What are the treatment options for autism?

Generally, treatment for people with autism aims to

• improve their quality of life,
• help them to take part in social activities, and
• help them to lead an independent life.

The specific aims will vary from person to person, depending on things like their age, the autism-related traits and behaviors, and their life circumstances. It also depends on the areas that are most challenging. The aims may include things such as:

• improving your attention and learning to share your attention – in other words, the ability to focus on certain things together with other people
• improving your social skills
• better understanding other people’s emotions and needs
• improving your language skills
• reducing stereotyped behavior
• learning to interact better with other people – for example, by learning to approach others and talk or play with them
• improving integration at school or work
• expanding your interests
• reducing challenging behavior such as aggression
• avoiding overwhelm and “meltdowns”
• coping better with sensory input
• improving everyday practical skills such as personal hygiene, getting dressed, cooking, and shopping
• improving movement and coordination
• improving fine and gross motor skills
• reducing anxiety
• relieving related health conditions

It is important to set realistic and needs-based treatment goals together with the healthcare professionals, and to regularly check whether these goals are being achieved. The treatment goals will also influence the choice of treatments.

The chosen treatment options will mainly depend on

• the person's age,
• what difficulties they have and which of those cause the most problems,
• how the family is affected,
• where support is needed in day-to-day life,
• what needs and interests the person with autism has, and
• whether they have any related health conditions.

There are various treatment options, depending on the person's stage of development and their intelligence.

The most appropriate treatment will depend on how the person with autism or their loved ones see their situation and what the goals of treatment are. That's important because for people with autism, it’s not just about managing the typical traits. For some, it might be more important to feel socially integrated or to learn to accept being “different” and not see it as a stigma. Or to be able to do a job that they enjoy. The main focuses of treatment will also depend a lot on their age.

Typical autism traits don’t necessarily cause suffering or need to be treated. An example: Very one-sided interests can cause problems for some people with autism, maybe because other abilities don't develop as a result. But special interests and the associated rituals can give others a sense of security and routine.

Please note: Some of the following information describes the situation in Germany. You may find that things are different elsewhere.

The recommended treatments include:

• Autism-specific behavioral therapy: This is a type of psychotherapy. It involves various exercises and techniques to improve certain abilities, such as being able to better read other people's signals and react to them. Behavioral therapy is a key part of treatment.
• Social skills training: The aim of this group therapy is to improve interactions with other people. It is a type of behavioral therapy.
• Parent training: There are different types of parent training. Parents might be given general information about autism and learn how they can support their child. It is also common to show parents how they can interact with their child and how to cope with difficult situations.
• Speech therapy: This is an option if there is a speech development problem.
• Occupational therapy: This can improve everyday practical skills and help people to become more independent.
• Psycho-education: Here the aim is to inform people about autism and help them to cope well with it. This is especially important for teenagers and young adults. Psycho-education is also offered as part of parent training.
• Medications: Medications are only an option in certain cases – for example, to manage aggressive and extreme stereotyped behaviors, and if there are related medical conditions such as ADHD or anxiety disorders.

In Germany, autism-specific early intervention treatment is aimed at preschool children (between the ages of 0 and 6 years). Targeted early intervention programs can have a positive effect on the child’s development. It can take place in special early intervention centers (Frühförderstelle / Frühförderzentrum), autism centers or practices, but also at home or at kindergarten. Parents and kindergarten teachers are closely involved in early intervention programs.

One important element is autism-specific behavioral therapy. Here the goals include helping the child to:

• play with other people
• interact with parents and other people
• share their attention
• improve their language skills (imitation, understanding symbols, speech abilities)
• improve everyday practical skills

The exact measures are adapted to the child’s stage of development. Children from about the age of 4 years can also have early intervention treatment in a small group.

The aim of autism-specific behavioral therapy is to learn or improve certain skills. For people with autism, that might include the skills needed to interact with other people. Behavioral therapy can also help them cope with challenges, burdens, anxiety, and stress. Related health conditions such as anxiety disorders and depression can be treated, too.

The therapy is often carried out using playful, everyday exercises so that the child can put what they learn into practice. A lot of things have to be practiced very intensively and in small steps over a long period of time. One reason for this is because people with autism often find it difficult to apply what they’ve learned to other situations. It is important that the exercises are repeated frequently, as well.

Behavioral therapy also includes guiding and supporting parents to help them interact with their child. The therapy can take place in individual or group sessions. That will depend on a number of things, including the child’s age.

Sometimes people with autism also have related diseases and problems that can be very distressing. These may even be harder to live with than the autism traits – both for the affected person and those around them.

There are treatments for:

• Sleep problems: You can talk to the therapists about which sleep hygiene techniques might be a good idea. These may include things like fixed bedtimes and bedtime routines, physical activities during the day, or making changes to the sleeping environment. If that doesn't help, doctors can prescribe medications containing the active ingredient melatonin. Melatonin is a hormone that controls the sleep/wake cycle.
• Eating disorders: Under the guidance of a behavioral therapist, people with autism can practice eating foods that they have rejected so far. When it comes to children, it is essential that their parents are involved here.
• Problems surrounding toilet use: Many children with autism wet themselves and have difficulties going to the toilet on their own. Toilet training from the age of about five can help. It is best for this to be offered as part of autism-specific early intervention treatment.
• Anxiety disorders and obsessive-compulsive disorder (OCD): Here behavioral therapy can help people to confront distressing situations step-by-step and then cope better with them. Sometimes medication can be used too.
• Depression: Things like exercise, positive activities, social contacts, and coping with stress are important here. Where necessary, psychotherapy and medications can be considered.
• Attention deficit hyperactivity disorder (ADHD): This can mainly be treated with medication.
• (Auto-) aggressive behavior: Parent training, behavioral therapy, daily routines and clear rules can help here. Certain antipsychotic medications may also be considered.
• Too much screen time: This is where someone might, for instance, play video games excessively, neglecting school and social contacts as a result. Access to screens should then be clearly regulated and limited. Behavioral therapy involving the whole family can be helpful here.
• Epilepsy: Many people with epilepsy take anti-epileptic medications regularly to prevent seizures.

When it comes to children and teenagers, parents are informed about every treatment and have to give their consent. The healthcare professionals and parents regularly talk about how the child is developing and think about what further treatment makes sense.

Parents are also shown how they themselves can support their child. They learn exercises and behavioral therapy techniques that they can use in everyday life – either from their healthcare professionals or in special sessions (psycho-education). They are given regular feedback on those things and can ask for advice at any time. It is very important that the children practice what they have learned over and over, in as many everyday situations as possible – including at kindergarten or school. Brothers and sisters can also be involved here.

Parents don’t just learn how to react to their child’s problems, but also to acknowledge their strengths and positive characteristics. Over time, they are then able to better recognize their child’s needs and support them. Parents see that they themselves can make a difference and have a positive effect on their child’s development.

But kindergarten and school staff should also be familiar with autism and help the child in line with the treatment goals. It can sometimes be a good idea for them to talk with the child's therapists, too.

Psycho-education is especially important for teenagers and adults. Put simply, it involves the therapist informing you about autism. This includes:

• Information about autism: What is autism? What types of autism are there? How does it affect your life?
• Learning to understand autism: What does autism mean for you? Why do you have certain behavioral patterns, feelings, and needs? Which of your characteristics have nothing (or only little) to do with autism?
• Learning to cope with autism: How can you deal with your special characteristics? What are your strengths? What challenges do you face? How can you organize your life? How can you deal with problems at school or at work?

There are also psycho-education sessions for parents. They are particularly helpful for parents whose child has recently been diagnosed with autism.

It can take place in specialized facilities like autism centers or social pediatric centers (Sozialpädiatrisches Zentrum in Germany) and – for young children – in early intervention centers. School-age children often have therapy in specialized practices and outpatient centers for psychiatry and psychotherapy. Speech therapy and occupational therapy are also offered in specialist practices. The therapy can sometimes take place at home.

For major issues, treatment in a day clinic or an inpatient clinic is an option. Clinics for (pediatric) psychiatry and psychotherapy are particularly helpful if related conditions are a big problem.

The available treatments can vary greatly from region to region. There are sometimes different kinds of therapy providers and not always enough options everywhere. So it's important to find out which offers there are near you – for example, by asking your pediatrician or family doctor or by contacting your social welfare office (Sozialamt) or an early intervention center (Frühförderstelle).

Treatment for younger children usually takes place in individual sessions. Parents are also closely involved. When the child’s abilities start to improve, the sessions might take place together with one or two other children with autism. That helps them get used to interacting with other people.

Older children, teenagers and adults with average intelligence may also have group therapy over several months (social skills training). Here the goal is to improve your social interactions, independence, and ability to manage your own feelings and needs. It also aims to help teenagers establish a sense of identity. That may include thinking about the “autism” diagnosis and what it means for your own life. Many people find these group sessions very positive and feel comfortable in a group setting for the first time. Especially during puberty, young people with autism also want to feel like they belong and want to socialize with other people of their age – both with and without autism.

Certain treatment approaches are not recommended by experts. This is because they are considered to not help in autism, or even to be harmful. They include:

• Chelation therapy / Detoxification therapy
• Colon (bowel) cleansing
• Bleaching (chlorine dioxide solution) / Miracle Mineral Solution (MMS)
• Diets and dietary supplements (unless there is a medical reason)
• Hormone therapy
• An injection made from the person's own blood cells
• Electroconvulsive therapy
• Stem cell therapy
• Stool transplant (fecal microbiota transplantation, FMT)
• Attachment therapy
• Packing / Ice-packing
• Irlen glasses
• Psychomotor patterning (also referred to as Doman-Delacato therapy)

Experts also discourage the use of something known as facilitated communication. Here, the child’s hand or arm is supported while operating a computer keyboard or pointing to letters, for example. That is different to the kind of supported communication that can be helpful in autism. Here the goal is to help the child to communicate by teaching them to use aids (such as computers) or by practicing gestures and sign language with them.

Autism itself can’t be treated with medication.

But some related problems can be reduced with medication. For instance, antipsychotic medications (neuroleptics) are an option if stereotyped behaviors are a big problem in daily life, and psychotherapy and other approaches don't help enough. Antipsychotic medications reduce activity in certain nerve cells in the brain and have a calming effect. In this way, they can help autistic people to reduce aggression towards themselves and others. But they can have side effects, too – such as tiredness, movement disorders, and weight gain. Because of this, it’s important that the doctor regularly checks whether the medication is having the desired effects and whether it is causing any side effects.

Medication can be used to treat certain related conditions, as well – such as depression, ADHD, or epilepsy.