Autistic%20disorder Treatment

Treatment

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

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

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

Social skills approach

Play/Interaction-based approach

Behavioral intervention for commonly associated symptoms