Research has shown that intensive behavioral therapy during the toddler or preschool years can significantly improve cognitive and language skills in young kids with Aspergers. There is no single best treatment for all kids with Aspergers, but the American Academy of Pediatrics recently noted common features of effective early intervention programs. These include:
- Encouraging activities that include typically developing kids, as long as such activities help meet a specific learning goal
- Guiding the youngster in adapting learned skills to new situations and settings and maintaining learned skills
- Having small classes to allow each youngster to have one-on-one time with the therapist or teacher and small group learning activities
- Having special training for moms and dads and family
- Measuring and recording each youngster's progress and adjusting the intervention program as needed
- Providing a high degree of structure, routine, and visual cues, such as posted activity schedules and clearly defined boundaries, to reduce distractions
- Providing focused and challenging learning activities at the proper developmental level for the youngster for at least 25 hours per week and 12 months per year
- Starting as soon as a youngster has been diagnosed with Aspergers
- Using a curriculum that focuses on:
- Cognitive skills, such as pretend play or seeing someone else's point of view- Language and communication
- Research-based methods to reduce challenging behaviors, such as aggression and tantrums
- Self-help and daily living skills, such as dressing and grooming
- Social skills, such as joint attention (looking at other people to draw attention to something interesting and share in experiencing it)
- Typical school-readiness skills, such as letter recognition and counting
One type of a widely accepted treatment is Applied Behavior Analysis (ABA). The goals of ABA are to shape and reinforce new behaviors, such as learning to speak and play, and reduce undesirable ones. ABA, which can involve intensive, one-on-one child-teacher interaction for up to 40 hours a week, has inspired the development of similar interventions that aim to help children with Aspergers reach their full potential. ABA-based interventions include:
- Pivotal Response Training: Aims at identifying pivotal skills, such as initiation and self-management that affect a broad range of behavioral responses. This intervention incorporates parent and family education aimed at providing skills that enable the youngster to function in inclusive settings.
- Verbal Behavior: Focuses on teaching language using a sequenced curriculum that guides kids from simple verbal behaviors (echoing) to more functional communication skills through techniques such as errorless teaching and prompting.
Other types of early interventions include:
- TEACCH (Treatment and Education of Autistic and related Communication handicapped Kids): Emphasizes adapting the youngster's physical environment and using visual cues (e.g., having classroom materials clearly marked and located so that students can access them independently). Using individualized plans for each student, TEACCH builds on the youngster's strengths and emerging skills.
- Interpersonal Synchrony: Targets social development and imitation skills, and focuses on teaching kids how to establish and maintain engagement with others.
- Developmental, Individual Difference, Relationship-based (DIR) / Floortime Model: Aims to build healthy and meaningful relationships and abilities by following the natural emotions and interests of the youngster. One particular example is the Early Start Denver Model, which fosters improvements in communication, thinking, language, and other social skills and seeks to reduce atypical behaviors. Using developmental and relationship-based approaches, this therapy can be delivered in natural settings such as the home or pre-school.
For kids younger than age 3, these interventions usually take place at home or in a youngster care center. Because moms and dads are a youngster's earliest educators, more programs are beginning to train moms and dads to continue the therapy at home.
Children with Aspergers may benefit from some type of social skills training program. While these programs need more research, they generally seek to increase and improve skills necessary for creating positive social interactions and avoiding negative responses. For example, Children’s Friendship Training focuses on improving kid's conversation and interaction skills and teaches them how to make friends, be a good sport, and respond appropriately to teasing.
Working With Schools—
Start by speaking with your youngster's teacher, school counselor, or the school's student support team to begin an evaluation. Each state has a Parent Training and Information Center and a Protection and Advocacy Agency that can help you get an evaluation. A team of professionals conducts the evaluation using a variety of tools and measures. The evaluation will look at all areas related to your youngster's abilities and needs.
Once your youngster has been evaluated, he has several options, depending on the specific needs. If your youngster needs special education services and is eligible under the Individuals with Disabilities Education Act (IDEA), the school district (or the government agency administering the program) must develop an individualized education plan, or IEP specifically for your youngster within 30 days.
IDEA provides free screenings and early intervention services to kids from birth to age 3. IDEA also provides special education and related services from ages 3 to 21. Information is available from the U.S. Department of Education.
If your youngster is not eligible for special education services (not all kids with Aspergers are eligible) he can still get free public education suited to his or her needs, which is available to all public-school kids with disabilities under Section 504 of the Rehabilitation Act of 1973, regardless of the type or severity of the disability.
The U.S. Department of Education's Office for Civil Rights enforces Section 504 in programs and activities that receive Federal education funds. More information on Section 504 is available on the Department of Education website.
During middle and high school years, your youngster's educators will begin to discuss practical issues such as work, living away from a parent or caregiver's home, and hobbies. These lessons should include gaining work experience, using public transportation, and learning skills that will be important in community living.
Some medications can help reduce symptoms that cause problems for your youngster in school or at home. Many other medications may be prescribed off-label, meaning they have not been approved by the U.S. Food and Drug Administration (FDA) for a certain use or for certain people. Physicians may prescribe medications off-label if they have been approved to treat other disorders that have similar symptoms to Aspergers, or if they have been effective in treating adults or older kids with Aspergers. Physicians prescribe medications off-label to try to help the youngest patients, but more research is needed to be sure that these medicines are safe and effective for kids and teens with Aspergers.
At this time, the only medications approved by the FDA to treat aspects of Aspergers are the antipsychotics risperidone (Risperdal) and aripripazole (Abilify). These medications can help reduce irritability—meaning aggression, self-harming acts, or temper tantrums—in kids ages 5 to 16 who have Aspergers.
Some medications that may be prescribed off-label for kids with Aspergers include the following:
- Stimulant medications, such as methylphenidate (Ritalin), are safe and effective in treating people with attention deficit hyperactivity disorder (ADHD). Methylphenidate has been shown to effectively treat hyperactivity in kids with Aspergers as well. But not as many kids with Aspergers respond to treatment, and those who do have shown more side effects than kids with ADHD and not Aspergers.
- Antipsychotic medications are more commonly used to treat serious mental illnesses such as schizophrenia. These medicines may help reduce aggression and other serious behavioral problems in kids, including kids with Aspergers. They may also help reduce repetitive behaviors, hyperactivity, and attention problems.
- Antidepressant medications, such as fluoxetine (Prozac) or sertraline (Zoloft), are usually prescribed to treat depression and anxiety but are sometimes prescribed to reduce repetitive behaviors. Some antidepressants may also help control aggression and anxiety in kids with Aspergers. However, researchers still are not sure if these medications are useful; a recent study suggested that the antidepressant citalopram (Celexa) was no more effective than a placebo (sugar pill) at reducing repetitive behaviors in kids with Aspergers.
The Aspergers Comprehensive Handbook