Autism is a heterogeneous diagnosis with symptoms that present in different ways. There is a large variety of interventions for autistic individuals. However, little is known about who chooses which specific interventions. We aimed to explore intervention prevalence and predict intervention use, based on demographic and autism-specific characteristics. This study used data on autistic children ( N = 1464, aged 1–17 years) from the Netherlands Autism Register. Most children (88%) had received therapies, and about half had received medication. Intervention use was mostly related to additional factors (lower IQ, special education and co-occurring diagnoses). Children with a lower IQ received less therapies, children attending special education or with a co-occurring diagnosis received more therapies. Children in special education or with a co-occurring diagnosis were more likely to receive several types of therapy and medication. Older age, higher IQ and being female were related to more guideline (autism-specific) or mainstream (targeting co-occurring problems) therapy use. Lower parental education was related to more mainstream medication use. More severe sensory issues increased the chance of other medication use. Other autism-specific characteristics (autism severity, social skills, repetitive and restrictive behaviours) were not related to intervention use. More transdiagnostic interventions should be available for children with autism who have additional difficulties. Lay abstract Autism is a condition that is characterised by social communication difficulties and restrictive and repetitive behaviours or interests. Autism can present in many different ways and various interventions are available. Some interventions are conventional, and they are recommended to be used for children with autism (guideline therapies) or for other disorders such as anxiety or attention-deficit hyperactivity disorder (mainstream therapies or medication), while others are less conventional (other therapies or medication, they are discouraged, unknown or alternative). Little is known about who chooses which intervention. This study found that most autistic children use some kind of intervention. Children who attend special education or have an additional diagnosis (other than autism) tend to receive more therapies, while children with a lower IQ receive fewer therapies. Older children, children with a higher IQ and girls are more likely to use conventional (mainstream or guideline) therapies. Children whose parents have a lower educational level are more likely to have used conventional medication. Whereas, children with more sensory issues (e.g. sensitivity to sound, smell or movement) were more likely to have used unconventional medication. This study found that other autism-related characteristics such as the number of autism symptoms, social skills and repetitive and restrictive behaviours were not related to the interventions used. More treatments focussed on multiple problems should be available for children with autism who have additional difficulties.

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Anger regulation is a challenge for children with autism spectrum disorders (ASD). We investigated if attention-based cognitive behavioral treatment, based on mindfulness cognitive therapy (MBCT) and dialectical behavior therapy (DBT), reduces aggressive behavior and improves anger coping in school-aged autistic children (n = 51). Children were randomized to an active-control or a treatment condition. The treatment included nine weekly sessions attention-based individual therapy. Parents in both conditions received three weekly psychoeducation group sessions to heighten awareness of expressed emotion (EE). For aggressive behavior, treatment reduced temper tantrums and arguing. No effect was found on destroying things and physical violence. For anger coping, treatment increased adaptive coping strategies of diffusion and social support seeking, but had no effect on assertion, rumination, and maladaptive coping direct anger out and avoidance. Treatment did not impact secondary outcome measures concerning children's quality of life (QoL) and parental stress-levels and psychological well-being. In conclusion, school-aged autistic children are able to acquire selfregulation skills reducing temper tantrums and arguing and increasing the use of adaptive anger coping strategies. The intervention shows potential to improve behavior and regulation, but little transfer to other domains. Limitations and future directions involving the child's social environment, including parents, siblings, and teachers are discussed. Lay SummaryChildren on the autism spectrum often show aggressive behavior. Treatment can train children to be more aware of their emotions. This study found that this can help reducing temper tantrums and arguing and increasing some coping skills, though no impact was found on several other domains of aggression and coping.

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