Which Behavior Therapy Works Best for Children with Autism?
With all the behavioral therapies for autism spectrum disorder, parents may feel at a loss. Start here to understand the pros and cons of each type.
There is no cure for autism, but various interventions diminish the symptoms, sometimes profoundly. Since both social and communication challenges are part of the autism diagnosis, behavioral and speech language therapy typically comprise the basis of a treatment plan. The challenge for clinicians, and a frustration for parents, is that no single educational plan works for all children.
The most generally successful approach for children with autism is behavioral therapy. Many people think that behavioral intervention is meant only for overly rambunctious children who act out. That’s not the case. Therapies for autism are the main tools for developing social skills.
The Benefits of Long-Term Behavioral Therapy
Parents are often confused over which behavioral therapy approach to take. For starters, schools frequently move autistic children into the mainstream early in their schooling. While that’s always the larger goal, shifting a child away from intensive behavioral programs that support social growth too soon can hamper his progress. Children who receive ongoing therapy are more likely to outgrow the diagnosis entirely, even if they spend less time in the mainstream initially. More intervention now can lead to more age-appropriate skills later, allowing an easier transition into the mainstream.
Another challenge is determining which type of behavioral therapy matches your child. There’s no way to know exactly what will work for any individual, apart from making a logical plan, being flexible in monitoring progress, and making adjustments when needed. Current research doesn’t say how much or what type of intervention is best, only that continuing behavioral therapy benefits a child.
The good thing about behavioral intervention is that it’s effective and safe. The not-so-good thing is that it’s labor-intensive and costly. Since behavioral therapy comes in a variety of styles, picking one may feel like a guessing game. But when deciding where to put time and energy, inside or outside of school, behavioral therapy remains the most reliable way to develop skills in children with autism.
Behavioral Therapies for Autism
Applied Behavior Analysis (ABA)
This therapy is the most-researched intervention for autism, and has been used for more than 50 years. It is a highly structured, scientific approach that teaches play, communication, self-care, academic and social living skills, and reduces problematic behaviors. A lot of research shows that it improves outcomes for children with autism.
ABA involves a therapist breaking down skills into component parts and, through repetition, reinforcement, and encouragement, helping a child learn them. With ABA, a therapist observes a child’s abilities and defines what would benefit him, even when a child is not interested in learning particular skills. For example, if a child is not interested in greeting others or in learning toilet training, an ABA therapist might focus on those skills anyway, because she recognizes their long-term value long before a child can.
ABA is the usual starting point for children with more severe symptoms. Therapists recommend as many as 40 hours a week of therapy, often in a full-time, classroom-based program. Even as skills improve and children begin to make friends and improve socially, ABA often continues to play a useful role.
Verbal Behavior Therapy (VBT)
This type of applied behavior therapy teaches non-vocal children how to communicate purposefully. Children learn how we use words functionally – to get a desired response. It’s not enough for a child to know that a cookie is called a cookie or to point to a cookie that he wants. VBT seeks to move children beyond labeling, a first step of learning language, and gesturing to vocalizing their requests – “I want a cookie.”
In a typical session, the therapist will present stimuli, such as food, activities, or toys, based upon a child’s preferences. The therapist uses stimuli that will attract a child’s interest — a cookie in the kitchen or a swing on the playground. Children are encouraged through repetition to understand that communication produces positive results; they get what they want because they use language to ask for it.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy which has been around since the 1960s, is usually recommended for children with milder symptoms of autism. Cognitive behavioral therapy aims to define the triggers of particular behaviors, so that a child starts to recognize those moments himself. Through practice, a therapist introduces practical responses. In other words, kids learn to see when they are about to head down a habitual behavioral or mental path (“I always freak out on tests”) and to practice something different instead (“I’m going to do that relaxation exercise I was taught”). CBT helps with concerns common to autism, such as being overly fearful or anxious.
Other behavioral models for autism focus more on developing skills a child already has and working on their deficiencies in subtler ways.
Developmental and Individual Differences Relationship (DIR) Therapy
DIR therapy (also called Floortime). With this therapy, a therapist — and parents – engages children through activities each child enjoys. It relies on a child having the motivation to engage and interact with others. The therapist follows a child’s lead in working on new skills.
Relationship Development Intervention (RDI)
RDI is a family-centered approach to treat autism focusing on defined emotional and social objectives meant to establish more meaningful relationships. This includes the ability to form an emotional bond and share experiences. It is commonly used with parents trained by RDI consultants. Goals are set to develop skills related to interpersonal engagement, such as empathy and overall motivation to engage with others. RDI breaks its various objectives down into step-by-step paths adults use to prompt development, such as building eye contact or back-and-forth communication.
Treatment and Education of Autistic and Related Communication Handicapped Children
This is a classroom-based program that customizes academic instruction and social development to a child’s strengths.
Social Skills Groups
Social skills groups help children engage in pragmatic language and manage real-world difficulties with peers. While observational studies show them to be effective, less research supports their success so far. Because children with autism are usually more comfortable talking and interacting with adults than with peers, social skills groups bring out difficulties that come up when being with peers.
In such groups, the leader sets up specific situations that mimic real life and guides a child to develop appropriate behaviors. The groups often use text and pictures to demonstrate social skills. Social scripts give children the specific language to manage difficult situations.
Behavioral therapy is usually not the only needed intervention for kids with autism, and is combined with speech language therapy and occupational therapy, and academic and family supports. Yet behavioral therapy is the foundation of skill building for most children with autism.
Mark Bertin, M.D., is a member of ADDitude’s ADHD Medical Review Panel.