What support helps? Overview and context

What support is about

The S3 guideline on therapy (AWMF 028-047) was published in 2021. Its validity expired on 23.03.2026. ^{[1; 2]} It stated that people with autism generally live with a chronic condition or disability that has a variable course. The diagnosis alone did not imply that ongoing therapeutic or other supportive measures are needed. ^{[1, Rec. 1]}

According to the guideline, support should always be aimed at the greatest possible independence. When goals had been achieved, it should be ended in a planned way. ^{[1, Rec. 1 and Rec. 6, Ch. C.3.2]}

Which goals there can be

The guideline named possible goal areas. Which of them matter in the individual case is decided together: ^{[1, Rec. 1]}

• social interaction and communication,
• distressing repetitive behaviours, sensory strain or interests,
• language, especially for children who do not yet speak,
• daily-living skills and independence,
• treatment of co-occurring mental and physical conditions.

According to the guideline, people with autism should be involved in setting their goals, and for children also the legal guardians. The goals should be realistic and appropriate to the individual need. ^{[1, Rec. 1]}

Which kinds of approaches there are

The guideline sorted the methods examined into three groups: ^{[1, Foreword]}

• Psychosocial methods: all training-based and psychoeducational methods, including classic behavioural therapy approaches. ^{[1, Foreword]} In the chapter on the competences of professionals, the guideline stated in a consensus-based recommendation that among the psychosocial methods, in particular different behavioural-therapy training methods appropriate to the skills and individual development are effective. ^{[1, Rec. 7]}
• Medication-based methods: medicines and dietary supplements. ^{[1, Foreword]} More in the article Medication.
• Other methods that are neither psychosocial nor medication-based. ^{[1, Foreword]}

Important for context: if an approach is not named in the guideline for a particular goal, this does not automatically mean it is ineffective. It may have been studied for a different goal or simply not yet been researched sufficiently. ^{[1, Foreword]} By contrast, under the guideline’s principle, methods proven to be ineffective should not be used, and ethically unacceptable methods never. ^{[1, Foreword]} More in the article Recognising controversial and dubious offers.

Individual approaches are described in the articles Autism-specific therapy and support, Early intervention and Psychotherapy.

Good planning: goals, duration, review

A central principle of the guideline read, in essence: every intervention should only be offered after appropriate assessment, relating to clearly defined and probably achievable goals. It should be reviewed regularly and carried out for a limited time. According to the wording, this applies to therapeutic interventions including drug therapy and to general psychosocial intervention or support. ^{[1, Foreword]}

Before a decision, the guideline says benefits and risks should be discussed and, for children, also whether a measure fits the whole family, including siblings. ^{[1, Rec. 6, Ch. C.3.2]}

Questions you can ask:

• What concrete goal are we pursuing?
• How will we know whether it has been reached?
• How long is the measure planned for, and when will it be reviewed?
• What does research say about this approach for this goal?

Who coordinates?

If care measures are needed, the guideline says they should be coordinated, linked and aligned “by a single point” (case management) to avoid gaps, duplication and ineffective or even harmful measures. According to the guideline, case management should only be carried out by a licensed professional, for example specialists in child and adolescent psychiatry or in psychiatry and psychotherapy, or psychotherapists. ^{[1, Rec. 6, Ch. C.3.2]} This is particularly important at transitions, for example from nursery to school or from school to work. ^{[1, Rec. 6, Ch. C.3.2]} How this is actually implemented in care in Germany, we have not checked.

Who bears the costs is explained in the articles Financing autism therapy and Understanding the support system.

Different views of “success”

The guideline reported a single British study (a report on measurement methods for children up to six years of age, with a survey of parents, young adults with autism, professionals and researchers): parents named as the most important contents of therapy success above all more contentment and cheerfulness, less anxiety, a positive self-image and less sorrow or suffering. Professionals, by contrast, most often measured success by skills such as social interaction with other children, play skills, attention or language. ^{[1, Ch. C.2.2.2]} This is a single finding that cannot be generalised.

Parents and young adults with autism stressed seeing autism more as “being different” rather than only as a “deficit” and improving the living environment so that autism is less “disabling”. ^{[1, Ch. C.2.2.2]} In a consensus-based recommendation, the guideline recommended not measuring the success of treatment or care only by improvements in core features. Greater life satisfaction should also count (for example less anxiety, more well-being, successful inclusion in social, school or work contexts). ^{[1, Rec. 4]}

Sources and literature

1. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. Interdisziplinäre S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Langversion, Stand 02.05.2021. – Guideline (in German); validity expired on 23 March 2026 according to the DGKJP overview ^[2]
2. DGKJP: Aktuelle Leitlinien (Übersicht mit AWMF-Registernummer und Gültigkeitsdatum). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)