Autism Spectrum Disorder: A Comprehensive Review of Clinical, Genetic, and Neurobiological Perspectives

Special Report: Autism Spectrum Disorder and Inflexible Thinking—Affecting Patients Across the Lifespan

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in social interaction and communication, repetitive and stereotyped behaviors, restricted interests, and sensory abnormalities. Its etiology is influenced by both genetic and environmental factors, with no definitive cause identified and no specific pharmacological treatments available, posing a significant burden on patients' families and society. In recent years, research has discovered that gut microbiota dysbiosis plays a crucial role in the pathogenesis of ASD. The gut microbiota can influence brain function and behavior through the gut-brain axis via the nervous system, immune system, and metabolic pathways. On the one hand, specific gut microbes such as Clostridium and Prevotella species are found to be abnormal in ASD patients, and their metabolic products, like short-chain fatty acids, serotonin, and GABA, are also involved in the pathological process of ASD. On the other hand, ASD patients exhibit immune system dysfunction, with gut immune cells and related cytokines affecting neural activities in the brain. Currently, intervention methods targeting the gut microbiota, such as probiotics, prebiotics, and fecal microbiota transplantation, have shown some potential in improving ASD symptoms. However, more studies are needed to explore their long-term effects and optimal treatment protocols. This paper reviews the mechanisms and interrelationships among gut microbiota, immune system, and nervous system in ASD and discusses the challenges and future directions of existing research, aiming to provide new insights for the prevention and treatment of ASD.

Background/Objectives: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition often accompanied by gastrointestinal (GI) symptoms and gut microbiota imbalances. The microbiota–gut–brain (MGB) axis is a bidirectional communication network linking gut microbes, the GI system, and the central nervous system (CNS). This narrative review explores the role of the MGB axis in ASD pathophysiology, focusing on communication pathways, neurodevelopmental implications, gut microbiota alteration, GI dysfunction, and emerging therapeutics. Methods: A narrative review methodology was employed. We searched major scientific databases including PubMed, Scopus, and Google Scholar for research on MGB axis mechanisms, gut microbiota composition in ASD, dysbiosis, leaky gut, immune activation, GI disorders, and intervention (probiotics, prebiotics, fecal microbiota transplantation (FMT), antibiotics and diet). Key findings from recent human, animal and in vitro studies were synthesized thematically, emphasizing mechanistic insights and therapeutic outcomes. Original references from the initial manuscript draft were retained and supplemented for comprehensiveness and accuracy. Results: The MGB axis involves neuroanatomical, neuroendocrine, immunological, and metabolic pathways that enable microbes to influence brain development and function. Individuals with ASD commonly exhibit gut dysbiosis characterized by reduced microbial diversity (notably lower Bifidobacterium and Firmicutes) and overpresentation of potentially pathogenic taxa (e.g., Clostridia, Desulfovibrio, Enterobacteriaceae). Dysbiosis is associated with increased intestinal permeability (“leaky gut”) and newly activated and altered microbial metabolite profiles, such as short-chain fatty acids (SCFAs) and lipopolysaccharides (LPSs). Functional gastrointestinal disorders (FGIDs) are prevalent in ASD, linking gut–brain axis dysfunction to behavioral severity. Therapeutically, probiotics and prebiotics can restore eubiosis, fortify the gut barrier, and reduce neuroinflammation, showing modest improvements in GI and behavioral symptoms. FMT and Microbiota Transfer Therapy (MTT) have yielded promising results in open label trials, improving GI function and some ASD behaviors. Antibiotic interventions (e.g., vancomycin) have been found to temporarily alleviate ASD symptoms associated with Clostridiales overgrowth, while nutritional strategies (high-fiber, gluten-free, or ketogenic diets) may modulate the microbiome and influence outcomes. Conclusions: Accumulating evidence implicates the MGB axis in ASD pathogenesis. Gut microbiota dysbiosis and the related GI pathology may exacerbate neurodevelopmental and behavioral symptoms via immune, endocrine and neural routes. Interventions targeting the gut ecosystem, through diet modification, probiotics, symbiotics, or microbiota transplants, offer therapeutic promise. However, heterogeneity in findings underscores the need for rigorous, large-scale studies to clarify causal relationships and evaluate long-term efficacy and safety. Understanding MGB axis mechanisms in ASD could pave the way for novel adjunctive treatments to improve the quality of life for individuals with ASD.

“A developmental disability that hinders the normal functioning of the brain, affecting, in varying degrees, communication skills and social interaction. Repetitive behaviours, and different ways of learning, paying attention, or reacting to things are often distinctive signs”. This standard definition of autism fails to describe the complexity of a condition that ranges in its manifestations from severe intellectual impairment to superior cognitive skills, like in the Asperger syndrome. To comprise such diversity, autism disorders are now covered under the umbrella term “autism spectrum disorder” (ASD). In most cases, ASD manifests during the first 5 years of life, with boys significantly more likely to be diagnosed than girls. ASD usually goes together with several other problems that frequently include anxiety, sleep disorders, or epilepsy. No cure exists; treatment, such as speech therapy, just attempts to alleviate specific deficits of autistic patients. > Nothing is simple in autism. Even the real number of people affected is uncertain. Nothing is simple in autism. Even the real number of people affected is uncertain. The US CDC estimates that about 1 in 68 (or 1.5%) of children in the USA are living with ASD (http://www.cdc.gov/ncbddd/autism/data.html). The WHO has a more conservative estimate, last revised in January this year, of 1 in 160 children, based on a larger set of epidemiological surveys (http://www.who.int/mediacentre/factsheets/autism-spectrum-disorders/en/). Needless to say, most studies were conducted in developed countries, and the prevalence of ASD in many low‐ and middle‐income countries remains largely unknown. > Along the years, many potential causes have been indicated, including genetic and environmental factors, exposure to toxins during pregnancy, wide gaps between parent ages, and so on Although the general consensus is that prevalence rates are increasing globally, this point is debated too. Some analyses indicate that a large percentage of the increase in ASD owes to improved awareness and …

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is characterized by abnormalities in the brain, leading to difficulties in social interaction and communication, as well as learning and attention. Early diagnosis of ASD is challenging as it mainly relies on detecting abnormalities in brain function, which may not be evident in the early stages of the disorder. Facial expression analysis has shown promise as an alternative and efficient solution for early diagnosis of ASD, as children with ASD often exhibit distinctive patterns that differentiate them from typically developing children. Assistive technology has emerged as a crucial tool in improving the quality of life for individuals with ASD. In this study, we developed a real-time emotion identification system to detect the emotions of autistic children in case of pain or anger. The emotion recognition system consists of three stages: face identification, facial feature extraction, and feature categorization. The proposed system can detect six facial emotions: anger, fear, joy, natural, sadness, and surprise. To achieve high-performance accuracy in classifying the input image efficiently, we proposed a deep convolutional neural network (DCNN) architecture for facial expression recognition. An autoencoder was used for feature extraction and feature selection, and a pre-trained model (ResNet, MobileNet, and Xception) was applied due to the size of the dataset. The Xception model achieved the highest performance, with an accuracy of 0.9523%, sensitivity of 0.932, specificity of 0.9421, and AUC of 0.9134%. The proposed emotion detection framework leverages fog and IoT technologies to reduce latency for real-time detection with fast response and location awareness. Using fog computing is particularly useful when dealing with big data. Our study demonstrates the potential of using facial expression analysis and deep learning algorithms for real-time emotion recognition in autistic children, providing medical experts and families with a valuable tool for improving the quality of life for individuals with ASD.

Personalized repetitive transcranial magnetic stimulation guided by the spectral electroencephalogram may enhance and democratize therapy for autism spectrum disorder

This comprehensive review critically examines the gut-brain axis (GBA) and its implications in autism spectrum disorder (ASD). The GBA is a complex, bidirectional communication network that integrates the gastrointestinal tract, the central nervous system, and the gut microbiota. This axis is mediated through various physiological pathways, including the enteric nervous system (ENS), the vagus nerve, immune responses, and metabolic activities of gut microorganisms. ASD, a developmental disorder marked by social impairments and repetitive behaviors, presents with notable neurological irregularities. The review highlights the increased prevalence of gastrointestinal (GI) disturbances in individuals with ASD, suggesting a potential link between GI symptoms and the severity of ASD-related behaviors. This correlation is supported by evidence of altered gut microbiota composition in ASD, indicating significant interactions between the gut environment and neurological health. Moreover, the pathophysiology of ASD is explored with an emphasis on genetic and environmental contributions to neurodevelopmental impairments. Key topics include synaptic dysfunction, the roles of neurotransmitters like GABA and serotonin, and the impact of gut-brain interactions on ASD progression. Specifically, this review addresses how gut microbiota may influence metabolic alterations, immune dysregulation, oxidative stress, mitochondrial function, and neurotransmitter production in ASD. Emerging research on microbiome-based therapies for ASD is discussed, focusing on the potential of probiotics, prebiotics, and faecal microbiota transplantation (FMT) as novel interventions. Ethical considerations in this burgeoning field are also considered, highlighting the necessity for rigorous scientific inquiry and ethical oversight. The review advocates for a multidisciplinary approach to understanding and addressing the complexities of ASD. By integrating insights from genetics, neuroscience, psychology, and gastroenterology, a more comprehensive understanding of the role of GBA in ASD can be achieved. This interdisciplinary perspective is crucial for developing effective, individualized treatments and improving the quality of life for individuals with ASD.

Federal law requires that children with disabilities, including those with autism spectrum disorders (ASDs), receive their education in the least restrictive environment, which frequently includes general education settings. Children with ASDs characteristically exhibit difficulties in social interaction, communication, and restricted interests. Consequently, general educators may face various challenges when teaching this population of students. Teachers’ opinions regarding the general practice of inclusion have been thoroughly researched, and they generally express positive views. The goal of the current study was to expand upon previous research about general educators’ perspectives regarding teaching students with ASDs. More specifically, this study investigated general educators’ level of knowledge and understanding of ASDs, their level of understanding and use of the available evidence-based interventions for ASDs, their perspectives of included students with ASDs, as well as their opinions about the different factors that help and hinder the education of students with ASDs in inclusion classrooms. Because this study had a limited response rate of 11.16%, the results can only be generalized to those participants who completed the survey. Based on the survey results of this study, most teachers viewed the practice of including students with ASDs positively. Regarding training, almost half of teachers in this study responded that they had not received education in ASDs or their major/associated characteristics; however, the overwhelming majority of teachers indicated that training in ASDs is critical. The current study also found that the majority of general educators had not received training in providing evidence-based interventions to students with ASDs. A significant relationship was found, however, in that teachers with a master’s degree were more likely to utilize certain evidence-based interventions for ASDs that have been identified by national research centers. This study also investigated the different factors that influence general education teachers’ perspectives of students with ASDs. Implications for the field of education were identified for both training and practice. In particular, general education teachers need ample opportunities for professional development and training through their educational programs and school districts. Additionally, they need support from other key individuals, including administrators, parents, support staff, colleagues, and school psychologists.

Changes to the diagnostic criteria for autism in the DSM-5 raised concerns that some children with DSM-IV Pervasive Developmental Disorders (PDD) would not meet the DSM-5 criteria for Autism Spectrum Disorder (ASD). Research specifically applying the DSM-5 ASD criteria to preschool-aged children is required given the importance of a timely autism diagnosis and early intervention. Few studies have specifically applied the DSM-5 ASD criteria to preschool-aged children. Autism diagnoses and symptoms may change as children develop over time; however, few studies have longitudinally examined patterns of diagnostic and symptom change from early childhood into adolescence. The aims of this thesis were therefore to compare autism diagnoses according to the DSM-IV and DSM-5, to longitudinally examine the diagnostic stability of autism over time using both diagnostic systems; and finally to explore the patterns of DSM-5 ASD symptom stability and change from early childhood to early adolescence. Between 2003 and 2005, 185 young children (aged 20-55 months) with autism and/or developmental delay were assessed as part of a longitudinal study. A subset of this sample (n=50) were then re-assessed in early adolescence (aged 11-15 years). Best-estimate clinical diagnoses were given according to DSM-IV and DSM-5 criteria based on a comprehensive diagnostic assessment, including the Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS). File reviews for the 50 participants were completed to retrospectively apply the DSM-5 ASD criteria in early childhood. To assess the sensitivity and specificity of the DSM-5 ASD criteria, ADOS and ADI-R items were assigned to the DSM-5 criteria and retrospectively applied to the full sample in early childhood (n=185). The findings indicated good DSM-5 sensitivity (.84) at the expense of specificity (.54). Children with PDD who were not classified with DSM-5 ASD (n=20) had significantly lower rates of comorbid behaviour and emotional problems than children with PDD who were classified with DSM-5 ASD (n=106). In children with PDD, gender, language delay, developmental level or adaptive behaviour did not significantly differ between those classified with DSM-5 ASD and those who were not classified with DSM-5 ASD. Best-estimate DSM-IV and DSM-5 diagnoses were then compared for the sample. Of the 43 children with PDD, 12% did not meet the DSM-5 criteria for ASD in early childhood (aged less than 5 years). These children typically had DSM-IV diagnoses of Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) and required symptoms on one additional subdomain to meet the DSM-5 criteria. By adolescence, they had developed sufficient symptoms to meet the full DSM-5 criteria for ASD. In early adolescence (aged 11-15 years), 10% of children with PDD did not meet the DSM-5 criteria for ASD based on their current symptoms alone, although they met the diagnostic criteria once past symptoms were taken into account. Consistent with previous research, DSM-IV Autistic Disorder remained stable over time (89%) while all children with PDD-NOS had a change in diagnosis. Stability of DSM-IV PDD (98%) and DSM-5 ASD (89%) were high. Changes in core ASD symptoms between early childhood and early adolescence differed based on the measure used. Clinician-observed (ADOS) symptoms remained stable over time; however, ADI-R Social-Communication symptoms reduced over time while changes relating to restricted and repetitive behaviours and interests (RRBs) differed depending on the RRB subtype. RRB symptoms relating to stereotyped or repetitive motor movements, use of objects or speech reduced over time while RRB symptoms relating to insistence on sameness, inflexible adherence to routines, or ritualised patterns of verbal or nonverbal behaviour increased. Higher developmental level in early childhood was associated with lower ASD symptoms on average during childhood and adolescence; however, it was not associated with symptom change over time. Together, the findings from this thesis contribute to the growing body of research into the impact of the DSM-5 ASD criteria in young children and the characteristics of those who may not meet the diagnostic criteria. The findings indicate that patterns of symptom change may differ based on the assessment tool utilised and that differentiating between ASD symptom subtypes is necessary as broader domain scores may mask differing symptom trajectories. Although autism diagnoses may typically remain stable over time, some children may not yet have sufficient symptoms to meet the DSM-5 criteria for ASD in early childhood. Furthermore, the types of symptoms that require the most clinical attention may change as children develop. These findings highlight the importance of ongoing monitoring of children with autism to ensure that intervention programs are adjusted based on the needs of each child.

This study aims to investigate the process of fostering inclusivity for children with autism spectrum disorder (ASD) within educational contexts, with a specific focus on understanding the efficacy of Applied Behavior Analysis (ABA) and Assessment of Basic Language and Learning Skills (ABLLS) programs. It draws from experiences gained through collaboration with professionals and parents at the Princesse Lalla Meryem Pour Enfants Autistes Institute in Tangier. Set within the dynamic landscape of Morocco's disability support and education sector, this research unfolds within the framework of the Princesse Lalla Meryem Pour Enfants Autistes Institute in which ABA and ABLLS programs are used extensively, complemented by individualized support provided by dedicated assistants for each student. Furthermore, cognitive behavioral therapy is integrated into the educational approach. The overarching goal of the organization is to equip children with ASD with the necessary skills to integrate successfully into mainstream educational institutions. By employing a participatory action research methodology, this study engages closely with professionals, parents, and autistic students. Qualitative interviews, observations, and collaborative reflections serve as key methods to understand the nuances and effectiveness of ABA, ABLLS, and cognitive behavioral therapy in fostering inclusivity. Initial findings highlight the pivotal role of individualized support and evidence-based interventions such as ABA, ABLLS, and cognitive behavioral therapy in promoting the inclusion of children with ASD. Insights gleaned from the experiences of both professionals and parents shed light on promising practices and areas for further enhancement in preparing autistic children for successful integration into mainstream educational institutions. This study enriches the existing literature by providing firsthand insights into the practical applications of ABA, ABLLS, and cognitive behavioral therapy within the context of an inclusive educational organization in Morocco. By bridging theory and practice along with incorporating diverse perspectives, the study aims to inform the development of more effective inclusive policies and practices, ultimately contributing to the successful integration of children with ASD into mainstream educational settings.

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition that affects about 1 in 100 children worldwide. It involves a wide range of challenges, from social difficulties to repetitive behaviours, often accompanied by other conditions like epilepsy, sleep problems, and digestive issues. Despite ongoing research, we still don’t fully understand what causes these disorders or how to effectively diagnose and treat ASD. Recent studies suggest that the gut microbiota, the community of microbes living in our intestine, may play a significant role in neurodevelopmental disorders like ASD. The gut and brain can communicate in a bidirectional manner through a complex network called the gut-brain axis, which involves immune, metabolic, and neuronal pathways. Alterations in the composition of the gut microbes, known as dysbiosis, could contribute to ASD development and severity by disrupting these connections. This thesis investigates the gut microbiome’s role in ASD from multiple angles. We identified specific gut bacterial markers linked to the condition in three independent study populations using machine learning. We developed different humanized mouse models that are promising tools to deepen on the investigation of the gut-brain axis in ASD. Finally, we also explored dietary interventions, such as probiotic and synbiotic diets, to promote ‘healthy’ changes in the gut bacterial composition that might translate into beneficial effects in processes along the gut-brain axis like behaviour. By deepening our understanding of how gut microbes interact with the brain, this research offers new hope for more effective and personalized treatments for ASD. It highlights the potential of targeting the gut microbiome to improve the quality of life for individuals living with this condition.

Video Podcast: https://youtu.be/zO11bwRk4Cg

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent difficulties in social communication and social interaction, coupled with restricted, repetitive patterns of behavior or interest. Research indicates that aggression rates may be higher in individuals with ASD compared to those with other developmental disabilities. Aggression is associated with negative outcomes for children with ASD and their caregivers, including decreased quality of life, increased stress levels, and reduced availability of educational and social support. Therapeutic strategies including functional behavioral assessment, reinforcement strategies, and functional communication training may have a significant impact in reducing the frequency and intensity of aggressive behavior in individuals with ASD. Pharmacologic treatments, particularly the use of second-generation antipsychotics, may also be of some benefit in reducing aggression in individuals with ASD. With the ever-increasing rate of ASD diagnosis, development of effective therapeutic and pharmacologic methods for preventing and treating aggression are essential to improving outcomes in this disorder.

Autism spectrum disorders (ASD) are a class of neurodevelopmental disorders characterized by impairments in communication and social reciprocity, and by the presence of restricted and repetitive interests and behaviors.1 The prevalence of ASD is currently estimated to be 6.7 per 1000 school-age children in the United States,2 making ASD and co-occurring conditions an important public health issue. One condition that may occur more often in children with ASD than in children with typical development is vitamin D deficiency. Vitamin D is a fat-soluble vitamin, long known to be important in calcium homeostasis and bone health. As evidence has accumulated that vitamin D receptors are present in a wide variety of tissues, vitamin D deficiency has been implicated in numerous disease states.3 Having ASD could potentially put a child at greater risk of vitamin D deficiency secondary to dietary restrictions or decreased exposure to sunlight. Children with ASD may limit their own diet because of sensory aversions or restricted interests. The diet may also be restricted by parents to eliminate exposure to certain dietary proteins, such as the milk protein casein, in an attempt to treat the ASD symptoms.4 Children with ASD may have decreased exposure to sunlight because their after-school hours are often devoted to table-based therapies, they do not commonly participate in organized outdoor sports, and their preferred leisure activities often involve video game, computer, or TV screens in an indoor setting. We previously reported that children with ASD have decreased mean metacarpal bone cortical thickness (BCT) compared with a reference population.5 Based on this, our overarching hypothesis is that children with ASD are at risk of decreased bone mineral density compared with typically developing children. For this study our focus was limited to one component contributing to bone mineral density, vitamin D. The aim was to test the hypothesis that children with ASD have a lower concentration of circulating vitamin D – plasma 25(OH)D. We compared plasma concentration of 25(OH)D in Caucasian males with and without ASD and 25(OH)D concentration in males with ASD with and without a casein-free diet.

If you have concerns about your child’s development and behavior, your child should be seen to tell if she needs therapy. You do not need a diagnosis of autism spectrum disorder (ASD) to begin many kinds of therapy. There can be a long wait for ASD diagnosis, so it is important to start therapy while your child is still waiting for a diagnosis. However, once your child is diagnosed with ASD, she may be able to get more interventions, such as applied behavioral analysis (ABA). It is important to have your child seen by an ASD specialist even if your child is already receiving intervention.The goals of any autism intervention are to help your child achieve his potential by learning key life skills in the areas that are hard for him. Most ASD therapy focuses on improving social communication and interaction skills and on reducing problem behaviors such as not being flexible or wanting to do the same thing over and over. Autism therapy can be provided at home, at school, or in a clinic setting. Most children with ASD need therapy in more than one setting. Most autism intervention is usually provided by speech pathologists, occupational therapists, psychologists, or behavioral analysts.When deciding what kinds of interventions to pick for your child, it is important to think about which of them are evidence based, or shown to work in scientific studies. No matter what approach is used it is very important that you and other caregivers get involved. Then you can use the approach at home and in the community with your child.You might want to start by finding out what intervention types are available in your area. Consider what kinds of intervention will be covered through your child’s school and/or health insurance programs. Talk with your child’s pediatrician, other parents, and community organizations to get a better idea about what will be the right fit for your family.For some families, there may not be many choices. For instance, there may be only one ABA provider in your area that is covered under your child’s insurance. Keep in mind that the individual provider is just as important as the type of intervention. You may need to try several types of intervention to find one that is the best match for your child. It is also important to think about how your child’s needs may change over time. Set aside time every year to look at the services your child is getting and to see if they are meeting your child’s needs.Autism therapy in school (including early intervention, early childhood special education, and public school) is your child’s legal right under the Individuals with Disabilities Education Act, and it is free to your family. To get autism therapy through your school system, you need to ask for an Individualized Family Service Plan (for children younger than 5) or an Individualized Education Program (for children older than 5). Ask your child’s pediatrician if you need help with this. Schools must provide autism-related therapy to children within a few months of a request.Intervention services can also be given through your child’s health insurance. How much and what kinds of services your child’s insurance will pay for depends on the type of insurance and where you live. Many states have laws that make health insurers cover autism therapy services, even up to 40 hours per week. You can look online to find out what the autism therapy coverage laws are in your state. Intervention services through your child’s health insurance may require a co-pay. You can call your insurance company to find out what is covered under your child’s health plan and how much you will have to pay. You can also ask them for a list of in-network autism intervention providers, to lower costs to your family.Getting autism intervention services is usually hard. You and your child’s pediatrician may need to fill out a lot of paperwork, and your child may be placed on a long waiting list. Sometimes you will be asked to have more tests done before therapy can be started. It will help to stay organized and get help from your child’s pediatrician, social worker, child psychiatrist, family counselor, or community organizations. It is normal to feel frustrated, confused, or “stuck.” Remember that your job as a parent is to advocate for what your child needs, so don’t feel bad about checking in with providers if you have been waiting for a long time.Early intervention and early childhood special education are programs given through the educational system for children aged 0 to 3 (early intervention) or 3 to 5 (early childhood special education). These services are offered either in your home or in a center. Early intervention and early childhood special education are available locally in all parts of the United States. These services can be just for autism or can be more general, such as speech therapy. You can refer your child for these services, and you do not need any paperwork from a doctor or school to do so. The best way to find out how to get these resources in your state is to ask your child’s pediatrician or look online. Once you have made a request, federal law requires that your child be seen in 45 days and that therapy be given to your child if she needs it. Early intervention and early childhood special education programs use many different kinds of autism intervention, some of which are described in this handout.Applied behavioral analysis is an intervention that teaches children developmental, social, and language skills. The therapy is intensive, which for most children means at least 15 hours per week. Therapy is usually covered through your child’s medical insurance. Applied behavioral analysis can be done at home or in the clinic or community. It also typically involves a lot of parent participation.In ABA therapy, goals are set by a therapy team, and the therapist works with the child and sometimes the parent, one goal at a time. A strong ABA program will consider your child’s favorite interests and activities, have a good learning environment, develop clear behavioral plans, measure your child’s progress, and work with your child at home and in other places your child often visits.Although ABA will not cure your child’s ASD, studies show ABA works in skill building and improvement in challenging behaviors. Some say that more hours per week of therapy works better than fewer hours.There are several different approaches to ABA therapy. Some common evidence-based approaches includeMany ABA providers use a combination of approaches.Developmental relationship interventions focus on teaching adults how to improve a child’s communication and social skills through play. By playing with others, children learn to communicate, control their emotions, and understand more about social relationships. These interventions have been shown to improve ASD symptoms like social attention in scientific studies. Some common evidence-based developmental interventions includeNaturalistic developmental behavioral interventions (NDBIs) use both ideas from ABA and ideas from developmental relationship interventions. They focus on child-led teaching, chances for natural learning, clear goals, and measuring progress. The most studied NDBI is the Early Start Denver Model, which has been shown in small studies to improve IQ and problem behaviors of children who have ASD.Recent evidence shows that parents can be good autism therapists for their child when given the right tools. Training sessions for parents and other caregivers can happen in the home, the school, or other community settings, or even through an electronic tablet. JASPER (Joint Attention, Symbolic Play, Engagement, & Regulation) is an example of an evidence-based parent training intervention for ASD. Other parent training programs may be available in your area.Many children with ASD have a hard time having conversations, understanding social cues (such as eye contact or facial expressions), or playing with others. Social skills instruction is used mainly for school-aged children with ASD, both at school and outside of school. Social skills instruction can happen one-on-one with an adult, or with a small group of other children. There have also been some studies showing that video and computer social skills training may also help children. An example of an evidence-based social skills intervention for teens is the Program for the Education and Enrichment of Relational Skills intervention. If you are interested in social skills instruction for your child with ASD, you can ask your child’s school, or contact your child’s pediatrician to find a program in the community.Other types of treatment that might help your child include speech therapy, alternative and augmentative communication therapy, occupational therapy, and physical therapy. These therapies are often not just for ASD but for more general problems that these children face. These types of therapies are often available both at school and through your child’s health insurance.The information contained in this resource should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Original resource included as part of Caring for Children With Autism Spectrum Disorder: A Practical Resource Toolkit for Clinicians, 3rd Edition.Inclusion in this resource does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this resource. Website addresses are as current as possible but may change at any time.The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this resource and in no event shall the AAP be liable for any such changes.