Editing Asperger syndrome (section)

== Management ==
{{Further|Autism therapies}}

Treatment attempts to manage distressing symptoms and to teach age-appropriate social, communication, and vocational skills that are not naturally acquired during development.<ref name="McPart2006" /> Intervention is tailored to the needs of the individual based on multidisciplinary assessment.<ref>{{cite journal | vauthors = Khouzam HR, El-Gabalawi F, Pirwani N, Priest F | title = Asperger's disorder: a review of its diagnosis and treatment | journal = Comprehensive Psychiatry | volume = 45 | issue = 3 | pages = 184–91 | year = 2004 | pmid = 15124148 | doi = 10.1016/j.comppsych.2004.02.004}}</ref> Although progress has been made, data supporting the [[efficacy]] of particular interventions are limited.<ref name="McPart2006" /><ref>{{cite journal | vauthors = Attwood T | title = Frameworks for behavioral interventions | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 65–86, vi | date = January 2003 | pmid = 12512399 | doi = 10.1016/S1056-4993(02)00054-8}}</ref>

=== Therapies ===
<!-- Please respect alphabetical order. -->
Managing ASD may involve multiple therapies that address core symptoms of the disorder. While many professionals agree that the earlier the professional support the better, there is no combination that is recommended above others.<ref name=NINDS /> Professional support for ASD varies depending on the individual; it takes into account the linguistic capabilities, verbal strengths, and nonverbal vulnerabilities of individuals.<ref name=McPart2006 />

Many of those diagnosed with ASD or similar disorders advocate against behavioral therapies, like Applied behavior analysis (ABA) and Cognitive behavioral therapy (CBT), often as part of the [[autism rights movement]], on the grounds that these approaches frequently reinforce the demand on autistic people to [[Autistic masking|mask their neurodivergent characteristics]] or behaviors to favor a more '[[neurotypical]]' and narrow conception of normality.<ref>{{Cite web |title=Commentary: The autistic community is having a reckoning with ABA therapy. We should listen |url=https://fortune.com/2022/05/13/autistic-community-reckoning-aba-therapy-rights-autism-insurance-private-equity-ariana-cernius/ |access-date=2023-10-31 |website=Fortune |language=en}}</ref><ref>{{Cite journal | vauthors = McGill O, Robinson A |date=2020-01-01 |title="Recalling hidden harms": autistic experiences of childhood applied behavioural analysis (ABA) |journal=Advances in Autism |volume=7 |issue=4 |pages=269–282 |doi=10.1108/AIA-04-2020-0025 |s2cid=225282499 |issn=2056-3868|url=https://strathprints.strath.ac.uk/73753/1/McGill_Robinson_AA_2020_autistic_experiences_of_childhood_Applied_Behavioural_Analysis.pdf }}</ref><ref>{{cite journal | vauthors = Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, Mandy W | title = "Putting on My Best Normal": Social Camouflaging in Adults with Autism Spectrum Conditions | journal = Journal of Autism and Developmental Disorders | volume = 47 | issue = 8 | pages = 2519–2534 | date = August 2017 | pmid = 28527095 | pmc = 5509825 | doi = 10.1007/s10803-017-3166-5 }}</ref> ABA has faced a great deal of [[Applied behaviour analysis#Criticism|criticism]] over the years. Recently, studies have shown that ABA may be abusive and can increase PTSD symptoms in patients.<ref>{{Cite journal | vauthors = Kupferstein H |date=2018-01-02 |title=Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis |url=https://www.emerald.com/insight/content/doi/10.1108/AIA-08-2017-0016/full/html |journal=Advances in Autism |language=en |volume=4 |issue=1 |pages=19–29 |doi=10.1108/AIA-08-2017-0016 |issn=2056-3868 |s2cid=4638346}}</ref><ref>{{Cite journal | vauthors = Sandoval-Norton AH, Shkedy G, Shkedy D |date=2019-01-01 | veditors = Rushby JA |title=How much compliance is too much compliance: Is long-term ABA therapy abuse? |journal=Cogent Psychology |language=en |volume=6 |issue=1 |pages=1641258 |doi=10.1080/23311908.2019.1641258 |issn=2331-1908 |s2cid=199041640 |doi-access=free}}</ref><ref>{{cite journal | vauthors = Wilkenfeld DA, McCarthy AM | title = Ethical Concerns with Applied Behavior Analysis for Autism Spectrum "Disorder" | journal = Kennedy Institute of Ethics Journal | volume = 30 | issue = 1 | pages = 31–69 | date = 2020 | pmid = 32336692 | doi = 10.1353/ken.2020.0000 | s2cid = 216557299 }}</ref><ref>{{cite journal | vauthors = Bottema-Beutel K, Crowley S, Sandbank M, Woynaroski TG | title = Research Review: Conflicts of Interest (COIs) in autism early intervention research - a meta-analysis of COI influences on intervention effects | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 62 | issue = 1 | pages = 5–15 | date = January 2021 | pmid = 32353179 | pmc = 7606324 | doi = 10.1111/jcpp.13249 }}</ref><ref>{{Cite journal | vauthors = McGill O, Robinson A |date=2021-10-26 |title="Recalling hidden harms": autistic experiences of childhood applied behavioural analysis (ABA) |url=https://www.emerald.com/insight/content/doi/10.1108/AIA-04-2020-0025/full/html |journal=Advances in Autism |language=en |volume=7 |issue=4 |pages=269–282 |doi=10.1108/AIA-04-2020-0025 |issn=2056-3868 |s2cid=225282499}}</ref><ref>{{Cite journal | vauthors = Shkedy G, Shkedy D, Sandoval-Norton AH |date=June 2021 |title=Long-term ABA Therapy Is Abusive: A Response to Gorycki, Ruppel, and Zane |journal=Advances in Neurodevelopmental Disorders |language=en |volume=5 |issue=2 |pages=126–134 |doi=10.1007/s41252-021-00201-1 |issn=2366-7532 |doi-access=free}}</ref> The [[Autistic Self Advocacy Network]] campaigns against the use of ABA in autism.<ref name="Autistic Self Advocacy Network">{{cite web |author=Autistic Self Advocacy Network |title=Autistic Self Advocacy Network – Nothing About Us Without Us |url=http://www.autisticadvocacy.org/ |website=www.autisticadvocacy.org}}</ref><ref name="DeVita-Raeburn_2016">{{cite web |date=2016-08-11 |title=Is the Most Common Therapy for Autism Cruel? |url=https://www.theatlantic.com/health/archive/2016/08/aba-autism-controversy/495272/ |website=[[The Atlantic]] |vauthors=DeVita-Raeburn E}}</ref>

In the case of CBT and talking therapies, the effectiveness varies, with many reporting that they appeared 'too self-aware' to gain significant benefit, as the therapy was designed with neurotypical people in mind.<ref>{{Cite web | vauthors = Nicholls A |date=2021-10-14 |title=Why Doesn't Standard Talking Therapy Work for Autistic People? |url=https://www.dralicenicholls.com/why-doesnt-standard-talking-therapy-work-for-autistic-people/ |access-date=2023-11-03 |website=Dr Alice Nicholls |language=en-GB}}</ref><ref>{{Cite web |title=Is CBT effective when working with autistic people? |url=https://www.counselling-directory.org.uk/memberarticles/is-cbt-effective-when-working-with-people-with-autism |access-date=2023-11-03 |website=www.counselling-directory.org.uk |language=en-GB}}</ref> In autistic children, specifically, they also report that it is only mildly beneficial in aiding with their anxieties.<ref>{{Cite web |date=2021-11-16 |title=Cognitive behavioral therapy may be only mildly effective for anxious, autistic children |url=https://www.spectrumnews.org/news/cognitive-behavioral-therapy-may-be-only-mildly-effective-for-anxious-autistic-children/ |access-date=2023-11-03 |website=Spectrum {{!}} Autism Research News |language=en-US}}</ref>

A typical program of professional support generally includes:<ref name="NINDS" />
* [[Applied behavior analysis]] (ABA) procedures, including [[positive behavior support]] (PBS)—or training and support of parents and school faculty in behavior management strategies to use in the home and school, and [[social skills]] training for more effective interpersonal interactions.<ref>{{cite journal | vauthors = Krasny L, Williams BJ, Provencal S, Ozonoff S | title = Social skills interventions for the autism spectrum: essential ingredients and a model curriculum | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 107–22 | date = January 2003 | pmid = 12512401 | doi = 10.1016/S1056-4993(02)00051-2}}</ref> The [[Autistic Self Advocacy Network]] campaigns against the use of ABA in autism;<ref name="Autistic Self Advocacy Network" /><ref name="DeVita-Raeburn_2016" />
* [[Cognitive behavioral therapy]] to improve [[stress management]] relating to anxiety or explosive emotions<ref name="Myles">{{cite journal | vauthors = Myles BS | title = Behavioral forms of stress management for individuals with Asperger syndrome | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 123–41 | date = January 2003 | pmid = 12512402 | doi = 10.1016/S1056-4993(02)00048-2}}</ref> and to help reduce obsessive interests (although this may produce negative impact by demonising special interests) and repetitive routines;
* [[Medication]] for coexisting conditions such as [[major depressive disorder]] and [[anxiety disorder]]s;<ref name="Towbin" />
* [[Occupational therapy|Occupational]] or [[physical therapy]] to assist with poor [[sensory processing]] and [[motor coordination]]; and,
* [[Social communication]] intervention, which is specialized [[speech therapy]] to help with the [[pragmatics]] and give-and-take of normal conversation.<ref>{{cite journal | vauthors = Paul R | title = Promoting social communication in high functioning individuals with autistic spectrum disorders | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 87–106, vi–vii | date = January 2003 | pmid = 12512400 | doi = 10.1016/S1056-4993(02)00047-0}}</ref>

Of the many studies on behavior-based early intervention programs, most are [[case report]]s of up to five participants and typically examine a few problem behaviors such as [[self-injury]], [[aggression]], noncompliance, [[stereotypies]]<!-- Not "stereotypes" -->, or spontaneous language; unintended [[side effect]]s are largely ignored.<ref name=interrev>{{cite journal | vauthors = Matson JL | title = Determining treatment outcome in early intervention programs for autism spectrum disorders: a critical analysis of measurement issues in learning based interventions | journal = Research in Developmental Disabilities | volume = 28 | issue = 2 | pages = 207–18 | year = 2007 | pmid = 16682171 | doi = 10.1016/j.ridd.2005.07.006}}</ref> Despite the popularity of social skills training, its effectiveness is not firmly established.<ref>{{cite journal | vauthors = Rao PA, Beidel DC, Murray MJ | s2cid = 2507088 | title = Social skills interventions for children with Asperger's syndrome or high-functioning autism: a review and recommendations | journal = Journal of Autism and Developmental Disorders | volume = 38 | issue = 2 | pages = 353–61 | date = February 2008 | pmid = 17641962 | doi = 10.1007/s10803-007-0402-4}}</ref> A randomized controlled study of a model for training parents in problem behaviors in their children with AS showed that parents attending a one-day workshop or six individual lessons reported fewer behavioral problems, while parents receiving the individual lessons reported less intense behavioral problems in their AS children.<ref>{{cite journal | vauthors = Sofronoff K, Leslie A, Brown W | title = Parent management training and Asperger syndrome: a randomized controlled trial to evaluate a parent based intervention | journal = Autism | volume = 8 | issue = 3 | pages = 301–17 | date = September 2004 | pmid = 15358872 | doi = 10.1177/1362361304045215 | s2cid = 23763353}}</ref> Vocational training may be important to teach job interview etiquette and workplace behavior to older children and adults with AS, and organization software and personal data assistants can improve the work and life management of people with AS.<ref name="McPart2006" />

[[Fecal microbiota transplant|Fecal Microbiota Transplantation]] (FMT) is an innovative therapy for AS that aims to restore microbial balance in the patient's [[gastrointestinal tract]] by introducing healthy fecal microbiota acquired from people with a diverse microbial composition. This approach attempts to reconstruct the patient's gut microbiota by taking into account the intricate interactions between the human gut and the [[central nervous system]] via the [[Gut–brain axis|gut-brain axis]] (GBA). Any disruption in gut health has been linked to an increased susceptibility to diverse [[neurodevelopmental disorder]]s.<ref name=":0" />

It is vital to remember that research of AS specifically operates upon the out-dated classification of this syndrome as external to ASD (Autism Spectrum Disorder). Similarly, we should also note that ASD is a spectrum and support varies dramatically depending on the individual.

=== Medications ===
No medications directly treat the core symptoms of AS.<ref name=Towbin>{{cite journal | vauthors = Towbin KE | title = Strategies for pharmacologic treatment of high functioning autism and Asperger syndrome | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 12 | issue = 1 | pages = 23–45 | date = January 2003 | pmid = 12512397 | doi = 10.1016/S1056-4993(02)00049-4 | url = https://zenodo.org/record/1260194}}</ref> Although research into the efficacy of pharmaceutical intervention for AS is limited,<ref name="McPart2006" /> it is essential to diagnose and treat [[comorbid]] conditions.<ref name="Baskin" /> Deficits in self-identifying emotions or in observing effects of one's behavior on others can make it difficult for individuals with AS to see why medication may be appropriate.<ref name=Towbin /> Medication can be effective in combination with behavioral interventions and environmental accommodations in treating comorbid symptoms such as anxiety disorders, major depressive disorder, inattention, and aggression.<ref name="McPart2006" /> The [[atypical antipsychotic]] medications [[risperidone]], [[olanzapine]] and [[aripiprazole]] have been shown to reduce the associated symptoms of AS;<ref name="McPart2006" /><ref>{{cite journal | vauthors = Hirsch LE, Pringsheim T | title = Aripiprazole for autism spectrum disorders (ASD) | journal = The Cochrane Database of Systematic Reviews | issue = 6 | pages = CD009043 | date = June 2016 | volume = 2016 | pmid = 27344135 | doi = 10.1002/14651858.CD009043.pub3 | pmc = 7120220}}</ref><ref>{{cite journal | vauthors = Blankenship K, Erickson CA, Stigler KA, Posey DJ, McDougle CJ | title = Aripiprazole for irritability associated with autistic disorder in children and adolescents aged 6–17 years | journal = Pediatric Health | volume = 4 | issue = 4 | pages = 375–81 | date = September 2010 | pmid = 21359119 | pmc = 3043611 | doi = 10.2217/phe.10.45}}</ref> risperidone can reduce repetitive and self-injurious behaviors, aggressive outbursts, and impulsivity, and improve stereotypical patterns of behavior and social relatedness. The [[selective serotonin reuptake inhibitor]]s (SSRIs) [[fluoxetine]], [[fluvoxamine]], and [[sertraline]] have been effective in treating restricted and repetitive interests and behaviors,<ref name="McPart2006" /><ref name="Baskin" /><ref name="Foster" /> while stimulant medication, such as [[methylphenidate]], can reduce inattention.<ref name="CCD2007">{{cite journal | vauthors = Myers SM, Johnson CP | title = Management of children with autism spectrum disorders | journal = Pediatrics | volume = 120 | issue = 5 | pages = 1162–82 | date = November 2007 | pmid = 17967921 | doi = 10.1542/peds.2007-2362 | doi-access = free}}</ref> In addition, scientists have made a noteworthy finding that [[Oxytocin (medication)|oxytocin]], a hormone, plays a significant role in shaping human social behavior and the formation of interpersonal connections.<ref name=":0" />

Care must be taken with medications, as side effects may be more common and harder to evaluate in individuals with AS, and tests of drugs' effectiveness against comorbid conditions routinely exclude individuals from the autism spectrum.<ref name=Towbin /> Abnormalities in [[metabolism]], [[Electrical conduction system of the heart|cardiac conduction]] times, and an increased risk of [[Diabetes mellitus type 2|type 2 diabetes]] have been raised as concerns with antipsychotic medications,<ref name="Newcomer">{{cite journal | vauthors = Newcomer JW | title = Antipsychotic medications: metabolic and cardiovascular risk | journal = The Journal of Clinical Psychiatry | volume = 68 | issue = Suppl 4 | pages = 8–13 | year = 2007 | pmid = 17539694}}</ref><ref name="Chavez">{{cite journal | vauthors = Chavez B, Chavez-Brown M, Sopko MA, Rey JA | title = Atypical antipsychotics in children with pervasive developmental disorders | journal = Paediatric Drugs | volume = 9 | issue = 4 | pages = 249–66 | year = 2007 | pmid = 17705564 | doi = 10.2165/00148581-200709040-00006 | citeseerx = 10.1.1.659.4150 | s2cid = 6690106}}</ref> along with serious long-term neurological side effects.<ref name=interrev /> SSRIs can lead to manifestations of behavioral activation such as increased impulsivity, aggression, and [[sleep disturbance]].<ref name="Foster" /> [[Weight gain]] and fatigue are commonly reported side effects of risperidone, which may also lead to increased risk for [[extrapyramidal symptoms]] such as restlessness and [[dystonia]]<ref name="Foster" /> and increased serum [[prolactin]] levels.<ref>{{cite journal | vauthors = Staller J | title = The effect of long-term antipsychotic treatment on prolactin | journal = Journal of Child and Adolescent Psychopharmacology | volume = 16 | issue = 3 | pages = 317–26 | date = June 2006 | pmid = 16768639 | doi = 10.1089/cap.2006.16.317}}</ref> Sedation and weight gain are more common with [[olanzapine]],<ref name="Chavez" /> which has also been linked with diabetes.<ref name="Newcomer" /> Sedative side-effects in school-age children<ref>{{cite journal | vauthors = Stachnik JM, Nunn-Thompson C | s2cid = 31715163 | title = Use of atypical antipsychotics in the treatment of autistic disorder | journal = The Annals of Pharmacotherapy | volume = 41 | issue = 4 | pages = 626–34 | date = April 2007 | pmid = 17389666 | doi = 10.1345/aph.1H527}}</ref> have ramifications for classroom learning. Individuals with AS may be unable to identify and communicate their internal [[Mood (psychology)|moods]] and emotions or to tolerate side effects that for most people would not be problematic.<ref>{{cite journal|title=Asperger syndrome and high functioning autism: research concerns and emerging foci|journal=Current Opinion in Psychiatry|volume=16|issue=5|pages=535–42|year=2003|vauthors=Blacher J, Kraemer B, Schalow M|doi=10.1097/00001504-200309000-00008|s2cid=146839394}}</ref>