Education, Training and Behavioral Interventions

1. An organized and structured full-day, full-year educational program that includes a predictable schedule and routine, curriculum modifications, and the services of well trained and experienced educational staff.

2. Applied behavior analytic procedures to teach basic skills (communicative, adaptive, and academic), with specific strategies for generalization.  A combination of discrete trial, verbal behavior, incidental teaching, and pivotal response training should be provided.

3. Cognitive-behavioral strategies for executive function weaknesses and difficulties with temporal and sequential concepts (e.g., daily schedules and calendars depicting the major events, transitions, and responsibilities of the day, etc.).

4. Operant behavioral programming strategies (e.g., differential reinforcement procedures) are recommended to extinguish maladaptive behaviors, and foster adaptive ones – paying attention to the motivating potential of selected reinforcers and the most effective length of reinforcement intervals.

5. Periodic functional analyses of behavior will be of benefit in accurately identifying salient antecedent and consequent conditions that serve to maintain both adaptive and maladaptive patterns of behavior.  An in-home component is also quite important in order to foster the maintenance and generalization of adaptive skills.

6. A comprehensive social skills training program that spans school, home, and community environments. This should include curriculum-based training, ideally presented in a small group setting.  Specific strategies should be implemented for enhancing skill generalization across social environments (school, home, community).

7. Ongoing communication training by an experienced speech and language pathologist is also important, emphasizing pragmatics and semantics (within both verbal and nonverbal domains).

8. Adaptive skill training, basic social judgment, appropriate school-related social skills.

Psychopharmacology (medication)

Although there are no presently known medications that are capable of directly improving the core social and communicative impairments of autism, targeted psychopharmacological treatment can sometimes be of benefit in reducing frequently associated affective and behavioral symptoms and symptom clusters.  Unfortunately there are relatively few systematic research studies assessing the effectiveness and potential side effects among individuals with ASD/PDD. The available literature suggests that several classes of psychotropic medication may be beneficial for different symptom clusters.

1. Neuroleptics (major tranquilizers, antipsychotic medications):  The neuroleptics appear to be the most predictably helpful class of medication for the treatment of affective and behavioral symptoms commonly associated with ASD.  Of the newer generation neuroleptics, risperidone (Risperdal) has been studied systematically in ASD. Potentially responsive symptoms include hyperactivity, agitation, anxiety, obsessive-compulsive symptomatology, aggression, self-injury, rigidity and inflexibility, as well as mood lability.

In the short term, the neuroleptics tend to be well tolerated by children with autism (except for weight gain), and are effective in relatively low doses.  However, because of the risk of potentially serious side effects (e.g., tardive dyskinesia), the neuroleptics should be used judiciously.

2. Selective serotonin reuptake inhibitors (SSRIs):  The SSRIs can reduce anxiety, obsessive-compulsive symptomatology, and inflexibility among some individuals with autism spectrum conditions (especially older adolescents and adults).  In younger children, activation and disinhibition can occur, sometimes limiting the usefulness and optimal efficacy.  Clomipramine (Anafranil) is a less specific serotonin agonist that carries a lower risk for activation, but has potential cardiovascular side effects (of most concern among children).

3. Other potentially beneficial mediations include the stimulants (methylphenidate, amphetamine), the alpha-agonists (guanfacine, clonidine), and anticonvulsant mood stabilizers (valproate).