Intervention Approaches Used for Children With Autism Spectrum Disorder—Autism Toolkit

ICD10

F84.0

When should I seek intervention for my child?

If you have concerns about your child's development and behavior, your child should be seen to tell if she needs therapy. You do not need a diagnosis of autism spectrum disorder (ASD) to begin many kinds of therapy. There can be a long wait for ASD diagnosis, so it is important to start therapy while your child is still waiting for a diagnosis. However, once your child is diagnosed with ASD, she may be able to get more interventions, such as applied behavioral analysis (ABA). It is important to have your child seen by an ASD specialist even if your child is already receiving intervention.

How can intervention help my child with autism spectrum disorder (ASD)?

The goals of any autism intervention are to help your child achieve his potential by learning key life skills in the areas that are hard for him. Most ASD therapy focuses on improving social communication and interaction skills and on reducing problem behaviors such as not being flexible or wanting to do the same thing over and over. Autism therapy can be provided at home, at school, or in a clinic setting. Most children with ASD need therapy in more than one setting. Most autism intervention is usually provided by speech pathologists, occupational therapists, psychologists, or behavioral analysts.

How do I choose what type of intervention is right for my child?

When deciding what kinds of interventions to pick for your child, it is important to think about which of them are evidence based , or shown to work in scientific studies. No matter what approach is used it is very important that you and other caregivers get involved. Then you can use the approach at home and in the community with your child.

You might want to start by finding out what intervention types are available in your area. Consider what kinds of intervention will be covered through your child's school and/or health insurance programs. Talk with your child's pediatrician, other parents, and community organizations to get a better idea about what will be the right fit for your family.

For some families, there may not be many choices. For instance, there may be only one ABA provider in your area that is covered under your child's insurance. Keep in mind that the individual provider is just as important as the type of intervention. You may need to try several types of intervention to find one that is the best match for your child. It is also important to think about how your child's needs may change over time. Set aside time every year to look at the services your child is getting and to see if they are meeting your child's needs.

How do I access intervention services for my child?

Autism therapy in school (including early intervention, early childhood special education, and public school) is your child's legal right under the Individuals with Disabilities Education Act, and it is free to your family. To get autism therapy through your school system, you need to ask for an Individualized Family Service Plan (for children younger than 5) or an Individualized Education Program (for children older than 5). Ask your child's pediatrician if you need help with this. Schools must provide autism-related therapy to children within a few months of a request.

Intervention services can also be given through your child's health insurance. How much and what kinds of services your child's insurance will pay for depends on the type of insurance and where you live. Many states have laws that make health insurers cover autism therapy services, even up to 40 hours per week. You can look online to find out what the autism therapy coverage laws are in your state. Intervention services through your child's health insurance may require a co-pay. You can call your insurance company to find out what is covered under your child's health plan and how much you will have to pay. You can also ask them for a list of in-network autism intervention providers, to lower costs to your family.

Getting autism intervention services is usually hard. You and your child's pediatrician may need to fill out a lot of paperwork, and your child may be placed on a long waiting list. Sometimes you will be asked to have more tests done before therapy can be started. It will help to stay organized and get help from your child's pediatrician, social worker, child psychiatrist, family counselor, or community organizations. It is normal to feel frustrated, confused, or "stuck." Remember that your job as a parent is to advocate for what your child needs, so don't feel bad about checking in with providers if you have been waiting for a long time.

What kinds of intervention are available for my child with ASD?

Early Intervention and Early Childhood Special Education

Early intervention and early childhood special education are programs given through the educational system for children aged 0 to 3 (early intervention) or 3 to 5 (early childhood special education). These services are offered either in your home or in a center. Early intervention and early childhood special education are available locally in all parts of the United States. These services can be just for autism or can be more general, such as speech therapy. You can refer your child for these services, and you do not need any paperwork from a doctor or school to do so. The best way to find out how to get these resources in your state is to ask your child's pediatrician or look online. Once you have made a request, federal law requires that your child be seen in 45 days and that therapy be given to your child if she needs it. Early intervention and early childhood special education programs use many different kinds of autism intervention, some of which are described in this handout.

Applied Behavioral Analysis

Applied behavioral analysis is an intervention that teaches children developmental, social, and language skills. The therapy is intensive, which for most children means at least 15 hours per week. Therapy is usually covered through your child's medical insurance. Applied behavioral analysis can be done at home or in the clinic or community. It also typically involves a lot of parent participation.

In ABA therapy, goals are set by a therapy team, and the therapist works with the child and sometimes the parent, one goal at a time. A strong ABA program will consider your child's favorite interests and activities, have a good learning environment, develop clear behavioral plans, measure your child's progress, and work with your child at home and in other places your child often visits.

Although ABA will not cure your child's ASD, studies show ABA works in skill building and improvement in challenging behaviors. Some say that more hours per week of therapy works better than fewer hours.

There are several different approaches to ABA therapy. Some common evidence-based approaches include

Discrete trial training
Pivotal response training
Reciprocal imitation training

Many ABA providers use a combination of approaches.

Developmental Relationship Interventions

Developmental relationship interventions focus on teaching adults how to improve a child's communication and social skills through play. By playing with others, children learn to communicate, control their emotions, and understand more about social relationships. These interventions have been shown to improve ASD symptoms like social attention in scientific studies. Some common evidence-based developmental interventions include

Developmental, Individual-differences, & Relationship-based (DIR) model Floortime
Relationship Development Intervention (RDI)

Naturalistic Developmental Behavioral Interventions

Naturalistic developmental behavioral interventions (NDBIs) use both ideas from ABA and ideas from developmental relationship interventions. They focus on child-led teaching, chances for natural learning, clear goals, and measuring progress. The most studied NDBI is the Early Start Denver Model, which has been shown in small studies to improve IQ and problem behaviors of children who have ASD.

Parent-Mediated Treatment

Recent evidence shows that parents can be good autism therapists for their child when given the right tools. Training sessions for parents and other caregivers can happen in the home, the school, or other community settings, or even through an electronic tablet. JASPER (Joint Attention, Symbolic Play, Engagement, & Regulation) is an example of an evidence-based parent training intervention for ASD. Other parent training programs may be available in your area.

Social Skills Instruction

Many children with ASD have a hard time having conversations, understanding social cues (such as eye contact or facial expressions), or playing with others. Social skills instruction is used mainly for school-aged children with ASD, both at school and outside of school. Social skills instruction can happen one-on-one with an adult, or with a small group of other children. There have also been some studies showing that video and computer social skills training may also help children. An example of an evidence-based social skills intervention for teens is the Program for the Education and Enrichment of Relational Skills intervention. If you are interested in social skills instruction for your child with ASD, you can ask your child's school, or contact your child's pediatrician to find a program in the community.

Other Intervention Types

Other types of treatment that might help your child include speech therapy, alternative and augmentative communication therapy, occupational therapy, and physical therapy. These therapies are often not just for ASD but for more general problems that these children face. These types of therapies are often available both at school and through your child's health insurance.