In brief
"The" autism therapy does not exist. The 2021 guideline assessed methods separately by goal (for example social interaction, language, repetitive behaviour) and by age. For promoting social interaction and communication, the evidence was best for behaviour-therapy-based, manualised methods: in preschool children beginning early and with parent guidance; in school children, adolescents and adults without intellectual disability as time-limited group therapy. [1, Rec. 10, 14, 17] Many other services were not, or not sufficiently, effective for these goals, or the body of studies was not sufficient. [1, Rec. 12, 22] Not sufficiently established does not mean "proven ineffective" and vice versa.
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] Newer studies are not taken into account in it. The findings reproduced are not automatically wrong, but they are not backed by a valid guideline.
How the guideline classified evidence
The guideline distinguished evidence-based recommendations (body of studies; grades A “soll” (should), B “sollte” (should, weaker), 0 “kann” (may)) and consensus-based recommendations (expert consensus, “KKP”) where there was no sufficient body of studies. [1, Ch. C.1] More on reading studies: How good is a study? and on the guideline itself: The S3 guidelines on autism.
What was studied for social interaction and communication
| Age / group | Finding according to the 2021 guideline | Basis |
|---|---|---|
| Preschool children | Early-starting, individualised, behaviour-therapy-based therapy following a manual with parent guidance; duration at least one year, at least 2 hrs/week (grade A, evidence level 2 to 3) | [1, Rec. 10] |
| School children and adolescents without intellectual disability | Time-limited (3–6 months), manualised group therapy (grade A, evidence level 1 to 2); small to medium improvements in social skills, stable after 3 months | [1, Rec. 14, Ch. C.4.2.2] |
| Adults without intellectual disability | Time-limited group therapy (grade A, evidence level 2); three small studies | [1, Rec. 17] |
| People with intellectual disability | Hardly any methods tested; consensus-based recommendations | [1, Rec. 13, 16, Ch. C.4.2.3] |
On early, very intensive programmes, the guideline reported: the intensive early intervention EIBI (Cochrane review, all studies with high risk of bias) showed no effect on social interaction and communication, but did on language and (unblinded-assessed) adaptive behaviour; the improvement in intelligence quotient was not stable at follow-up. For the Early Start Denver Model, IQ and language improved after two years in one study, but not autism symptoms. [1, Ch. C.4.2.2] Recommendation 10 names no particular programme but features such as setting, duration and contents. [1, Rec. 10]
What should explicitly not be used
For the goal “social interaction and communication”, according to recommendation 12 (grade A, evidence level 2 to 3; age group toddler to primary school) the following, among others, should not be used: a particular parent-training group programme (Hanen), pure parent training without involving the child, pure structuring measures without targeted training, music therapy, isolated computer training, auditory and sensory integration therapy according to Ayres, animal-assisted therapies, facilitated communication and eclectic approaches. [1, Rec. 12] This applies to this goal and this age group, not across the board. Dissenting vote: The Deutsche Musiktherapeutische Gesellschaft argued for deleting the negative recommendation on music therapy. [1, Rec. 12] Further methods (dietary supplements, diets, chelation and immune therapies) should not be used for this goal. [1, Rec. 22] More: Recognising controversial and dubious offers.
Medication
For social interaction and communication, according to the guideline there were no medicines with robust effect; they should not be used for this goal. [1, Rec. 20] Medicines can, however, play a role for accompanying disorders (such as ADHD, anxiety, depression). [1, Rec. 21] More: Medication in autism.
What do we know – what is still open?
Evidence-based findings (2021 guideline, expired)
- Time-limited, manualised group therapy for school children, adolescents and adults without intellectual disability: small to medium effects on social skills. [1, Rec. 14, 17]
- Early-starting, behaviour-therapy-based therapy with parent guidance in the preschool years (evidence level 2). [1, Rec. 10]
Consensus-based
- Therapy in intellectual disability, duration and design in the preschool years, individual therapy as an alternative. [1, Rec. 11, 13, 15, 16, 19]
Open
- Replication of many results; many studies were small and not blinded. [1, Ch. C.4.2.2]
- The methods examined in studies were “relatively little known” and hardly available in Germany in 2021; few German-language manuals had been tested in controlled studies. [1, Ch. C.4.2.3]
- Dissenting votes from professional associations (including behaviour-therapy associations and Autismus Deutschland e. V.) on group formats: groups had “a certain added benefit” and should, where possible, stand alongside individual therapy and parent counselling. The reasons are in the guideline report, which the editorial team has not read. [1, Rec. 14]
- Perspectives of people on the spectrum on the goals and benefits of therapy are only marginally represented in the parts of the studies read. [1, Rec. 4, 27]
What else you should know
- Clarify goals: According to the guideline, any therapy should be planned with clearly defined, concrete goals for a limited period. [1, Rec. 1] More: What support helps?.
- Success is also measured by life satisfaction, not only by core features. [1, Rec. 4]
- Not covered: studies since 2021 and therapies that the guideline did not address.
Note: This article offers general information. It does not replace personal advice or treatment by professionals.
Sources and literature
- 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. 1, 4, 10–17, 20–22, 27; Kap. C.1, C.4). – Guideline (in German); expired on 23 March 2026 (see no. 2)
- DGKJP. Aktuelle Leitlinien (Eintrag 028-047: „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
Terms from this article
- Oxytocin
- A substance studied as a nasal spray to improve social skills in autism. The 2021 guideline could not recommend it because of inconsistent results.
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