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Understanding autism

Autism and intellectual disability

Who is it for? For parents, relatives and professionals who want to understand how autism and an intellectual disability can be connected and what the guideline said about support.

In brief

Autism can occur with and without intellectual disability. In many recommendations, the 2021 S3 guideline therefore distinguished between people with and without intellectual disability. [2, Ch. C.1] Intellectual disability is among the common co-occurring conditions in autism; it must be clarified in detail, also because it makes differentiation from other conditions harder. [1] For promoting general cognitive skills, the guideline gave an evidence-based recommendation only for small children; later, promoting daily-living skills is in the foreground. [2, Rec. 39, 40] The guideline expired on 23.03.2026. [3]

This English translation was produced with AI assistance and has not yet been independently reviewed.

Status of the guideline: This article uses the S3 guideline on therapy (2021). It expired on 23.03.2026. [3] The statements are not automatically wrong, but they are not backed by a valid guideline.

Two features that can occur side by side

According to the 2024 expert overview, intellectual disability is among the mental co-occurring conditions in autism. [1] At the same time, according to the overview, autism is very varied, among other things in severity and in language and cognitive abilities. [1] A discrepancy between cognitive skills and social or daily-living skills should be taken into account in interaction, and under- or over-demand avoided. [2, Rec. 3] This article gives no figures on how often both occur together, because the sources read contain no information on this that we can classify with certainty.

Support for small children

If improving general cognitive skills is a therapy goal, then according to the guideline (grade of recommendation B) comprehensive training in different areas of development should be used for toddlers and preschool children with and without intellectual disability. Essential elements are promoting self-initiated learning through more social motivation as well as play, imitation and interaction skills, widening the repertoire of play and stimuli while building interests and curiosity, and frequent practice in different situations. [2, Rec. 39] For children with below-average cognitive skills or a slow learning pace, therapy frequency can be increased for a limited time from about 2 to 5 to 10 hours per week (grade of recommendation C). The effect should be reviewed regularly, about every 6 months, using standardised tests, since only some children benefit from intensified therapy. [2, Rec. 39] More on the therapy methods: Autism-specific therapy and support and Early intervention.

From primary school age and in adulthood

In primary school age, adolescence and adulthood, according to the guideline promoting general cognitive skills is as a rule no longer a specific therapy goal; instead, individual promotion of daily-living skills should take place. [2, Rec. 40] For a reading and spelling disorder or a calculation disorder, therapy should be planned according to the corresponding S3 guidelines. [2, Rec. 40] The guideline group also recommended developing and scientifically evaluating (pre-)school support programmes that can be implemented in the German school system, and creating corresponding training opportunities for educators and teachers. [2, Rec. 41] On school: School support workers in everyday school life.

What does not work

According to the guideline (grade of recommendation A, evidence level 1), there were no biological methods available that improve cognitive skills in people with autism and intellectual disability, for example vitamins, minerals or omega-3 fatty acids. The same applied to alternative methods such as auditory integration training, biofeedback, music therapy or massage. Such methods should not be used with the aim of improving cognitive skills. [2, Rec. 43] Notes on dubious offers: Recognising dubious offers.

What else you should know

  • Stay individual. The guideline stressed individual skills and needs. [2, Rec. 3]
  • Daily-living skills and participation move into the foreground later; benefits for this: housing and assistance and Integration assistance.
  • Keep co-occurring conditions in mind: Common co-occurring conditions.
  • Not covered: assessment of intelligence in detail, prevalence figures, support in adulthood apart from the statements named.

Note: This article offers general information. It does not replace personal advice or treatment by professionals.

Sources and literature

  1. Höhne E, Kamp-Becker I. Diagnostik der Autismus-Spektrum-Störung. Pädiatrie (Rosenfluh) 2024;(4+5):27–32. https://rosenfluh.ch/media/paediatrie/2024/04-05/Diagnostik-der-Autismus-Spektrum-Stoerung.pdf – Expert overview (in German)
  2. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Stand Text 02.05.2021 (Kap. C.1; Empf. 3, 39, 40, 41, 43). – Guideline (in German); expired on 23 March 2026 (see no. 3)
  3. DGKJP. Aktuelle Leitlinien (Eintrag 028-047: „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)

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