Intervention Therapies & Support

Early intervention and ongoing support help autistic children and adults reach their unique potential. It is important to find the therapy approach and therapist that are a good fit for you.

Find approaches that are evidence-based, emerging or supportive therapies like the ones listed below. Note that not every treatment or approach may be readily available in your area.

Seek a professional who supports you or your child and uses positive approaches to help develop skills. The goal isn’t to change the individual or make them appear more neurotypical. Therapy can help an individual build skills, cope with stress, communicate in ways suited to their needs and wishes, and address behaviors that could hurt themselves or others. 

Finding the Right Therapy and Therapist for You

Think about which kind of therapy approach you prefer and ask questions to help you find the right therapist. If it’s for your child, observe sessions initially and keep an eye on how things are going. 

• How do they handle different situations? For example, how would they handle it if your child wasn’t agreeing to do something they asked them to? 
• How do they interact with you or your child? 
• How does your child seem to feel after a session? 

Consider the Costs and Availability 

Whether insurance will cover a particular therapy, therapist, practice or location varies widely. Each state, city and county may have different programs and potential funding to help families and autistic individuals. Ask questions and look into funding options including what your health insurance may or may not cover. Coverage and funding for adult services is more difficult. For more information see this article in the Milestones Autism Planning (MAP) Tool. 

There may be a long wait to get a first appointment with therapists, so making a first appointment while you are finalizing your plans may be helpful.

Avoiding Potentially Harmful or Scam Approaches

In seeking help families and individuals may hear about many different approaches and strategies. It is important to be careful about what you try and to avoid things that may be harmful, a scam, and/or a way to get money from you.

Autism is a lifelong condition and how an individual is naturally wired. Milestones cherishes each individual and is here to support people. We urge you to use caution and ensure any therapy or approach is sound and safe. If something sounds too amazing to be true, it probably is.

Buzzwords and phrases to watch for that mean you should probably avoid that strategy:

• It will “cure” autism 
• It will heal or reset your body
• It will eliminate all the toxins in your body
• It will heal or cure almost anything/a long list of disabilities or diseases  
• It sounds magical or too amazing to be true
• It costs a lot of money

The free Milestones autism helpdesk is here to support you.

Intervention Approaches to Consider:

Speech-Language Therapy addresses challenges with language and communication. For autistic individuals a Speech Language Pathologist (SLP) can build communication and social skills in a variety of settings like home, school, and work. SLPs can help develop an individual's skills in expressive language (what a person communicates), receptive language (what a person comprehends) or in using Augmented Alternative Communication (AAC) if needed.

Occupational Therapy helps individuals increase participation in daily living activities and develop adaptive skills. Occupational Therapy can help develop fine motor skills, needed for activities such as handwriting and manipulating small objects. An Occupational Therapist properly trained in sensory issues can also help in finding strategies, activities, and tools to meet an autistic person's individual sensory needs.

Applied Behavior Analysis (ABA) is a method of behavior modification using principles of operant conditioning, systematically analyzing and shaping behavior using techniques in which the targeted behavior is modified with reinforcement or punishment. Typically a Registered Behavior Technician (RBT) works directly with the individual, following a behavior intervention plan created by a Board Certified Behavior Analyst (BCBA).

• PIVIT Assessment Tool: This assessment is designed to help parents/caregivers advocate for what types of treatment design they desire and are comfortable with when beginning ABA services. This form will help to inform the clinician designing treatment by calling attention to personal and family values. It is not a diagnostic tool. 
• Note: A number of autistic individuals and other autism community members have expressed concerns with ABA, including that it is less effective long term and less ethical compared to other interventions. These discussions are ongoing.

Many common and useful tools for working with autistic children - such as breaking down tasks into steps (Task Analysis), visual supports, or social stories -  can be used across interventions.

Play Therapy is a form of psychotherapy or counseling that uses play in order to help a person explore and express their feelings and build various skills. Play therapy is different from play-based therapy. Play-based therapy is any intervention that incorporates play when working with children, while play therapy is a specific approach practiced by a Registered Play Therapist (RPT). It can be used with both children and adults. 

TEACCH (The Treatment and Education of Autistic and Communication Handicapped Children) is an approach developed specifically to support autistic individuals and consists of a framework called Structured Teaching. This method features strategies in which the environment and materials around an autistic person can be structured to be accessible to their unique ways of thinking. This generally falls into five areas: Physical Structure, Visual Schedules, Work Systems, Routines and Visual Strategies, and Visual Structure and Materials. 

Floortime (also known as DIRFloortime®) is a developmental relationship-based intervention designed specifically for young autistic children. It uses play-based intervention that helps a child develop skills including communication, self-regulation and problem-solving. Floortime is built on the idea of playfully engaging with the child by following their lead and interests and gradually, gently challenging them as a means to encourage further development. It is typically delivered in the home by a professional who has completed a Floortime certification program.

SCERTS® is an educational model and research-based framework designed to address the core needs and challenges of autistic individuals. SCERTS stands for Social Communication, Emotional Regulation, and Transactional Support. The first two areas focus on development of these skills for the autistic person, while the last (Transactional Support) focuses on helping those around the autistic person (family members, teachers, etc.) develop strategies, providing supports and creating an accessible environment. 

• Additional Resources about SCERTS®: 
  • https://scerts.com
  • https://barryprizant.com
  • https://autismlevelup.com

Social Skills Groups and Coaching can help autistic individuals develop desired social skills, provide a safe place to practice those skills, and/or simply have a group of other autistic, neurodivergent, or mix of autistic and neurotypical peers to socialize with. Some social skills groups focus more on building particular skills, while others function more casually to provide socializing opportunities with a facilitator. It may be provided by different types of therapists or facilitators such as a speech therapist, social worker, school guidance counselor, or peer-to-peer counselor. 

Supportive Therapies and Strategies

The following therapies and strategies are often combined with other therapy approaches or can serve a supplementary benefit to more central therapies. While not all listed here are designed specifically for autistic individuals, they can be helpful depending on each person’s needs and preferences.

Augmentative Alternative Communication (AAC) Strategies are any methods of communication other than speaking. AAC strategies are available for people of all ages and all ability levels if they have any difficulty communicating through speech. No-tech and low-tech options include gestures, writing, drawing, sign language, letter boards, or picture boards. High-tech options include applications on a tablet designed for alternative communication or using a dedicated speech-generating device that speaks through a computer-generated voice. A Speech Language Pathologist (SLP) can help with assessing and introducing what AAC strategies will work best for the individual.

Social Narratives and Social Stories™ convey information in a narrative format specifically designed to support autistic individuals. The purpose of Social Stories™ is to support the meaningful exchange of information between family members or professionals and an autistic individual of any age. Social Stories™ are not created with the purpose of directly changing behavior, but rather accurately, completely and neutrally conveying information about social situations in an accessible format, by which behavior change may naturally follow. A social story can be created by anyone supporting an autistic individual. For more information about social stories, visit: https://carolgraysocialstories.com

Trauma-Informed Therapy is an approach that always keeps in mind the potential that an individual could have trauma in their life or be at risk of encountering a traumatic event. Trauma-informed therapy can be particularly helpful for autistic populations, as research shows that autistic individuals are more vulnerable to being victims of certain traumas or may experience certain events as more traumatic than a neurotypical person. 

Additional Resources on Trauma-Informed Therapy:

• https://store.samhsa.gov/product/TIP-57-Trauma-Informed-Care-in-Behavioral-Health-Services/SMA14-4816
• https://traumainformedbehaviorsupport.com/trauma-informed-behavior-support-its-about-quality-of-life/

Neurodiversity-Affirming Therapy is a term used by providers who want to distinguish that they provide care based around the principles of neurodiversity. Neurodiversity is the idea that developmental and neurological differences are not inherently wrong, but rather a natural form of human diversity with both positive and negative aspects. For autistic individuals, neurodiversity-affirming therapists will usually take a strengths-based approach, rather than deficits-based, and will help the individual live their “best life as an autistic person,” rather than trying to eliminate or change autistic characteristics. In some cases a neurodiversity-affirming therapist may themselves be neurodivergent and/or autistic. For a directory of neurodivergent therapists: https://ndtherapists.com/

Collaborative Proactive Solutions (CPS) is an evidence-based, trauma-informed treatment model, developed by child psychologist Dr. Ross Greene, for helping address behavioral issues and conflict with children of any age. The child is involved in a problem-solving process that identifies and addresses the underlying “unsolved problems” behind the behavior. The CPS model has been shown to not only help resolve conflicts and reduce behavioral issues, but also help children develop essential problem-solving skills. For more information, visit https://www.cpsconnection.com/

Cognitive Behavioral Therapy (CBT) is a psychotherapeutic intervention that can be helpful for dealing with feelings of anxiety or depression. It works to help clients change their patterns of negative thoughts or behaviors, with the goal being to increasingly respond more effectively to those thoughts or behaviors when they occur. CBT is not an autism-specific therapy and should not be used to address autism-specific traits or challenges, however it can be helpful in some cases for co-occurring anxiety or depression common among autistic people. CBT can be provided by a licensed counselor, psychologist, or clinical social worker. Here is an additional resource: Cognitive behavioral therapy may be only mildly effective for anxious, autistic children | Spectrum | Autism Research News 

Physical Therapy can help with gross motor development, which is movement using large muscles in the body for activities like walking and running. Physical therapy may help autistic persons build muscle control and strength if this is an area of challenge for them. 

Music Therapy uses music to assist individuals address goals such as reducing stress or increasing self-expression. It can help autistic individuals develop skills in areas of communication, social interaction, self-expression and self-regulation, especially for those who show an interest in music or auditory stimulation.  

Equine-Assisted Therapy involves engaging in various activities with horses for the purpose of physical and mental health treatment. For autistic individuals, therapeutic horseback riding or hippotherapy can help improve muscle tone, coordination, speech skills and personal confidence. Hippotherapy should be delivered by a licensed physical therapist, occupational therapist, or speech therapist. 

Service Animals or Animal-Assisted Therapy use animals to help assist individuals or provide therapeutic value. Service animals, most often service dogs, are trained to help a person with specific medical needs, such as alerting to epileptic seizures, stopping self-injurious behavior, or noticing signs of anxiety and performing calming actions such as laying across the person’s lap. It is important that service animals are properly trained and certified.

Additional Reading

"For Whose Benefit?: Evidence, Ethics and Effectiveness of Autism Interventions" -- Autistic Self-Advocacy Network (ASAN)

Therapist Neurodiversity Collective -- an international neurodiversity-affirming therapy, education, and advocacy organization

Supporting Autistic Children Guideline -- recommendations from Australia's National Health and Medical Research Council

Treatment and Intervention Services for Autism Spectrum Disorder -- Centers for Disease Control and Prevention

Autism Strategies and Interventions -- The Spectrum, an Autism SA Initiative