Autism: Support and Treatment Algorithm
Autism isn’t a disease to cure. The GP’s job is a timely, respectful diagnosis, support that fits the person, and treating the co-occurring conditions that cause the most distress. Graded options, built on the Australian national guidelines.
Evidence grades: A strong · B moderate · C weak or mixed · D anecdotal · X avoid.
Step 0 · Recognise and refer
- Children: speech delay, limited joint attention or pointing, loss of skills, repetitive play, strong sensory responses, parental concern. Adults: lifelong social differences, burnout, anxiety or depression not responding, family history.
- Girls and women are under-recognised and often mask; ask about camouflaging and exhaustion.
- Refer for assessment following the national guideline (paediatrician, psychiatrist or psychologist; multidisciplinary when needed). Hearing test in children.
- Check co-occurring conditions: ADHD, anxiety, depression, sleep, epilepsy, GI problems, intellectual disability, eating problems, hypermobility.
Step 1 · Supports (children)
Goals set with the family; neurodiversity-affirming.
- B · ModerateParent-mediated and naturalistic developmental behavioural interventionse.g. PACT, JASPER: build communication through everyday play.
- Evidence
- RCTs show gains in social communication; PACT effects persisted 6 years later
- How
- Speech pathologists and early intervention services; NDIS early childhood approach
- Watch for
- B · ModerateSpeech pathology and occupational therapyCommunication (including AAC) and sensory or daily-living goals.
- Evidence
- Moderate evidence for targeted goals
- How
- Allied health; NDIS for eligible children
- Watch for
- B · ModerateSchool supportsVisual schedules, quiet spaces, predictable routines.
- Evidence
- Guideline consensus
- How
- School learning support plans
- Watch for
Step 2 · Co-occurring conditions
Treat what causes distress; most medicines target these, not autism itself.
- A · StrongADHD medicationAs in the ADHD algorithm; start lower, go slower.
- Evidence
- Methylphenidate helps about half (RUPP), with more side effects than in ADHD alone
- How
- See /algorithms/adhd/
- Watch for
- Irritability, appetite.
- B · ModerateAdapted CBT for anxietyConcrete, visual, interest-based CBT.
- Evidence
- Moderate evidence in autistic children and adults
- How
- Psychologist with autism experience
- Watch for
- B · ModerateMelatonin for sleepAfter sleep hygiene and routine.
- Evidence
- RCTs show faster sleep onset and longer sleep in autistic children
- How
- Prolonged-release paediatric melatonin (Slenyto) 2–5 mg
- Watch for
- Morning drowsiness.
- A · StrongRisperidone or aripiprazole for severe irritability or aggressionWhen behaviour support hasn’t worked and there’s risk of harm.
- Evidence
- RCTs show large reductions in irritability
- How
- Low dose; specialist-guided
- Watch for
- Weight gain, metabolic effects, sedation, prolactin (risperidone).
- C · Weak / mixedSSRIs for repetitive behaviours
- Evidence
- Trials in children negative; some benefit for anxiety or depression in adults
- How
- Start very low
- Watch for
- Activation and agitation.
- X · AvoidChelation, hyperbaric oxygen, MMS (bleach), stem cells, secretin, strict special diets
- Evidence
- No benefit; some cause serious harm
- How
- Avoid
- Watch for
Adults
- Psychoeducation and connection with autistic-led community help self-understanding and wellbeing.
- Reasonable adjustments at work or study; written communication; sensory accommodations.
- Recognise autistic burnout: reduce demands, sensory load and masking; it isn’t depression, though both can coexist.
- Treat anxiety, depression, sleep and ADHD as usual, with adapted approaches and lower starting doses.
- Higher suicide risk: ask directly and plan safety.
Common questions
Is there medication for autism?
Not for autism itself. Medicines treat co-occurring conditions such as ADHD, anxiety, sleep problems and severe irritability or aggression.
What therapies help autistic children?
Parent-mediated and naturalistic developmental approaches (such as PACT and JASPER), speech pathology and occupational therapy, chosen around the child’s and family’s goals.
Evidence and references
- Autism CRC: National guideline for the assessment and diagnosis of autism in Australia
- Autism CRC: National guideline for supporting autistic children and their families (2022)
- Pickles A et al. Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up (Lancet 2016)
- RUPP Autism Network. Risperidone in children with autism and serious behavioral problems (NEJM 2002)
maladywise.com/algorithms/autism/