Autism therapies

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Autism therapies
A three-year-old with autism points to fish in an aquarium, as part of an experiment (2004) on the effect of intensive shared-attention training on language development.[1]
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Autism therapies include a wide variety of therapies that help people with autism, or their families. Such methods of therapy seek to aid autistic people in dealing with difficulties and increase their functional independence.

Many therapies marketed towards people with autism and/or their parents claim outcomes that have not been supported by Level of Research (LOE) Level 1 (highest level assigned based on the methodological quality of their design, validity, and applicability to patient care). Level 1 research includes evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results.^[2]

Autism is a neurodevelopmental condition characterized by differences in reciprocal social interaction and communication as well as restricted, repetitive interests, behaviors, or activities.^{[3]: 60 [4]} As of 2023, no therapy exists to eliminate autism within someone, let alone to a high degree of viability. Treatment is typically catered to the person's needs. Treatments fall into two major categories: educational interventions and medical management. Training and support are also given to families of those diagnosed with autism spectrum disorders (ASDs).^[5]

Studies of interventions have some methodological problems that prevent definitive conclusions about efficacy.^[6] Although many psychosocial interventions have some positive evidence, suggesting that some form of treatment is preferable to no treatment, the systematic reviews have reported that the quality of these studies has generally been poor, their clinical results are mostly tentative, and there is little evidence for the relative effectiveness of treatment options.^[7] Intensive, sustained special education programs and behavior therapy early in life can help children with ASD acquire self-care, social, and job skills,^[5] and often can improve functioning, and decrease severity of the signs and observed behaviors thought of as maladaptive;^[8] Available approaches include applied behavior analysis (ABA), developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy.^[5] Occupational therapists work with autistic children by creating interventions that promote social interaction like sharing and cooperation.^[9] They also support the autistic child by helping them work through a dilemma as the OT imitates the child and waiting for a response from the child.^[9] Educational interventions have some effectiveness in children: intensive ABA treatment has demonstrated effectiveness in enhancing global functioning in preschool children,^[10] and is well established for improving intellectual performance of young children.^[8] Neuropsychological reports are often poorly communicated to educators, resulting in a gap between what a report recommends and what education is provided.^[11] The limited research on the effectiveness of adult residential programs shows mixed results.^[12]

Historically, "conventional" pharmacotherapy has been used to reduce behaviors and sensitivities associated with ASD.^[13] Many such treatments have been prescribed off-label in order to target specific symptoms.^[14] Today, medications are primarily prescribed to adults with autism to avoid any adverse effects in the developing brains of children. Therapy treatments, like behavioural or immersive therapies, are gaining popularity in the treatment plans of autistic children. Depending on symptomology, one or multiple psychotropic medications may be prescribed. Namely antidepressants, anticonvulsants, and antipsychotics.^[14]

As of 2008 the treatments prescribed to children with ASD were expensive;^[15] indirect costs are more so. For someone born in 2000, a U.S. study estimated an average discounted lifetime cost of $5.23 million (2025 dollars, inflation-adjusted from 2003 estimate^[16]), with about 10% medical care, 30% extra education and other care, and 60% lost economic productivity.^[17] A UK study estimated discounted lifetime costs at £2.26 million and £1.45 million for a person with autism with and without intellectual disability, respectively^[18] (2025 pounds, inflation-adjusted from 2005/06 estimate^[19]). Legal rights to treatment are complex, vary with location and age, and require advocacy by caregivers.^[20] Publicly supported programs are often inadequate or inappropriate for a given child, and unreimbursed out-of-pocket medical or therapy expenses are associated with likelihood of family financial problems;^[21] one 2008 U.S. study found a 14% average loss of annual income in families of children with ASD,^[22] and a related study found that ASD is associated with higher probability that child care problems will greatly affect parental employment.^[23] After childhood, key treatment issues include residential care, job training and placement, sexuality, social skills, and estate planning.^[20]