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Interventions

An intervention is any kind of activity that’s designed to improve your child’s quality of life. But which ones are available?

Boy using an iPad © Photo by Phil Ashley

Put simply, an intervention is any kind of activity that’s designed to improve your child’s quality of life. Treatments, therapies and provision of services are typical examples of an intervention, but there are lots of different kinds, and the number increases all the time.

When it comes to autism – a condition that affects almost everything in a person’s life – there’s a lot of variety in what an intervention aims to address. Some aim to address the ‘core symptoms’ (social communication and interaction, and restricted, repetitive behaviours and interests), while others try to tackle more specific issues such as anxiety or self-harming.

Beyond prescribing medication or advising medical procedures, a doctor may suggest any of the following:

  • Art therapy
  • Chiropody/podiatry (foot specialists)
  • Diets
  • Occupational therapy
  • Orthoptic lenses for visual sensitivity
  • Orthotics (foot supports)
  • Osteopathy
  • Physiotherapy
  • Psychotherapy
  • Speech and language therapy

Medical professionals are likely to use and recommend a wide range of techniques, and some health professionals often work together – for instance, occupational therapists, speech and language therapists (SALTs) and psychotherapists often collaborate in supporting the same patient.

However, there is a range of other interventions available beyond those that your doctor might typically recommend. As with many things related to autism, some interventions have good science backing them up while others don’t. A lot of interventions can be expensive and time-consuming – and if they aren’t done responsibly, they can be actually dangerous – so it’s important to do your research before you commit to any one in particular.

Our list of interventions below only provides an overview of the ones available. Please visit the Research Autism website for more detailed information.

(A practical note: we’ve sorted the interventions alphabetically for convenient scrolling. Since several of the terms we’ll be discussing are large catch-alls, some actual objects or methods may come up under more than one heading.)

Alternative and Augmentative Communication (AAC)

One of the most common problems for a child with autism is difficulty in using language. AAC is a catch-all term that covers any form of communication people may use if, for either physical or psychological reasons, everyday speech is a problem for them. In other words, AAC isn’t an autism-only treatment, but for some children dealing with autism, it can help them make themselves understood.

What’s the difference between ‘alternative’ and ‘augmentative’ communication systems? It’s fairly simple:

  • Alternative communication is designed to replace speech
  • Augmentative communication is designed to support and/or enhance speech

Another distinction you’re likely to encounter is between the ‘Unaided’ and ‘Aided’ systems of communication. The ‘aid’ in this case means a technological one:

  • Unaided AAC doesn’t require any kind of tool or equipment
  • Aided AAC uses a tool or device (which may or may not be electronic)

Examples of Unaided AAC Systems

  • Facilitated Communication: Also known as supported typing, this is a method where a ‘facilitator’ physically supports the child and helps him or her point at pictures or words. The concept is based on the idea that a lot of the difficulties of autism are caused by problems with movement rather than with understanding or communication. Research Autism states that they ‘do not believe that it is an appropriate intervention for people with autism.’
  • Sign Language: There are a lot of varieties that can be used here, from full adult languages like American Sign Language or British Sign language to disability - specific languages like Makaton – a simplified system designed to help children with language or motor difficulties express themselves. If you’ve ever watched CBeebies and seen Justin Fletcher, aka Mr Tumble, it’s Makaton he’s using.
  • Total Communication Training: Rather than being a single system, this is a tailored approach that makes use of signing, speech, written and visual aids depending on the needs and abilities of the particular child.

Examples of Aided AAC Systems

Aided AAC systems are often subdivided into ‘high tech’ and ‘low tech’.

Low Tech AAC uses non-electronic communication aids. Examples include:

  • Communication boards: The board shows words, photos and/or symbols to help the child understand.
  • Picture Exchange Communication System (PECS): The adult and child exchange picture cards to communicate – so, for instance, if the child is thirsty, he or she gives an adult the card with a picture of a drinking glass so the adult knows he or she wants a drink. The system of cards begins with teaching the child to express basic needs and progresses to more and more complex communication, including whole sentences.
  • PIC: This covers picture based AAC systems other than PECS.

High Tech AAC uses electronic devices. This doesn’t necessarily mean computers, though it can do: at the most basic end, high tech AAC can involve single message switches. Examples of high tech AAC include:

  • Mobile devices: Smartphones and tablets are common options, and there’s a burgeoning range of apps that can support a child’s communication.
  • Voice Output Communication Aids Devices, also known as VOCAs or Speech Generating Devices: At their most basic, this involves devices that play a single pre-recorded message when a button is pressed; more elaborate ones let users combine words to create whole sentences that the computer ‘speaks’.

In most cases, AAC systems can be very helpful for the right person; it’s largely a question of working out which will best suit your child.

Assistive and Adaptive Technology

This is a very broad term which basically means  gadgets that make life easier for your child.

Unsurprisingly, there are a lot of these. They’re sometimes divided into high tech and low tech; as with AAC, the distinction is that high tech involves something electronic and low tech doesn’t.

Behavioural and Developmental Interventions

There are a number of different schools when it comes to behavioural interventions, such as Applied Behaviour Analysis (ABA), Early Intensive Behavioural Interventions, and Pivotal Response Training.

Their unifying principle is that they aim to teach skills (such as social skills or being able to dress yourself) and discourage negative behaviours (such as violence or self harm). Exact methods vary, but all behavioural interventions rest on being systematic about the ‘behaviour’ they’re trying to teach, breaking a task down into smaller, more manageable steps and then teaching them in a structured manner.

Developmental interventions, meanwhile, focus on ‘core deficits’ – that is, they identify general issues that the child is struggling with, take note of things that he or she is already interested in or doing, and use those to help him or her develop. Therapists, teachers and/or parents may be involved: the programme usually starts by trying to build engagement and interaction, and then moves on to more specific skills such as logical reasoning and symbolic thinking.

In practice, behavioural and developmental interventions aren’t exactly two separate camps. To begin with, there’s plenty of overlap between them, as a lot of their most fundamental techniques, such as ‘modelling’ (demonstrating/setting an example) and ‘reinforcing’ (praise and/or rewards) are used by both. In addition, many combined/multi-component approaches include ideas from both, and many educational interventions use a bit of both as well. It’s possible to be purist about one or the other, but in terms of what you may be able to access, it’s quite possible what you’ll find is a bit of mix-and-match.

Biomedical Interventions

What does ‘biomedical’ mean? Actually, the answer may depend on who you ask. The guidance recently published by NICE uses the word to mean any biologically-based intervention, which includes medicines like antipsychotics. On the other hand, some people prefer to use the word to describe interventions that target purely physical (ie ‘biomedical’) issues, such as stomach problems, immune dysfunctions, detoxification abnormalities or nutritional difficulties. In other words, if you hear someone say ‘biomedical’, it’s probably smart to clarify whether they mean ‘medicine in general’ or if they mean ‘medicine for physical symptoms only’.

How relevant biomedical interventions will be to you, will depend entirely on your child. Supporters argue that a lot of the problems of autism are either caused or worsened by physical difficulties acting as ‘triggers’. By that logic, the right biomedical intervention should be able to solve the problems, or at least reduce them.

Biomedical interventions are wide ranging. Some of them are fairly mainstream, while others are what most doctors would describe as complementary or alternative medicine. Examples of the latter can include special diets, nutritional supplements and hormones, or ‘off-label’ use of medications – that is, using a medicine to treat something it’s not normally prescribed for. Some examples are particularly controversial; for instance, chelation therapy (chemically removing heavy metals from the body, ordinarily a treatment for mercury and lead poisoning) has been implicated in at least one death, and both it and hyperbaric oxygen therapy (breathing pure oxygen in a pressurized room or tube, ordinarily a treatment for decompression sickness) are treatments NICE specifically warns not to use as treatments for autism.

There are so many biomedical interventions available that it would be impossible to give all-purpose advice about them. The best thing to do, as with any medical intervention, is to make sure that if you decide to try something, you do it under the guidance of a trustworthy GP or other healthcare professional.

Complementary/Alternative Medicine

‘Complementary’ and ‘alternative’ are broad terms that cover any kind of health care system, practice or product that isn’t part of conventional Western medicine – that is, the kind practiced by doctors and their allied colleagues, such as nurses, osteopaths, physiotherapists and psychologists. The phrase ‘complementary and alternative medicine’ is sometimes shorted to CAM.

What’s the difference between complementary and alternative? Basically, complementary medicine works alongside conventional medicine: examples would include meditation-based therapy, animal-based therapy and yoga. Alternative medicine is used in place of conventional medicine, for example ayurvedic medicine, homeopathy and naturopathy.

As with any other medical intervention, you should make sure to consult a GP or other health professional before taking any risks.

Diets

A lot of people would argue that diet is a key factor when it comes to managing the problems people with autism face. The solutions they propose can be classed as special diets, dietary supplements or a combination of the two.

A special diet is one designed to increase the amount of certain nutrients someone takes in (such as omega-3), or to reduce others (such as gluten, casein or yeast), or both; you can read more on our diets page. A supplement is taken alongside regular eating in the form of a pill, tablet or similar.

Supplements sometimes suggested for people with autism include a great many options; common ones include:

  • Amino acids-based supplements, eg. Carnitine, Carnosine, Dimethylglycine, Glutamate, Glutamine, Glutathione, Phenylalanine, Piracetim, Taurine, Tryptophan and Tyrosine
  • Botanicals and botanical derivatives, eg. Ginkgo Biloba, Luteolin, Quercetin, St John's Wort and Yokukansan
  • Enzymes and enzyme derivatives, eg. Bromelain, Dipeptidyl Peptidase, Papain and Tetrahydrobiopterin (BH4)
  • Essential fatty acids, eg. Cholesterol, Omega 3 and Omega 6

There’s a common belief that supplements can’t do any harm, but many contain active ingredients that can pose risks. For example, according to the Office of Dietary Supplements: ‘... getting too much vitamin A can cause headaches and liver damage, reduce bone strength, and cause birth defects. Excess iron causes nausea and vomiting and may damage the liver and other organs.’ It’s important to talk to a GP or other healthcare professional before starting a course just to make sure you don’t run into any ill effects.

Motor/Sensory Intervention

It’s not uncommon for people with autism to have some difficulties with sensory issues and/or their motor function. It’s quite common for very young children with autism to be late developers with sitting up, walking and running, for example, and problems with certain sensations or sounds isn’t unusual either. Motor and sensory interventions aim to manage these.

Motor intervention covers any treatment or therapy which works with motor function (ie. movement), such as physiotherapy. Improved coordination and control are often the focus; this may be whole-body coordination or more specific. Two terms you’re likely to encounter are ‘gross motor skills’ and ‘fine motor skills’: ‘gross’ refers to big things like walking, while ‘fine’ refers to precise movements, particularly with using the hands and fingers. Children with autism may have difficulties with both, in which case motor intervention can help.

Sensory intervention aims to tackle sensitivities. If a child simply can’t bear certain noises or textures, sensory intervention aims to help them become better able to tolerate them so their quality if life isn’t so plagued by discomfort and stress.

There are also therapies, such as sensory integrative therapy and occupational therapy, which use both motor and sensory techniques. Some of these you can do at home with your son or daughter as well as taking him or her to a professional.

Physical activities such as sports, dance movement therapy or tai chi also come under the general heading of motor intervention. These can either work by improving a child’s coordination simply by practice (if you do a lot of yoga, say, it’s likely your balance will get better), or by helping him or her relax and feel more comfortable in his or her body (a calming massage, for instance).

Psychotherapy

What counts as psychotherapy? With so many schools of thought in lively debate with each other, it’s almost impossible to give a definition that nobody will quibble – but broadly speaking, ‘psychotherapy’ can mean one of two things: either a counselling/talking therapy, where you go to a trained professional, sit or lie down and talk through your feelings, or a broader definition that includes any kind of treatment that helps people to understand themselves and manage their feelings.

In practice, many good therapists consider it their duty to be well-informed about different schools of thought and use whatever’s useful from each (talking cure therapists, for instance, often take a bit of a pick-and-mix approach), so finding a therapist or programme that ‘gets’ your son or daughter and works well with him or her may be the most important thing. To help you start looking, though, here are some general categories:

  • Cognitive and behavioural therapies (CBT): These deal with thoughts and perceptions, and work on unlearning patterns that cause us distress.
  • Humanistic therapies: These aim to be holistic (i.e. looking at the person as a whole) and encourage the client/patient to think about their feelings and take responsibility for their thoughts and actions.
  • Creative therapies: (Though these can also be classed as psychodynamic therapies.) Art therapy, dance movement therapy, drama therapy, music therapy and play therapy would all be involved. Their purpose is not to get the child producing great works of art – he or she doesn’t need to have any ‘talent’ – but rather to help him or her express emotions in positive and empowering ways.
  • Mindfulness training: A mind-body approach that teaches meditation and relaxation techniques to help someone grow more aware of their feelings and better able to manage them calmly.

The fundamental rule when considering therapies is that the person undergoing them should find them a positive experience. Therapies that take extreme measures are more likely to be cruel than helpful, and for a child whose anxiety levels are likely to be unusually high to begin with, they can do serious damage. Look for therapists who are realistic and well-informed about the difficulties of autism but sympathetic to your child’s feelings and respectful of his or her rights, and if you feel instinctively uncomfortable, err on the side of caution. A good therapist can be very helpful, though, so find someone that both you and your child feel able to trust.

Which should I choose?

The range of interventions available for a child with autism is so board that no one website could cover them all; this is just a basic introduction of the most common ones. What will be best for your son or daughter is something that only you and they can decide.

The main principles are to make sure you consult a trustworthy professional before embarking on anything that might have side-effects, be a little skeptical of anyone who makes overly grandiose claims, and research any unconventional-sounding treatments to make sure they aren’t harmful or cruel. Many interventions, though, do make a really positive difference in a child’s health, wellbeing, skills and quality of life, so if you can find the ones that are right for your child, there’s a lot of support and help out there. 

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