When it comes to autism therapies, how do you know which ones are the right ones for your child? Every child is unique, and your child’s therapies should be personalized to their unique biological and developmental profile. As a pediatric neurologist and board-certified behavior analyst - working with thousands of children and families over the past twenty years - my mission has been to help parents create the best autism therapy program for their child and family.
A whole-child approach to autism means investigating and treating all the factors that are important for your child’s lifelong health and development. This might sound daunting, but I truly believe every parent can do this for their child. All you need is the right knowledge and a roadmap to guide you.
The journey to whole-child health begins with understanding the genetics, neurochemistry, and electrophysiology that influence the formation of brain networks.
Genetics: the DNA signature housed within each of our cells that determines so much of our physical make-up
Neurochemistry: the delicate and dynamic balance of natural chemicals like neurotransmitters in the brain
Electrophysiology: the intricate electrical patterns of firing in the brain
It also involves adopting a whole-body perspective, where we consider how factors like nutrition, sleep, metabolism, gastrointestinal health, and many other bodily functions affect learning and development. It also means considering how different external environments – at home, at school, and in the community – shape your child’s brain and body health.
In 2014, I founded Cortica with the aim of providing whole-child autism care to as many children and families as possible. Cortica’s centers around the country provide comprehensive medical, developmental, behavioral, and family therapies for autism, through in-center, in-home, and telehealth services. To get started creating a complete therapy program for your child, keep reading for the ten essential elements of whole-child care.
Ten Essential Elements of Whole-Child Autism Care
Genetics and Metabolism
Medications and Diets
Child and Family Wellness
1. Genetics and Metabolism
The symptoms of autism have a biological cause, so when a child is diagnosed with autism, one of the first steps should be to conduct medical tests that can help identify the underlying cause(s).
If a genetic test shows a finding, how does it help your child? There are several ways. Sometimes the finding reveals a specific genetic diagnosis (some examples of genetic syndromes associated with autism are Angelman Syndrome, Tuberous Sclerosis Complex, and Fragile X Syndrome). Having this diagnosis means that your child can be connected to the best resources and treatments, including novel therapies that are in research development. Other times the genetic finding may point to a specific biochemical or metabolic pathway in the body that can be targeted through diet, nutritional supplementation, medication, or other medical therapies.
Tests for mitochondrial dysfunction and other potentially treatable metabolic causes of autism are also important. Because the quality of genetic and metabolic testing continues to improve rapidly, it may be appropriate to repeat tests at regular intervals if a cause is not initially identified.
Research studies show that about a quarter to a third of children diagnosed with autism will experience seizures. Seizures can appear in many ways. For some children, seizures involve loss of consciousness and shaking of the arms and legs. For others, seizures can be very subtle and cause only brief interruptions to the child’s attention or activity. Some seizures take place during sleep and may not be noticeable at all.
Because seizures and related disturbances of the brain’s electrical activity are common in autism and can interfere with learning and development, a test to measure the brain’s electrical activity – called an EEG or electroencephalogram – is recommended for all children with autism. There are many effective treatments for seizures, including lifestyle changes (like improving sleep), dietary modifications (such as low glycemic index and ketogenic diets), medications, device therapies, and surgery.
Sleep disturbance occurs in about 80% of children diagnosed with autism. The most common disturbances are trouble falling asleep, trouble staying asleep, and waking up too early. These types of sleep disturbances are called dyssomnias.
There are many reasons that your child might have trouble sleeping. Research studies suggest that children with autism have disturbances to hormones and neurotransmitters, such as cortisol, serotonin, and melatonin, which can affect sleep. If your child has gastrointestinal symptoms such as reflux or constipation, or if your child has enlarged tonsils, adenoids, or other obstructions to the airway, these can also disrupt sleep. Factors, such as routines around bedtime and during the night, can affect sleep patterns, as can environmental factors, such as noise, temperature, lighting.
4. GI Symptoms
Gastrointestinal symptoms, like constipation, diarrhea, reflux, painful stooling, and abdominal pain, are common in autism. Research studies have found that close to half of children diagnosed with autism experience GI symptoms and that these symptoms can get in the way of learning and development.
Keep track of your child’s frequency and size of bowel movements, color, smell, and any symptoms such as bloating or gas. Notice if your child lays on their abdomen, pushes their abdomen against other objects, or seems to have more repetitive behaviors or tantrums when they have not had a bowel movement for a day or more. An abdominal x-ray, stool analysis, or other medical tests might be helpful in evaluating your child’s GI symptoms. Dietary changes, supplements, and many other safe and effective therapies are available. Sometimes a child’s tantrums or other behaviors that have not improved with behavior intervention resolve once GI symptoms are treated.
5. Medications and Diets
This category captures all the different medications and diets that should be considered for autism to help directly with development and behavior. A thoughtful approach to these treatment options means understanding how they act on the brain and body, understanding how they might affect your child (both benefits and side effects), and considering which ones are actually doable for your child and family.
Dietary changes can have benefits but making those changes can be hard. If you’ve tried to change your own diet or your child’s and could only keep it up for a few days, you’re not alone. Almost all the families I work with have tried dietary changes on their own and have struggled to be consistent. Most have chosen a diet based on the experiences of others, rather than information about their own child’s health. Elimination diets (where one or more foods are eliminated from the diet) are popular, but for many children expansion of nutrient-dense whole foods is a more appropriate first step. Adding nutrients to the diet through supplementation can also be beneficial, especially when there are findings on laboratory testing showing a deficiency, such as low iron or low vitamin D. Working with a nutritionist, dietician, nurse practitioner, or physician who specializes in pediatrics and neurodevelopment can give you the best chance of success.
Medications are an important category of autism treatment. Medications can be considered for children with autism at any age. Decisions about medications should be based on the type and degree of symptoms your child is having and the efficacy and safety profile of medication options. Ultimately, the question should be “Is there a medication that can help my child’s development and brain health in a meaningful way, and do those benefits outweigh the risks of side effects?”
6. Mental Health Symptoms
Children with autism are at higher risk for experiencing, anxiety, inattention, and mood disturbances. It’s important to recognize these symptoms if they are present and to provide treatment. These symptoms can sometimes cause more difficulty than the core symptoms of autism. Screening questionnaires that are completed by parents, other caregivers, or teachers can help identify if these symptoms are present. Effective treatments include medications, nutritional supplements, device therapies, counseling, and others.
7. Social Communication
One of the core symptoms of autism is difficulty with social interaction and communication, including developing relationships with others. Teaching these skills is one of the main goals of developmental and behavioral therapies. The term developmental therapies is used to refer to therapies, such as pediatric occupational therapy, physical therapy, music therapy, and speech-language therapy, which help to promote child development. Behavioral therapy (also known as Applied Behavior Analysis or ABA) is also an effective approach to supporting child development. The focus of ABA is on modifying the environment in order to build new skills and to reduce undesirable behaviors.
Social communication and social interaction are complex skills that require a set of precursor skills within developmental domains such as sensory processing, motor function, cognition, and language. Therapists support your child to reach higher and higher levels of ability in these areas by setting appropriate goals, and putting in place the supports and strategies that will help your child reach them. The right goal for your child at any given point in time can be thought of as the “just-right challenge.” The concept of the just-right challenge came from A. Jean Ayres, a pioneer in the field of occupational therapy. She used this term to describe the therapist’s choice of treatment activities for a child that are not too easy and not too difficult. By selecting the right activities and the right supports, a therapist or caregiver can guide a child to greater and greater levels of skill.
In the field of autism therapy, behavior is often categorized into two types: those skills for daily living and leisure activities that we want to help build and those undesirable behaviors that interfere with daily function that we want to reduce. Developmental and behavioral therapies are the best tools we have for accomplishing behavior change. Setting the right goals important for building daily living and leisure skills, just as it is for social communication skills.
To be successful, all therapies require a high level of parent engagement. Significant improvements to your child’s behavior are far more likely if you participate in therapy sessions and apply the right strategies at other times and in other settings. If your child receives therapy with a speech-language pathologist for 30 or 60 minutes a week, the benefits of those sessions will be sustained over time and generalized to other settings if you practice those skills with your child throughout the rest of the week. Think about a child who takes a piano lesson once a week, but does not practice through the rest of the week – their piano skills are not likely to improve. The same is true for the skills taught through developmental and behavioral therapies.
Sensory and motor skills (sometimes combined in the term “sensorimotor”) are essential building blocks for higher-level skills in social communication, daily living, and leisure. Sensory processing includes the five senses that most people are familiar with (sight, sound, smell, taste, and touch), as well as three other senses that are less well-known: interoception, which refers to our awareness of internal sensations; proprioception, which refers to our awareness of the position of the body in space; and vestibular sense, which refers to our sense of balance and motion. Occupational therapists and music therapists who are trained in sensory processing can help build your child’s skills in these important areas.
Motor skills include the ability to plan and carry out sequences of movements as well as the ability to replace repetitive movements with more complex, goal-oriented actions. Physical therapy, occupational therapy, music therapy, and ABA can all help to build motor skills. Speech-language therapy is the field of therapy that focuses on building the oral-motor skills that are important for speech production.
10. Child and Family Wellness
The final element of whole-child care for autism is the most important. Autism affects the whole family. It’s important to take time to cultivate the well-being of your child and your whole family. Whole-child care for autism really means whole-family care. By focusing on your own health and wellness, you’ll be giving your child a great gift. If you don’t already have a counselor, coach, therapist, spiritual advisor, or support group to help build your own health and well-being, now is the time to find one. There’s no better environment for your child to learn and grow than a home where all members are at their best.
The journey with autism can sometimes be overwhelming, isolating, and uncertain, but it doesn’t have to be that way. Every day, I see children surpass their goals and families achieve peace and stability at home and a greater sense of hope and well-being. By adopting a whole-child approach to autism care, you’ll know that you’re on the right path.