This resource provides pediatricians and other pediatric clinicians with practical information about prescribing or recommending common supports and services for children on the autism spectrum, or for whom there are indicators of autism.  

  • For the purposes of this resource, we are using the term “supports and services” to describe a range of common evidence-based and informed therapies, interventions, and support approaches for children on the autism spectrum. 
  • This resource is not a comprehensive list of subspecialty referrals for the evaluation of other specific co-occurring medical and/or behavioral concerns. 
  • This resource does not offer a prescriptive guide/algorithm on what supports and services to prescribe for your patients.
  • There are multiple approaches that clinicians may take when considering what supports and services to prescribe. Two approaches are outlined in this resource: prescription/recommendation type and core area of need. Overlap across these categories exists.  

Guiding Principles for Prescribing Supports and Services: 

All supports and services for children on the autism spectrum should: 

  • Have clear goals
  • Be individualized (every child and family is unique)
  • Be developmentally appropriate
  • Be person and family centered with shared decision-making of goals and priorities
  • Be administered in a natural/least restrictive environment when possible
  • Never utilize aversive punishment or be traumatic
  • Be strength-based (supportive of an Autistic “way of being”). 

Additional Prescribing Consideration: 

  • Access to supports and services varies based on a number of factors, including geographic location of the pediatric clinicians and family/caregiver. 
  • Clinicians prescribing supports and services to children on the autism spectrum are encouraged to document the related diagnosis/code on prescriptions for appropriate supports/services.  For instance, if a child has a feeding disorder, the appropriate diagnoses could be pediatric feeding disorder (chronic), dysphagia (oral phase), and autism spectrum disorder.  If autism spectrum disorder and speech / language disorder is listed as the only diagnoses, it may be denied by the insurance carrier.    

For more information on caring for children on the autism spectrum, view the AAP clinical report, Identification, Evaluation, and Management of Children With Autism Spectrum Disorder

Approach 1: Prescription/Recommendation Type 

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Therapy Services

State-based Early Intervention (EI), ages 0-3

Definition

Every state in the US has an EI program for infants and toddlers (Birth-3). The EI program supports early development in children at risk for or diagnosed with developmental delays. This program can support children across all 5 developmental domains when there are concerns. Eligibility criteria is state specific. Infants and toddlers are screened/evaluated for appropriate services. State EI programs are a part of the Individuals with Disabilities Education Act (IDEA) Part C. 

Skills Supported

  • Communication
  • Physical (gross motor, vision, hearing, sensory)
  • Cognitive (thinking, problem solving)
  • Adaptive/Self-help
  • Socioemotional 

Pediatric Clinician Role

  • Screen for developmental delays, conduct developmental surveillance.
  • Refer to state-based EI program for eligibility determination; support coordination and follow up after referral.
  • Understand that evaluation and therapy is based on helping the child have access to education and supporting functional participation in the school environment. 

More Information

State-based Early Intervention (EI), ages 0-3

Definition

Every state in the US has an EI program for infants and toddlers (Birth-3). The EI program supports early development in children at risk for or diagnosed with developmental delays. This program can support children across all 5 developmental domains when there are concerns. Eligibility criteria is state specific. Infants and toddlers are screened/evaluated for appropriate services. State EI programs are a part of the Individuals with Disabilities Education Act (IDEA) Part C. 

Skills Supported

  • Communication
  • Physical (gross motor, vision, hearing, sensory)
  • Cognitive (thinking, problem solving)
  • Adaptive/Self-help
  • Socioemotional 

Pediatric Clinician Role

  • Screen for developmental delays, conduct developmental surveillance.
  • Refer to state-based EI program for eligibility determination; support coordination and follow up after referral.
  • Understand that evaluation and therapy is based on helping the child have access to education and supporting functional participation in the school environment. 

More Information

School Based Intervention, Ages 3-5   (Early Childhood Special Education)

Definition

Every school district has a program to support children with additional learning needs/developmental delays. Children are screened/evaluated for services through their school district and may be determined eligible for additional support. These programs are part of the IDEA Part B. 

Skills Supported

  • Communication
  • Physical (gross motor, vision, hearing, sensory)
  • Cognitive (thinking, problem solving)
  • Adaptive/Self-help
  • Socioemotional 

Pediatric Clinician Role 

  • Support families/caregivers to request evaluation through local school district.
  • Understand the basic rules/regulations related to school services to support families/caregivers as they navigate the process. 
  • Understand that evaluation and therapy is based on helping the child have access to education and supporting functional participation in the school environment.
  • Request and review a copy of evaluation/progress reports for your information and the medical record.
  • Check in with child/family about services being received and progress toward goals.  

More Information

School Based Intervention, Ages 3-5   (Early Childhood Special Education)

Definition

Every school district has a program to support children with additional learning needs/developmental delays. Children are screened/evaluated for services through their school district and may be determined eligible for additional support. These programs are part of the IDEA Part B. 

Skills Supported

  • Communication
  • Physical (gross motor, vision, hearing, sensory)
  • Cognitive (thinking, problem solving)
  • Adaptive/Self-help
  • Socioemotional 

Pediatric Clinician Role 

  • Support families/caregivers to request evaluation through local school district.
  • Understand the basic rules/regulations related to school services to support families/caregivers as they navigate the process. 
  • Understand that evaluation and therapy is based on helping the child have access to education and supporting functional participation in the school environment.
  • Request and review a copy of evaluation/progress reports for your information and the medical record.
  • Check in with child/family about services being received and progress toward goals.  

More Information

School Based Intervention, Ages 5-22 (Special Education)

Definition

Every school district follows IDEA Part B process for evaluating school aged children who may need additional educational support.  Individual Education Plans (IEP) may be developed for children who are determined to be eligible for more support at school.  

*504 Plans may be appropriate for some individuals on the autism spectrum when they are not eligible for an IEP.  

Skills Supported

  • Communication
  • Physical (gross motor, vision, hearing, sensory)
  • Cognitive (thinking, problem solving)
  • Adaptive/Self-help
  • Socioemotional 

Pediatric Clinician Role 

  • Support families/caregivers to request evaluation through local school district. 
  • Understand the basic rules/regulations related to school services to support families/caregivers as they navigate the process.
  • Understand that evaluation and therapy is based on helping the child have access to education and supporting functional participation in the school environment.
  • Request and review a copy of evaluation/progress reports for your information and the medical record.
  • Check in with child/family about services being received and progress toward goals. 
  • Support child/family to advocate for necessary services across school settings and transitions.  

More Information

School Based Intervention, Ages 5-22 (Special Education)

Definition

Every school district follows IDEA Part B process for evaluating school aged children who may need additional educational support.  Individual Education Plans (IEP) may be developed for children who are determined to be eligible for more support at school.  

*504 Plans may be appropriate for some individuals on the autism spectrum when they are not eligible for an IEP.  

Skills Supported

  • Communication
  • Physical (gross motor, vision, hearing, sensory)
  • Cognitive (thinking, problem solving)
  • Adaptive/Self-help
  • Socioemotional 

Pediatric Clinician Role 

  • Support families/caregivers to request evaluation through local school district. 
  • Understand the basic rules/regulations related to school services to support families/caregivers as they navigate the process.
  • Understand that evaluation and therapy is based on helping the child have access to education and supporting functional participation in the school environment.
  • Request and review a copy of evaluation/progress reports for your information and the medical record.
  • Check in with child/family about services being received and progress toward goals. 
  • Support child/family to advocate for necessary services across school settings and transitions.  

More Information

Clinical Occupational Therapy 

Definition

Occupational therapy assesses and supports individuals to develop, adapt or maintain meaningful activities for daily living, and supports fine motor development. 

Skills Supported

  • Feeding
  • Self-care/hygiene
  • Executive functioning skills like planning and task management
  • Handwriting
  • Fine motor skills
  • Sensory modulation skills  

Pediatric Clinician Role 

  • Prescribe occupational therapy to support appropriate skill development outside of the school setting. 
  • Review evaluation/progress reports
  • Discuss progress toward goals with child/family 

Clinical Occupational Therapy 

Definition

Occupational therapy assesses and supports individuals to develop, adapt or maintain meaningful activities for daily living, and supports fine motor development. 

Skills Supported

  • Feeding
  • Self-care/hygiene
  • Executive functioning skills like planning and task management
  • Handwriting
  • Fine motor skills
  • Sensory modulation skills  

Pediatric Clinician Role 

  • Prescribe occupational therapy to support appropriate skill development outside of the school setting. 
  • Review evaluation/progress reports
  • Discuss progress toward goals with child/family 

Clinical Speech Language Therapy 

Definition

Speech therapy assesses oral motor skills and communication skills. 

Skills Supported

  • Swallowing/Feeding and Restrictive Eating
  • Expressive Language skills (Sound production, articulation)
  • Social communication skills (gestures, non-verbal skills, conversations)
  • Listening/receptive language skills 

Pediatric Clinician Role 

  • Prescribe speech/language therapy to support appropriate skill development. 
  • Review evaluation/progress reports
  • Discuss progress toward goals with child/family 

Clinical Speech Language Therapy 

Definition

Speech therapy assesses oral motor skills and communication skills. 

Skills Supported

  • Swallowing/Feeding and Restrictive Eating
  • Expressive Language skills (Sound production, articulation)
  • Social communication skills (gestures, non-verbal skills, conversations)
  • Listening/receptive language skills 

Pediatric Clinician Role 

  • Prescribe speech/language therapy to support appropriate skill development. 
  • Review evaluation/progress reports
  • Discuss progress toward goals with child/family 

Clinical Physical Therapy 

Definition

Physical therapy assesses movement and motor skills.  

Skills Supported

  • Gross motor skills (e.g., running, jumping)
  • Toe-walking 

Pediatric Clinician Role 

  • Prescribe physical therapy to support appropriate skill development
  • Review evaluation/progress reports
  • Discuss progress toward goals with child/family 

Clinical Physical Therapy 

Definition

Physical therapy assesses movement and motor skills.  

Skills Supported

  • Gross motor skills (e.g., running, jumping)
  • Toe-walking 

Pediatric Clinician Role 

  • Prescribe physical therapy to support appropriate skill development
  • Review evaluation/progress reports
  • Discuss progress toward goals with child/family 

Applied Behavior Analysis (ABA) 

Definition

ABA assesses and modifies behavior through teaching to increase communication, increase social and functional skills and reduce interfering behaviors.

Skills Supported

  • Preacademic and academic skills
  • Communication skills
  • Safety skills
  • Play/social skills
  • Requesting 
  • Following directions
  • Reducing self-harm 
  • Reducing aggression 

Pediatric Clinician Role 

  • Understand the basic differences in types of ABA therapy and have resources available for a family/caregiver to make informed decision about types of ABA therapy available
  • Prescribe ABA therapy to support appropriate skill development 
  • Review evaluation/progress reports
  • Discuss progress toward goals with child/family 

Applied Behavior Analysis (ABA) 

Definition

ABA assesses and modifies behavior through teaching to increase communication, increase social and functional skills and reduce interfering behaviors.

Skills Supported

  • Preacademic and academic skills
  • Communication skills
  • Safety skills
  • Play/social skills
  • Requesting 
  • Following directions
  • Reducing self-harm 
  • Reducing aggression 

Pediatric Clinician Role 

  • Understand the basic differences in types of ABA therapy and have resources available for a family/caregiver to make informed decision about types of ABA therapy available
  • Prescribe ABA therapy to support appropriate skill development 
  • Review evaluation/progress reports
  • Discuss progress toward goals with child/family 

Parent-training 

Definition

Parent training supports families/caregivers to understand the core characteristics of autism and how they can adapt their parenting strategies to support their child.

Skills Supported

  • Communication strategies to increase skills
  • Strategies to respond to interfering behavior 
  • Knowledge of autism characteristics
  • Knowledge of autism supports and services 

Pediatric Clinician Role 

  • Understand local and/or virtual resources available for parent training and support
  • Encourage families/caregivers to learn and grow with their child’s needs 

Parent-training 

Definition

Parent training supports families/caregivers to understand the core characteristics of autism and how they can adapt their parenting strategies to support their child.

Skills Supported

  • Communication strategies to increase skills
  • Strategies to respond to interfering behavior 
  • Knowledge of autism characteristics
  • Knowledge of autism supports and services 

Pediatric Clinician Role 

  • Understand local and/or virtual resources available for parent training and support
  • Encourage families/caregivers to learn and grow with their child’s needs 

Counseling 

Definition

Supports families/caregivers and children to develop coping skills and stress reduction.

Skills Supported

Address some of the following: 

  • anxiety
  • phobias
  • obsessive thoughts
  • mood symptoms
  • oppositional behaviors
  • self-injurious behaviors 

Pediatric Clinician Role 

  • Understand that children on the autism spectrum may communicate in alternative means (augmentative communication device) and this may allow them to engage in needed counseling support. 

Counseling 

Definition

Supports families/caregivers and children to develop coping skills and stress reduction.

Skills Supported

Address some of the following: 

  • anxiety
  • phobias
  • obsessive thoughts
  • mood symptoms
  • oppositional behaviors
  • self-injurious behaviors 

Pediatric Clinician Role 

  • Understand that children on the autism spectrum may communicate in alternative means (augmentative communication device) and this may allow them to engage in needed counseling support. 


Approach 2: Core Area of Need 

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Area of Need

Social skills 

Skills Supported

  • Social communication
  • Peer interaction 
  • Peer conversation
  • Understanding social cues 

Types of Supports/Services Available  

School (including EI) and/or clinical interventions that focus on engagement of the child with others:  

  • For toddlers/very young children: Naturalistic Developmental Behavioral Interventions: e.g. Early Start Denver model, Pivotal Response Treatment
  • For children with less interest in social engagement:   
    • Behavioral interventions: e.g. Applied Behavioral Analysis, discrete trial training
  • Social Interventions/Social Curricula for school aged, children who are verbal: Program for the Education and Enrichment of Relational Skills (PEERS), Social Thinking model

Additional Considerations for Pediatric Clinicians 

  • Many available options and models to support social skill development in children on the spectrum.
  • Encourage families to explore their available options and work with therapists to establish goals that are individualized, developmentally appropriate and non-aversive.  

Social skills 

Skills Supported

  • Social communication
  • Peer interaction 
  • Peer conversation
  • Understanding social cues 

Types of Supports/Services Available  

School (including EI) and/or clinical interventions that focus on engagement of the child with others:  

  • For toddlers/very young children: Naturalistic Developmental Behavioral Interventions: e.g. Early Start Denver model, Pivotal Response Treatment
  • For children with less interest in social engagement:   
    • Behavioral interventions: e.g. Applied Behavioral Analysis, discrete trial training
  • Social Interventions/Social Curricula for school aged, children who are verbal: Program for the Education and Enrichment of Relational Skills (PEERS), Social Thinking model

Additional Considerations for Pediatric Clinicians 

  • Many available options and models to support social skill development in children on the spectrum.
  • Encourage families to explore their available options and work with therapists to establish goals that are individualized, developmentally appropriate and non-aversive.  

Self-injurious or aggressive behavior 

Skills Supported

  • Functional communication skills 
  • Replacement of interfering behavior with adaptive behavior
  • Safety strategies 

Types of Supports/Services Available  

  • Therapies that support functional communication like speech and language therapy (Example: Picture Exchange Communication System (PECS) or Augmentative and Alternative Communication (AAC)).
  • Referral to a behavioral therapist who can assess behavior through a Functional Behavioral Assessment (FBA).
  • If the behavior is happening at school, parents may request (in writing) an FBA to help the school understand the behavior and how to address it.  

Additional Considerations for Pediatric Clinicians 

  • These behaviors are difficult to assess and typically are a form of communication. 
  • Assess for pain and other underlying medical factors when self-injury/aggression begins or when there is a change in pattern.
  • Optimize functional communication for the child and engage behavioral specialists to help reduce the interfering behavior.  

Self-injurious or aggressive behavior 

Skills Supported

  • Functional communication skills 
  • Replacement of interfering behavior with adaptive behavior
  • Safety strategies 

Types of Supports/Services Available  

  • Therapies that support functional communication like speech and language therapy (Example: Picture Exchange Communication System (PECS) or Augmentative and Alternative Communication (AAC)).
  • Referral to a behavioral therapist who can assess behavior through a Functional Behavioral Assessment (FBA).
  • If the behavior is happening at school, parents may request (in writing) an FBA to help the school understand the behavior and how to address it.  

Additional Considerations for Pediatric Clinicians 

  • These behaviors are difficult to assess and typically are a form of communication. 
  • Assess for pain and other underlying medical factors when self-injury/aggression begins or when there is a change in pattern.
  • Optimize functional communication for the child and engage behavioral specialists to help reduce the interfering behavior.  

Restrictive Eating 

Skills Supported

  • Increased food acceptance
  • Increased texture acceptance
  • Well-balanced nutritional intake 

Types of Supports/Services Available  

  • Speech or occupational therapist with experience in feeding. 
  • Pediatric dietician to assess nutritional intake for growth and adequate nutrition. 
  • Calorie supplements may be recommended following the nutritional assessment.

Additional Considerations for Pediatric Clinicians 

  • Consider routine lab evaluation to evaluate for significant vitamin and mineral deficiencies.  

Restrictive Eating 

Skills Supported

  • Increased food acceptance
  • Increased texture acceptance
  • Well-balanced nutritional intake 

Types of Supports/Services Available  

  • Speech or occupational therapist with experience in feeding. 
  • Pediatric dietician to assess nutritional intake for growth and adequate nutrition. 
  • Calorie supplements may be recommended following the nutritional assessment.

Additional Considerations for Pediatric Clinicians 

  • Consider routine lab evaluation to evaluate for significant vitamin and mineral deficiencies.  

Toe Walking 

Skills Supported

  • Functional ambulation/gait 

Types of Supports/Services Available  

  • State EI program or school district special education services for evaluation
  • Gait evaluation from professionals including pediatric physical therapy, physical medicine and rehabilitation, orthopedics and/or neurology
  • Orthotics based on evaluation and recommendations  

Additional Considerations for Pediatric Clinicians 

  • Toe walking may result from increased need for proprioceptive (sensory input) or may be from an underlying neurologic issue. 
  • Consider referral for gait assessment in children with toe-walking to further assess treatment need and options.  

Toe Walking 

Skills Supported

  • Functional ambulation/gait 

Types of Supports/Services Available  

  • State EI program or school district special education services for evaluation
  • Gait evaluation from professionals including pediatric physical therapy, physical medicine and rehabilitation, orthopedics and/or neurology
  • Orthotics based on evaluation and recommendations  

Additional Considerations for Pediatric Clinicians 

  • Toe walking may result from increased need for proprioceptive (sensory input) or may be from an underlying neurologic issue. 
  • Consider referral for gait assessment in children with toe-walking to further assess treatment need and options.  

Adaptive skills  

Skills Supported

  • Self-care including dressing, undressing, hygiene
  • Utensil/cup use for feeding
  • Coloring/writing with crayons/pencils 

Types of Supports/Services Available  

  • School-based supports to assess adaptive and fine motor skills
  • Clinical occupational therapy for assessment and treatment planning
  • Inclusion of adaptive skills among IEP goals addressed in school settings and/or through OT in other settings 
  • Home supports/services may also focus on these skills 

Additional Considerations for Pediatric Clinicians 

  • Monitor muscle tone and strength when considering adaptive and fine motor skill needs as low tone in hands and mouth can affect these skills and require intervention.  

Adaptive skills  

Skills Supported

  • Self-care including dressing, undressing, hygiene
  • Utensil/cup use for feeding
  • Coloring/writing with crayons/pencils 

Types of Supports/Services Available  

  • School-based supports to assess adaptive and fine motor skills
  • Clinical occupational therapy for assessment and treatment planning
  • Inclusion of adaptive skills among IEP goals addressed in school settings and/or through OT in other settings 
  • Home supports/services may also focus on these skills 

Additional Considerations for Pediatric Clinicians 

  • Monitor muscle tone and strength when considering adaptive and fine motor skill needs as low tone in hands and mouth can affect these skills and require intervention.  
Last Updated

01/18/2024

Source

American Academy of Pediatrics