Autistic%20disorder Treatment
Principles of Therapy
- There is no pharmacological cure for autism
- Medications are most beneficial when used in conjunction with developmental, educational, behavioral and habilitative therapies
- There is no single medication that consistently benefits all patients with autism spectrum disorder (ASD)
Indications
- If presenting with comorbid psychiatric or neurodevelopmental conditions
- For short to medium term intervention for specific severe symptoms
- For aggressive or self-injurious behavior
- For anxiety, depression, tics, obsessive-compulsive behaviors, hyperactivity, sleep disorders
Goals
- Minimize disruptive/disturbing symptoms
- Facilitate access to intervention
- Maximize benefits of nonmedical intervention
- Improves the patient’s and the family’s quality of life
Pharmacotherapy
Atypical Antipsychotics
Aripiprazole
- Approved for the short-term treatment of irritability in autistic children 6-17 years of age
- Studies showed improvement in challenging behavior and repetitive behavior
Risperidone
- Approved for the short-term treatment of irritability, hyperactivity and stereotypic behavior in autistic children 5-16 years of age
- Has less extrapyramidal effects than typical antipsychotics
- Children may gain weight within the first few months of treatment
- Prolactin levels may rise but with no clinical effects seen
- Improvement in repetitive behavior, social withdrawal and hyperactivity were observed in several studies
Conventional Antipsychotics
- Eg Haloperidol, Chlorpromazine
- Haloperidol is being considered in the management of temper tantrums, aggression, hyperactivity, withdrawal and stereotypical behavior
- Limitation of use is due to sedation, irritability and extrapyramidal dyskinesia
Selective Serotonin Reuptake Inhibitors (SSRI)
- Eg Fluoxetine, Fluvoxamine
- Studies have shown that Fluoxetine improved the mood of adolescent and adult patients and reduced ritualistic or repetitive behavior
- Fluvoxamine has been shown to be effective in the treatment of obsessive-compulsive disorder (OCD), refractory depression and social phobia
- Fluvoxamine has been considered for repetitive thought and maladaptive behavior but it can cause occasional worsening of hyperactivity in patients
Investigative Agents
- Various clinical studies are being conducted to prove the therapeutic effects of Oxytocin on patients with autism spectrum disorder
- Oxytocin therapy may have the potential to improve social responsiveness based on several studies
- Methylphenidate is another agent undergoing clinical trials, showing potential in controlling joint attention and self-regulation behaviors, but further studies are needed to conclude its use for the treatment of autism
Non-Pharmacological Therapy
Early Developmental Intervention
- Intervention programs for autistic toddlers commonly involve the following:
- A predictable program with routine that should stress the ability to pay attention to other people, imitate others, use of preverbal and verbal communication, play and social interaction
- Systematic individual teaching of skills to support the child’s specific needs
- Functional approach to dealing with the child’s problematic behavior
- Family involvement
- There is evidence that if intensive early intervention is done on children diagnosed before 5 years, a better outcome is expected
Educational Systems
- Help autistic children from the age of 3-21 years
- Individualize the intervention and consider the patient’s developmental status, (eg specific strengths and deficits)
- Usually includes speech therapy with use of visual cues
- Shows improvement in the expressive language at 4 years of age if speech therapy is given between 2-3 years of age
- For the minimally speaking child, alternative-augmentative communication systems may be recommended because these may stimulate speech acquisition in non-verbal children and enhance expression in verbal children
- Other communication interventions includes: Responsive Education and Prelinguistic Milieu Teaching (RPMT), Reciprocal Imitation Training (RIT), Picture Exchange Communication System (PECS)
- Occupational therapy gives assessment and intervention to maximize daily living activities
- Sensory Integration Therapy (SIT)
- Perceptual Motor Training
- Social skills should be taught
- Use strategies to minimize maladaptive behavior and encourage compliance
- Social skill taught explicitly through modeling and feedback
- Positive reinforcement should be applied
- Involvement of the parents is critical
- Parents and caregivers should be encouraged to share information about special educational needs with school personnel for better planning of intervention and support
Behavioral Management
- Notable treatment approach to autistic disorder is Applied Behavior Analysis (ABA)
- Most effective when started early and applied consistently
- Reinforce proper desirable behavior using behavioral psychologic theory
- Implement behavioral training and management protocols at home and school
- Should be initiated after complete assessment of the child’s behavioral characteristics and environment
- Positive reinforcement strategy should be used
- Parents, caregivers and teachers should be trained to consistently implement the behavioral strategy in all of the child’s environments
- Social competence should be developed as part of behavioral rehabilitation plan
Early intensive behavioral and developmental approach
- UCLA/Lovaas
- Early start Denver model
- Parent training approaches
- Discrete Trial Training (DTT)
- Pivotal Response Training (PRT)
Social skills approach
- Social skills training
Play/Interaction-based approach
- Joint attention intervention
- Symbolic play and play-based interventions
Behavioral intervention for commonly associated symptoms
- Cognitive behavioral therapy for anxiety or anger management
- Sleep workshop for sleep disturbances