Therapies for Children with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by impaired social communication and social interaction accompanied by atypical patterns of behavior and interest. ASD is differentiated from other developmental disorders by significant impairments in social interaction and communication, along with restrictive, repetitive, and stereotypical behaviors and activities. Social communication and social interaction features include deficits in social-emotional reciprocity (e.g., deficits in joint attention, atypical social approach and response, conversational challenges, reduced sharing of interest, emotions, and affect); deficits in nonverbal communication (e.g., atypical eye contact, reduced gesture use, limited use of facial expressions in social interactions, challenges understanding nonverbal communication); and deficits in forming and maintaining relationships (e.g., diminished peer interest, challenges joining in play, difficulties adjusting behavior to social context). ASD features of restricted repetitive patterns of behavior, interests, or activities may include stereotyped motor mannerisms, use of objects, or speech (e.g., simple motor stereotypies, repetitive play, echolalia, and formal or idiosyncratic speech); insistence on sameness, inflexible adherence to routines, or ritualized patterns of behavior (e.g., distress at small changes, rigid patterns of thought and behavior, performance of everyday activities in ritualistic manner); intense preoccupation with specific interests (e.g., strong attachment to objects, circumscribed or perseverative topics of interest); and sensory sensitivities or interests (e.g., hyperreactivity or hyporeactivity to pain and sensory input, sensitivity to noise, visual fascination with objects or movement). ASD symptoms cause impairment across many areas of functioning and are present early in life. However, impairments may not be fully evident until environmental demands exceed children's capacity. They also may be masked by learned compensatory strategies later in life. Many children with ASD may also have intellectual impairment or language impairment, and the disorder may be associated with known medical, genetic, or environmental factors. Treatments for ASD that families pursue include behavioral, educational, medical, allied health, and complementary approaches. Individual goals for treatment vary for different children and may include combinations of therapies. For many individuals, core symptoms of ASD (impairments in communication and social interaction and restricted/repetitive behaviors and interests) may improve with intervention and over time; however, deficits typically remain throughout the lifespan. Lifelong management-often using multiple treatment approaches-may be required to maximize functional independence and quality of life. This systematic review updates the behavioral intervention portion of our comprehensive review of therapies for children with ASD published in 2011. ASD intervention categories overlap substantially, and it can be difficult to cleanly identify the category into which an intervention should be placed. Ultimately, we defined behavioral interventions to include early intensive behavioral and developmental interventions, social skills interventions, play/interaction-focused approaches, interventions targeting symptoms commonly associated with ASD, and other general psychosocial approaches. This behavioral category of intervention explicitly does not include primarily medical interventions, complementary and alternative interventions, allied health interventions, or educationally focused interventions unless a behavioral intervention representative of the operationalization above was included within the study design.