1. The programme at a glance
Indication. A child or adolescent aged 2 to 17, autistic or undergoing assessment for strongly suspected autism, whose family is asking for help: understanding the diagnosis, supporting the young child's communication, coping with crises and challenging behaviour, treating anxiety, supporting adolescence. The programme applies with or without intellectual disability, with or without spoken language; each module specifies its conditions.
Reference model. Structured family support, which starts with the environment — predictability, communication, sensory experience, school — before asking the child to change, then offers an evaluated intervention according to age and the request: for the young child, a parent-mediated intervention, that is, one carried out by the parents with guidance from the therapist (section 11); for challenging behaviour, parent training based on functional analysis, which looks for what triggers a behaviour and what it gives the child (section 42); for anxiety, cognitive behavioural therapy (CBT) adapted to autism; in adolescence, work on self-understanding and on preparing for transitions. The model of understanding is that of the adult manual, transposed to the child: a lasting gap between what the environment demands and what the child can give, and a family that organises itself around this gap (section 6).
What is meant by challenging behaviour. A behaviour which, through its intensity, frequency or duration, puts the child or others in danger, or compromises their learning and participation: hitting, biting, self-injury, destroying things, running off, crises lasting several hours. The Haute Autorité de santé, the French health authority that publishes good practice recommendations, speaks of "problem behaviour" and adopts this functional definition (Haute Autorité de santé, 2026).
Format. A common core of eight sessions, the first seven at the start and the eighth at the end, and a module chosen according to age and the request. Sessions last 60 minutes, the first one 90; those of module C last 90 minutes, shared between the child and the parents, as in the reference trial (Wood et al., 2020). One session a week, or one every one to two weeks in module A, with daily practice at home. Three booster sessions follow, at one, three and six months, plus one before each change of school (section 41).
Mechanism targeted. Reducing what overwhelms the child, giving them the means to communicate and to regulate themselves, changing the adult responses that unintentionally maintain crises or anxiety, and supporting parents who are carrying a great deal. The aim is not to make the child less visibly autistic.
| Session |
Focus |
Session output |
| T1 |
Welcoming the family and locating the diagnosis |
Diagnosis located, safety checked, baseline measures |
| T2 |
The portrait of the child and their environment |
Worksheet 1 completed with the parents |
| T3 |
Understanding autism, after the diagnosis |
Parents' questions dealt with, plan for talking to the child about it |
| T4 |
The formulation, the goals and the choice of module |
Balance drawn, two or three rated goals (worksheet 2), module chosen |
| T5 |
A predictable day, communication made possible |
Visual timetable in place (worksheet 3) |
| T6 |
The senses and adjustments |
Sensory profile, three dated adjustments (worksheet 4) |
| T7 |
School |
Plan for school written with the teacher (worksheet 5) |
| A1 |
Watching the child play, then playing together |
Baseline video, daily practice started (worksheet 6) |
| A2 to A9 |
Coaching through play, one target per session |
One target practised and filmed at each session |
| A10 |
Comparing, then handing over |
Videos compared, handover to the child's daily settings |
| B1 |
Functional analysis |
Target behaviours defined, record started (worksheet 7) |
| B2 |
Preventing, and teaching what replaces |
Three preventive measures, one replacement behaviour chosen |
| B3 |
Instructions, transitions and consequences |
Instruction and transition routine rehearsed in session |
| B4 |
The crisis plan |
Plan written in three stages (worksheet 7) |
| B5 to B8 |
Practising, generalising, measuring |
One skill learned, school involved, measures repeated |
| C1 |
Sorting out what is frightening |
Worries sorted into three categories |
| C2 |
The thermometer and the tools for calming down |
Personal thermometer (worksheet 8) |
| C3 |
The challenge ladder, and what the parents do |
Ladder written, one accommodation withdrawn |
| C4 to C11 |
The challenges |
Challenges done in session, three at home each week |
| C12 |
Keeping the gains |
Relapse prevention plan, measures repeated |
| D1 |
Understanding one's autism |
What the adolescent knows, put into their own words |
| D2 |
My passport |
Passport written by the adolescent (worksheet 9) |
| D3 |
Energy, camouflaging and recovery |
One load removed, one recovery time protected |
| D4 |
Friends, groups and bullying |
One relationship goal, a plan against bullying |
| D5 |
Puberty, romantic life and online safety |
Safety rules chosen by the adolescent |
| D6 |
Preparing for transitions |
Next transition prepared in writing |
| T8 |
Review, plan and next steps |
Measures repeated, written plan, dated boosters |
The four typical pathways, and their rationale.
- A young child aged 2 to 5, after a recent diagnosis: common core and module A, eighteen sessions in all. This number falls within the range of the parent-mediated interventions that have been evaluated: eighteen sessions over a year in the PACT trial, with thirty minutes of practice a day at home (Green et al., 2010), twenty-four sessions in one JASPER trial (Kasari et al., 2010), three months in another (Kasari, Lawton et al., 2014). A meta-analysis found no link between the amount of parent coaching and the outcome (Nevill et al., 2018). This module does not replace the early interventions of at least ten hours a week, delivered by trained professionals, that the Haute Autorité de santé (2026) recommends: it provides the parent-mediated activities that it recommends adding to them.
- A child aged 3 to 12 with challenging behaviour: common core and module B, sixteen sessions in all. The reference trial comprised eleven core sessions, two optional sessions, two home visits and two booster calls over twenty-four weeks, in children aged 3 to 7 (Bearss et al., 2015); the Haute Autorité de santé also recommends these parent-mediated interventions between the ages of 6 and 12 (Haute Autorité de santé, 2026).
- A child aged 7 to 17 whose anxiety interferes with daily life, and who can rely on language: common core and module C, twenty sessions in all. The trials comprise twelve 90-minute group sessions (Reaven et al., 2012) or sixteen individual sessions (Wood et al., 2020); the common core provides part of what they contain, namely psychoeducation and adjustments.
- An adolescent aged 12 to 17: common core and module D, fourteen sessions in all. No trial has evaluated support of this kind in adolescence; this number is a clinical choice, and the manual says so.
When two modules are needed, start with the one that weighs most on the child's life, repeat the measures, then go on to the second; the sessions add up.
What the family takes away. Nine printable worksheets, listed in section 48: our child's portrait, our goals, the predictable day, our child's senses, the plan for school, our play times, crises, my thermometer and my challenges, and my passport.
What distinguishes this programme from the other manuals on this site. It is the counterpart, for ages 2 to 17, of Autism in adults: a therapist's manual, whose position it adopts. It says what falls to the psychologist and what falls to the rest of the team. And it devotes a whole module to what other manuals deal with in a few paragraphs: Treating anxiety in children: a therapist's manual devotes an adaptation for the autistic child in its section 33, and Treating oppositional defiant disorder in children: a therapist's manual warns that its programme does not apply as it stands to the autistic child; modules B and C are the adapted versions.
2. Before you begin
The four preliminary decisions
Where does the diagnosis stand? Warning signs without a diagnosis, a recent diagnosis, an old diagnosis with a new difficulty, an adolescent diagnosed late: the approach differs (section 4). None of these situations prevents you from starting.
Does a risk come before the programme? Running off, serious self-injury, dangerous aggression, suicidal ideation, violence suffered, bullying, a sudden loss of abilities, a parent who has collapsed: each has its own course of action in section 9, and it comes before everything else.
What is the request, and whose is it? The parents, the school and the child do not always ask for the same thing. Note down each one's request, and ask the child, as soon as they can answer, what they most definitely do not want changed.
Can the parents commit? Modules A, B and C rest on them. An exhausted parent does not practise thirty minutes a day: you then start by lightening their load (section 44).
What falls to the psychologist, and what does not
Autism in children is generally diagnosed by a second-line team trained in neurodevelopmental disorders (Haute Autorité de santé, 2018), and support brings together many professions.
What falls to the psychologist. Taking part in the assessment, if trained in the instruments; drawing up and explaining a formulation; supporting the parents after the diagnosis has been given; delivering the interventions within their competence — parent training, parent-mediated intervention, adapted CBT, work on regulation and challenging behaviour, social skills groups if trained to run them; and coordinating with the school.
What falls to others. The assessment and therapy of language and communication, including alternative communication, fall to the speech and language therapist. Motor and sensory assessments and the corresponding therapies are the domain of the psychomotor therapist and the occupational therapist. The medical assessment — hearing, vision, genetics, epilepsy, sleep, eating, pain — falls to the paediatrician, the paediatric neurologist or the child psychiatrist, and medication to the doctor. The hours of early educational intervention are provided by trained teams, and rights and disability compensation by social services. The psychologist does not do this work: they make sure it is done, and that everyone is pursuing the same goals.
What this programme does not treat
It does not make a diagnosis. It describes what a full assessment consists of and how to contribute to it (section 10).
It does not replace intensive early interventions or speech and language therapy. It is added to them.
It does not, on its own, treat severe depression, a serious eating disorder, catatonia, a psychotic episode, or dangerous behaviour that requires a team. These call for medical and multidisciplinary care (section 45).
It does not aim for an appearance of normality. Section 3 explains why.
How to use it
Read the whole text before the first session, in particular sections 3, 6, 9, 10 and 42. Each session follows the same framework: the aim, the steps, what you say, common mistakes and the criterion for moving on. A session is validated when its criterion is met, not because it has taken place; with an autistic child, it is common for one session to take up two.
3. A position: neurodiversity, the evidence, and the child
What neurodiversity has brought
The idea is that autism is a lasting and different way of perceiving, processing information and relating to others, and not an illness to be cured. Carried first by autistic people, it is now discussed in research (Pellicano and den Houting, 2022). It brings the child clinician three things. Attention to the goals that the child and their family actually pursue. A reading of communication as a two-way problem: this is the double empathy problem described by Milton (2012), and an experiment points in the same direction, in which information was passed on as well between autistic people as between non-autistic people, and less well in mixed groups (Crompton et al., 2020). And a different view of repetitive movements, which autistic adults describe as a way of soothing themselves and regulating intense emotions (Kapp et al., 2019).
What the evidence also says
Associated disorders, bullying and suicide risk are more common among autistic young people (sections 8 and 9). Part of these difficulties comes from the environment, another part from difficulties of the young person's own, which do not disappear when the environment changes.
The position of this manual
The aim is the child's quality of life, participation and well-being, and support for their family. The Haute Autorité de santé also asks that the child's pathway leave room for their self-determination (Haute Autorité de santé, 2026). No goal concerns eye contact, the suppression of harmless repetitive movements, the disappearance of an interest, or an appearance of normality.
What can be treated is treated. Anxiety, depression, insomnia, self-injury, dangerous behaviour or suicide risk are not autistic traits to be respected: they have treatments, and the autistic child is entitled to them, with the necessary adaptations. Giving up on treating them in the name of acceptance would deprive the child of a chance of getting better.
A behaviour that injures or endangers is worked on. Biting oneself, hitting, running off are not differences: you look for what the behaviour expresses or obtains, and you teach another way of getting the same thing (section 42).
The child does not decide as an adult does, but their voice counts. Decisions are taken with the parents; the child's view carries growing weight in them with age, and NICE (the National Institute for Health and Care Excellence, the British agency that publishes good-practice guidelines) asks that children who wish it be offered shared decision-making (National Institute for Health and Care Excellence, 2013).
The debates are presented, not settled beyond the evidence. The one about intensive behavioural interventions is set out in section 11, with its sources.
Vocabulary
In a large British survey, the term "autistic" was chosen by a large share of autistic adults and parents, but by far fewer professionals, nearly half of whom chose "person with autism"; no wording was unanimous (Kenny et al., 2016). This manual writes "autistic child". Use the family's words, and the child's own as soon as they have some.
4. Four entry situations not to be confused
1. Warning signs in a young child, without a diagnosis
What you observe. Parents worried about their child's communication or play, often before the age of three, sometimes after the loss of words or gestures that had already been acquired.
What points the way. The warning signs in section 5. Parents' concerns are one of them, on their own (Haute Autorité de santé, 2018).
What it implies. You do not wait for the diagnosis. The Haute Autorité de santé recommends an examination by the doctor within three weeks, referral to a second-line team, and therapies started without waiting, within three months (Haute Autorité de santé, 2018); it also recommends intervening from the first signs (Haute Autorité de santé, 2026). You can begin the common core and module A during the wait.
2. The diagnosis has just been made
What you observe. Parents coming out of the diagnostic feedback with a report, many questions and often no intervention in place.
What it implies. This is the main situation of this programme. The Haute Autorité de santé asks that parents be supported during the transition between the end of the diagnostic process and the setting up of interventions (Haute Autorité de santé, 2018).
3. An old diagnosis, a new difficulty
What you observe. Crises that are increasing, anxiety, refusal to go to school, bullying, puberty.
What points the way. The change compared with how the child usually is: a new difficulty is rarely "the autism getting worse". Look for a co-occurring condition, pain, a change in the environment (sections 8 and 9).
What it implies. You treat the new difficulty, and you update the child's portrait.
4. The adolescent diagnosed late
What you observe. Often a girl, often after other diagnoses — anxiety, depression, an eating disorder —, who has compensated for a long time.
What points the way. Camouflaging (section 5) and the exhaustion that follows it.
What it implies. Module D, often with module C. The Haute Autorité de santé recommends access to diagnosis at any age, guarding as much against overdiagnosis as against underdiagnosis (Haute Autorité de santé, 2026). The adult manual describes late diagnosis in its section 39.
The three sorting questions
"What worries you most today, and since when?" It places the family among the four situations and dates the change.
"What has already been done, by whom, and what helped or did harm?" It avoids repeating what has failed and identifies interventions that were badly experienced.
To the child, using their means of communication: "What is hard for you at the moment? And what don't you want us to change?" It gives the child a place from the very first session.
5. Autism by age: what you observe
DSM-5-TR and ICD-11 describe two domains: lasting difficulties in social communication and interaction, and restricted and repetitive behaviours, interests or activities, which include sensory differences (section 7). The way they look changes with age.
The toddler
The major warning signs are, at any age, parents' concerns about communication and language, and any regression in language or relationships; in the young child, the absence of babbling, of pointing at a distance and of other social gestures at 12 months, the absence of words at 18 months, and the absence of two-word combinations that are not echoed at 24 months (Haute Autorité de santé, 2018). Around 18 months, it is the combination of at least two difficulties that raises the alarm — in attention shared with the adult, response to their name, shared smiling, pointing coordinated with gaze, language, imitative play, responses to sensations — and no isolated sign has predictive value (Haute Autorité de santé, 2018). A regression in language or relationships before the age of three justifies prompt referral (National Institute for Health and Care Excellence, 2011).
The preschool and school-age child
Play is often repetitive or centred on objects, changes and transitions are costly, group instructions and implicit ones are poorly grasped, and the playground, noisy and without written rules, is difficult for many. It is common in clinical practice for a child to hold it together at school and overflow at home: the evening crisis is not a tantrum saved for the parents, it is the end of a day of effort.
The adolescent
Social demands increase and become implicit; groups, codes and social media change quickly. Associated psychiatric disorders become more common from adolescence onwards, which calls for increased vigilance (Haute Autorité de santé, 2026); the question of identity arises, and puberty adds bodily changes that are hard to anticipate.
Girls, and children who camouflage
Among children who meet the criteria, the male-to-female ratio is closer to three to one than to four to one; it is higher in studies that only count diagnoses already made, which suggests that girls who meet the criteria are not being diagnosed (Loomes et al., 2017). Camouflaging refers to the strategies, conscious or having become automatic, by which an autistic person masks their characteristics or compensates for their difficulties: observing and imitating, preparing their sentences, holding back their movements. A systematic review of studies conducted in children and in adults finds sex differences in camouflaging, and a link between camouflaging and poorer mental health (Cook et al., 2021).
The senses
Sensory differences have been part of the criteria since DSM-5: sensations perceived too strongly, too weakly, or sought out. The same child may cover their ears at the noise of the school canteen and not feel that they have hurt themselves.
Communication
It ranges from the absence of spoken language to language that is very rich but literal. A child who speaks little is not a child who has nothing to say: it is a child who needs another channel (section 42).
Interests and strengths
Intense interests are often a source of pleasure, competence and calm, and a lever: NICE recommends incorporating them, when possible, into CBT for anxiety (National Institute for Health and Care Excellence, 2013). Strengths are looked for in this particular child, with examples, and not in a list of qualities assumed to be typical.
How many children
Studies published worldwide since 2012 give a median prevalence of about one child in a hundred, with very large variations; about a third of the autistic children identified have an intellectual disability (Zeidan et al., 2022). In the United States, the surveillance network of the Centers for Disease Control and Prevention estimated that in 2022 one 8-year-old child in 31 was autistic across the sixteen sites monitored, with 3.4 boys for every girl; in 2020, across the eleven sites monitored at the time, the figure was one in 36. In 2022, among children whose cognitive level was known, 39.6% had an intellectual disability (Maenner et al., 2023; Shaw et al., 2025). The rise in the figures reflects, according to the authors, better awareness of autism, the broadening of its definition and of identification, and the availability of services; it does not demonstrate that autism itself has become more common (Zeidan et al., 2022).
What autism is not
It is not caused by upbringing: the theories that claimed so have been abandoned, and they still weigh on families. Its heritability is estimated at 83% in a large Swedish study of twins and siblings (Sandin et al., 2017). The measles, mumps and rubella vaccine does not increase the risk, according to a cohort of more than 650,000 Danish children (Hviid et al., 2019). In families who already have an autistic child, a younger child is also autistic in about one case in five (Ozonoff et al., 2024), which justifies close monitoring of the siblings' development.