Autism, Educational Treatments for

Autism and related disorders (together called “pervasive developmental disorders” or “autistic spectrum disorders”) are characterized by deficits in three areas: social relatedness, communication, and repetitive behaviors. Social impairments include behaviors such as lack of eye contact, poor nonverbal communication, lack of joint attention (pointing things out to others to share interests), lack of interest in peers or poor peer relationships, and impaired attunement to the emotions of others. Communication deficits include delayed language, poor conversational ability, stereotyped language, and stereotyped or impoverished pretend play. Repetitive behaviors include preoccupations with certain objects or topics, resistance to change in the routine or environment, repetitive motor behaviors, and visual fascinations.

Autism is usually apparent by age 3, and sometimes as early as the first year of life. Symptoms evolve with development, but the core impairments often persist throughout childhood, adolescence, and adulthood. Although autism is usually regarded as a lifelong disorder, it can often be treated effectively with a combination of behavioral, educational, and biological interventions (for a review of common programs, see Gresham, Beebe-Frankenberger, & MacMillan, 1999). Many comprehensive treatment programs for children with autism have reported increases in developmental levels, IQ, social behaviors, and functional language skills and decreases in maladaptive, self-injurious, or repetitive behaviors. However, children on the autistic spectrum constitute a very heterogeneous group, and different treatments may be effective for different children. Most treatment efficacy studies have methodological problems, such as small samples and no control groups. The definitive treatment studies in which children with different characteristics are randomly assigned to treatments of different types and intensities have not been done and are probably not feasible, so current thinking about treatment efficacy is based on rather limited empirical data.

This entry briefly discusses many of the common treatment approaches used with children with autism. It focuses on the educational approaches that are most frequently cited in the literature. Biological and “alternative” treatments are also used with children with autism, but they are not the focus of this entry. Biological treatments primarily include medications aimed at ameliorating interfering behaviors and coexisting mood disorders. “Alternative” treatments, those that are not widely accepted or have little supporting empirical data, include nutritional supplements, special diets, sensory integration therapy, and many others. As has been frequently noted, absence of evidence does not constitute evidence of absence, and some of these “alternative” treatments may ultimately prove effective for some children. One notable exception is facilitated communication, for which there is little empirical support (Simpson & Myles, 1995).

Research is unanimous in finding that early intervention is crucial for optimizing outcome. “Early” is generally considered under the age of 5, and the earlier the better, with intervention starting before age 3 considered optimal. Of the approaches considered below, all are applicable to children from toddlerhood and preschool through adolescence, but in general, the applied behavior analysis and developmental approaches are usually chosen for preschool children, while the TEACCH model (Treatment and Education of Autistic and Related Communication-Handicapped Children) and applied behavior analysis are often chosen for school-aged children.