A number of therapies can help people with autism improve their abilities and reduce their symptoms. Starting therapy early -- during preschool or before -- improves the chances for your child’s success, but it’s never too late for treatment.
The American Academy of Pediatrics (AAP) recommends you start to research therapies as soon as you suspect your child has autism, rather than waiting for a formal diagnosis. It can take a lot of time, tests, and follow-ups with specialists to get a formal diagnosis.
What works varies from person to person. Get to know some of the most popular -- and proven -- therapies.
Children with autism often play differently than other kids do. They’ll likely focus on parts of a toy (like wheels) rather than the whole toy. They “pretend play” like other kids do. And they may not want to play with others.
But to many children with autism spectrum disorder (ASD), playing is the way they express themselves -- their toys and their actions may become their words. Play can help children with ASD learn and connect with other people, both children and adults, in a way they understand.
Play therapy can improve their social and emotional skills, help them think in different ways, add to their language or communication skills, and expand the ways they play with toys and relate to other people.
Children with ASD can benefit from any one of several kinds of play therapy:
Floortime is a common play therapy. You, a teacher, or a therapist gets down on the floor to play with your child on their terms. You join in by playing the same way that your child is playing, then you add something to the game.
It might be a second toy or a few words to introduce language to the game. The goal is to create play that goes back and forth between you and your child to encourage more communication and add something new to their play. It should help them grow emotionally and learn how to better focus their thinking.
Your child may meet with a therapist for up to 25 hours per week for Floortime, or you and your child can do this at home. Studies show that most children who have Floortime therapy for 25 hours a week for 2 years or longer improve in all areas of development.
Integrated play groups (IPGs) combine children both with and without autism spectrum disorder so those with ASD can follow their peers’ lead and learn how to play. Groups have three to five children, with just a few children with ASD in each group.
Adult leaders set the tone for play, but the children eventually take over. If your child participates in IPGs, they might pretend play more over time, and they’ll have many chances to improve their social skills while they spend time with other kids.
IPGs can meet for up to 3 hours a week. Research shows that children with ASD who had two 30-minute IPG sessions a week for 4 months improved their quality of play, used their toys in a more typical way, and showed improved social interaction with their peers.
Joint attention symbolic play engagement and regulation (JASPER) can help your child better focus on a toy and a person at the same time. Improving joint attention skills can help them play with other children. The JASPER program can also help your child engage in more pretend play, broaden the way they play with toys, speak more with others, and improve other social skills.
Children who have JASPER therapy often meet one-on-one with a therapist. JASPER is sometimes offered in preschool settings. Children may have this type of therapy for up to 25 hours per week.
You may notice that your child gains new skills within just a few weeks. They might be talking more while they play. Or they could be “driving” cars down a ramp instead of just spinning the wheels. This type of therapy could go on for months or years, depending on their needs.
How can you find play therapy?
You can ask your doctor to refer you to local therapists who engage in play therapy. You can also search online at the Association for Play Therapy’s play therapist directory.
Occupational therapy helps with activities of daily living and the use of everyday objects, like learning to button a shirt or hold a fork the right way. But it can involve anything related to school, work, or play. The focus depends on the child’s needs and goals.
What does an occupational therapist do?
Occupational therapists work as part of a team that includes parents, teachers, and other professionals. They help set specific goals for the person with autism. These goals often involve social interaction, behavior, and classroom performance.
Occupational therapists can help in two main ways: evaluation and therapy.
The therapist watches children to see if they can do tasks they are expected to do at their ages -- getting dressed or playing a game, for example. Sometimes, the therapist will have the child recorded during the day to see how the child interacts with people and things around them. That helps the therapist determine the kind of care the child needs. The therapist might look closely at:
- Attention span and stamina
- Transition to new activities
- Play skills
- Need for personal space
- Responses to touch or other kinds of stimuli
- Motor skills like posture, balance, or manipulation of small objects
- Aggression or other types of behaviors
- Interactions between the child and caregivers
Once an occupational therapist has gathered information, they can develop a program for your child. There is no single ideal treatment program. But early, structured, individualized care has been shown to work best.
Occupational therapy may combine a variety of ideas, including:
- Physical activities, like stringing beads or doing puzzles, to help a child develop coordination and body awareness
- Play activities to help with interaction and communication
- Developmental activities, like brushing teeth and combing hair
- Adaptive strategies, including going through transitions
How does occupational therapy benefit people with ASD?
The overall goal of occupational therapy is to help people with autism improve their quality of life at home and in school. The therapist helps introduce, keep up, and improve skills so people with autism can be as independent as possible.
Occupational therapy may help with:
- Daily living skills such as toilet training, dressing, brushing teeth, and other grooming skills
- Fine motor skills required for holding things in their hands while writing or cutting with scissors
- Gross motor skills used for walking, climbing stairs, or riding a bike
- Sitting, posture, or perceptual skills, like telling the differences between colors, shapes, and sizes
- Awareness of their body and its relation to others
- Visual skills for reading and writing
- Play, self-help, problem-solving, communication, and social skills
By working on these skills during occupational therapy, a child with autism may be able to:
- Develop relationships with children and adults
- Learn how to focus on tasks
- Learn how to delay gratification
- Express feelings in more appropriate ways
- Play with other children
- Learn how to self-regulate
- How can someone get OT services for autism spectrum disorder?
Occupational therapy services are available privately, through a statewide early childhood intervention program, or at school. Public law requires schools to provide certain types of occupational therapy to people who need it. Private insurance also usually covers OT. Medicaid may cover occupational therapy for autism, even for families with higher incomes. School-based OT usually works to complement educational goals, like improving handwriting, so the child can keep up by taking notes. Private therapy will be more medically intensive.
People with ASD may have major problems with both speech and nonverbal communication. They may also find it very hard to interact socially. For these reasons, speech therapy is a central part of treatment for autism. It helps children with speaking, as well as communicating and interacting with others. It can involve nonverbal skills, like making eye contact, taking turns in a conversation, and using and understanding gestures. It might also teach kids to express themselves using picture symbols, sign language, or computers.
What are the common speech and communication issues with autism?
About 1 in 3 people with autism have trouble producing speech sounds to effectively communicate with others.
A person with autism may:
- Not talk at all
- Utter grunts, cries, shrieks, or throaty, harsh sounds
- Hum or talk in a musical way
- Babble with word-like sounds
- Use foreign-sounding "words" or robotic-like speech
- Parrot or often repeat what another person says (called echolalia)
- Use the right phrases and sentences, but with an unexpressive tone of voice
A person with autism may also have communication challenges like:
- Trouble with conversational skills, including eye contact and gestures
- Trouble understanding the meaning of words outside the context where they were learned
- Memorization of things heard without knowing what's been said
- Use of echolalia -- the repeating of another person's words as they are being said -- as the main way to communicate
- Little understanding of the meaning of words or symbols
- Lack of creative language
A child with autism has to do more than learn how to speak. The child also must learn how to use language to communicate. That means knowing how to have a conversation. It also includes understanding both verbal and nonverbal cues from other people -- like facial expressions, tone of voice, and body language.
What role does speech therapy play in the treatment of autism?
Speech-language pathologists are therapists who specialize in treating language problems and speech disorders. They are a key part of the autism treatment team. With early screening and detection, speech therapists often lead the way in helping with the diagnosis of autism and making referrals to other specialists.
Once autism is diagnosed, speech therapists figure out the best ways to improve communication. The speech-language pathologist works closely with the family, school, and other professionals. If someone with autism is nonverbal or has major trouble with speech, the speech therapist may introduce alternatives to speech, including:
- Electronic "talkers"
- Signing or typing
- Using pictures instead of words to help a child learn to communicate
- Improving articulation of speech by massaging or exercising lips or facial muscles
- Having people sing songs that match the rhythm, emphasis, and flow of sentences
Some of these methods are supported more by research than others. Be sure to discuss them thoroughly with the speech-language pathologist and your child's pediatrician.
How does speech therapy benefit people with ASD?
Speech therapy can improve overall communication. This makes it possible for people with autism to improve their ability to form relationships and function in day-to-day life.
Specific goals of speech therapy include helping the individual with autism:
- Articulate words well
- Communicate both verbally and nonverbally
- Understand verbal and nonverbal communication, and what other people mean in different settings
- Start communication without prompting from others
- Know the appropriate time and place to communicate something; for example, when to say "good morning"
- Grow conversation skills
- Exchange ideas
- Communicate in ways to develop relationships
- Enjoy communicating, playing, and interacting with other
- Learn self-control
When is the best time to start speech therapy for autism?
The earlier speech therapy is started, the better. Autism spectrum disorder is usually clear before age 3. Language delays can be noticed as early as 18 months of age. In some cases, autism can be identified as early 10 to 12 months of age. It is very important to start speech therapy as early as possible, when it can have the biggest effect.
With early identification and treatment, two out of three preschoolers with autism improve communication skills and their grasp of spoken language. Research shows those who improve the most are often those who receive the most speech therapy.
To find a speech-language pathologist, go to the American Speech-Language-Hearing Association's web site at www.asha.org. You can ask your pediatrician for other suggestions.
Applied Behavior Analysis (ABA)
This type of therapy uses rewards to reinforce positive behaviors and teach new skills. Parents and other caregivers are trained so they can give the autistic child moment-by-moment feedback.
Treatment goals are based on the individual. They might include communication, social skills, personal care, and school work. Studies show children who receive early, intensive ABA can make big, lasting gains.
There are different types of ABA. They include:
- Discrete trial training (DTT). This breaks a desired behavior into the simplest steps.
- Early intensive behavioral intervention (EIBI). This form of ABA is designed for young children, usually under age five.
- Pivotal response treatment (PRT). The focus here is on important areas of a child’s development, like self-management and taking charge in social situations.
- Verbal behavior intervention (VBI). Improving a child’s verbal skills is the goal.
Therapeutic Horseback Riding
Doctors also call this “hippotherapy.” Here, a child rides a horse under the guidance of a therapist. Riding is a form of physical therapy because the rider needs to react and adjust to the movements of the animal. Research shows it helps children from ages 5 to 16 improve their social and speaking skills. It can also help them to be less irritable and hyperactive.