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Effects of Various Therapies on Children with Autism

Ava Burcsak, Kimberly McCann, Abigail Schuster, Codi Taylor

04/07/2021

Nurs 3749: Nursing Research

Dr. Valerie O’Dell

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Abstract

The purpose of this research is to look at the relationship between non-pharmacological and

pharmacological therapies for children under eighteen with autism and the effect it has on their

behavioral and learning outcomes. Autism is a neurological disorder causing impairments in

social and communication skills while also featuring some evidence of restricted and repetitive

behaviors. Communication is an issue for many children with autism. Often these children

experience problems throughout their childhood and later carry problems into adulthood. It has

been found that early interventions at a young age are the most beneficial in assisting kids

throughout their childhood. Non-pharmacological therapy and medication therapy were assessed

and findings exemplified great improvement for these children. Both of these forms of

interventions were proven to assist with memory, behavioral functioning and verbal

communication. There was a correlation between therapy and an improvement in outcomes the

children experienced. It was found there was an increase in capabilities of the study participants,

in many ways. The therapies discussed, focused on all methods to improve behavior,

communication and motor function in children diagnosed with autism spectrum disorder (ASD).
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Effects of Various Therapies on Children with Autism

Children with autism often struggle behaviorally with social interactions among peers

and within themselves. Autism can lead to limited communication and interaction that can

further interfere with child development. Presently, no treatment has been shown to cure ASD.

However, numerous investigations have been introduced to diminish symptoms of ASD and

enhance quality of life as well as social interactions. Quality of life is defined by the

improvement of an individual’s intellectual abilities and activities of daily living. The question

remains unclear as to whether or not non-pharmacological and pharmacological therapies are

necessary to benefit the child both throughout their childhood and adult life. Therefore, the

following research question was addressed: In children diagnosed with autism, how does the use

of non-pharmacological therapy and pharmacological therapy influence a child's quality of life in

the first 18 years?

Literature Review

Introduction

To address the relationship among the various therapies utilized, the information was

obtained via CINAHL. Nine sources were reviewed in a comprehensive analysis based on the

management of autism symptoms in young children. The sources analyzed are categorized into

interventions for emotional and social function, motor and sensory function, speech and auditory

function, and pharmacological treatment for children with autism. These children varied among

gender and ages from those of infancy to age eighteen. Autism has a large impact on an

individuals day to day tasks. Therefore, music therapy, family centered therapy, yoga therapy,

aquatic therapy, speech therapy, antipsychotics and beta blockers as forms of therapy will be

further discussed to assist with those developmental deficits.

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Music Therapy

One way to help children with ASD better regulate their emotions is through music

therapy, which allows the children to engage in relationships that have been formed through

connection and coherence. Music relates to these children in a flexible and dynamic way. Music

facilitates meaningful nonverbals and improves communication ability. There was a study

conducted by Abmus, Calvet, Gold, Iversen, Mossler, Reimer, Schmid & Schumacher (2017)

that examined the relationship between autism and music therapy as it relates to social skills.

The study addressed generalized improvement in social ability and interaction of children who

took part in the study, as well as if the intensity of the study played a role in how much benefit

was taken away. The research utilized a randomized method and divided the children into 2

groups. Ages ranged from four to seven and children were excluded if they had any other serious

sensory disorders. Overall, there were 48 children, 81% being boys, due to the fact boys have a

higher autism rate than girls. This study also ensured that it included children from a variety of

ethical and cultural backgrounds. The children were split into two control groups with one group

participating in low intensity classes, being held once per week. The other group of children

took part in high intensity classes, held three times per week. This study was conducted over a

five-month time period, and children were evaluated at month one, five, and twelve after the

study was concluded. Standardized tools were utilized and both the parents and a blind assessor

who had no background information on the children when they were evaluated. The findings

demonstrated that music therapy did in fact improve behavioral outcomes, communication

barriers, language, and emotional attunement. Findings also revealed music is a form of

communication that supports the development of expressive abilities.

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Music promotes a relational experience based on expression and interests. It is suggested

that the caregiver’s ability to synchronize with them influences attachment and social

understanding. Music therapy is now offered in some public-school settings, or in the home.

The music used for this form of therapy tries to connect to the child’s mood, expression, and

current social responsiveness. This experience gives the child the ability to feel related

interpersonally in a way they were never able to before. This has been found as a very effective

tool to implement early in a child’s life who has the diagnosis of autism spectrum disorder, this

method as well as other forms of therapy can be used in conjunction or separately.

Family Centered Therapy

Another form of intervention to improve social skills in young children with autism is

family centered therapy. Han, Park, Park II & YOO (2020) conducted a study to analyze the

correlation between individualized family- centered therapy as an early intervention for infants

with suspected autism. The M-CHAT-R/F was the screening tool used in this study to screen for

risk of autism in infants, scores range from 0-20. Categories are as follows: 0-2 is low risk, 3-7

is moderate risk, and 8 or more is high risk for autism. For the infants falling under high risk,

early intervention is required in toddler years to lower the impact of ASD. This study consisted

of three toddlers between 24 and 36 months who scored 8 or more on the modified autism

checklist as infants and had no other conditions. Baseline values were noted as well as change

over time assessed every 4 weeks. The study lasted roughly 14 weeks and the interventions took

place in the family’s homes. Infants were recorded performing 10 minutes of free play,

researchers were looking for training of question and answer scenarios, as well as task and

feedback. The children were in a familiar environment that had minimal auditory or visual

distractions. After implementing this therapy, findings revealed that the quality of social skills as
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well as interactions amongst others improved drastically. These babies were found to regulate

verbal replies and produce language more appropriately based on age. They also maintained

better eye contact with others. It has been proven that early intervention before the age of 3 has

the most influence on the child’s brain, due to neuroplasticity being more active during that time

period. The use of family- centered therapy has greatly improved children's interaction with the

environment and those who take care of them. It was also found that communication function

and social interactions benefited from family centered therapy.

Motor and sensory function

When talking about children with autism there has been a significant amount of evidence

indicating problems not only with behavior but also with sensory and motor function. Evidence

has shown complications with balance, postural control, unsteady gait and incoordination

causing further issues with poor handwriting and dexterity issues. These motor problems have

been shown in some children with ASD as early as infancy while others develop problems later

in childhood, this emphasizes the need for individualized therapy. Research has begun to show

evidence that teaching these children functional motor skills also helps improve their social

skills.

Yoga

Kaur and Bhat (2019), tested the effectiveness of an eight-week yoga intervention course

on children ages five to thirteen with ASD for improvement in gross and fine motor skill

performance. The sample consisted of twenty-four children with autism. The study group was

split into two with half of the children being in the yoga intervention group while the other half

was placed in an academic group. The study included three types of measurements including the

following: standardized motor test, imitation test and final evaluations by parents. The
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standardized motor test was also known as The Bruininks -Oseretsky Test of Motor Proficiency

which was performed during pretesting and post-testing sessions to assess for generalized

changes in motor performance following the interventions. The Imitation test was also known as

The Training Specific Imitation Test, which utilized models to guide the children. This was

developed using a variety of actions that were practiced in training sessions to assess the

imitation skills of the subjects during the interventions. It was administered in early, mid, and

late training sessions. The last test performed was an Exit Questionnaire that was used to assess

whether the parents perceived the interventions used to be socially meaningful for their child.

The treatments included expert sessions that were delivered by a pediatric physical therapist

trained in applied behavioral analysis and yoga expertise. This included four sessions a week,

two of them with the expert and two with videos to do at home with their parents. The expert

sessions had the trainer and a “model” who was an undergrad student that was used to act as the

child’s buddy and role model during training sessions. The results concluded that the academic

group showed statistical improvements in both fine motor pre and post-test without changes in

gross motor and the yoga group showed extreme improvement in all areas as sessions

progressed.

Aquatic Therapy

In the other study, Caputo, Ippolito, Mazzotta, Sentenza, Muzio, Salzano & Conson

(2018) tested the effectiveness of a multisystem aquatic therapy on behavioral, emotional and

social skills of children with ASD. The sample included twenty-six children between the ages of

six and twelve with seventeen of them being males and nine of them being females.

Measurement for the study was done in three ways. The first form of measurement was The

Childhood Autism Rating Scale (CARS; Schopler et al. 1993), this test evaluated autistic
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symptoms of autism by having the examiner rate the child’s behavior on fifteen domains. The

domains included the following: relating to people, imitation, emotional response, body use,

object use, adaption to change, emotional response, visual response, listening response, near

response, near receptor response, fear or anxiety, verbal communication, non-verbal

communication, activity level, intellectual response and general impression. Each domain is then

rated on a scale of one to four with one being normal for age and four being severely abnormal

for age. The next form of measurement used was the Vineland Adaptive Behavior Scale (VABS;

Sparrow et al. 1984) where they investigated the children’s adaptive behavior in a

semi-structured interview with a primary caregiver to gather information on communication,

daily living skills, and socialization from birth and motor skills. The last form of measurement

used was the Humphries’ Assessment of Aquatic Readiness (HAAR; Humphries 2008) which

used a checklist to assess aquatic skills in five stages. These included: mental adjustment,

introduction to water environment, rotations, balance and control, and independent movement in

water. Treatment protocols included three phases. The first phase was the Emotional Adaptation

Phase that was centered on building a relationship between the expert and the child with ASD by

exploring the pool and poolside with instructor and parent. The second phase was known as the

Swimming Adaptation Phase aimed at teaching swimming skills through aquatic exercises made

for individuals with disabilities. The last phase was the Social Integration Phase where the child

participates in small groups of four to six children doing swimming activities and games to

facilitate social interaction. The results showed that group one (the controlled group) scored a

41.23 and group two (the raw group) scored 30.46. These results indicated that the control group

had significantly higher scores in all domains, except non-verbal communication and general

impression which results did not change with intervention. Overall, the study showed that the
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effects of exercise interventions on children with ASD showed improved motor skill learning and

functional capacities, while also improving behavioral, cognitive and social difficulties. Exercise

and social interaction have shown to be the most effective ways to improve motor and sensory

function in children with autism spectrum disorder. Yoga and Aquatic therapy has proven the

effectiveness of exercise interventions on motor and sensory function. These also provide proof

of improvement in many other domains shown to be problematic in children with autism.

Speech

Children with autism commonly have a delay in speech and cognitive abilities. There are

many different resources that can be used to increase their intellectual abilities and provide

support with their speech and cognitive production. According to Biller and Johnson (2019),

some children with autism are not able to speak as many spoken words compared to children

developing without autism, “Minimally verbal children typically have a limited repertoire of

only one or two communicative functions (CFs). Additionally, they produce a limited number of

single speech sounds, syllables, and true words” (Biller & Johnson, 2019, p. 377). Different

social and cognitive abilities were taken into consideration during this study. They measured

joint attention, symbolic playing, communicative intent, and gestural use to get a background on

how the child interacts and plays with items appropriate to their age (Biller & Johnson, 2019,

p.383). Among the children that took part in the study, it showed that the children with autism

had difficulty in finding the control for their speech and sound production abilities, which should

be assessed in each child with autism (Biller & Johnson, 2019, p. 377).

According to Topuz and Ulke‐Kurkcuoglu (2019), their study shows that increasing

verbal interaction in children with autism using audio script procedures, and how it benefits their

expressive communication with peers.

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The findings showed that the initiation emitted by the children increased during audio

script and script-fading procedure. Children also generalized initiation across different

conditions and maintained the acquired skills. Finally, the social validity findings showed

that the opinions of the parents regarding the procedure were overall positive

(Ulke-Kurkcuoglu, Topaz, 2019).

During this study, the researchers developed an understanding for how the child used expressive

language, then took age appropriate toys and watched how the children interacted with each toy.

Interacting with the children in a comfortable environment helped the researchers understand

how to verbally interact with the child with their appropriate age group (Ulkle-Kurkcuoglu &

Topaz, 2019, p. 4850). Increasing verbal interaction with autistic children while using audio

script resulted in positive effects on their ability to communicate with peers in different social

settings, while also communicating better with their parents while doing activities at home.

(Ulkle-Kurkcuoglu & Topaz, p.4857). This study was beneficial for the children to use their

cognitive abilities in social settings, which includes school, home, or anywhere unfamiliar to

them. This would increase the child's intellectual abilities in school by answering questions, or

explaining how they feel.

Keeping a child with autism in a welcoming and non-stressful environment is important

to correlate into their daily living.

Sensitivity to sounds and atypical reactions to sensory input by individuals with autism

spectrum disorder (ASD) have been reported in the literature. In response to this

sensitivity, some individuals use ear protection devices (EPDs) such as noise-canceling

headphones, earplugs, or earmuffs to attenuate the perceived unpleasant sounds

(Neave-DiToro, Fuse, Bergen, 2021, p. 409).

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Auditory sensory issues related to auditory hypersensitivity and sensory processing issues have

been highly linked to people diagnosed with autism spectrum disorder. (Neave-DiToro, Fuse,

Bergen, 2021, p. 410) According to Neave-DiToro, Fuse and Bergen, they stated that “

individuals with ASD are more likely to exhibit (a) hypersensitive hearing ability (89%), (b)

discomfort when listening to certain people’s voices (89%), (c) discomfort when hearing sudden

and/ or unexpected loud noises (99%), and difficulty functioning in noisy environments (97%)”

(Neave-DiToro, Fuse, Bergen, 2021, p. 409). This study shows the positive outcomes for a child

with autism that struggles with auditory hypersensitivity, and how noise cancelling headphones,

earmuffs, or earplugs may benefit them.

Pharmacological Therapy: Antipsychotics

Antipsychotic drugs may be administered to children with autism spectrum disorders

(ASD) as a pharmacological intervention to control behavioral symptoms. Irritability is a typical

ASD manifestation and studies have shown that those who are prescribed antipsychotics exhibit

these aggressive behaviors. This drug is indicated for distinctive manifestations of ASD. It is

essential to weigh the benefits and drawbacks of prescribing the medication. Antipsychotic use in

children is linked to a variety of adverse effects, the most common of which are extrapyramidal

side effects, obesity, and hyperprolactinemia (Downs, Hotopf, Ford, Simonoff, Jackson, Shetty,

Stewart, & Hayes, 2015). Clinical guidelines have advocated towards families with ASD

children to be careful when administering antipsychotics and to only treat if a child exhibits

harmful actions such as self-abuse and impulse behaviors (Downs, Hotopf, Ford, Simonoff,

Jackson, Shetty, Stewart, & Hayes, 2015). The reason is due to the risk of those adverse effects

discussed above and the little safety evidence accessible for children with ASD. Downs, Hotopf,

Ford, Simonoff, Jackson, Shetty, Stewart & Hayes (2015) study found the following:
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In the largest study to date using non-administrative, clinical mental health records in

ASD, we found antipsychotic prescribing for children with ASD was strongly associated

with comorbidity. Intellectual disability and psychiatric comorbidities, including

hyperkinetic, depression, psychotic, obsessive–compulsive and tic disorders, were all

associated with antipsychotic treatment (p. 652).

In the current research conducted there was no significant evidence related to the use of

antipsychotics, Risperidone and Aripiprazole with anxiety disorders. There was no conclusive

evidence related to environmental factors, such as history of caregiver mental illness, ethnicity,

and poor living environments influencing the use of antipsychotic medication either. In Downs,

Hotopf, Ford, Simonoff, Jackson, Shetty, Stewart & Hayes research there were positive

associations with aggressive, self-harm behaviors and high parental worry for child’s symptoms

for using Risperidone and Aripiprazole. Adolescents were in high demand for antipsychotics

compared to younger participants.

Pharmacological Therapy: Beta Blockers

Another pharmacological intervention found to be beneficial towards ASD, is

Propranolol. The adrenergic antagonist medication has been indicated for off-label testing for

those with anxiety and performance anxiety. In the present qualitative study, a single dose of

Propranolol did exhibit significant evidence for reducing anxiety levels. Numerous behaviors

were observed that were known to be influenced in ASD “including verbal abilities, facial

scanning as well as functional connectivity in single-dose psychopharmacological challenge

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studies” (Beversdorf et al., 2008; Beversdorf et al., 2011, Bodner et al., 2012, Zamzow et al.,

2014, Narayanan et al., 2010, p. 1172). The research consisted of 20 individuals with ASD who

got a single dose of Propranolol or a dose of a placebo. After the drug was administered,

participants played out a conversational correspondence task by partaking in a short conversation

with the scientist. As the research predicted, Propranolol essentially improved performance on

memory and verbal correspondence in children. While it likewise exhibited improvement in

nonverbal communication abilities. The results were not critical among anxiety levels and

autonomic activity such as the parasympathetic nervous system (PNS) and sympathetic nervous

system (SNS). Although, the PNS manages social behaviors. Both the PNS and SNS did not

have an impact on the medication’s therapeutic response.

Conclusion

In children diagnosed with autism, how does the use of non-pharmacological therapy and

pharmacological therapy influence a child's quality of life in the first 18 years? When addressing

this question, the benefits to children with ASD must be individualized. All together the studies

exemplified that both interventions assist in reducing ASD manifestations and improve day to

day life in numerous ways. The different discoveries assisted with improving the children's

behavioral outcomes such as communication skills, memory, and language barriers. These

studies also show significant improvement in motor and sensory function in children with ASD.

It is unclear on how the severity of this disorder may affect outcomes, each child is different and

therefore will respond differently than their peer. However, it is essential to understand that the

use of both treatments are individualized and the risks of every therapy ought to be taken into

consideration prior to utilizing them. With a combination of individualized non-pharmacological

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and pharmacological treatments, there is a chance for improvement in physical and social

lifestyle for these children suffering with ASD.

References
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K. (2017). The therapeutic Relationship as Predictor of Change in Music Therapy with
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