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Which Behavior Therapy Works Best for Children with Autism?
Autism Spectrum Disorders have kept behavioral scientists and researchers busy for decades. We have learned so much and yet there is so much that we still can’t figure out. Consider, for example, the increasing numbers of children diagnosed with autism every year. Going back to 1997, SARRC (Southwest Autism Research and Resource Center) roughly estimated 1 in 2,500 children born in the United States were diagnosed with autism spectrum disorders. By the year 2000, the CDC (Centers for Disease Control) began monitoring these numbers and reported that 1 in 68 children born in the United States were diagnosed with ASDs.
Currently we know how to identify children with ASDs at an earlier developmental age and stage- some signs start as early as 6 to 12 months of age. Still, autism is increasing at an alarming rate- 1 in 54 children born in the United States were diagnosed with autism in 2020. Yet, with all of the research and all of the advances that have been made on behalf of autism in the field of behavioral psychology there is currently no known cure.
Autism is treated by various therapies depending on the severity of the symptoms and the specific needs of the child with autism. The most common therapy used to treat autism is applied behavior analysis (ABA) therapy. ABA therapy is an evidence based behavioral therapy that focuses on improving communication skills, social skills and behavioral skills while reducing socially undesirable or inappropriate behaviors. ABA uses positive reinforcement to accomplish these goals.
ABA is the most common therapy because it has been the most effective autism therapy for the last fifty years. However, there are some other types of therapies that are worth mentioning because they are either good supplementary therapies to ABA therapy or they provide excellent stand alone benefits for specific symptoms of autism.
What Therapies, Besides ABA Therapy, Also Help with Autism?
Speech Therapy is commonly recommended for children on the autism spectrum to help with communication and speech. A speech therapist can help children with compromised speech but they do much more than just help with pronunciation and teaching children how to speak. Speech therapy also addresses the misuse of language and helps those with autism to avoid misunderstanding language as they communicate with others. They teach their clients how to interpret body language and look for subtle physical signals. They also work with pragmatics in speech so that children know when, how and to whom they can say certain things to. Speech therapy teaches inflection or “prosody” which is the movement in a person’s voice as they speak. Children on the spectrum often need to learn this skill because many have a “flat” or monotone pattern of speech that causes them to appear emotionless to others. Conversation skills, grammar, and social skills are also practiced with question and answer exercises as well as concept skills. Concepts can be difficult for some children with autism because concepts require abstract thought to make sense of some of the concepts. As you can see, there is much more to speech therapy than just learning how to speak clearly.
PECS is an acronym for Picture Exchange Communication System.
Using single pictures, a child with autism can show someone what they would like to gain access to. This is part of the goal for Phase I of six phases. Phase II would work on generalizing the skills from Phase I, Phase III is picture discrimination whereby individuals learn to choose from a collection of pictures of their favorite things and ask (mand) for them. They can build a sentence to communicate by using sentence starters such as “I want” or “I need” and finishing the sentence with the rest of the pictures during Phase IV. Phase V moves on to responses so that the child will learn how to answer as well as ask. In the final phase (VI), children are taught to respond (comment) to questions such as “What do you see?” or “How do you feel?” They would use this opportunity to form sentences using starters such as “I feel” or “I see”.
Occupational Therapy is sometimes necessary for children with autism due to physical challenges that sometimes accompany autism. OT sessions can focus on:
*Gross motor skills to improve coordination
*Social skills to enhance physical activities with groups
*Fine motor skills to improve handwriting and activities that require small muscles and hand/eye coordination
*Play therapy to improve interaction and imaginary play skills with others
*Sensory skills to help children who have weak responses or extreme responses to sound, smell, touch, light or taste
The skills that are learned in occupational therapy improve daily living, the ability to perform academically and interact with others in social settings.
Nutrition Therapy- While there hasn’t been any substantial evidence that specific diets lesson the symptoms of autism, some parents believe that they see a difference in their child’s behavior when they add or subtract certain foods. Gluten and casein are hot topics with parents who report behavioral changes in their children when they are exposed to these proteins. Continued research is being conducted to examine the “leaky gut” theory which refers to the possibility of these proteins seeping through the intestinal tract, “fermenting” in the bloodstream and ultimately resulting in impaired behavior when the fermented blood reaches the brain. So far, this theory is unsubstantiated. However, nutritional therapy can be helpful for children with autism due to their limited preferences. Children with autism have a higher incidence of gastrointestinal problems and tend to have thinner bone density than children without autism. Working with a nutritional therapist can help to remedy potential health problems associated with limited food choices.
Art Based Therapy– This type of therapy refers to dance, music, drama and visual arts. The idea behind this type of therapy is that it provides an outlet for communication and expression that children with autism may or may not be able to express verbally or socially. Depending on what type of art form your child participates in, expressing themselves artistically can help with some of the skills that are being addressed in occupational therapy by exercising fine motor skills. Communication and social skills can also be improved by working with others in drama groups, or music and dance groups. Their senses can be engaged by color, art medium, and sound. It also provokes cognitive skills such as decision making, self awareness and perception and can also increase the chances of overcoming intolerance to certain stimuli like smells, sights and sounds that were previously unpleasant to them.
Social Skills Therapy– This type of therapy is specific to the improvement of social skills and communication. The focus of social skills therapy is to improve communication by developing the child’s communication skills so that they can carry a conversation, understand jokes and sarcasm, answer questions, read non verbal cues and improve speech overall. Circle Care Services has a great group of therapists who oversee a social skills group within the practice. (link here)
Horseback Therapy– Also known as Equine Therapy, this form of occupational therapy focuses on teaching attention, self control and sensory management. Riding a horse can also be beneficial to how a child with autism carries their own posture. During a ride, they will inevitably have to adjust to different movements from the horse and the children may move in different ways than they are normally accustomed to and widen their range of movement without even thinking about it. This type of therapy is credited with improved adaptive behaviors like responding to new challenges, coping with everyday life, communicating, resilience and mental flexibility. While equine therapy may still be in the early stages of research, what is known now is showing positive benefits and improvements in regulating behavior, sociability, irritability, lethargy and hyperactivity.
Yoga Therapy– Anyone who practices yoga for an extended amount of time will most likely express the benefits of yoga such as improved strength, posture, cardiovascular fitness, coordination, body awareness, focus, concentration, stress reduction, balance and flexibility. For children with autism there are additional benefits that are helpful. Yoga can help children with autism to self regulate impulsive, obsessive, aggressive and self stimulatory behaviors. If they attend a class with peers or other people in the community you can also expect to see improvement in social and communication skills, awareness and expression of emotions, reduced frustration and a positive self body image.
Relationship Development Intervention (RDI)– RDI is a type of therapy that is focused on building social and emotional skills by developing “dynamic intelligence” (the ability to think flexibly). Parents are trained by certified behavioral consultants to be the primary “therapists” in this program. RDI has six main objectives:
- “Emotional Referencing: the ability to learn from the emotional and subjective experiences of others
- Social Coordination: the ability to observe and control behavior to successfully participate in social relationships.
- Declarative Language: the ability to use language and non-verbal communication to express curiosity, invite others to interact, share perceptions and feelings and coordinate your actions with others.
- Flexible thinking: the ability to adapt and alter plans as circumstances change.
- Relational Information Processing: the ability to put things into context and solve problems that lack clear cut solutions and have no “right and wrong” solutions.
- Foresight and Hindsight: the ability to think about past experiences and anticipate future possibilities based on past experiences”.
How do I make sense of all the different treatments?
These are just some of the many additional and alternative therapies that are out there for families to explore.
Making sense of all of these choices is a matter of what is best for your family. ABA therapy has proven to be the most effective therapy for children with autism. It is still referred to as the “Gold Standard” by which all other forms of treatment should be measured.
“The Maine Department of Health and Human Services (HHS) and the Department of Education (DOE) reviewed 150 studies with 43 different treatment approaches for people with autism. The meta-analysis used the evaluative method for determining evidence-based practice in autism to assign each intervention a rating based on the amount of evidence involved in the treatment process. The report found that ABA therapy was one of the few that met standards as an established evidence-based therapy.”
Knowing this, there still might be an area of a child’s life that could be served well by additional therapies or perhaps alternative therapies. There is nothing wrong with trying new things. It certainly wouldn’t hurt to enroll your child in a Yoga class with other children who have autism. Most children certainly wouldn’t mind spending time with animals if Horseback Therapy sounds like something interesting that your family would like to try.
Most of the alternative therapies have some cross-over elements of social, occupational or behavioral therapy that complements ABA, speech therapy, social skills groups or occupational therapy. Any combination of these could be a wonderful way of reinforcing the learning that is taking place in ABA therapy.
What are the Costs for These Alternative Therapies?
Parents of children with autism are well aware of how costly it is for therapy services. Ideally, private insurance is the best option for autism treatment. However, some of the alternative therapies mentioned here, such as yoga or horseback, are most likely going to be out of pocket expenses. ABA, occupational therapy, and speech therapy are likely to be covered by private insurance. Social skills groups are also likely to be covered especially if it is part of the treatment program with your ABA provider.
Here are some very rough estimates of annual costs for the therapies mentioned above- all of these are approximate costs and dependent on individual need:
- ABA therapy can range anywhere from $20,000-$60,000 annually
- Speech Therapy- Initial Assessments are approximately $250; half hour sessions are approximately $65 and one hour sessions- $130
- Occupational Therapy- Initial Assessments $250; hourly $100- $200
- Yoga Therapy is typically a private pay therapy; classes for children with autism range from a per class fee or a monthly membership at a yoga gym. Prices will vary with each facility or instructor
- Horseback therapy is typically a private pay therapy ranging from $60- $250 per session
- Art Therapy is a private pay therapy and will vary with each type of activity; private dance lessons, music lessons and drama lessons range from $60-$200 per month depending on whether your child receives group instruction or private lessons. Art therapy (paint, ceramics, and other various forms of media) are approximately the same cost.
- RDI (Relationship Development Intervention)- may or may not be covered by private pay insurance. Initial assessments can cost approximately $250 and sessions can range $100-$200 per session.
It is roughly estimated that it takes $60,000 annually or more to support a child who has autism. It is a good idea to secure private insurance to keep out of pocket expenses to a minimum. Many of the therapies that are not covered by private insurance are the equivalent of what most families spend on extracurricular activities for their children who are involved in sports, drama, dance, theater or music. However, for the child that requires speech, occupational or behavioral therapy it is best to make sure that your insurance covers the cost. If it doesn’t, reach out to your local public health department, school district or state department and ask for assistance to find resources that are covered by government programs or the school district. There are plenty of resources out there.
When Should I Consider Medications for My Child with Autism?
There are certain circumstances that may require making the difficult decision to allow your doctor to prescribe medications for your child with autism. This is not an easy decision and it is always best to take time to carefully consider all of the variables and seek another doctor’s opinion if there are too many questions left unanswered while trying to decide.
Generally speaking, it is always best to consider the full impact of deciding against medication. Will the child suffer adverse effects if they are left untreated? Will the child have difficulty with behavioral therapy without medication? Will they have difficulty in school without medication? If a child needs medication at an early age to help with academics or to sleep and they don’t receive it, the long term effects could be devastating.
Medication is usually reserved for symptoms such as aggression, insomnia, self injurious behaviors due to anxiety or frustration, attention deficits, and obsessive compulsive behaviors. Without medication, these types of behaviors can limit friendships, academic achievement, cause aggression toward others, harm to self and insomnia can cause a long list of problems including depression, obesity, irritability and attention deficit problems.
When considering medication, the benefits should outweigh the risks for the child. Earlier is better than later because some of these symptoms are harder to reverse after too much time has gone by.
Take your time when making life changing decisions for your child and your family.
The team at Circle Care would love to answer any questions about ABA, alternative therapies, medications or any other questions you may have about your child with autism. Our staff is dedicated to helping you make good choices for your child as you consider a course of treatment for your child with autism.
We hope to hear from you as you start your journey with your child. Give us a call and let us help you with a plan for the future that will benefit your child and your entire family.