repetitive verbal habits for people with ASD1.
Auditory integration training (AIT) can help improve auditory processing deficits and concentration. It involves listening to electronically modified music, voice, or sounds to improve function1. This can be beneficial for people with ASD who have trouble listening, or focusing.
B6/Magnesium supplements have been a popular complementary treatment for ASD for over 20 years. Research studies have reported mild improvement in symptoms with their use1.
b-Calm2 is an MP3 player loaded with audio tracks specifically developed as “audio sedation” to help people with ASD screen out sounds that can cause distraction, induce stress, and adversely affect social and academic performance. The tracks combine two types of sounds: live recordings of nature sounds and white noise. At low levels, people can converse and interact. At higher volume, the tracks can cover up voices and noise to reduce sensory overload.
Casein- and gluten free diets3 and other dietary changes may help to improve behavior, or gastrointestinal symptoms of a comorbid condition. At least half of families living with ASD try this as an alternative therapy, but much research is pointing away from it being a valid, useful treatment option. It’s important to work with a nutritionist or dietician when making major changes in eating habits to ensure that a child or adult’s nutritional needs are being met. Put a plan in place to determine if symptoms change alongside changes in diet, and recruit teachers to objectively observe if changes are worth the effort. An improvement could be reducing the consumption of processed foods that have high levels of sugar and fat and consuming more whole foods like fruits and vegetables.
Dimethyl glycine (DMG) and trimethyl glycine (TMG) are nutritional supplements that are sometimes suggested to treat ASD. Some small studies found no effect when compared with a placebo1.
Melatonin supplements can help to reduce insomnia and sleep dysfunction in children with autism. Poor sleep worsens symptoms, such as repetitive behavior and social problems.
Music therapy can help improve social and communication skills for people with ASD, when paired with other educational and therapy interventions, according to some studies1.
Omega-3 fatty acids have been shown to reduce repetitive behavior, hyperactivity, and social skills in some small studies.
Relaxation strategies and mindfulness can help people with ASD to calm down when they feel overstimulated. Weighted clothing or a pressure massage can sometimes alleviate symptoms. Yoga can help some to increase their sense of well-being while decreasing anxiety.
Sensory therapies may reduce sensitivity to touch, light, balance, or hearing for people with ASD. Similar to treatment for sensory processing disorder, sensory therapies for ASD are done by an occupational therapist, who can help retrain the senses. Typically, the OT creates a “sensory diet” a plan in which the child is slowly introduced to activities in a gentle, fun way to help him or her get used to a wider range of stimulation.
Sulforaphane, a compound found in broccoli sprouts and other cruciferous vegetables, may have a positive effect on the social and behavioral problems associated with autism according to one study4. The compound triggers a “heat-shock” response in some cells, which can decrease hyperactivity and repetitive behaviors. More research is needed to determine if this has a beneficial effect.
1Susan E. Levy, M.D. and Susan L. Hyman, M.D. “Complementary and Alternative Medicine Treatments for Children with Autism Spectrum Disorders.” NCBI. (2009). Web. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597185/)
2Kay Marner. “b-Calm: An MP3 Player for ADHD and Autism Symptoms?” ADDitude Magazine. (2011). Web. (https://www.additudemag.com/adhd/article/8416.html)
3“Complementary and Alternative Medicine Treatments for Children with Autism Spectrum Disorders.” Autism Speaks. (2015). Web. (https://www.autismspeaks.org/what-autism/treatment/complementary-treatments-autism)
4Devon Frye. “Compound Found in Broccoli Shows Promise as Autism Treatment.” ADDitude Magazine. (2014). Web. (https://www.additudemag.com/adhdblogs/19/11019.html)