Therapy based interventions typically focus on communication and social skill development (Speech Pathology) or sensory motor development (Occupational Therapy). These interventions are likely to be used in conjunction with other interventions.
The communications problems of autistic children vary to some degree and may depend on the intellectual and social development of the individual. Some may be completely unable to speak whereas others have well-developed vocabularies and can speak at length on topics that interest them. Any attempt at therapy must begin with an individual assessment of the child's language abilities by a trained speech and language pathologist.
Though some autistic children have little or no problem with the pronunciation of words, most have difficulty effectively using language. Even those children who have no articulation problems exhibit difficulties in the pragmatic use of language such as knowing what to say, how to say it, and when to say it as well as how to interact socially with people. Many who speak often say things that have no content or information. Others repeat verbatim what they have heard (echolalia) or repeat irrelevant scripts they have memorized. Some autistic children speak in a high-pitched voice or use robotic sounding speech.
Two pre skills for language development are joint attention and social initiation. Joint attention involves an eye gaze and referential gestures such as pointing, showing and giving. Children with autism lack social initiation such as questioning, make fewer utterance and fail to use language as a means of social initiation. Though no one treatment is found to successfully improve communication, the best treatment begins early during the preschool years, is individually tailored, and involves parents along with professionals. The goal is always to improve useful communication. For some verbal communication is realistic, for others gestured communication or communication through a symbol system such as picture boards can be attempted. Periodic evaluations must be made to find the best approaches and to reestablish goals for the individual child.
With thanks to Autism Speaks
Occupational Therapy can benefit a person with autism by attempting to improve the quality of life for the individual. The aim is to maintain, improve, or introduce skills that allow an individual to participate as independently as possible in meaningful life activities. Coping skills, fine motor skills, play skills, self help skills, and socialization are all targeted areas to be addressed. Through occupational therapy methods, a person with autism can be aided both at home and within the school setting by teaching activities including dressing, feeding, toilet training, grooming, social skills, fine motor and visual skills that assist in writing and scissor use, gross motor coordination to help the individual ride a bike or walk properly, and visual perceptual skills needed for reading and writing. Occupational therapy is usually part of a collaborative effort of medical and educational professionals, as well as parents and other family members. Through such collaboration a person with autism can move towards the appropriate social, play and learning skills needed to function successfully in everyday life.
With thanks to Autism Speaks
As many as 40% of children with autism are reported to have some form of sensory difficulty. Sensory Integration Therapy aims to improve the sensory processing capabilities of the brain. The treatment is commonly delivered by occupational therapists and may involve activities such as swinging in a hammock, balancing on beams, and brushing or stroking the child's body. Despite recommendations for use of Sensory Integration therapy with children with autism and anecdotal reports little experimental evidence of its benefits has been reported in the literature. Dawson and Watling (2000) reviewed the evidence regarding sensory integration, auditory integration and traditional occupational therapy and found only poor quality evidence providing either no, or at best equivocal, support for Sensory Integration therapy and found no empirical evidence on the practice of occupational therapy in autism. The MADSEC Autism Task Force (2000) reported similar findings following a review of the literature. They concluded that SI cannot be considered to be an effective treatment for children with autism on the basis of current research and that caution is called for on the basis of one study reporting an increase in self injurious behaviour.
Despite the lack of randomised controlled trials, it was noted that over 80 studies, measuring some aspect of the effectiveness of Sensory Integration Therapy, have been conducted. The lack of research supporting SI places the role of this therapy in the treatment of autism in a difficult position. Its effectiveness is unsubstantiated at this point and yet Sensory Integration Therapy is widely accepted and practiced by professionals working with children with autism in Australia.
The Picture Exchange Communication System (PECS) is a program that teaches children to interact with others by exchanging pictures, symbols, photographs, or real objects for desired items. The goals of PECS include the identification of objects that may serve as stimuli for each child's actions and the learning of responses to simple questions with multi-picture systems. The Picture Exchange Communication System is a highly structured program that uses behavioural principles of stimulus, response, and reward to achieve functional communication. The program claims to teach children to initiate communication and to generalise these skills to a variety of objects and communicative partners. The manual that accompanies this method of teaching describes procedures as empirically tested and describes very positive results. The PECS is an example of a behavioural program that uses ABA to teach functional communication via the strong visual modality characteristic of children with autism. This is in contrast to the oral/aural focus on speech development of the more traditional behavioural programs (e.g., Lovaas, 1987).
There are few well controlled studies that have evaluated PECS. Schwartz et al. (1998) conducted two studies that looked at the rate of acquisition of PECS and the program's effect on communication across settings and modalities in children with a range of disabilities including autism. All the children mastered the stages of PECS but the study was limited by the lack of a control group, the reliance on pre-school records for information, and the heterogeneous group of children studied. The second study indicated that the children increased their communicative functions and showed generalisation to settings outside the teaching situation. About half of this group developed spontaneous speech by the end of the PECS training and were found to continue to make gains in their verbal skills during observations after the end of the PECS teaching. Charlop-Christy, Carpenter, Loc, LeBlanc and Kellet (2002) studied three children with autism to determine the rate of acquisition and the effect on the children's verbalisations. They found that the children acquired the skills in an average time of 170 minutes and showed increases in their mean length of utterance. The findings of increased verbal speech in the latter two studies is an interesting phenomena given that functional communication, rather than verbal speech is the aim of the program and that the program has been criticised for the lack of emphasis on verbal skills (Richards, 2000).