31.5 Autism Spectrum Disorder
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acquisition, and for parents, may be administered at a lower
intensity such as weekly; however, once parents are trained,
the interventions occur throughout the day with the child.
Another example of a parent training approach is the Hanen
More Than Words Program.
Social Skills Approaches
1. Social Skills Training.
Typically provided by therapeutic
leaders to children of various ages in a group setting with
peers; children are given guided practice in initiating social
conversation, greetings, initiating games, and joint attention.
Emotion identification and regulation are often included in
practice with recognizing and learning how to label emotions
in given social situations, learning to attribute appropriate
emotional reactions in others, and social problem-solving
techniques. The goals are that with practice in the group
setting, the child will be able to use the techniques in less-structured settings and internalize strategies to interact posi-
tively with peers.
Behavioral Interventions (BIs) and Cognitive-Behavioral Therapy (CBT) for Repetitive
Behaviors and Associated Symptoms
1.
Behavioral Therapy.
Applied behavioral analysis has been
found to be somewhat effective in reducing some repetitive
behaviors in children and adolescents with autism spectrum
disorder. Early intervention is recommended for repetitive
behaviors that are self-injurious; behavioral interventions
may need to be combined with pharmacologic treatments to
adequately manage the symptoms.
2.
Cognitive-Behavioral Therapy.
There is a significant evi-
dence base from RCTs for the efficacy of CBT for symptoms
of anxiety, depression, and obsessive-compulsive disorders
in children. There are fewer controlled trials of this treatment
in children with autism spectrum disorder, although there
are at least two published studies in which CBT was used to
treat repetitive behavior in individuals with autism spectrum
disorder.
Interventions for comorbid symptoms in autism
spectrum disorder
1. Neurofeedback.
This modality has been administered in an
attempt to influence symptoms of attention-deficit/hyperac-
tivity disorder (ADHD), anxiety, and increased social inter-
action by providing computer games or other games in which
the desired behavior is reinforced, while the child wears elec-
trodes that monitor electrical activity in the brain. The aim is
to influence brainwave activity to prolong or produce electri-
cal activity present during the desired behaviors. This modal-
ity is still under investigation in the treatment of symptoms
in autism spectrum disorder.
2. Management of insomnia in autism spectrum disorder.
Insomnia is a prevalent concern among children and ado-
lescents with autism spectrum disorder, and both behavioral
and pharmacologic interventions may be administered to
improve this condition. The most common behavioral inter-
vention for insomnia in autism spectrum disorder is based
on changing the parents behavior first toward the child at
bedtime and throughout the night, such that there is a removal
of reinforcement and attention for being awake, leading to a
gradual extinction of the “staying awake” behavior. Several
studies using massage therapy before bedtime in children
with autism spectrum disorder between the ages of 2 years
and 13 years provided an improvement in falling asleep and
a sense of relaxation.
Educational interventions for children with autism
spectrum disorder
1. Treatment andEducation ofAutistic and Communication-
related Handicapped children (TEACCH).
Originally
developed at the University of North Carolina at Chapel Hill
in the 1970s, TEACCH involves structured teaching based on
the notion that children with autism spectrum disorder have
difficulty with perception, and so this teaching method incor-
porates many visual supports and a picture schedule to aid
in teaching academic subjects as well as socially appropriate
responses. The physical environment is arranged to support
visual learning, and the day is structured to promote auton-
omy and social relatedness.
2. Broad-based approaches.
These educational plans include
a blend of teaching strategies that use behavioral analysis and
also focus on language remediation. Behavioral reinforce-
ment is provided for socially acceptable behaviors while
academic subjects are being taught. TEACCH may also be
incorporated into a broader special educational program for
autism spectrum disorder.
3. Computer-basedapproaches andvirtual reality.
Computer-
based approaches and virtual reality teaching are centered
on using computer-based programs, games, and interactive
programs to teach language acquisition and reading skills.
This provides the child with a sense of mastery and delivers a
behaviorally based instruction in a modality that is appealing
for the child. The Let’s Face It! program is a computerized
game that helps to teach children with autism spectrum dis-
order to recognize faces. It consists of seven interactive com-
puter games that target changes in facial expression, attention
to the eye region of the face, holistic face recognition, and
identifying emotional expression. A randomized controlled
trial of use of this program with children with autism spec-
trum disorder provided evidence that after 20 hours of face
training with Let’s Face It!, compared to the control group,
the trained children demonstrated improvement in their abil-
ity to focus on the eye region of a face and improved their
analytic and holistic face-processing skills. Several stud-
ies using virtual reality environments to teach children with
autism spectrum disorder social skills and interaction have
provided evidence of their value. In one study, a virtual café
for children with autism spectrum disorder allowed the chil-
dren to practice ordering and paying for drinks and food by
navigation with the use of a computer mouse.
Psychopharmacological Interventions
Psychopharmacological interventions in autism spectrum dis-
order are mainly directed at ameliorating impairing associated
behavioral symptoms rather than core features of autism spec-
trum disorder. Target symptoms include irritability, broadly
