Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Autism spectrum disorder in children and adolescents: Behavioral and educational interventions

Laura Weissman, MD
Carolyn Bridgemohan, MD
Section Editors
Marilyn Augustyn, MD
Marc C Patterson, MD, FRACP
Deputy Editor
Mary M Torchia, MD


Autism spectrum disorder (ASD) is a biologically based neurodevelopmental disorder characterized by impairments in two major domains: 1) deficits in social communication and social interaction and 2) restricted repetitive patterns of behavior, interests, and activities [1]. ASD encompasses disorders previously known as autistic disorder (classic autism, sometimes called early infantile autism, childhood autism, or Kanner's autism), childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified, and Asperger disorder (also known as Asperger syndrome). (See "Autism spectrum disorder: Diagnosis", section on 'Diagnostic criteria' and "Asperger syndrome (a specific autism spectrum disorder): Clinical features and diagnosis in children and adolescents" and "Asperger syndrome (a specific autism spectrum disorder): Management and prognosis in children and adolescents".)

The discussion that follows will focus on behavioral and educational interventions for children with ASD. Related topics are presented separately:

(See "Autism spectrum disorder: Terminology, epidemiology, and pathogenesis".)

(See "Autism spectrum disorder: Clinical features".)

(See "Autism spectrum disorder: Diagnosis".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jun 14, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. American Psychiatric Association. Autism spectrum disorder. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA 2013. p.50.
  2. Maglione MA, Gans D, Das L, et al. Nonmedical interventions for children with ASD: recommended guidelines and further research needs. Pediatrics 2012; 130 Suppl 2:S169.
  3. Myers SM, Johnson CP, American Academy of Pediatrics Council on Children With Disabilities. Management of children with autism spectrum disorders. Pediatrics 2007; 120:1162.
  4. Myers SM. Management of autism spectrum disorders in primary care. Pediatr Ann 2009; 38:42.
  5. Lai MC, Lombardo MV, Baron-Cohen S. Autism. Lancet 2014; 383:896.
  6. Spence SJ, Thurm A. Testing autism interventions: trials and tribulations. Lancet 2010; 375:2124.
  7. National Research Council, Committee on Educational Interventions for Children with Autism. Educating Children with Autism, Lord C, McGee JP (Eds), National Academy Press, Washington, DC 2001.
  8. New York State Department of Health Early Intervention Program. Clinical practice guideline: The guideline technical report: Autism/Pervasive developmental disorders assessment and intervention for young children (age 0-3 years). Publication No. 4217, Albany, NY 1999.
  9. Seida JK, Ospina MB, Karkhaneh M, et al. Systematic reviews of psychosocial interventions for autism: an umbrella review. Dev Med Child Neurol 2009; 51:95.
  10. Ospina MB, Krebs Seida J, Clark B, et al. Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review. PLoS One 2008; 3:e3755.
  11. Spreckley M, Boyd R. Efficacy of applied behavioral intervention in preschool children with autism for improving cognitive, language, and adaptive behavior: a systematic review and meta-analysis. J Pediatr 2009; 154:338.
  12. Howlin P, Magiati I, Charman T. Systematic review of early intensive behavioral interventions for children with autism. Am J Intellect Dev Disabil 2009; 114:23.
  13. Parr J. Autism. In: Clinical Evidence Handbook, BMJ Publishing Group, London 2008. p.69.
  14. Bassett K, Green CJ, Kazanjian A. Autism and Lovaas treatment: A systematic review of effectiveness evidence. Office of Health Technology Assessment, Centre for Health Services and Policy Research (BCOHTA); 2000. Available at: www.chspr.ubc.ca/node/351 (Accessed on May 18, 2010).
  15. The National Autism Center's National Standards Report. National Autism Center, Randolph, MA, 2009. Available at: www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf (Accessed on May 18, 2010).
  16. Scottish Intercollegiate Guidelines Network. Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders. A national clinical guideline. Scottish Intercollegiate Guidelines Network, Edinburgh 2007. www.sign.ac.uk/guidelines/fulltext/98/index.html (Accessed on November 10, 2011).
  17. Reichow B, Wolery M. Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA young autism project model. J Autism Dev Disord 2009; 39:23.
  18. McConachie H, Diggle T. Parent implemented early intervention for young children with autism spectrum disorder: a systematic review. J Eval Clin Pract 2007; 13:120.
  19. Warren Z, McPheeters ML, Sathe N, et al. A systematic review of early intensive intervention for autism spectrum disorders. Pediatrics 2011; 127:e1303.
  20. Kasari C, Gulsrud A, Freeman S, et al. Longitudinal follow-up of children with autism receiving targeted interventions on joint attention and play. J Am Acad Child Adolesc Psychiatry 2012; 51:487.
  21. Reichow B, Barton EE, Boyd BA, Hume K. Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev 2012; 10:CD009260.
  22. Fletcher-Watson S, McConnell F, Manola E, McConachie H. Interventions based on the Theory of Mind cognitive model for autism spectrum disorder (ASD). Cochrane Database Syst Rev 2014; :CD008785.
  23. Baird G, Charman T, Cox A, et al. Current topic: Screening and surveillance for autism and pervasive developmental disorders. Arch Dis Child 2001; 84:468.
  24. Rutter M. Autism: its recognition, early diagnosis, and service implications. J Dev Behav Pediatr 2006; 27:S54.
  25. Howlin P. Practitioner review: psychological and educational treatments for autism. J Child Psychol Psychiatry 1998; 39:307.
  26. Rogers SJ. Empirically supported comprehensive treatments for young children with autism. J Clin Child Psychol 1998; 27:168.
  27. Dawson G, Osterling J. Early intervention in autism: effectiveness and common elements of current approaches. In: The Effectiveness of Early Intervention: Second Generation Research, Guralnick MJ (Ed), Paul Brookes, Baltimore 1997. p.307.
  28. Zwaigenbaum L, Bryson S, Lord C, et al. Clinical assessment and management of toddlers with suspected autism spectrum disorder: insights from studies of high-risk infants. Pediatrics 2009; 123:1383.
  29. Orinstein AJ, Helt M, Troyb E, et al. Intervention for optimal outcome in children and adolescents with a history of autism. J Dev Behav Pediatr 2014; 35:247.
  30. Ruble LA, McGrew J, Dalrymple N, Jung LA. Examining the quality of IEPs for young children with autism. J Autism Dev Disord 2010; 40:1459.
  31. Schreibman L, Dawson G, Stahmer AC, et al. Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder. J Autism Dev Disord 2015; 45:2411.
  32. Weitlauf AS, McPheeters ML, Peters B, et al. Therapies for children with autism spectrum disorder: Behavioral interventions update. Comparative Effectiveness Review No. 137. Agency for Healthcare Research and Quality, August 2014. http://www.ncbi.nlm.nih.gov/books/NBK241444/ (Accessed on April 12, 2016).
  33. Levy SE, Mandell DS, Schultz RT. Autism. Lancet 2009; 374:1627.
  34. Rogers SJ, Vismara LA. Evidence-based comprehensive treatments for early autism. J Clin Child Adolesc Psychol 2008; 37:8.
  35. Matson JL, Benavidez DA, Compton LS, et al. Behavioral treatment of autistic persons: a review of research from 1980 to the present. Res Dev Disabil 1996; 17:433.
  36. Granpeesheh D, Tarbox J, Dixon DR. Applied behavior analytic interventions for children with autism: a description and review of treatment research. Ann Clin Psychiatry 2009; 21:162.
  37. Gillberg C, Steffenburg S. Outcome and prognostic factors in infantile autism and similar conditions: a population-based study of 46 cases followed through puberty. J Autism Dev Disord 1987; 17:273.
  38. Sigman M, McGovern CW. Improvement in cognitive and language skills from preschool to adolescence in autism. J Autism Dev Disord 2005; 35:15.
  39. Stevens MC, Fein DA, Dunn M, et al. Subgroups of children with autism by cluster analysis: a longitudinal examination. J Am Acad Child Adolesc Psychiatry 2000; 39:346.
  40. Hilton JC. Communication skills of young children diagnosed with autism: comparative effectiveness of applied behavior analysis and developmental, individual-difference, relationship-based interventions (dissertation). James Madison University, Harrisonburg, VA 2005.
  41. Farrell P, Trigonaki N, Webster D. An exploratory evaluation of two early intervention programmes for young children with autism. Educ Child Psychol 2005; 22:29.
  42. Ozonoff S, Cathcart K. Effectiveness of a home program intervention for young children with autism. J Autism Dev Disord 1998; 28:25.
  43. Panerai S, Ferrante L, Zingale M. Benefits of the Treatment and Education of Autistic and Communication Handicapped Children (TEACCH) programme as compared with a non-specific approach. J Intellect Disabil Res 2002; 46:318.
  44. Tsang SK, Shek DT, Lam LL, et al. Brief report: application of the TEACCH program on Chinese pre-school children with autism--Does culture make a difference? J Autism Dev Disord 2007; 37:390.
  45. Warren Z, Veenstra-VanderWeele J, Stone W, et al. Therapies for children with autism spectrum disorders. AHRQ Publicatin No.11-EHC029-EF, Agency for Healthcare Research and Quality; Rockville, MD 2011.
  46. Macalpine ML. Play in autism: the power of microdevelopment. Dissert ABst Int B: Sciences and Engineering 1999; 59:5593.
  47. Yoder P, Stone WL. A randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. J Speech Lang Hear Res 2006; 49:698.
  48. Aldred C, Green J, Adams C. A new social communication intervention for children with autism: pilot randomised controlled treatment study suggesting effectiveness. J Child Psychol Psychiatry 2004; 45:1420.
  49. McConachie H, Randle V, Hammal D, Le Couteur A. A controlled trial of a training course for parents of children with suspected autism spectrum disorder. J Pediatr 2005; 147:335.
  50. Kaale A, Smith L, Sponheim E. A randomized controlled trial of preschool-based joint attention intervention for children with autism. J Child Psychol Psychiatry 2012; 53:97.
  51. Kaale A, Fagerland MW, Martinsen EW, Smith L. Preschool-based social communication treatment for children with autism: 12-month follow-up of a randomized trial. J Am Acad Child Adolesc Psychiatry 2014; 53:188.
  52. Kasari C, Freeman S, Paparella T. Joint attention and symbolic play in young children with autism: a randomized controlled intervention study. J Child Psychol Psychiatry 2006; 47:611.
  53. Kasari C, Paparella T, Freeman S, Jahromi LB. Language outcome in autism: randomized comparison of joint attention and play interventions. J Consult Clin Psychol 2008; 76:125.
  54. Kasari C, Gulsrud AC, Wong C, et al. Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. J Autism Dev Disord 2010; 40:1045.
  55. Kasari C, Kaiser A, Goods K, et al. Communication interventions for minimally verbal children with autism: a sequential multiple assignment randomized trial. J Am Acad Child Adolesc Psychiatry 2014; 53:635.
  56. Kasari C, Lawton K, Shih W, et al. Caregiver-mediated intervention for low-resourced preschoolers with autism: an RCT. Pediatrics 2014; 134:e72.
  57. Dawson G, Rogers S, Munson J, et al. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics 2010; 125:e17.
  58. Estes A, Munson J, Rogers SJ, et al. Long-Term Outcomes of Early Intervention in 6-Year-Old Children With Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry 2015; 54:580.
  59. Bearss K, Johnson C, Smith T, et al. Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial. JAMA 2015; 313:1524.
  60. Green J, Charman T, McConachie H, et al. Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial. Lancet 2010; 375:2152.
  61. Oono IP, Honey EJ, McConachie H. Parent-mediated early intervention for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev 2013; :CD009774.
  62. Solomon R, Van Egeren LA, Mahoney G, et al. PLAY Project Home Consultation intervention program for young children with autism spectrum disorders: a randomized controlled trial. J Dev Behav Pediatr 2014; 35:475.
  63. Pickles A, Le Couteur A, Leadbitter K, et al. Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial. Lancet 2016; 388:2501.
  64. Golan O, Baron-Cohen S. Systemizing empathy: teaching adults with Asperger syndrome or high-functioning autism to recognize complex emotions using interactive multimedia. Dev Psychopathol 2006; 18:591.
  65. Silver M, Oakes P. Evaluation of a new computer intervention to teach people with autism or Asperger syndrome to recognize and predict emotions in others. Autism 2001; 5:299.
  66. Moore M, Calvert S. Brief report: vocabulary acquisition for children with autism: teacher or computer instruction. J Autism Dev Disord 2000; 30:359.
  67. Oxman J, Konstantareas MM, Liebovitz-Bojm SF. Simultaneous communication training and vocal responding in nonverbal autistic and autistic-like children. Int J Rehabil Res 1979; 2:394.
  68. Yoder PJ, Layton TL. Speech following sign language training in autistic children with minimal verbal language. J Autism Dev Disord 1988; 18:217.
  69. Goldstein H. Communication intervention for children with autism: a review of treatment efficacy. J Autism Dev Disord 2002; 32:373.
  70. Paul R, Sutherland D. Enhancing early language in children with autism spectrum disorders. In: Handbook of Autism and Pervasive Developmental Disorders, 3rd ed, Volkmar FR, Paul R, Klin A, Cohen D (Eds), John Wiley & Sons, Hoboken, NJ 2005. p.946.
  71. Millar DC, Light JC, Schlosser RW. The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: a research review. J Speech Lang Hear Res 2006; 49:248.
  72. Bondy A, Frost L. The Picture Exchange Communication System. Behav Modif 2001; 25:725.
  73. Layton TL. Language training with autistic children using four different modes of presentation. J Commun Disord 1988; 21:333.
  74. Reichow B, Steiner AM, Volkmar F. Social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD). Cochrane Database Syst Rev 2012; :CD008511.
  75. The Gray Center for Social Learning and Understanding. Available at: www.thegraycenter.org (Accessed on February 19, 2010).
  76. Kasari C, Rotheram-Fuller E, Locke J, Gulsrud A. Making the connection: randomized controlled trial of social skills at school for children with autism spectrum disorders. J Child Psychol Psychiatry 2012; 53:431.
  77. Landa RJ, Holman KC, O'Neill AH, Stuart EA. Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: a randomized controlled trial. J Child Psychol Psychiatry 2011; 52:13.
  78. Antshel KM, Polacek C, McMahon M, et al. Comorbid ADHD and anxiety affect social skills group intervention treatment efficacy in children with autism spectrum disorders. J Dev Behav Pediatr 2011; 32:439.
  79. Case-Smith J, Arbesman M. Evidence-based review of interventions for autism used in or of relevance to occupational therapy. Am J Occup Ther 2008; 62:416.
  80. Dawson G, Watling R. Interventions to facilitate auditory, visual, and motor integration in autism: a review of the evidence. J Autism Dev Disord 2000; 30:415.
  81. Section On Complementary And Integrative Medicine, Council on Children with Disabilities, American Academy of Pediatrics, et al. Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics 2012; 129:1186.
  82. Williames LD, Erdie-Lalena CR. Complementary, holistic, and integrative medicine: sensory integration. Pediatr Rev 2009; 30:e91.
  83. Baranek GT. Efficacy of sensory and motor interventions for children with autism. J Autism Dev Disord 2002; 32:397.
  84. Rogers SJ, Ozonoff S. Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence. J Child Psychol Psychiatry 2005; 46:1255.
  85. Schaaf RC, Miller LJ. Occupational therapy using a sensory integrative approach for children with developmental disabilities. Ment Retard Dev Disabil Res Rev 2005; 11:143.
  86. Weitlauf AS, Sathe N, McPheeters ML, Warren ZE. Interventions Targeting Sensory Challenges in Autism Spectrum Disorder: A Systematic Review. Pediatrics 2017; 139.
  87. Harris SL, Handleman JS, Jennett HK. Models of educational intervention for students with autism: home, center, and school-based programming. In: Handbook of Autism and Pervasive Developmental Disorders, 3rd ed, Volkmar FR, Klin PR, Cohen D (Eds), John Wiley & Sons, Hoboken, NJ 2005. p.882.