Children with autism spectrum disorder (ASD) have difficulties navigating everyday situations. Read on to learn more from the American Academy of Pediatrics about communication, social, and sensory interventions.

Communication Interventions

Children with ASD may not understand the purpose of verbal and nonverbal communication. Thus, most, if not all, children will benefit from formal speech and language interventions. There is a wide range of severity of communication disorders in children with ASD. Some children can’t express themselves at all. They may need intensive treatment that may include teaching a nonverbal means of communication, such as using the Picture Exchange Communication System (PECS) or other picture-based systems or using electronic communication devices (such as speech-generating devices). The range of communication skills is quite variable, depending on the severity of ASD, including normal vocabulary and use of grammar but a delay or lack in the social use of language for conversation.

Many children with ASD who develop speech may communicate in unusual ways. Speech therapy must address these difficulties at different levels. Treatment is provided or directed by a trained speech-language pathologist. Family and other members of the team are also involved in the treatment plan. Therapy is aimed at using any effective means of providing communication while, at the same time, working to increase all levels of communication, including verbal output or speech. For children who do not use words, therapists will promote the use of natural gestures, teach sign language, or use pictures or a device to communicate. Some parents worry that these methods will prevent their child from learning words. Research supports the opposite conclusion: children who have developed some means of communication, even if it is nonverbal, may develop speech skills more quickly. PECS is a nonverbal visual language system that uses photographs, line drawings, and pictures to teach children to request items that they want or need. Visual language systems such as pictures and signs are paired with spoken language and can be used to teach basic aspects of communication.

The communication program is usually a part of a larger developmentally or behaviorally based program. The speech-language pathologist should help the other team members make sure communication goals are included in the service plan and addressed in the educational setting.

For children with ASD and fluent language, goals of treatment should include a focus on the social use of language, back-and-forth conversation, and building social skills and relationships. Any treatment program must include frequent reassessment of progress, and goals should be adjusted as needed.

Social Skill Interventions

Many children with ASD learn to interact through communication. Joint attention is a building block for later social and communication skills. In fact, research studies have shown that functional language often begins to develop about 1 year after a child has mastered joint attention. Joint attention and communication are most efficiently learned in daily interactions in the family. Learning experiences should be incorporated into a child’s regular daily activities. These activities should begin as early as possible, as soon as language delays are identified if any are identified.

Outside the family, the most important strategy in improving social skills is providing children with ASD with as many opportunities as possible to play and interact with typically developing peers. As children with ASD get older, they will need explicit teaching to learn to interact appropriately with peers at school and in the community. This teaching should include direct social skills therapy sessions as well as coaching and support in class and less structured times such as lunch and recess.

Theory of Mind: Seeing Things as Others See Them

Theory of mind is the ability to see things from another person’s point of view. This skill naturally develops in typically developing children at about 4 years of age.

The ability to see things from the perspective of another person builds on earlier developmental capacities. To understand the intentions and feelings of others, children must first master joint attention and feel pleasure or joy in connecting with others. They then need to experience the wishes or feelings of others through back-and-forth exchanges of gestures and sounds. It is through experiencing other people’s gestures and sounds and responding to them that children begin to understand how other people feel. When children begin to be able to use words, true signs, or picture symbols, they can give a voice to this gradually emerging understanding of the intentions and feelings of others. They begin to show the capacity for taking the perspective of someone else, including empathy, or a theory of mind.

Social Stories

Once a child has more language, instruction may progress to social stories.

In this approach to help a child with ASD learn how to behave in various situations, a script or cartoon is created showing how the child might feel and appropriate ways to respond. Sample social stories published in books provide information about various social situations through the use of pictures and text to prepare a child before he actually encounters a similar setting. The stories provide a springboard for back-and-forth discussion about what conversations and behaviors might be expected to occur in that setting to offer suggestions to the child and prevent difficulties and embarrassment. The use of social stories is supplemented with modeling and role-playing of appropriate behaviors as well as corrective feedback. This technique may still be very helpful even in teen and adult years. Parents or caregivers are encouraged to create novel stories with multiple variations and twists on the published stories that are better suited for their own child’s activities, situation, and level of understanding.

Other approaches to social skill development include having children with ASD interact with other children without ASD in group settings. This may include structured play or conversational activities with a trained adult at home or school.

Sensory-Motor Interventions

Many children with ASD seem to have unusual sensory aversions or cravings. They may dislike touch, hugging, certain sounds such as motors or machinery, textures, and consistency of certain foods. It is difficult to understand the meaning of such aversions for these children. There may be other behaviors that children use to actively seek certain sensations, such as smell or deep pressure. Some children engage in repetitive self-stimulating behaviors such as rocking back and forth, spinning, self-injurious behavior (such as self-biting, head banging, and skin picking), and repetitive oral exploration (mouthing) of nonedible objects.

It has been suggested that children with ASD may have difficulties with sensory integration. Basic brain research is revealing that people with ASD may have difficulty processing information that comes in through visual, hearing, and other sensory pathways at the same time.

Sensory overload has been cited as a potential cause of tantrums or disruptive behaviors. Children with ASD may seem to ignore or crave sensory input. Sensory processing difficulties are symptoms of central nervous system problems that are common in people with a variety of developmental disabilities and are not unique to ASD.

Sensory integration therapy as currently provided by occupational therapists uses procedures such as deep pressure, brushing, wearing a weighted vest, and swinging to regulate sensory input. These therapies seem to have a calming effect on some children and are often cited as proof that they are effective.

Although such interventions are widely practiced and currently being studied, little data support the claims of benefits of such interventions at this time. Other interventions, such as auditory integration training (AIT) or behavioral optometry, are also used to regulate or change the response to sensory input. They also currently lack data to support their claims. These latter interventions are not endorsed by the AAP.

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