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Therapies & support

Occupational therapy and speech therapy in autism

Who is it for? For parents of children on the autism spectrum who want to know what speech therapy and occupational therapy can do and what the 2021 guideline stated on them.

In brief

The guideline did not describe language support in autism as the task of one professional group alone: it first named comprehensive, low-frequency psychosocial therapy methods (about 2 hours per week) with parent involvement, and stated on a consensus basis that speech and language therapists should be closely involved within the therapy. [1, Rec. 31, Ch. C.5.1] For difficulties with motor skills, it recommended diagnosing an accompanying developmental disorder of motor functions if the criteria are met, and where appropriate treating it in a task-oriented way. [1, Rec. 36] Occupational therapy as a professional group is not explicitly recommended in this context; the guideline speaks of therapy approaches, not of professions. This is a reading by the editorial team.

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

Status of the guideline: This article relies substantially on the S3 guideline on therapy (2021). According to the overview of the DGKJP, its validity expired on 23.03.2026. [2] The recommendations reproduced are not automatically wrong, but they are currently not backed by a valid guideline.

Language and communication: speech and language therapy

In Germany, according to the guideline, language support is as a rule offered primarily by speech and language therapists. [1, Ch. C.5.1.3] For toddlers and preschool children, it recommended (grade of recommendation B, evidence-based): first the comprehensive, low-frequency psychosocial therapy methods that in a natural learning format practise, among other things, self-initiative, non-verbal communication, joint attention, symbolic play, imitation and receptive as well as expressive language. Attention should be paid to generalisation into everyday life; the setting should include work with the child and guidance of the parents (grade A). [1, Rec. 31]

Children who have difficulty learning non-verbal communication can additionally be supported with picture cards or visual symbols; these serve as an aid (“prompt”) and should be reduced promptly as soon as the child begins to communicate with sounds and words (grade C). [1, Rec. 31] For non-speaking children from late primary school age, adolescents and adults, it stated on a consensus basis: if speaking is not learned after correct and sufficiently long use of the methods named, a picture card system or a device with speech output can be used; picture card systems or devices with speech output were named; they must be systematically introduced, adapted to the level of development and answered in the same way by all interaction partners. [1, Rec. 32] More: Augmentative and alternative communication.

For pragmatic language problems (use of language in a social context) in children and adolescents with age-appropriate language, the guideline named the effective group-based methods for promoting social interaction (grade A). [1, Rec. 31] Articulation and fluency disorders are not more common in autism; if they cause impairment they should be treated according to the general guidelines. [1, Rec. 34]

What should not be used

  • Auditory integration training and neurofeedback should not be used to treat language and speech disorders in autism (grade A, evidence level 2). [1, Rec. 33]
  • Medication should currently not be used for this (grade B). [1, Rec. 33]
  • Facilitated communication should not be used to promote language development or communication, since there is no evidence for it. [1, Rec. 35] More: Recognising controversial and dubious offers.
  • Improvisation-based music therapy should not be used for language support (grade B). [1, Rec. 31]

Motor skills: task-oriented therapy

Difficulties in gross and fine motor skills are so common in autism that they were in part regarded as part of autism. The guideline group nevertheless recommended making both diagnoses if the criteria of a specific developmental disorder of motor functions are met. [1, Ch. C.5.2] If participation is considerably impaired, and with distress and cooperation, therapy for this disorder can take place according to the guideline; task-oriented approaches are to be preferred. [1, Rec. 36] The guideline justified this by saying that there is more evidence for task-oriented approaches than for body-function-oriented ones. [1, Ch. C.5.2] Beyond the source guidelines, the guideline found no studies of its own on treating motor skills in autism. [1, Ch. C.5.2.2]

Sensory aspects

On sensory integration therapy, the guideline names a small pilot study in which individual therapy goals were achieved better but sensory behaviours did not improve markedly. [1, Ch. C.4.3.2] For the goal of social interaction and communication, it named sensory integration therapy according to Ayres among the methods that should not be used [1, Rec. 12]; for the goal of reaction to sensory stimuli, it made no recommendation for it, therapies beyond the approaches named “cannot currently be recommended”. [1, Rec. 30] More: Recognising and preventing sensory overload.

What do we know – what is still open?

Evidence-based recommendations (2021 guideline, expired)

  • Low-frequency comprehensive therapy with parent guidance for language support in the preschool years (grade B/A). [1, Rec. 31]
  • Do not use auditory integration training and neurofeedback (grade A). [1, Rec. 33]

Consensus-based recommendations (expert consensus)

  • Close involvement of speech and language therapists; picture cards or speech-output devices for people who do not speak; no facilitated communication; task-oriented motor therapy in case of considerable impairment. [1, Rec. 32, 35, 36, Ch. C.5.1]

Open

  • There were hardly any studies of their own on treating motor skills in autism; the guideline saw a need for further investigation. [1, Ch. C.5.2.3]
  • For adults and for people with minimal language, there were no additional controlled studies. [1, Ch. C.5.1.2]
  • How occupational therapy and speech therapy concretely complement each other in everyday life is not described in the sources read.

What else you should know

Note: This article offers general information. It does not replace a personal assessment, advice or treatment by professionals (paediatricians, speech and language therapists, occupational therapists).

Sources and literature

  1. 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 (Empf. 30–36; Kap. C.4.3.2, C.5.1–C.5.2). – Guideline (in German); expired on 23 March 2026 (see no. 2)
  2. 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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