Management of Children With Autism Spectrum Disorders
Pediatrics
Myers, S. M., & Johnson, C. P. (2007).
Pediatrics, 120(5), 1162-1182.
This guideline provides recommendations for the management of children on the autism spectrum. The target audience of this guideline is pediatricians. In place of formal recommendations, conclusive statements regarding the level of evidence supporting a specific treatment are included. This document was partially updated by Hyman et al. (2020). For more information, please see the Notes on This Article section.
Council on Children With Disabilities, American Academy of Pediatrics
This guideline was most recently re-affirmed in 2014, see the statement of reaffirmation at the <a href="https://doi.org/10.1542/peds.2014-2679" title="https://doi.org/10.1542/peds.2014-2679">Pediatrics Journal</a> webpage. The guideline below provides additional updated recommendations:
Speech-language pathology treatment is most likely to be effective when delivered in close collaboration with teachers, support personnel, families, and peers as opposed to traditional, pull-out, low-intensity service delivery (p. 1165).
"People with [autism spectrum disorders] ASDs have [difficulties] in social communication, and treatment by a speech-language pathologist usually is appropriate" (p. 1165)
"A social skills curriculum should target responding to the social overtures of other children and adults, initiating social behavior, minimizing stereotyped perseverative behavior while using a flexible and varied repertoire of responses, and self-managing new and established skills" (p. 1166).
"Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups" (p. 1164).
"Most children [on the autism spectrum] can develop useful speech, and chronologic age, lack of typical prerequisite skills, failure to benefit from previous language intervention, and lack of discrepancy between language and IQ scores should not exclude a child from receiving speech-language services" (p. 1165).
"The efficacy of [Sensory Integration] SI therapy has not been demonstrated objectively"; however, intervention that promotes "sensory" abilities "may be helpful as a part of an overall program that uses desired sensory experiences to calm the child, reinforce a desired behavior, or help with transitions between activities" (p. 1166).
Some evidence supports the use of traditional and naturalistic behavioral approaches to teach social skills.
Many interventions (e.g., Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH), relationship-focused models) have documented improvements in key deficits in children on the autism spectrum, however, controlled trials are lacking.
A variety of augmentative and alternative communication (AAC) approaches (e.g., picture programs, gesture, signs) have been shown to often be effective in enhancing communication in children on the autism spectrum. Some nonverbal individuals may benefit from voice-output communication aids, however the published evidence is limited. Additionally, there is some evidence that AAC may stimulate some children on the autism spectrum to learn speech (p. 1165).
<p>The guideline authors recommend the following regarding comprehensive programs for children on the autism spectrum:</p>
<ul>
<li>initiating early intervention when ASD diagnosis is suspected rather than deferring until diagnosis is definitive;</li>
<li>systematically planning intensive intervention for at least 25 hours per week, 12 months per year;</li>
<li>having a low student-to-teacher ratio;</li>
<li>providing family inclusion;</li>
<li>allowing for opportunities for interaction with typically developing peers;</li>
<li>maintaining ongoing progress measurement and documentation;</li>
<li>having a strong structural element;</li>
<li>using strategies for generalization and maintenance;</li>
<li>using assessment-based curricula that address various components of communication, social skills, self-management, and responsibility and independence (p. 1164).</li>
</ul>
