Autism Spectrum Disorder (ASD)

Finding The Right Treatment

Treatment of ASD

ASD is typically treated with a combination of therapy and medications.

Talk therapy

Therapy can help many adults with ASD better understand their thoughts, emotions, and behaviors – and the emotions and behaviors of others. Things that make an individual feel happy, sad, or frustrated may be different from other people. Similarly, other people may have different interests or opinions. Social skills training helps support adults with ASD on their journey to navigate the social world and cope with changes. Therapists can teach the person with ASD how to cope better with the inherent changeability of other people, as flexible thinking is a construct that can be extremely frustrating and difficult for the person with ASD.

Through therapy, people with autism can also learn about the ways in which other people act. These signs and signals may baffle the person with ASD, but there are often observable patterns one can begin to identify, such as body language, the tone and pitch of a person’s voice, and whether or not they engage in eye contact. Recognizing those social clues can be very helpful.

Adults with ASD may also struggle with understanding how to filter their thoughts and feelings in social situations. For example, when a sister asks her brother with ASD if he likes her new haircut, he may reply impulsively with very negative thoughts about the haircut and not think about how his response may make her feel. Perspective taking is an area that is commonly difficult for those with ASD, and can be greatly improved with social skills training.

An individual with ASD may also struggle with symptoms of anxiety and/or depressed mood. Cognitive behavioral therapy (CBT) is a method that helps individuals identify unhelpful thought patterns, challenge self-destructive cognitions, and replaces them with more constructive thinking. Learning new things or reframing thoughts can be very challenging. It takes hard work and practice, but adults with ASD benefit from strengthening these skills with a therapist.

Finding a therapist

Therapy has been proven to yield major improvements in the lives of those with ASD, and it is best to work with a therapist who is experienced in helping adults with ASD. In addition, people with ASD may benefit from occupational therapy or speech therapy. Many experts in ASD concentrate on children and adolescents and it may be challenging to find a therapist experienced in treating adults with ASD. The nearest local branch of the National Autism Society may be able to provide a referral to a neurologist, psychiatrist, or psychologist who is experienced in treating adults who have ASD.

The decision to start therapy

Many people try to cope with their distress on their own, and then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Asking one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes your insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.

Determining whether medications will play a role in treatment

The core symptoms of autism, specifically the difficulty in communication and idiosyncratic behaviors, do not respond to currently available medications. Nevertheless, medications can play a role in the treatment of associated conditions. For instance, medications such as risperidone and aripiprazole are helpful in treating aggression, irritability, and sometimes repetitive behaviors. These medications have official FDA indication in children with ASD but thus far not in adults.

Selective serotonin reuptake inhibitors (SSRI) are often used to treat depression, anxiety and obsessive-compulsive

behaviors that frequently occur in patients with ASD. Notable medications include fluoxetine, sertraline and paroxetine.

These medications do not have an official indication for ASD in adults but have been widely adopted as a way to relieve certain ASD symptoms.

It is not uncommon for ADHD symptoms to coexist in patients with ASD. For this reason, long-acting stimulant medication, such as Concerta, Adderall XR and Vyvanse are commonly used to treat hyperactivity, inattention and impulsivity in complicated ASD patients.

Some clinicians use mood stabilizing medications, such as lithium carbonate and valproic acid to decrease mood swings and irritability in patients with autism spectrum disorder. There is not a lot of information published supporting the use of these medications for ASD.

Finally, anticonvulsant medications such as lamotrigine and topiramate are used in individuals with ASD. These medications might decrease irritability. Lamictal in particular can be well tolerated. It should be noted that these do not have official FDA indication.

Healthcare providers that can prescribe medications

Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN, or a new primary doctor.