Ask An Expert / Autism Spectrum Disorder

After a year of therapies, my son with autism and ADHD hasn’t made much progress. Will this ever get better? What must we do?

Gains are gradual with these kids. Mark (and celebrate!) every success, and consider changing therapies

Mandi Silverman, PsyD, MBA
Mandi Silverman, PsyD, MBA

Clinical Psychologist, ADHD and Behavior Disorders Center

Child Mind Institute

My son is 5 and has low-functioning autism. He also has a lot of sensory integration problems and ADHD. He is basically non-verbal. His doctors have him on Risperidon and Ritalin. He receives special needs intervention therapy twice a week for an hour per session and I home school him combining schoolwork with OT and speech therapy. After almost a year of intensive therapies he still can't tell the different colors, he can't produce whole sentences. He will switch words around (we wondered about dyspraxia?) and still has behavioral problems? Will this ever get better? What must we do?

Thank you for asking this question. It sounds like your son has some complicated needs, and for parents, the needs of children with autism spectrum disorder can be overwhelming.

It’s great that you are taking a comprehensive approach to treatment, so he’s getting behavioral therapy as well as OT and speech therapy — that’s essential.

One thing you might consider is finding a way to increase the amount of time he’s getting behavioral therapy from 2 hours a week. It’s usually recommended that a child with low-functioning ASD get 25-40 hours a week of ABA-based therapy for 1 to 3 years.

That’s so your son can not only learn but practice skills, in structured and unstructured settings. Children with ASD need to replicate the interactions and the experiences many, many times in order to achieve mastery.

And in terms of progress, it’s important to recognize that for kids with these needs progress is gradual. A year may seem an inordinate amount of time, but it’s not for these kids. The key is to identify and appreciate any smaller gains that your son has made, celebrate them and let him know how proud you are of him, which then paves the way for additional success. So he may not be able to tell the difference between colors, but maybe for the first time he’s using words that indicate color? He’s not talking in complete sentences, but is he using 2-word sentences? It’s a step on the way to a 3-word sentence, with a verb.

So I hope you will take a look at the last year and list as many successes and achievements as possible, however small, and use that as your barometer for understanding whether things are getting better and whether you should adjust treatment approach and maybe increase the behavioral therapy.

Each provider you’re working with, including the OT and speech therapist, should have a specific treatment plan and goals. Progress should be measured and discussed quarterly, and that should help you evaluate your son’s gains.

If you think the support he’s getting needs to be reevaluated, perhaps seek a second opinion from another psychiatrist.

You could also consider enrolling him in an educational setting that’s specifically for kids with ASD. Usually when kids have very complicated needs we recommend a very structured educational program that combines carefully tailored teaching methods with behavioral support and additional therapies.

It’s important to keep in mind, as you handle these tough decisions, that with ASD there are so many permutations and combinations of symptoms that no two kids with ASD are the same. It’s totally impossible to gauge your child’s success against another’s — even another child who’s nonverbal. You can only look at him in his own context, and know that change is gradual, so it’s sometimes hard to evaluate what’s happening.