Being a mother of a son on the autism spectrum, eclecticism was our choice. Our biggest breakthrough was intensive communication therapy at age 16. He literally had to sit and learn lists of words and phrases and when to use it. Getting a dog and train the dog also helped a lot. Getting him to join clubs with whatever interest was the top priority at that moment also helped - from back row observer to participant which either did not happen or took up to 2 years! He tried a support group/group therapy in early adulthood, but it was a disaster. The different levels of functioning and motivation pulled him down and caused resistance. The social scene of the group also caused anxiety.

It is an ongoing process and we address the needs as it pops up. My personal experience may be biased, but I think our success is the fact that eclectic therapy addressed what ever unique need he had for change at that very moment. Working with people living the autism spectrum, taught me to keep an open mind and be super flexible. There is not a one-size-fit-all solution.

Recommendations from 5-min.Clin.Consult, 2018:

GENERAL MEASURES

• Parent/school/patient education

• Work closely with teacher.

• Behavioral therapy/environmental changes

Behavioral interventions for ages 4 to 5 years and behavioral interventions plus stimulant medications as first-line treatment for ages 6 to 17 years (3)[A].

MEDICATION

• Stimulant choice should be based on cost, formulary, convenience, and

duration. A second type of stimulant should be tried if the first treatment fails.

All stimulant capsules can be opened and sprinkled (note Concerta is a pill).

First Line Stimulant:

• Dexmethylphenidate (initial: 2.5 mg BID; increase total daily by 2.5 to 5 mg weekly up to maximum dose of 20 mg/day; OR initial: 5 mg in a.m.; increase daily dose by 5 mg weekly up to maximum dose of 30 mg/day);

• Methylphenidate (Short-acting: initial 5 mg BID before breakfast and lunch; increase by 5 to 10 mg weekly to maximum dose of 60 mg/day (divided

BID/TID; OR Intermediate-acting: 20 mg once in a.m.; increase by 10 mg weekly up to 40 to 60 mg, or 10 mg BID; increase by 10 mg weekly to 40 to 60 mg; OR Long-acting: 20 mg in AM; increase by 10 to 20 mg weekly to 40 to 60

mg, or 20 mg in AM; increase 10 to 20 mg weekly until 40 to 60

mg.)

Nonstimulant:

• SNRI (Atomoxetine: ≤70 kg: 0.5 mg/kg/day initial; increase after a minimum of 3 days to target dose of 1.2 mg/kg/day; maximum of 1.4 mg/kg/day; >70 kg: 40 mg daily; increase after minimum of 3 days to target dose of 80 mg/day; dose may be increased to maximum of 100 mg/day after additional 2 to 4 weeks);

• α2-Agonist, modest efficacy, high side effects (Clonidine XR: 0.1 mg once daily at bedtime; increase by 0.1 mg weekly; doses should be taken twice daily with equal or higher split dosage given at HS; maximum of 0.4 mg/day; taper when discontinued.)

One of the greatest challenges facing scientists and therapists is the lack of a universal model for working with children with autism. This is due to the large differences between them, due to differences in the origin of the disorder, early developmental features, time of diagnosis, and so on. All this determines the need for complex therapy, leading directions of which should be linguistic, motor and behavioral. Determining the effect are the plan's work plan and the engagement of parents in it.

Autism spectrum disorder being a highly heterogeneous group of disorder as Deidre Pretorius stated it is unlikely that there could be a one-size-fit-all solution. treatment should be highly individualized.

DSM-5 recommends use of specifiers along with the diagnosis of ASD which implies the need of personalized treatment in accordance with the specifiers.

Level of care should be determined based on severity (from out-patient care to institutionalized care)

Treatment of core-symptoms using behavioral therapies and speech and language therapy.

Treatment of cor-morbid ,medical diseases associated with ASD phenotype

( e.g. treatable inborn errors (homocystinuria, biotinidase deficiency, PKU and ect.)

Treatment of co-morbid psychiatric conditions such as ADHD using behavioral therapies and psychopharmacotherapy. ( Vugar J Jalilov )

Even though the literature does not support use of Improvisational music therapy in treating co-symptoms of ASD, it may be useful in a subgroup of children with lesser severity.

eclecticism/joint therapies should be used as early as possible in treating children with ASD as brain plasticity in early childhood may compensate for the impaired neuronal pathways...

There is a big mistake among therapists of children with autism. Due to the strong memory, children learn mechanically to remember images, words, letters and numbers, the meanings of which they usually do not understand. Such learning is self-directed, as children can not apply knowledge in practice. I think the greatest attention should be paid to the self-care skills (eating, washing, dressing, shoes, etc.) that children do not know, which makes them helpless. The work on motor functions and praxis is decisive and should be based on other types of therapy. It is known that movements are the first and primary function of the nervous system.

There were over 1200 anecdotal reports of autism improvement using N1N3bis 2 mercaptoisothalamide (NBMI) or OSR#1 for short from 2008-2010. The compound was removed from the market by the FDA due to the parents of autistic children blogging about how it had helped their child. The company made no claims except that it quenches oxidative stress. 2.5 million doses sold as a supplement with adverse event tracking and there were no drug related adverse events reported. In 2010 the FDA issued a cease and desist order due to numerous parental reports of benefits for autistic children.

It is now almost 10 years later and nearly through the FDA and EMA's drug approval process with phase 1 and two phase 2 trials completed for safety and efficacy. The US FDA review panel acknowledged safety 3/2019 and as a result only want further animal testing which will take about 2 more years and no more human trials will be required. We are confident the animal testing will find similar results to the past studies that found animals given extremely large amounts of NBMI are totally healthy and look much better than normal controls.

If you need the compound immediately you will have to travel to either New Zealand or Lebanon where it is available as an unapproved orphan drug. There are Chinese knockoff but testing shows they are highly contaminated. @boyd haley

An approach used with young children with ASD which has shown positive short- and long-term effects is PACT (parent-mediated communication-focussed treatment. Reference is:

Green, J., Charman, T. & McConachie, H. et al., (2010). Parent-mediated communication-focussed treatment in children with autism (PACT): a randomised controlled trial. The Lancet, 375 (9732), 2152-2160.

Pickles, A., LeCouteur, A. Leadbetter, A. et al., (2016). Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial. The Lancet, 388 (10059), 2501-2509.

Thank you so much Dawn Bernadette Male!

I don't think there will ever be a magic bullet for autism. I am autistic and I was diagnosed as an adult. I have a personalized communication passport which is very useful for people to understand me. Music therapy is useful and activities to build a child self esteem. Social stories are brilliant. There is a lot more study needed around probiotics, acupuncture and the role of hormones in autism before we can say these will be useful interventions.

Have you heard of the social communication approach called Intensive Interaction (Nind & Hewett, 1994)? You can see some of the published resources and research summaries here: https://www.intensiveinteraction.org/resources/publications-bibliography/

Psycho-education is most important: learning what makes one different and why.

Auti-coaching is also very good it gives handles to cope and to blend in. The chosen methode ( ACT, RTF...) doesn't really matter. The auti-coach can tackle subject by subject.

Some cognitive therapy might also be very useful.

Some therapies or methods tend to focus too much on a set structure and since every ASD-case is different they often prove to be disappointing. Some authors such as Delfos come up with complete nonsense.

Marcin Boryczko Thanks for sharing this topic amongst the members.

Thanks, dear Indika Neluwa-Liyanage for your useful response

Regards

Amina

Applied behavior analysis (ABA) is considered the gold standard treatment for symptoms of autism spectrum disorder. I have attached a single meta analysis here, but there are hundreds of studies documenting its effectiveness.

https://www.sciencedirect.com/science/article/abs/pii/S1750946718300485

The neurobiological origin of autism and its individual manifestation explain the existence of different approaches to therapy. The effect of them depends on the individual combination of symptoms and the predominant influance of a particular type of them. Among all tha variety there are obligatory symptoms - impaired emotional development, which require separate type of therapy, in parallel with that of other disorders (language, sensory-motor, ect.).

The debate over which are the best therapies for children with autism does not stop. Many scientists constantly point out the advantages of behavioral therapies, but there is no clear statistical evidence for this. The reason is the individual nature of the manifestation of the pathology, which does not allow unification of the therapies and acceptance of one as the most successful. In addition, behavior is a very broad category that does not have a central core. In my opinion, the goal of any therapy should be aimed at forming skills for a full independent life: awareness of behavior (of others and one's own) in different situations, self-care skills, communication skills (verbal and nonverbal), care for one's own health. . This wide range of qualities implies a wide range of therapies, as each quality "steps" on a different basis (cognitive, motor, emotional).