Can Autism Spectrum Be Treated

Psychiatry, Psychosomatics & Psychotherapy

Depending on the age, severity of the illness, other comorbid psychiatric disorders and cognitive skills, different psychotherapeutic and medicinal forms of therapy are necessary. Basically, they must be autism-specific, i.e. the specific limitations and skills of patients with autism spectrum disorders must be observed and treated. In general, patients with autism spectrum disorders need a manageable, predictable environment in order to feel safe. This applies to the situation of psychotherapy (individual or group) as well as to school and work as well as parental and medical treatment of patients. Psychoeducation and the involvement of parents and key caregivers should be part of every therapy. The older the children are, the more necessary it is to be informed about one's own clinical picture as part of a related psycho-education.

The early intensive behavior therapy has been researched relatively well and shows - with sufficient intensity and duration - good effects on cognitive skills. Natural or incidental learning is particularly helpful in promoting spontaneous speech and language skills. In small groups closely guided by behavioral therapy, social interaction with peers can be practiced successfully even in preschool age if the child has already mastered interaction with adults well.

Small children with autism spectrum disorders are motivated by operant procedures to first practice the correct use of toys and other exercise materials, play behavior, imitation and collective attention. This is followed by exercises in linguistic sounds, passive and active vocabulary ‘(also using picture cards) as well as non-verbal and verbal communication. In addition, the correct and communicative use of language as well as social interaction with peers and adults in play and in everyday situations are practiced. Depending on the need, toilet training, exposure to specific fears or compulsive acts, as well as training in everyday practical skills in psychotherapy can also take place. Attempts at behavior and appropriate behavior are first materially reinforced, then socially. For some children, very small step-by-step guidance is necessary as part of the discrete learning format on leadership (prompting), behavior chaining and behavior modification (shaping) with a lot of repetition and practice of individual steps. Other children learn basic skills more quickly on their own (especially if they are more easily affected and have better cognitive skills from the start). With these children, the discrete learning format is often no longer sufficient, but rather a little less, but still highly structured behavioral therapeutic methods of random or natural learning as well as the training of key behaviors and learning on the model then come into play. Ideally, parents as well as educators and teachers are involved in the therapy and work at home and in kindergarten / school in the same way with the child, at least on the same therapy goals. This increases the number of practice units and leads to a generalization of the skills learned. Generalization in particular is difficult for patients with autism spectrum disorder, which is why it must be practiced particularly well.

As a rule, early intervention is carried out from the age of approx. 2-3 years up to school enrollment (duration approx. 3 years). After that, further educational support should take place through the school. Autism-specific individual therapies have not been investigated and evaluated for primary school and adolescents. They are not in the foreground of further therapeutic efforts, but rather the psychoeducation of parents and teachers, whereby the supportive interaction with the children and adolescents in the school and at home is the main focus.

Training of social skills in the group

With children, adolescents and increasingly also with adults who are cognitively gifted, autism-specific social competence training in groups is particularly effective in order to improve social interaction, one's own action planning and one's own handling of anger and anger. The duration is usually 12 to 18 double hours; In some cases, group therapy can also last a year. A “refresher training” can take place after a break of half a year or a full year. So far there are no studies comparing limited to ongoing therapies. However, in order to prevent therapy fatigue and to promote the integration of children and adolescents into everyday school life and the circle of friends, a limited group therapy of approx. 4 - 6 months (i.e. 12 - 18 double hours per week) is recommended, as this is more goal-oriented and more focused on that Practice is geared towards everyday life.

Psychotherapeutic treatment of comorbid diseases

If there is a comorbid anxiety or obsessive-compulsive disorder, this can and should - if the cognitive prerequisites are met - be treated lege artis using classic cognitive behavioral therapy and exposure methods. Studies have shown that anxiety-specific group therapies in patients with Asperger's syndrome and anxiety disorder could significantly reduce anxiety.

Various psychotropic drugs help in particular with comorbid illnesses and additional behavioral problems. However, they can only alleviate the core autistic symptoms in the area of ​​stereotypical behavior. So-called atypical antipsychotics (e.g. risperidone) can improve self-aggression and aggression from others, as well as stereotypes and comorbid compulsions. Hyperactivity and impulsiveness (rash behavior) can be improved with special stimulants (e.g. methylphenidate) or atomoxetine. Remergil can help against depressive mood; occasionally also selective serotonin reuptake inhibitors (SSRI), which, however, have a much smaller effect than in non-autistic patients with depressive disorder.

Concomitant diseases such as epileptic seizures must be treated with appropriate medication (e.g. anti-epileptics).

To improve speech, movement and sensation, patients with autism spectrum disorder can also receive speech therapy, which can improve expressive language skills, tone and volume. Occupational therapy can also be effective when dealing with a wide range of materials and fine motor skills if there are corresponding difficulties. The effectiveness of music therapy, art therapy or therapy with animals (e.g. dolphins) has not yet been scientifically proven. Physiotherapy is usually not necessary, unless there are additional diseases that require physiotherapeutic treatment, such as scoliosis or infantile cerebral palsy.