Expanding Access, Improving Implantation

There are numerous existing therapies and supports that have been successful in helping kids with autism reach their potential, but there are also barriers. Pediatricians sometimes fail to use common screening measures according to the standardized instructions, says Diana Robins, PhD. Robins helped develop one of the most commonly used tools, the Modified Checklist for Autism in Toddlers (M-CHAT), which includes a round of standardized questions to ask when initial screening raises red flags (Pediatrics, Vol. 133, No. 1, 2014). But pediatricians sometimes cherry-pick a few questions from the checklist instead of using the whole scale, Robins says, and often fail to ask the standardized follow-up questions for children who may be on the spectrum.

Research by David Mandell, ScD, a professor of psychiatry at the University of Pennsylvania, has found racial and ethnic disparities in autism diagnosis, suggesting that underserved populations, in particular, aren’t getting the screenings and referrals they need (American Journal of Public Health, Vol. 99, No. 3, 2009). Mandell’s work has also shown that when preschoolers get early intervention in research settings, the resulting improvements in communication, daily functioning, social skills and other developmental domains are often quite large (Nahmias, A.S., et al., The Journal of Child Psychology and Psychiatry, Vol. 60, No. 11, 2019).

Applied behavior analysis, or ABA, for example, is considered the gold standard for autism intervention. This therapy focuses on reinforcing specific behaviors, such as communication or self-care. Though ABA has its critics, who argue that reinforcement for behaviors focuses too much on forcing children with autism to act typical without addressing

their psychological and mental health needs, behavioral interventions have a substantial amount of research supporting their efficacy. A review co-authored by Dawson found that such behavioral interventions can improve language, cognitive abilities and social communication while reducing aggression and anxiety symptoms (Current Opinion in Pediatrics, Vol. 23, No. 6, 2011). But many children end up on years-long waitlists for behavioral interventions, owing to provider shortages and low Medicaid reimbursement rates.

While behavioral interventions are effective for those who can access them, there are currently no pharmaceutical treatments specifically for autism. Children are sometimes prescribed atypical antipsychotics, antiepileptic drugs and other pharmaceuticals off-label, but evidence of their efficacy is often mixed or lacking, and side effects can be intolerable, according Na Young Ji, MD.

Psychologists are tackling many of these problems. One push is to train pediatricians to implement screening correctly, Robins says. Another top priority is to do research examining whether early diagnosis yields quicker intervention, which in turn is expected to yield better outcomes in children with autism.


Pappas, S. (2020). Helping People with Autism Reach their Full Potential. Vol. 52. No. 5.

Pg. 26. American Psychological Association.