Prescription medicine primer: pharmacology of autism spectrum disorders.
Subject: Autism (Drug therapy)
Autism (Genetic aspects)
Authors: Bhagar, Harpriya A. "Sonya"
Schmetzer, Alan D.
Pub Date: 09/22/2008
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2008 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Fall, 2008 Source Volume: 11 Source Issue: 3
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 187049619
Full Text: [ILLUSTRATION OMITTED]

In the last few decades, autism has become a household name. Americans are now more aware than ever of this debilitating illness affecting young children. The Diagnostic and Statistical Manual's classification lists autistic disorder as a qualitative impairment in social interaction and communication, with restrictive, repetitive, and stereotyped patterns in behaviors and interests, and with an onset prior to 3 years of age.

Autism Spectrum Disorders (also known as Pervasive Developmental Disorders) refer to autism, Rett's disorder, Asperger's syndrome, and Pervasive Developmental Disorders not otherwise specified (NOS). In a recent study, Autism Spectrum Disorders were found to affect 1 out of 162 children aged 8 years old (Nicholas et al., 2008).

Currently, genetic factors (autism is found in siblings at a rate 50 times higher than the general population), developmental factors (such as complications of pregnancy), immunological factors, temporal lobe abnormalities, decreased Purkinje cell counts in the cerebellum, and high levels of plasma serotonin are implicated in its etiology (Kaplan, Sadock, & Gregg, 1994). Although an increased brain volume, and in some cases, altered gray/white matter ratios have been seen, there have been no microscopic pathological changes observed in autism (Casanova, 2007).

The treatment of this complex disorder is indeed very challenging. Several behavioral interventions in conjunction with psychotropics are the current mainstay of treatment. One study found that 70% of children ages 8 and up with ASD received some form of psychoactive medication in a given year. The seven most commonly prescribed classes were antidepressants, stimulants, antipsychotics, anticonvulsants, hypotensive agents, anxiolytic/sedative/hypnotics, and benzodiazepines (Oswald & Sonenklar, 2007). Risperidone, an anti-psychotic, has shown some benefit for irritability and repetition and social withdrawal (Jesner, Aref-Adib, & Coren, 2007). However, medications do not necessarily treat the core/main symptoms of ASD, such as poor communication, poor eye contact, social withdrawal, and repetitive behaviors. Antidepressants such as selective serotonin reuptake inhibitors may treat irritability and other co-morbid depressive and anxiety symptoms. Anxiolytics such as benzodiazepines might decrease anxiety symptoms, which may present as worsening of stereotypical behaviors, like head banging, running around in circles, and screaming. Hypotensive agents such as clonidine may help the child with sleep.

Certainly co-morbid Attention Deficit Hyperactivity Disorder is another concern in this age group. Significant benefit has been observed in reducing inattention and hyperactivity with atypical antipsychotics such as risperidone and quetiapine, and benefit from stimulants like methylphenidate and atomoxetine has also been reported (Hazell, 2007).

To summarize, medications for ASD are used in conjunction with structured learning programs. More resources for autism-related research are needed for advancement in behavioral and biological treatment options.

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Increasing Cases of Autism

Bar chart of the number (per 1,000 U.S. resident children aged 6-11) of children aged 6-11 who were served under the Individuals with Disabilities Education Act (IDEA) with a diagnosis of autism, from 1996 through 2005. Counts of children diagnosed with autism for each year were taken from Table 1-9 of IDEA Part B Child Count (2005). These were divided by census estimates for U.S. resident population aged 6-11 taken from US census estimates for 1990-1999 resident population by age and the similar estimates for 2000-2005; for all years, the September population estimates were used.

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LEARNING OBJECTIVES

After studying this article, participants should be better able to do the following:

1. Name one medicine used to treat the core symptoms of ASD.

2. Name two medications used symptomatically in ASD.

3. Describe various pharmacological treatments for ASD.

ABSTRACT

In the last few decades, autism has become a household name. Americans are now more aware than ever of this debilitating illness affecting young children. The Diagnostic and Statistical Manual's classification lists autistic disorder as a qualitative impairment in social interaction and communication, with restrictive, repetitive, and stereotyped patterns in behaviors and interests, and with an onset prior to 3 years of age. Autism Spectrum Disorders (also known as Pervasive Developmental Disorders) refer to autism, Rett's disorder, Asperger's syndrome, and Pervasive Developmental Disorders not otherwise specified (NOS). in a recent study, Autism Spectrum Disorders were found to affect 1 out of 162 children aged 8 years old (Nicholas et al., 2008).

KEY WORDS: autism, pharmacology

TARGET AUDIENCE: physicians

PROGRAM LEVEL:

DISCLOSURE:

PREREQUISITES: none

POST CE TEST QUESTIONS

1. ASD includes all except

a) autism

b) Rett's disorder

c) Asperger's syndrome

d) psychosis not otherwise specified

2. The Diagnostic and Statistical Manual's classification lists all of the following as criteria of autism except

a) qualitative impairment in social interaction and communication

b) restrictive, repetitive, and stereotyped patterns of behaviors and interests

c) low intellectual functioning in all cases

d) onset prior to 3 years of age

3. The following are implicated in the etiology of autism

a) genetic factors

b) developmental factors

c) both of the above are correct

d) none of the above are correct

4. Core symptoms of ASD include

a) stereotyped behaviors like head banging and running in circles

b) good social interaction

c) good eye contact

d) excellent verbal communication

5. Successful treatment of ASD consists of

a) behavioral interventions only

b) medications only

c) behavioral interventions and in some cases medications

d) none of the above

6. The most commonly prescribed medications for ASD are all except

a) lithium

b) antipsychotics

c) anxiolytic/sedative/hypnotics and benzodiazepines

d) anti-depressants

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References

Casanova, M.F. (2007, October). The neuropathology of autism. Brain Pathology, 17(4), 422-433.

Hazell, P. (2007, Jam/Feb.). Drug therapy for attention-deficit/hyperactivity disorder-like symptoms in autistic disorder. Journal of Paediatrics and Child Health, 43(1-2), 19-24.

Jesner, O.S., Aref-Adib, M., & Coren, E. (2007, Jan. 24). Risperidone for autism spectrum disorder. Cochrane Database of Systematic Reviews 2007, Issue 1: CD005040.

Kaplan, H.I., Sadock, B.J., & Grebb, J.A. (1994). Pervasive Developmental Disorders. In Kaplan and Sadock, Comprehensive Textbook of Psychiatry (7th ed.) (p. 1052). Maryland: Williams & Wilkins.

Nicholas, J.S., Charles, J.M., Carpenter, L.A., King, L.B., Jenner, W., & Spratt, E.G. (2008, February). Prevalence and characteristics of children with autism-spectrum disorders. Annals of Epidemiology, 18(2), 130-136.

Oswald, D.P., & Sonenklar, N.A. (2007, June). Medication use among children with autism spectrum disorders. Journal of Child and Adolescent Psychopharmacology, 17(3), 348-355.

Harpriya A. (Sonya) Bhagar, MBBS, is an assistant professor of clinical psychiatry at Indiana University School of Medicine and is a member of the American Psychotherapy Association. She can be reached at hbhagar@iupui.edu.

Alan Schmetzer, MD, FAPA, Master Therapist, is vice-chair of the American Psychotherapy Association Executive Advisory Board and has been a member of the association since 1998. He is a professor of psychiatry at Indiana University School of Medicine and can be reached at aschmetz@iupui.edu.
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