Severe autism, also called low-functioning autism, presents many challenges. Much of the time, severe autism can require 24-hour care and supervision.
Treatment can help people with severe autism to gain more independence, however. Therapies can improve social skills, increase communication abilities, reduce behavior problems, and enhance daily life functioning skills.
The earlier a person begins treatment services for severe autism, the better. Early intervention helps to build skills that can be used to manage autism symptoms. If this therapy is done when the child is at preschool age, or before that point, the results are better.
Applied behavior analysis (ABA) is one of the most supported treatment methods for all ranges of autism, including severe autism. ABA helps to reinforce desired behaviors through rewards and positivity while discouraging unwanted behaviors.
Additional treatment methods can be used in conjunction with ABA to support someone with severe autism. Occupational therapy and sensory integration therapies help children to complete daily activities and cope with sensory issues. Speech and language therapy can improve language and communication skills, even in someone who is nonverbal.
Severe autism often warrants multiple therapy types, as well as family support, to teach sustainable skills for managing the disorder and improving overall life functioning.
What Is Severe Autism?
There are three main diagnosable levels of autism, a spectrum disorder. Level 1 is considered high-functioning or less severe, while Level 3 is considered low-functioning and the most severe type.
People with Level 3 autism have significant difficulties socializing and participate in negative and potentially unsafe behaviors. They often have problems speaking and difficulties with nonverbal communication. They may not be able to complete basic life tasks.
Since autism is a spectrum disorder, there is a wide range of severity and disability within the disorder.
Severe autism can often be recognized as early as infancy. Babies may struggle to make eye contact, respond to their name, or babble.
Communication, language, motor skill, and behavioral delays are common in autistic babies and toddlers. While the diagnosis is not considered to be stable until around age 2, parents and caregivers may notice the signs of autism much earlier.
Signs of severe autism can include:
- Impaired social interaction.
- Regression of learned language or motor skills.
Poor language skills or being completely nonverbal.
Inability to understand and respond to others.
Limited or no eye contact.
Repeating phrases out of context.
Mimicking phrases or vocal tones without understanding what they mean.
Intense fixation on objects to the point of obsession.
Lining up objects or toys.
Inability to deviate from routine.
Extreme difficulties with change.
Repetitive motions or speech patterns.
Poor impulse control.
Sensory processing issues.
Difficulties with motor functions.
Use of objects in ways other than intended.
Severe autism often co-occurs with other disorders, most commonly fragile X syndrome, epilepsy, and tuberous sclerosis. These comorbid conditions can present additional challenges, such as further developmental delays, speech and language issues, motor skill problems, reduced cognitive abilities, seizures, and tumors.
Functioning With Severe Autism
Level 3 autism can require significant levels of support and ongoing care into adulthood. But with treatment, individuals with severe autism can learn how to manage some of their symptoms to perform daily life tasks.
Without treatment, it can be difficult for a person with severe autism to communicate effectively or perform simple tasks, such as grooming, toileting, and feeding themselves. Social skills may be nonexistent.
Many people with low-functioning autism are nonverbal. Therapies can teach them communication skills that do not require language or verbal speech, giving them a way to communicate with the world around them.
Someone with a less severe form of autism will be more apt to learn social, communication, and behavioral skills that can allow them to function more freely in society. People with a mild to moderate level of autism can often support themselves, even hold jobs, and live on their own.
Severe autism indicates a higher level of impairment and disability. It will typically mean that a person requires continuous support and will be unable to live alone.
Treatment Options for Severe Autism
Severe autism can benefit from multiple forms of treatment used collaboratively to support the person and family as a whole.
Treatment plans are devised by team made up of medical and mental health professionals. It often involves a multidisciplinary approach, and no two treatment plans are alike.
Goals for treating severe autism include:
- Maintaining the safety of the child and those around them.
- Improving communication abilities, for both verbal and nonverbal communication.
- Reducing problematic behaviors.
- Enhancing social skills.
- Building functional life skills to aid in everyday life.
Treatment plans can include:
- Early interventions.
- Behavior therapies, primarily applied behavior analysis (ABA) therapy.
- Occupational therapy.
- Sensory integration therapy.
- Speech and language therapy.
- The use of assistive technology.
- Medications to address specific symptoms.
- Nutrition plans.
- Complementary or holistic approaches.
- Family training, counseling, and support.
Treatment plans will also include methods for managing any co-occurring disorders simultaneously.
Severe autism usually requires a lot of support. Combining medical interventions (when needed) as well as behavioral therapies, speech and language therapies, and occupational therapies together can offer a comprehensive approach.
It’s well established that early diagnosis and early intervention result in better treatment outcomes for autism.
Young children’s brains are not fully formed, and this plasticity means they are better attuned to learn the lessons of therapy. Before age 5, toddlers can adapt better to therapy than older children.
Early intervention can take many forms, including both public and private varieties. Many early intervention programs (EIPs) are state-run, and their services vary depending on where you live. These programs are for young toddlers, typically under age 2.
Many parents hire ABA and other therapy providers to provide early intervention on a private basis. These sessions are often covered by insurance.
Early intervention programs can teach a child with autism essential developmental skills, such as:
- Emotional skills.
- Physical skills.
- Communication skills.
- Social skills.
- Thinking skills.
Applied Behavior Analysis (ABA)
ABA is a form of behavior therapy that can benefit all ranges on the autism spectrum, from high-functioning autism to severe autism. The therapy uses positive reinforcement techniques and rewards to motivate children to behave in a desired way. This reinforcement of positive behavior thereby discourages negative behavior.
ABA is an adaptive therapy type, meaning it can be tailored to fit anyone in many different environments. Severe autism can make it challenging for a child to work in uncomfortable or unfamiliar settings. ABA is flexible enough to work within the parameters of what best supports learning for the specific child.
ABA techniques can help to improve:
- Self-care skills, such as grooming and going to the bathroom.
- Learning and cognitive abilities.
- Social skills.
- Motor skills.
- Play abilities.
An ABA therapist establishes goals for the client and then breaks those goals down into smaller parts. Progress is tracked and closely monitored, and the therapy approach is reevaluated as needed.
Families work with board certified behavior analysts (BCBAs), who assess the child and design the overall treatment plan. Registered behavior technicians (RBTs) work directly with the child to carry out the treatment plan. RBTs must practice under the supervision of a BCBA.
Behavior therapies can help people with severe autism learn how to control impulses and manage potentially dangerous behaviors. Safety is a main priority with severe autism, as both self-harm and aggression may be present. Positive reinforcement can be used to teach coping skills and redirect negative behaviors into desired actions.
Occupational & Sensory Integration Therapy
Severe autism presents difficulties with the ability to perform daily life tasks, such as grooming, toileting, and feeding. Occupational therapy works to teach these self-reliance skills.
Occupational therapy (OT) can improve:
- Cognitive skills.
- Physical skills.
- Motor skills.
- Social skills.
An occupational therapist can work in a variety of settings, including within the home. The therapist identifies the individual’s particular strengths and weaknesses to design a plan that improves self-care and life skills. Occupational therapists can address both large and fine motor skills as well as help with specific skills for certain tasks.
Sensory integration therapy is essentially a type of modern occupational therapy that is often used to treat people with low-functioning autism.
Severe autism may involve extreme sensory issues, including a hypersensitive sense of touch, difficulties eating or swallowing food, trouble with loud noises, and being overly sensitive to bright lights. Sensory integration therapy can help a child with sensory issues learn how to process stimuli and manage sensory information better.
Speech-Language Therapy & Assistive Technology
Individuals with severe autism often struggle with language and communication abilities. Many are nonverbal.
Speech and language therapy can improve both verbal and nonverbal language and communication skills. This therapy may involve the use of aids, such as:
- Hand gestures.
- Sign language.
- Assistive technology.
Speech therapy can help to strengthen the muscles around the neck, jaw, and mouth that are related to speech. Therapy sessions may focus on improving speech sounds and understanding body language.
Nonverbal individuals can learn to use assistive technology, such as an electronic tablet or communication board, to communicate. The Picture Exchange Communication System (PECS), another form of nonverbal communication, involves picture symbols as methods of communication.
Hope for the Future
Parents of children with severe autism often feel overwhelmed, worried that their child’s skills will forever be stuck where they are now. This is not the case.
Through consistent therapy, children with severe autism can acquire necessary life skills, improve their ability to communicate, and learn to better function in the world.
Autism research is ongoing. New treatment approaches will likely be discovered in the coming years, but as of now, modern treatment options for severe autism are promising.
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