Where is the Evidence? A Narrative Literature Review of the Treatment Modalities for Autism Spectrum Disorders

Effectiveness of Fabric Weaving Therapy for Children with Autism Spectrum Disorder: A Randomized Waitlist-Controlled Trial

Objectives: To evaluate the effectiveness of weaving therapy on clinical outcomes and quality of life of autistic children. Design: Randomized waitlist-controlled trial. Setting/Location: Developmental and Behavioral Pediatrics Clinic, Faculty of Medicine Ramathibodi Hospital. Subjects: Twenty-three autistic children. Interventions: Weaving therapy was performed weekly for 6 months (3 months for hospital-based intervention and 3 months for home-based intervention). Outcome measures: Childhood Autism Rating Scale-second edition (CARS-2) and Pediatric Quality of Life Inventory (PedsQL) were measured at preintervention, 3 and 6 months postintervention. Methods: Twenty-three autistic children, aged 7.8-16.6 years, were randomized into an intervention group (N = 11) and a 3-month waitlist period group (N = 12). Ten weaving sessions were performed by the children, along with their parents, weekly for 3 months in hospital, and continued at home for an additional 3 months. The weaving therapy was delayed for 3 months in the waitlist group, followed by a 6-month intervention as the intervention group. Results: There was significant improvement on CARS-2 (p < 0.01) and PedsQL scores (p < 0.01) in the intervention group after the first 3-month weaving therapy. Meanwhile, in the waitlist group, no significant difference was found on CARS-2 (p = 0.09) and PedsQL scores (p = 0.26) during no weaving period. After the waitlist group began weaving therapy for 3 months, the authors found a significant improvement on both CARS-2 and PedsQL scores (p < 0.01both). Between-group comparisons showed that the intervention group had significant improvement on CARS-2 (p = 0.002) and PedsQL (p < 0.001) after 3-month weaving comparing with the waitlist group. After all the 23 participants finished a 6-month weaving therapy, there was significant difference in CARS-2 (p < 0.001) and PedsQL scores (p < 0.001) between pre- and postintervention. Conclusions: These findings suggest that traditional Thai fabric weaving therapy, as an alternative and complementary intervention, appears to be an effective therapy in improving the clinical symptoms and quality of life among autistic children. Clinical Trial Registration number: TCTR20200420002.

Multimodal Physiotherapy Approach for Autism With Speech Impairment and Attention Deficit: A Case Report

Autism is a disorder distinguished by significant challenges in social interaction and communication coupled with repetitive and stereotypical patterns of behavior and activities. Deficits in social interaction and language development become apparent before age three. In children, this condition is referred to as autism spectrum disorder (ASD). Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity. Individuals with ADHD may struggle with sustaining attention, organizing tasks, and completing assignments. They may exhibit hyperactive behaviors such as fidgeting, difficulty staying seated, and impulsive actions like interrupting others. ADHD can significantly impact daily functioning and is often diagnosed in childhood, with symptoms potentially persisting into adulthood. The disorder has three main subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined presentation. Treatment typically involves a combination of behavioral interventions, psychoeducation, and, in some cases, medication, aiming to provide support and strategies for individuals to manage their symptoms effectively in various aspects of life. Cognitive impairment in ASD varies, meaning it could be at the sensory perception level of cognitive processing, learning, and memory. The goal of the training intervention was to control physiological arousal, enhance awareness, keep annoyance from getting worse, and encourage self-regulation abilities. In this case report, we discuss the approach of multimodal physiotherapy for autism with speech impairment and attention deficit. Furthermore, physiotherapy needs to find a position in the new mental health care paradigm in order to contribute to mental health care.

Registered Behavior Technicians' Training Experiences for Severe Problem Behavior: A Survey

Registered Behavior Technicians (RBTs) are the primary paraprofessionals who deliver applied behavior analysis (ABA) services to individuals with autism spectrum disorder (ASD) under supervision of a Board Certified Behavior Analyst (BCBA). Effective training and supervision for RBTs providing ABA services is critical, especially for technicians working with children who exhibit severe behaviors. Recent research has assessed the needs of BCBAs working with individuals who exhibit severe problem behavior (Colombo et al., 2021). However, no research exists to identify the needs and ongoing training offered to the RBTs who provide ABA services to clients who exhibit severe problem behavior. Thus, the purpose of the current study was to survey RBTs for their initial training experiences and ongoing supports offered when working with clients who exhibit severe problem behavior. Results indicated that some RBTs reported appropriate initial and ongoing training, however, 13% reported receiving no initial training and 29% reported receiving no ongoing training when working with clients who engaged in severe problem behavior. In addition, 75% of RBTs reported sustaining an injury themselves and 36% reported their client sustained some type of injury. Suggestions for improvement for training RBTs working with this population and directions for future research are discussed.

A Phase III Study of Bumetanide Oral Liquid Formulation for the Treatment of Children and Adolescents Aged Between 7 and 17 Years with Autism Spectrum Disorder (SIGN 1 Trial): Participant Baseline Characteristics

The efficacy of bumetanide (oral liquid formulation 0.5 mg bid) as a treatment for the core symptoms of autism spectrum disorders in children and adolescents aged 7-17 years is being investigated in an international, randomised, double-blind, placebo-controlled phase III study. The primary endpoint is the change in Childhood Autism Rating Scale 2 (CARS2) total raw score after 6 months of treatment. At baseline, the 211 participants analysed are broadly representative of autistic subjects in this age range: mean (SD) age, 10.4 (3.0) years; 82.5% male; 47.7% with intelligence quotient ≥ 70. Mean CARS2 score was 40.1 (4.9) and mean Social Responsiveness Scale score was 116.7 (23.4). Final study results will provide data on efficacy and safety of bumetanide in autistic children and adolescents.

Why We Need a Developmentally Appropriate Trauma Diagnosis for Children: a 10-Year Update on Developmental Trauma Disorder

Developmental Trauma Disorder (DTD) was proposed almost two decades ago as a psychiatric diagnosis for children who have been traumatically victimized and whose attachment bonding with primary caregivers has been compromised. DTD was designed to complement and extend post-traumatic stress disorder (PTSD) by addressing forms of trauma-related biopsychosocial dysregulation not included in PTSD, many of which are attributed to other psychiatric disorders. In the past decade, evidence from clinician surveys and research field trial studies has provided evidence of DTD's validity and potential clinical utility. The growing evidence base for DTD is summarized and clinical rationales for the proposed DTD symptoms are described. DTD shows promise as a developmentally-attuned traumatic stress diagnosis for traumatized children.

Torasemide Improves the Propionic Acid-Induced Autism in Rats: A Histopathological and Imaging Study

Objective

Autism spectrum disorder is a neurodevelopmental disease in which impaired social behaviors, impaired sociality, and restricted and repetitive behaviors are seen. Bumetanide is a loop diuretic that inhibits Na⁺-K⁺-2Cl^- cotransporter 1 and it is currently used in clinical phase studies in patients with autism spectrum disorder. In present research, it is purposed to demonstrate the beneficial effects of torasemide which is another Na⁺-K⁺-2Cl^- cotransporter 1 inhibitor on an experimental autism model induced with propionic acid by providing imaging and brain tissue investigations.

Methods

Male Wistar rats were used in the present study (n = 30). Propionic acid of 250 mg/kg/day was administrated intraperitoneally in rats to induce autism for 5 days. Three groups were created for present study as follows: group 1, normal control (n = 10); group 2, propionic acid and saline given group (n = 10); group 3, propionic acid + tora-semide-administrated group (n = 10).

Results

Torasemide group scored higher on behavioral tests compared to saline group. The brain levels of malondialdehyde, tumor necrosis factor-alpha, interleukin-2, interleukin-17, and Nuclear Factor kappa B (NF-κB), Glial fibrillary acidic protein (GFAP) were remarkably higher in propionic acid + saline group. In histopathology assessments, torasemide group had higher neuronal count of Cornu Ammonis 1, neuronal count of Cornu Ammonis 2 in hippocampus, and Purkinje cells in cerebellum. GFAP immunostaining index (Cornu Ammonis 1) and cerebellum were lower in torasemide group. Magnetic resonance spectroscopy revealed that mean lactate value was higher in propionic acid + saline group compared to torasemide group.

Conclusion

Our experimental results showed that torasemide might enhance gamma-aminobutyric acid activity. Torasemide can be considered another promising Na⁺-K⁺-2Cl^- cotransporter 1 inhibitor in the treatment of autism with a longer half-life and less side effects after further studies.

Repurposing SGLT2 Inhibitors for Neurological Disorders: A Focus on the Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a substantially increasing incidence rate. It is characterized by repetitive behavior, learning difficulties, deficits in social communication, and interactions. Numerous medications, dietary supplements, and behavioral treatments have been recommended for the management of this condition, however, there is no cure yet. Recent studies have examined the therapeutic potential of the sodium-glucose cotransporter 2 (SGLT2) inhibitors in neurodevelopmental diseases, based on their proved anti-inflammatory effects, such as downregulating the expression of several proteins, including the transforming growth factor beta (TGF-β), interleukin-6 (IL-6), C-reactive protein (CRP), nuclear factor κB (NF-κB), tumor necrosis factor alpha (TNF-α), and the monocyte chemoattractant protein (MCP-1). Furthermore, numerous previous studies revealed the potential of the SGLT2 inhibitors to provide antioxidant effects, due to their ability to reduce the generation of free radicals and upregulating the antioxidant systems, such as glutathione (GSH) and superoxide dismutase (SOD), while crossing the blood brain barrier (BBB). These properties have led to significant improvements in the neurologic outcomes of multiple experimental disease models, including cerebral oxidative stress in diabetes mellitus and ischemic stroke, Alzheimer's disease (AD), Parkinson's disease (PD), and epilepsy. Such diseases have mutual biomarkers with ASD, which potentially could be a link to fill the gap of the literature studying the potential of repurposing the SGLT2 inhibitors' use in ameliorating the symptoms of ASD. This review will look at the impact of the SGLT2 inhibitors on neurodevelopmental disorders on the various models, including humans, rats, and mice, with a focus on the SGLT2 inhibitor canagliflozin. Furthermore, this review will discuss how SGLT2 inhibitors regulate the ASD biomarkers, based on the clinical evidence supporting their functions as antioxidant and anti-inflammatory agents capable of crossing the blood-brain barrier (BBB).

Increased cannabis use in pregnant women during COVID-19 pandemic

Almost one in every 20 pregnant women self-reports marijuana use during pregnancy. During the COVID-19 pandemic, this number has risen to 1 in 6 pregnant women. Some of the main factors associated with cannabis use during pregnancy and lactation are management of chronic conditions, sensation-seeking, dealing with stress, and other conditions related to pregnancy. The action of cannabis on endocannabinoid receptors might cause poor blastocyst implantation, inhibition of decidualization, compromised placentation, miscarriage and poor embryo development.The children born to mothers who used cannabis during pregnancy manifested higher aggression, anxiety, hyperactivity, and higher levels of the hormone cortisol, compared to children of non-cannabis users. In this review we summarize the effects of cannabis use on fetal development during the COVID-19 pandemic based on the existing published peer-reviewed scientific literature. The COVID-19 pandemic has served as an additional stimulus that has increased cannabis use among pregnant women. Prenatal cannabis use is associated with health risks for the mother and child. Cannabis use in pregnant mothers is associated with low infant birth weight and potential negative neurodevelopmental effects in the offspring. It remains unclear how long these changes will persist in the affected children. It is essential that clinicians educate pregnant women about the harm of prenatal cannabis use, improve strategies to support women at risk, and create new intervention strategies to help them stop using cannabis.

Neural Correlates of Enhancing Question Asking and Initiations in Children with Autism Spectrum Disorders: A Randomized Clinical Trial

Children diagnosed with autism spectrum disorder (ASD) demonstrate challenges in various areas of social communication. The aim of this study was to examine the effect of Pivotal Response Treatment (PRT) targeting question-asking on brain activity in twenty 6-12-year-old autistic boys, using a Randomized Clinical Trial (RCT) design. Verbal children, diagnosed with autism, who lacked question asking in their communication were matched based on age and mean length utterance (MLU) and were randomly placed in either PRT intervention or treatment as usual (TAU) groups. Sessions were individually administered, lasting for 60 minutes three days a week for a two-month period. All children were tested before and after intervention to assess behavioral areas (questions, general communicative skills, and MLU) and both groups underwent electroencephalography for 10 minutes in open and closed eye resting-state conditions to assess neural correlates. Data were analyzed using covariance analysis and post-hoc using Mann-Whitney and Wilcoxon methods. Significant behavioral improvements in the PRT group were observed after intervention that correlated with changes in Electroencephalography (EEG) oscillations at several brain regions compared to the TAU group. The results of this study support other studies suggesting collateral neural changes following the PRT.

The role of probiotics in children with autism spectrum disorders: A study protocol for a randomised controlled trial

Background

Autism spectrum disorder (ASD) is a neurological and developmental condition that begins in infancy or earlier and lasts through the individual’s lifetime. The aetiology and mechanisms of ASD are not yet fully understood, and current treatment comprises mainly education and rehabilitation, without significant improvement in the core symptoms. Recent studies suggest that microbiota change in children with ASD after the ingestion of probiotics may improve the balance of microbiota and thus ASD symptoms.

Objective

The objectives of this study are to evaluate the efficacy of probiotics on the symptoms of children with ASD and the possible mechanisms involved.

Methods

This is a prospective controlled trial. A total of 160 children with ASD will be stratified and allocated to placebo and probiotics groups randomised according to the severity of their ASD symptoms. The probiotics group will be given probiotics supplements orally twice a day for 3 months and the control group will be given a placebo at the same amount, in addition to the baseline therapy of education and rehabilitation. All the children will be evaluated systematically by using different scales, questionnaires before, during, and after 3 months’ treatment, as well as 3 months after discontinuation. The potential impact of probiotics on immunity and inflammation, metabolism, and metagenome will also be investigated.

Discussion

Our previous study showed that the abundance of intestinal flora was greatly different in children with ASD, and that Bifidobacterium was associated with the severity of ASD. In the present study, we will investigate the impact of probiotics supplementation on the symptoms of Children with ASD, with the purpose of evaluating the possible therapeutic effects of additives on ASD and of providing a reference for clinical treatment. The results will help to disclose as yet unknown relationship between probiotics and ASD.

Trial registration

This study has been registered with Chinese Clinical Trial Registry (ChiCTR-2000037941).

Urban-Rural Disparity in the Incidence of Diagnosed Autism Spectrum Disorder in Taiwan: A 10-Year National Birth Cohort Follow-up Study

Autism spectrum disorder (ASD) is reportedly more prevalent in urban areas partly because of better accessibility and affordability to healthcare. With universal health insurance coverage in Taiwan, a previous study has shown no urban-rural disparity in the utilization rate of a child's preventive healthcare. Under this circumstance, we followed a birth cohort of 176,273 live births from 2006 to 2015 to detect the differences in ASD incidence between urbanicities. After adjusting for socioeconomic factors, children were 1.28 (95% confidence interval (CI): 1.13-1.44) and 1.54 (95% CI: 1.36-1.75) more likely to acquire ASD in satellite and urban areas compared with those in rural areas, respectively. A gradient association between parental educational attainment and ASD incidence was also noted. Greater ASD incidences in more urbanized areas and more advanced educated parents' children were detected under a circumstance with low barriers to healthcare.

Challenges of Caregivers Having Children with Autism in Kenya: Systematic Review

Background:

Caring for children with Autism Spectrum Disorder (ASD) is demanding, especially where access to services and support are inadequate. The present study aimed to systematically review the challenges associated with the caregivers whose children have autism.

Materials and Methods:

A systematic review design was utilized. The searches were conducted from February 2019 to January 2020. A qualitative analysis that was based on meta-aggregation approach and thematic analysis was used. Thereafter, data was presented into themes. The quality of all included studies was assessed using the Critical Appraisal Skills Program (CASP).

Results:

The search generated 909 articles of which only 9 met the inclusion criteria. The main findings were discussed under the following three thematic domains: 1) Stigma, 2) Financial burden, and 3) Caregiving burden.

Conclusions:

Evidence from the data reviewed showed financial burden faced by the caregivers whose children are diagnosed with ASD. This was manifested through both direct and indirect cost of treatment. Another key finding was that majority of the caregivers faced stigma from the community. This implies the low level of awareness of the ASD within the community. The present study calls for more programs on the present research problem within the community so as to increase awareness. Furthermore, the current advocacy of Universal Health Coverage programs in the country should incorporate ASD children.

Repeated Sessions of Transcranial Direct Current Stimulation on Adolescents With Autism Spectrum Disorder: Study Protocol for a Randomized, Double-Blind, and Sham-Controlled Clinical Trial

Background: Social-emotional difficulties are a core symptom of autism spectrum disorder (ASD). Accordingly, individuals with ASD have problems with social cognition such as recognizing emotions from other peoples' faces. Various results from functional magnetic resonance imaging and electroencephalography studies as well as eye-tracking data reveal a neurophysiological basis of these deficits by linking them to abnormal brain activity. Thus, an intervention targeting the neural origin of ASD impairments seems warranted. A safe method able to influence neural activity is transcranial direct current stimulation (tDCS). This non-invasive brain stimulation method has already demonstrated promising results in several neuropsychiatric disorders in adults and children. The aim of this project is to investigate the effects of tDCS on ASD symptoms and their neural correlates in children and adolescents with ASD. Method: This study is designed as a double-blind, randomized, and sham-controlled trial with a target sample size of 20 male participants (aged 12-17 years) diagnosed with ASD. Before randomization, the participants will be stratified into comorbid depression, comorbid ADHS/conduct disorder, or no-comorbidity groups. The intervention phase comprises 10 sessions of anodal or sham tDCS applied over the left prefrontal cortex within 2 consecutive weeks. To engage the targeted brain regions, participants will perform a social cognition training during the stimulation. TDCS-induced effects on ASD symptoms and involved neural circuits will be investigated through psychological, neurophysiological, imaging, and behavioral data at pre- and post-measurements. Tolerability will be evaluated using a standardized questionnaire. Follow-up assessments 1 and 6 months after the intervention will examine long-lasting effects. Discussion: The results of this study will provide insights into the changeability of social impairments in ASD by investigating social and emotional abilities on different modalities following repeated sessions of anodal tDCS with an intra-simulation training. Furthermore, this trial will elucidate the tolerability and the potential of tDCS as a new treatment approach for ASD in adolescents. Clinical Trial Registration: The study is ongoing and has been registered in the German Registry of Clinical Trials (DRKS00017505) on 02/07/2019.

Bumetanide Oral Liquid Formulation for the Treatment of Children and Adolescents with Autism Spectrum Disorder: Design of Two Phase III Studies (SIGN Trials)

There are currently no approved pharmacological treatments to improve social reciprocity and limit repetitive and rigid behaviors in autism spectrum disorder (ASD). We describe the design of two Phase III studies evaluating the efficacy/safety of bumetanide oral liquid formulation in ASD. These are international, multicenter, randomized, double-blind, placebo-controlled studies in children and adolescents with ASD aged 7 to 17 years (n = 200; study 1), or younger children with ASD aged 2 to 6 years (n = 200; study 2). The primary endpoint of each is change in Childhood Autism Rating Scale 2 total raw score after 6 months. These studies could contribute to the first pharmacological treatment to improve social reciprocity and limit repetitive and rigid behaviors in children and adolescents with ASD.

The Effect of Teaching Initiations on the Communication of Children with Autism Spectrum Disorder: A Randomized Clinical Trial

This study examined the effect of Pivotal response treatment (PRT) to improve verbal initiations in children with Autism Spectrum Disorder, age 6-12 years old, using a Randomized Clinical Trial design. Intervention was conducted three times a week for 2 months, for a total of 24 one-hour sessions. The PRT intervention taught a variety of questions and attention/assistance-seeking initiations. The treatment as usual (TAU) group received standard language intervention. Results showed that the PRT group made significant improvements in their number of verbal initiations as well as collateral gains in general communicative skills and mean length of utterance (MLU) compared to the TAU group. Theoretical implications of including motivational approaches to develop social initiations are reviewed.

Intensive intervention for adolescents with autism spectrum disorder: comparison of three rehabilitation treatments

INTRODUCTION

Autism spectrum disorder (ASD) is a set of heterogeneous neurodevelopmental conditions, characterised by difficulties in social communication and restricted, repetitive behaviours and interests. There are several rehabilitative interventions for individuals with ASD but the evidence of their effectiveness is low or moderate overall. The transition phase of ASD individuals from adolescence to adulthood represents an important challenge. Adults with ASD struggle to access employment or independent living.

METHODS

In our study, we evaluated the effect of three different high-intensity interventions, namely Applied Behaviour Analysis (ABA), Treatment and Education of Autistic and Communication-Handicapped Children (TEACCH) and Behavioural Educational Intervention (BEI), in 93 ASD (levels 2 and 3) adolescents (age range 12-18 years).

RESULTS

Our results showed that all adolescents with ASD reported an improvement of core symptoms, regardless of the type of treatment.

CONCLUSIONS

A high intensity intervention ameliorates the core symptoms of ASD, enriching evidence of effectiveness regarding adolescents with ASD.KEY POINTSIndividuals with ASD need lifespan support and they struggle to access employment, independent living and community inclusion.There are several rehabilitative interventions for individuals with ASD but the evidence of their effectiveness in adolescents is insufficient.The main purpose of this study was to evaluate the possible enhancement produced by three intensive interventions (ABA, TEACCH, BEI) of symptom severity and adaptive functions.Results show that independently of the treatment, individuals with ASD decrease in ASD severity.Individuals who were treated with the BEI and TEACCH programmes reported improvements in the adaptive domains.

Genetic Testing in Neurodevelopmental Disorders

Neurodevelopmental disorders are the most prevalent chronic medical conditions encountered in pediatric primary care. In addition to identifying appropriate descriptive diagnoses and guiding families to evidence-based treatments and supports, comprehensive care for individuals with neurodevelopmental disorders includes a search for an underlying etiologic diagnosis, primarily through a genetic evaluation. Identification of an underlying genetic etiology can inform prognosis, clarify recurrence risk, shape clinical management, and direct patients and families to condition-specific resources and supports. Here we review the utility of genetic testing in patients with neurodevelopmental disorders and describe the three major testing modalities and their yields - chromosomal microarray, exome sequencing (with/without copy number variant calling), and FMR1 CGG repeat analysis for fragile X syndrome. Given the diagnostic yield of genetic testing and the potential for clinical and personal utility, there is consensus that genetic testing should be offered to all patients with global developmental delay, intellectual disability, and/or autism spectrum disorder. Despite this recommendation, data suggest that a minority of children with autism spectrum disorder and intellectual disability have undergone genetic testing. To address this gap in care, we describe a structured but flexible approach to facilitate integration of genetic testing into clinical practice across pediatric specialties and discuss future considerations for genetic testing in neurodevelopmental disorders to prepare pediatric providers to care for patients with such diagnoses today and tomorrow.

Investigating Gaze Behaviour of Children Diagnosed with Autism Spectrum Disorders in a Classroom Setting

A defining feature of ASD is atypical gaze behaviour, however, eye-tracking studies in ‘real-world’ settings are limited, and the possibility of improving gaze behaviour for ASD children is largely unexplored. This study investigated gaze behaviour of ASD and typically developing (TD) children in their classroom setting. Eye-tracking technology was used to develop and pilot an operant training tool to positively reinforce typical gaze behaviour towards faces. Visual and statistical analyses of eye-tracking data revealed different gaze behaviour patterns during live interactions for ASD and TD children depending on the interaction type. All children responded to operant training with longer looking times observed on face stimuli post training. The promising application of operant gaze training in ecologically valid settings is discussed.

Beneficial Use and Potential Effectiveness of Physical Activity in Managing Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by poor social and communication skills. Therapeutic interventions are behavioral and educational—normally delivered as structured programs. Several well-established programs exist and most of them do not incorporate physical activity and exercise as core elements. Deficiencies in motor skills are associated with ASD and physical activity has been shown to reduce maladaptive behaviors with autistics. However, the notion of exercise being employed to manage autism is controversial. Meta-analysis and systematic reviews have concluded that physical activity has positive effects on social skills and behavior in young children and adolescents with autism. Activities such as martial arts have been singled out as being particularly beneficial. Established programs such as TEACCH have been successfully modified, as research trials, to be more physical activity-based and have shown positive results. Studies have also reinforced the importance of the role of parental involvement in delivering programs based on physical activity. There is a paucity of research evidence about the long-term effects of physical activity-based interventions. There is also disparity over the detailed nature of the activities and exercises that compose an effective program. Each person with autism has a highly individualized set of symptoms and characteristics for which highly individualized programs are warranted. This is especially true for physical activity programs.