What are interventions?
Intervention means doing something, taking action or using a treatment to try to improve a particular condition or problem. When it comes to autism spectrum disorder (ASD), there are many kinds of interventions offered. Depending on the type, they can involve the child, the parent or both. They might be one-off events or involve many sessions spread over years.
What types of intervention are there?
There’s a huge range of treatments, from those based on behaviour and development, to those based on medicine or alternative therapy. A chosen intervention might even be a combination of several others, or a variation that’s been tailored for your child.
Interventions are based on different theories about what causes ASD. These theories guide the approach taken, so hearing the theory behind an intervention helps you understand what it’s trying to do. For example, a theory about chemical imbalance in the body leading to ASD might lead to a therapy involving taking prescribed drugs or making changes in diet, to address the imbalance.
The intervention you choose depends a lot on what’s right for your child. Ideally, professionals will work with parents to find an intervention that suits. Read more about choosing interventions
Generally, the evidence suggests that early interventions that use a behavioural or educational focus have the best outcomes for the majority of children with ASD. These interventions include those based on the principles of Applied Behaviour Analysis (ABA)
(such as those using Discrete Trial Training (DTT)
as a teaching technique).
Below is a summary of the main types of intervention, with a look at what the research says. This is just one way to categorise interventions, and you’ll find that some interventions are based on (or include the use of) others.
Behaviour-based approaches to ASD focus on teaching children new behaviours and skills by using specialised, structured techniques. These techniques are the best teaching tools we have for developing skills and encouraging appropriate behaviour.
Behaviour-based approaches are probably the most scrutinised and best supported by evidence and research. Therefore, they are the most commonly used type of intervention for children with autism. Interventions using an Applied Behaviour Analysis (ABA) approach are particularly common and well supported.
There’s still some discussion about different behaviour-based interventions and how the research on them should be interpreted. For example, it’s not always clear whether the research is claiming that the intervention has led to ‘recovery’ or to an improvement in symptoms.
Examples of behaviour-based interventions include:
Medical interventions tend to focus on treating characteristics shown by children with ASD, such as difficulties in the areas of social interactions and relationships, communication and language, and repetitive behaviour and routines.
Every now and then, you’ll hear about a new ‘miracle cure’ for autism. So far there is no medicine proven as a cure for autism. Rather, most medication is used to improve (but not necessarily remove) problems like:
- behaviours associated with ADHD – inattention or over-activity
- symptoms of anxiety
obsessive compulsive behaviour
- self-harming behaviour, or
- sleep disorders
Prescribed medications may reduce these behaviours sufficiently for other (behavioural or developmental) interventions to be more effective.
Examples of medical interventions include:
Things to consider about medications
It’s always best to talk through medication options and use with your health professional, because there are clear rules about how medical interventions should be managed.
Some medications have had positive effects on particular symptoms (such as aggressive or hyperactive behaviour). Measuring the effects properly is not easy, however, and symptoms need to be monitored very carefully. You can discuss this with the prescribing doctor.
Also, there is still a real need for more research on the long-term side effects of medication, because many medications used or suggested have never been tested on children. Instead, they have been trialled with adults, and it is only assumed that they will work with children.
Some medications that have shown to be ineffective and/or harmful for children with autism include:
Developmental approaches to ASD aim to help children with forming positive, meaningful relationships with other people. They focus on teaching children social and communication skills in everyday, structured settings. They also aim to help children develop skills for daily living (often called 'functional' and 'motor' skills).
Although there isn’t enough good-quality research on developmental interventions, results of studies done on small parts of some of them have shown positive results.
Developmental interventions are sometimes called ‘normalised’ interventions.
Examples of developmental interventions include:
Some approaches combine elements of behavioural and developmental methods, and also use new information about autism and typical development.
Often a combined approach is the most effective, because it brings together characteristics of a good intervention. For example, any behavioural intervention will be much more effective if it is also family-based.
Examples of combined interventions include:
Family-based interventions for ASD emphasise the idea that family involvement in the therapy is central to meeting a child’s developmental needs. In particular, parents not only drive the decision-making about the intervention, but they also take a key role in delivering it.
These interventions are designed to provide guidance, training, information and support to family members.
Research on how well family-based interventions work is limited but growing. Real success with them depends on having strong and collaborative parent–professional relationships. Their effectiveness also relies on addressing the needs of the whole family, so that everyone in the family benefits, not just the child with autism.
Examples of family-based interventions include the:
Therapy-based approaches to ASD directly provide a specific therapy that targets specific difficulties. Examples include:
- developing a child’s communication and social skills using speech therapy
- developing skills for daily life, including physical skills, using occupational therapy.
Therapy-based approaches are often used together with (or as part of) other intervention programs.
Examples of therapy-based interventions include:
Alternative interventions for ASD include a broad range of treatments not often used in the mainstream medical system, due to a lack of scientific evidence.
There is a lot of discussion and controversy surrounding the choice of an alternative treatment for ASD. This is because:
- There is not much evidence to support the effectiveness of alternative interventions.
- Considerable evidence shows no effect at all for some (such as using secretin).
- There are potential risks associated with some of the treatments (such as withholding the MMR vaccine).
Another common concern about these types of therapies – even those that do no direct harm – is that they use time, energy and sometimes money that a family could otherwise spend on accessing well-established and well-supported therapies.
Examples of alternative interventions include:
Psychodynamic approaches to ASD are based on the assumption that autism comes from emotional damage to the child – a theory not supported by evidence.
Severely traumatised children can show behaviours similar to those associated with autism. But:
- Strong evidence now supports the theory that autism is a developmental and brain-based disorder, rather than an emotional one.
- There is little evidence to demonstrate how effective these therapies are.
Therefore, psychodynamic interventions are now seldom used.
Examples of psychodynamic therapies include holding therapy and pheraplay.
These include a range of interventions that sit outside the categories listed above. So far there isn’t much quality research testing the outcomes for these programs.
Finding and starting early intervention
In this short video, parents talk about early interventions for autism spectrum disorder (ASD). They describe how it can be difficult and confusing to know where to start with interventions and therapies. They also share their experiences of some different interventions and tests.
There are many excellent resources and interventions available. But as these mums and dads note, it’s important to choose interventions that are right for your child, and that are based on scientific evidence.