Each autism intervention or treatment plan should be tailored to address the person's specific needs. A person’s treatment plan can include behavioral interventions, other therapies, medicines or a combination of these.
The therapies described below are evidence based, Autism Speaks Canada encourages parents and adults to pursue treatments that are evidence based and informed.
Applied Behavior Analysis (ABA) is a therapy based on the science of learning and behavior. ABA therapy applies our understanding of how behavior works to real situations. The goal is to increase behaviors that are helpful and decrease behaviors that are harmful or affect learning.
Behavior analysis helps us to understand:
ABA therapy programs can help:
The methods of behavior analysis have been used and studied for decades. They have helped many kinds of learners gain different skills – from healthier lifestyles to learning a new language. Therapists have used ABA to help children with autism and related developmental disorders since the 1960s.
Applied Behavior Analysis involves many techniques for understanding and changing behavior. ABA is a flexible treatment:
Positive reinforcement is one of the main strategies used in ABA.
When a behavior is followed by something that is valued (a reward), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change.
First, the therapist identifies a goal behavior. Each time the person uses the behavior or skill successfully, they get a reward. The reward is meaningful to the individual – examples include praise, a toy or book, watching a video, access to a playground or other location, and more.
Positive rewards encourage the person to continue using the skill. Over time this leads to meaningful behavior change.
Understanding antecedents (what happens before a behavior occurs) and consequences (what happens after the behavior) is another important part of any ABA program.
The following three steps – the “A-B-Cs” – help us teach and understand behavior:
Looking at A-B-Cs helps us understand:
How could ABA help the student learn a more appropriate behavior in this situation?
With continued practice, the student will be able to replace the inappropriate behavior with one that is more helpful. This is an easier way for the student to get what she needs!
A qualified and trained behavior analyst (BCBA) designs and directly oversees the program. They customize the ABA program to each learner’s skills, needs, interests, preferences and family situation.
The BCBA will start by doing a detailed assessment of each person’s skills and preferences. They will use this to write specific treatment goals. Family goals and preferences may be included, too.
Treatment goals are written based on the age and ability level of the person with autism. Goals can include many different skill areas, such as:
The instruction plan breaks down each of these skills into small, concrete steps. The therapist teaches each step one by one, from simple (e.g. imitating single sounds) to more complex (e.g. carrying on a conversation).
The BCBA and therapists measure progress by collecting data in each therapy session. Data helps them to monitor the person’s progress toward goals on an ongoing basis.
The behavior analyst regularly meets with family members and program staff to review information about progress. They can then plan ahead and adjust teaching plans and goals as needed.
The instructor uses a variety of ABA procedures. Some are directed by the instructor and others are directed by the person with autism.
Parents, family members and caregivers receive training so they can support learning and skill practice throughout the day.
The person with autism will have many opportunities to learn and practice skills each day. This can happen in both planned and naturally occurring situations. For instance, someone learning to greet others by saying “hello” may get the chance to practice this skill in the classroom with their teacher (planned) and on the playground at recess (naturally occurring).
The learner receives an abundance of positive reinforcement for demonstrating useful skills and socially appropriate behaviors. The emphasis is on positive social interactions and enjoyable learning.
The learner receives no reinforcement for behaviors that pose harm or prevent learning.
ABA is effective for people of all ages. It can be used from early childhood through adulthood!
A board-certified behavior analyst (BCBA) provides ABA therapy services. To become a BCBA, the following is needed:
ABA therapy programs also involve therapists, or registered behavior technicians (RBTs). These therapists are trained and supervised by the BCBA. They work directly with children and adults with autism to practice skills and work toward the individual goals written by the BCBA. You may hear them referred to by a few different names: behavioral therapists, line therapists, behavior tech, etc.
ABA is considered an evidence-based best practice treatment by the US Surgeon General and by the American Psychological Association.
“Evidence based” means that ABA has passed scientific tests of its usefulness, quality, and effectiveness. ABA therapy includes many different techniques. All of these techniques focus on antecedents (what happens before a behavior occurs) and on consequences (what happens after the behavior).
More than 20 studies have established that intensive and long-term therapy using ABA principles improves outcomes for many but not all children with autism. “Intensive” and “long term” refer to programs that provide 25 to 40 hours a week of therapy for 1 to 3 years. These studies show gains in intellectual functioning, language development, daily living skills and social functioning. Studies with adults using ABA principles, though fewer in number, show similar benefits.
It’s important to find an ABA provider and therapists who are a good fit for your family. The first step is for therapists to establish a good relationship with your child. If your child trusts their therapists and enjoys spending time with them, therapy will be more successful – and fun!
The following questions can help you evaluate whether a provider will be a good fit for your family. Remember to trust your instincts, as well!
The Early Start Denver Model (ESDM) is a behavioral therapy for children with autism between the ages of 12-48 months. It is based on the methods of applied behavior analysis (ABA).
Parents and therapists use play to build positive and fun relationships. Through play and joint activities, the child is encouraged to boost language, social and cognitive skills.
ESDM therapy can be used in many settings, including at home, at a clinic, or in school. Therapy is provided in both group settings and one-on-one.
It has been found to be effective for children with a wide range of learning styles and abilities. ESDM can help children make progress in their social skills, language skills, and cognitive skills. Children who have significant learning challenges can benefit just as much as those without learning challenges.
Parent involvement is a key part of the ESDM program. Therapists should explain and model the strategies they use so that families can practice them at home.
An ESDM therapist may be any of the following:
All therapists must have specific training and certification in EDSM. This process requires them to:
This ensures that a certified professional has the knowledge and skills to successfully use the teaching strategies with children with autism.
Visit the Early Start Denver Model website to learn more.
Autism Speaks Canada Autism Response Team is a helpful online community for anyone whose life has been impacted by autism – family members, peers, friends and autistic Canadians. Whether you’re looking for a certified therapist or trainer, or resources to help you through transitions, or need support from an inclusive, diverse community, this is the place for you. There is something for everyone. Try it out for free.
Over a dozen studies have demonstrated the benefits of ESDM as an early intervention for autism among children as young as 18 months. These studies included children across a wide range of learning abilities.
Many of these studies looked at ESDM delivered by trained therapists in one-on-one sessions with the child. One looked at ESDM delivered to groups of children in childcare. Others looked at the benefits of training parents to deliver ESDM therapy at home.
Benefits include improved learning and language abilities and adaptive behavior and reduced symptoms of autism. Research using brain scans suggests that ESDM improves brain activity associated with social and communication skills.
The following questions can help you learn more about ESDM before you begin. It can also help you learn whether a particular therapist is a good fit for your family:
Floortime is a relationship-based therapy for children with autism. The intervention is called Floortime because the parent gets down on the floor with the child to play and interact with the child at their level.
Floortime is an alternative to ABA and is sometimes used in combination with ABA therapies.
The goal is for adults to help children expand their “circles of communication.” They meet the child at their developmental level and build on their strengths.
Therapists and parents engage children through the activities each child enjoys. They enter the child’s games. They follow the child’s lead.
Floortime aims to help the child reach six key milestones that contribute to emotional and intellectual growth:
Therapists teach parents how to direct their children into more and more complex interactions. This process, called “opening and closing circles of communication,” is central to the Floortime approach.
Floortime does not work on speech, motor or cognitive skills in isolation. It addresses these areas through its focus on emotional development.
Overall, this method encourages children with autism to push themselves to their full potential. It develops “who they are,” rather than “what their diagnosis says.”
Floortime takes place in a calm environment. This can be at home or in a professional setting.
Therapy sessions range from two to five hours a day. They include training for parents and caregivers as well as interaction with the child.
During a session, the parent or provider joins in the child’s activities and follows the child’s lead. The parent or provider then engages the child in increasingly complex interactions.
Floortime encourages inclusion with typically developing peers when used in a preschool setting.
Sessions emphasize back-and-forth play. This builds the foundation for shared attention, engagement and problem solving. Parents and therapists help the child maintain focus to sharpen interactions and abstract, logical thinking.
If the child is tapping a toy truck, the parent might tap a toy car in the same way. The parent might then put the car in front of the child’s truck or add language to the game. This encourages the child to respond and interact.
As children grow, therapists and parents match the strategies with their child’s developing interests. They encourage higher levels of interaction.
For example, instead of playing with toy trucks, parents can engage with model airplanes or even ideas and academic fields of special interest to their child.
Families are encouraged to use Floortime principals in their day-to-day lives.
Floortime was created by child psychiatrists Stanley Greenspan, M.D. and Serena Wieder, PhD. It is based on the Developmental Individual-difference Relationship-based model (DIR). Dr. Greenspan developed the DIR model as therapy for children with a variety of developmental delays and issues in the 1980s.
Different types of professionals seek special training in Floortime techniques, including:
Parents and caregivers can also learn Floortime techniques through workshops, books and websites.
In a 2003 study, Dr. Greenspan and Dr. Weider studied Joey, a child on the autism spectrum who spent three years engaging in Floortime with his father. Over that time, Joey enjoyed six daily Floortime sessions. He continuously improved, and the two scientists concluded that Floortime helped Joey progress.
In 2007, a pilot study conducted by independent researchers likewise showed a Floortime benefit for children with autism. Two other 2011 studies—one conducted in Thailand and one in Canada—further supported Floortime as significantly improving emotional development and reducing autism’s core symptoms.
The following questions can help you learn more about Floortime before you begin. It can also help you learn whether a particular therapist is a good fit for your family:
Occupational therapy (OT) helps people work on cognitive, physical, social, and motor skills. The goal is to improve everyday skills which allow people to become more independent and participate in a wide range of activities.
For people with autism, OT programs often focus on play skills, learning strategies, and self-care. OT strategies can also help to manage sensory issues.
The occupational therapist will begin by evaluating the person’s current level of ability. The evaluation looks at several areas, including how the person:
The evaluation will also identify any obstacles that prevent the person from participating in any typical day-to-day activities.
Based on this evaluation, the therapist creates goals and strategies that will allow the person to work on key skills. Some examples of common goals include:
Occupational therapy usually involves half-hour to one-hour sessions. The number of sessions per week is based on individual needs.
The person with autism may also practice these strategies and skills outside of therapy sessions at home and in other settings including school.
Some OTs are specifically trained to address feeding and swallowing challenges in people with autism. They can evaluate the particular issue a person is dealing with and provide treatment plans for improving feeding-related challenges.
A licensed Occupational Therapist (OT) provides OT services. The accreditation standards set by the Canadian Association of Occupational Therapists (CAOT) accepts the master’s degree in occupational therapy as the minimal educational requirement. Applicants to every province other than Quebec must successfully complete the National Occupational Therapy Certification Exam (NOTCE), as a requirement of registration. In the Yukon, Northwest Territories and Nunavut, occupational therapists are not currently a regulated health profession and, as such, do not need to complete the NOTCE to practice in the Territories.
In some cases, therapy services are provided by an Occupational Therapy Assistant (OTA). This is a person with an associate’s or bachelor’s degree, who is trained and supervised by a certified OT. The assistant works directly with the person with autism to practice skills and work towards goals that are written by the OT in the clinical treatment plan.
Pivotal Response Treatment (PRT) is a behavioral treatment for autism. This therapy is play-based and initiated by the child. PRT is based on the principles of Applied Behavior Analysis (ABA).
Goals of this approach include:
The PRT therapist targets “pivotal” areas of a child’s development instead of working on one specific behavior. By focusing on pivotal areas, PRT produces improvements across other areas of social skills, communication, behavior and learning.
Pivotal areas include:
Motivation strategies are an important part of the PRT approach. These emphasize natural reinforcement.
For example, if a child makes a meaningful attempt to request a stuffed animal, the reward is the stuffed animal – not a candy or other unrelated reward. Children are rewarded for making a good attempt, even if it is not perfect.
PRT was developed by Dr. Robert L. Koegel and Dr. Lynn Kern Koegel of Stanford University. It was previously called the Natural Language Paradigm (NLP). This approach has been used since the 1970s.
A variety of providers seek training in PRT methods, including:
Each program is tailored to meet the goals and needs of the individual person and his or her everyday routines.
A session typically involves six segments. Language, play and social skills are targeted with both structured and unstructured interactions.
The focus of each session changes as the person makes progress to accommodate more advanced goals and needs.
PRT programs usually involve 25 or more hours per week.
Everyone involved in the child’s life is encouraged to use PRT methods consistently in every part of his or her life. PRT has been described as a lifestyle adopted by the whole family.
PRT is one of the best studied and validated behavioral treatments for autism.
More than 20 studies suggest that PRT improves communication skills in many (though not all) children who have autism. Most of these studies looked at PRT delivered by trained therapists in one-on-one therapy sessions. Others looked at PRT delivered in group settings by school teachers and by trained parents in their homes. A 2017 review of brain imaging studies showed evidence that PRT improves brain activity associated with sociability and communication.
Relationship Development Intervention (RDI) is a family-based, behavioral treatment which addresses the core symptoms of autism. It focuses on building social and emotional skills. Parents are trained as the primary therapist in most RDI programs.
RDI helps people with autism form personal relationships by strengthening the building blocks of social connections. This includes the ability to form an emotional bond and share experiences with others.
RDI builds on the idea that “dynamic intelligence” is key to improving quality of life for individuals with autism.
Dynamic intelligence means the ability to think flexibly:
RDI involves a step-by-step approach to build motivation and teach skills. The teaching plan is based on the child’s current age and ability level. The parent or therapist uses a set of step-by-step, developmentally appropriate goals.
The initial goal is to build a “guided participation” relationship between parents and child, with the child as a “cognitive apprentice.” Once this relationship is in place, the family advances through a series of developmental goals for their child. The goal of this process is to improve “neural connectivity,” or brain function.
Parents, teachers and other caretakers continue to use the principles of RDI in the child’s daily life. They use positive reinforcement to help the child improve social skills, adaptability and self-awareness.
Parents and caregivers of people with autism usually serve as the primary therapist in an RDI program. Parents can learn the techniques of RDI through training seminars, books and other materials. They may choose to work with an RDI-certified consultant, as well.
Classroom teachers and behavioral therapists may also use RDI. Some specialized schools offer RDI in a private school setting.
The RDI consultant may begin by doing an assessment to learn how the child interacts with parents or teachers. The consultant will then create a teaching plan and goals based on the person’s development and abilities. The plan will include working on communication styles that best suit the child.
At the start, RDI involves one-on-one work between the parent and child. The parent or therapist applies stepwise, developmentally appropriate objectives to everyday life situations.
For instance, at first parents may limit how much they use spoken language. This encourages the child and parent to focus on eye contact and non-verbal communication.
As the child’s abilities increase, the goals and teaching plan change to meet his/her needs.
Next, the child begins spending time with a peer who shares similar social and emotional skills. This may be referred to as forming a “dyad” (meaning two children).
Gradually, additional children join the group. They meet and play in a variety of settings with the guidance of a parent or therapist. This allows them to practice forming and maintaining relationships in different contexts.
Families often use the principles of RDI in their day-to-day lives. Each family will make choices based on their child. Most families spend at least a few hours per week using RDI strategies.
To date, no independent studies have been published on RDI. In 2007, the technique’s developer (Dr. Steven Gutstein) published a report in the journal Autism that found positive results of RDI in a study group of 16 children. Independent research is needed to confirm benefits.
RDIconnect is RDI’s official website and provides resources for finding consultants and connecting with other families who use RDI.
Speech-language therapy addresses challenges with language and communication. It can help people with autism improve their verbal, nonverbal, and social communication. The overall goal is to help the person communicate in more useful and functional ways.
Communication and speech-related challenges vary from person to person. Some individuals on the autism spectrum are not able to speak. Others love to talk, but have difficulty holding a conversation or understanding body language and facial expressions when talking with others.
A speech therapy program begins with an evaluation by a speech-language pathologist (SLP) to assess the person’s communication strengths and challenges. From this evaluation, the SLP creates individual goals for therapy.
Common goals may include improving spoken language, learning nonverbal skills such as signs or gestures, or learning to communicate using an alternative method (such as pictures or technology).
Examples of the skills that speech therapy may work on include:
Some people with autism find that using pictures or technology to communicate is more effective than speaking. This is known as Alternative Augmentative Communication (AAC). Examples of AAC methods include:
The speech-language pathologist can help to identify which AAC method (if any) is right for someone with autism and teach him/her how to use the method to communicate.
Learn more about AAC and autism.
You can also visit the American Speech-Language Hearing Association’s AAC webpage for more information.
Speech therapy can also help people work on goals related to social communication. Speech therapists sometimes offer social skills groups in addition to one-on-one therapy.
They may also work on coaching children and adults on communication in different settings. This can include how to communicate with friends, communicating in a relationship, appropriate behavior at work, and more.
Some SLPs are specifically trained to address feeding and swallowing challenges in people with autism. They can evaluate the particular issue a person is dealing with and provide treatment plans for improving feeding-related challenges.
Speech therapy can take place in a variety of settings:
Services can be provided one-on-one, or in a group setting depending on what skill is being practiced.
Speech-Language Pathologists (SLP) provide speech therapy services. They have a master’s degree and are specially licensed to practice through the state.
You may notice that a speech therapist has the credentials “CCC-SLP” after their name. This stands for Certificate of Clinical Competence (CCC) and is a credential through the American Speech-Language Hearing Association (ASHA). It indicates that the speech therapist has achieved excellence in academic and professional standards. You can learn more on the ASHA website.
In some cases, a Speech Therapy Assistant provides direct speech therapy services. This is a person with an associate’s or bachelor’s degree, who is trained and supervised by a certified speech-language pathologist. The assistant works directly with the person with autism to practice skills and work towards goals that are written by the SLP in the clinical treatment plan.
The following questions can help you learn more about speech therapy before you begin. It can also help you learn whether a particular speech therapist or clinic is a good fit for your family:
The TEACCH® Autism Program is a clinical, training, and research program based at the University of North Carolina – Chapel Hill. TEACCH was developed by Dr. Eric Schopler and Dr. Robert Reichler in the 1960s. It was established as a statewide program in 1972 and has become a model for other programs around the world.
TEACCH uses a method called “Structured TEACCHing.” This is based on the unique learning needs of people with autism, including:
Structured TEACCHing provides strategies and tools for teachers to use in the classroom. These help students with autism to achieve educational and therapeutic goals. The Structured TEACCHing approach focuses on:
This method supports meaningful engagement in activities. It also works to increase students’ flexibility, independence, and self-efficacy.
Structured TEACCHing strategies can be used alongside other approaches and therapies.
TEACCH programs are usually applied in a classroom setting. TEACCH-based home programs are also available. Parents work with professionals as co-therapists for their children so that they can continue to use TEACCH techniques at home.
Structured TEACCHing uses organization and supports in the classroom environment to help students learn best. This includes:
TEACCH methods are used by a variety of autism professionals:
To become trained, professionals must go through a certification program offered by the TEACCH Autism Program in North Carolina. Training is offered both online and in-person on the TEACCH campus.
The program includes two certification levels, Practitioner and Advanced Consultant.
Visit the TEACCH website for more information on training and certification.
A 2011 review of more than 150 autism-intervention studies found that the TEACCH program had the strongest evidence of educational benefits of any recognized program. These benefits included improved learning (cognition) and motor skills.
Verbal Behavior (VB) therapy teaches communication and language. It is based on the principles of Applied Behavior Analysis and the theories of behaviorist B.F. Skinner.
This approach encourages people with autism to learn language by connecting words with their purposes. The student learns that words can help them get desired objects or results.
Verbal Behavior therapy does not focus on words as labels only (cat, car, etc.). Rather, it teaches why we use words and how they are useful in making requests and communicating ideas.
Language is classified into types, called “operants.” Each operant has a different function. Verbal Behavior therapy focuses on four word types:
VB and classic ABA use similar techniques to work with children. VB methods may be combined with an ABA program to work towards communication goals.
Verbal Behavior therapy begins by teaching mands (requests) as the most basic type of language. For example, the individual with autism learns that saying “cookie” can produce a cookie.
As soon as the student makes a request, the therapist repeats the word and presents the requested item. The therapist then uses the word again in the same context to reinforce the meaning.
The person does not have to say the actual word to receive the desired item. At first, he or she simply needs to make a request by any means (such as pointing). The person learns that communicating produces positive results.
The therapist then helps the student shape communication over time toward saying or signing the actual word.
In a typical session, the teacher asks a series of questions that combine easy and hard requests. This allows the student to be successful more often and reduces frustration. The teacher should vary the situations and instructions in ways that keep the student interested.
Verbal Behavior therapy uses a technique called “errorless learning.”
Errorless teaching means using immediate and frequent prompts to ensure the student provides the correct response each time. Over time, these prompts are reduced. Eventually the student no longer needs prompting to provide the correct response.
Step 1: The therapist holds a cookie in front of the student and says “cookie” to prompt a response from the child.
Step 2: The therapist holds the cookie and makes a “c” sound to prompt the response.
Step 3: The therapist holds the cookie in the child’s line of sight and waits for the request with no cue.
The ultimate goal is for the child to say “cookie” when he or she wants a cookie – without any prompting.
Most programs involve at least one to three hours of therapy per week. More intensive programs can involve many more hours.
Instructors train parents and other caregivers to use verbal-behavior strategies in their daily life.
Verbal Behavior Therapy can help:
A VB-trained therapist may be any of the following:
A 2006 review of 60 published studies concluded that Verbal Behavior Therapy helps many children with autism develop spoken language. The same review noted a lack of evidence on whether the approach produces broader benefits in daily living skills and overall improved outcomes.
B.F. Skinner published Verbal Behavior in 1957 to describe his functional analysis of language. In the 1970s, behavior analysts Vincent Carbone, Mark Sundberg and James Partington began adapting Skinner’s approach to create Verbal Behavior Therapy. Since 1982, the Association for Behavior Analysis International has published the annual, peer-reviewed journal The Analysis of Verbal Behavior.
For Information on VB, visit the Cambridge Center for Behavioral Studies website.