HELP FOR PARENTS OF CHILDREN WITH ASPERGER'S & HIGH-FUNCTIONING AUTISM

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Medical Treatment for the Symptoms of High-Functioning Autism

“What medications are used to treat the symptoms of high functioning autism? Which ones have the best track record? And, what are the side effects of these medications?”

There are several medications used to treat the symptoms associated with High-Functioning Autism (HFA) and Asperger’s (AS). Medications may be considered for problematic behaviors in these children and teens, for example:
  • aggression
  • anxiety
  • compulsions
  • depression
  • destructive behavior, or other disruptive behaviors
  • hyperactivity
  • inattention
  • irritability
  • mood lability
  • obsessions
  • perseveration
  • repetitive behaviors
  • self-injurious behavior
  • sleep disturbance
  • stereotypic movements

After medical causes and environmental factors have been ruled out, a trial of medication may be considered if the behavioral symptoms cause significant impairment in functioning and are responsive to behavioral interventions. In some cases, the diagnosis of a comorbid disorder (e.g., major depression, bipolar disorder, anxiety disorder, etc.) can be made reasonably, and the child can be treated with medications. Modifications of diagnostic criteria may be necessary to account for clinical presentations of psychiatric conditions in children with developmental disabilities, and certain tools (e.g., behavior checklists, structured interviews) may be helpful. In other cases, therapists opt to target specific problematic behaviors or symptom-clusters in the absence of a clear comorbid psychiatric diagnosis.

Approximately 45% of kids and teens (and up to 75% of grown-ups) with HFA and AS are treated with psychotropic medication. Older age, lower adaptive skills and social competence, and higher levels of problematic behavior are associated with the likelihood of medication use.

SSRIs—

Selective serotonin-reuptake inhibitors (SSRIs), antipsychotic agents, stimulants, and α-adrenergic agonist antihypertensive agents are the most commonly prescribed classes of medications for kids on the autism spectrum. Double-blind, placebo-controlled studies have demonstrated the effectiveness of the SSRIs fluoxetine and fluvoxamine in the treatment of repetitive and other problematic behaviors in young people with HFA and AS. Studies of these and other SSRIs have shown improvements in target symptoms, for example:
  • aggression
  • anxiety
  • aspects of social interaction and language
  • depressive symptoms
  • difficulty with transitions
  • irritability
  • meltdowns
  • repetitive behaviors
  • shutdowns
  • tantrums

Potential side-effects of SSRIs include – but are not limited to – the following: 
  • abdominal discomfort
  • agitation
  • apathy
  • behavioral activation
  • constipation
  • dizziness
  • drowsiness
  • dry mouth
  • fatigue
  • headache
  • hypomania or mania
  • nausea
  • sexual dysfunction
  • sleep difficulties
  • suicidal ideation

Risperidone—

Risperidone has become the first medication for the symptomatic treatment of irritability, aggressive behavior, deliberate self-injury, and tantrums in kids and teens with HFA and AS. Controlled studies have confirmed the short-term effectiveness of risperidone for these disruptive behaviors.

Potential side-effects include – but are not limited to – the following:
  • excessive appetite
  • constipation
  • dry mouth
  • dyslipidemia
  • extrapyramidal symptoms
  • hematologic abnormalities
  • hyperprolactinemia
  • insulin resistance
  • neuroleptic malignant syndrome
  • QTc prolongation
  • sedation
  • seizures
  • tardive dyskinesia
  • urinary retention
  • weight gain

Methylphenidate—

Recent studies of methylphenidate have demonstrated improvement in hyperactivity, impulsivity, and inattention in kids with HFA and AS. Methylphenidate is effective in some of these young people, but the response rate is lower than that in kids with ADHD, adverse effects are more frequent, and it is unclear whether the results can be generalized to other stimulants.

Potential side-effects of stimulant medications include – but are not limited to – the following:
  • abdominal discomfort
  • appetite reduction
  • delayed sleep onset
  • exacerbation of tics
  • increased anxiety
  • increased blood pressure
  • increased heart rate
  • inhibition of growth
  • irritability
  • jitteriness
  • repetitive behaviors

Clonidine—

Studies have documented modest benefits of clonidine in reducing hyperarousal symptoms (e.g., hyperactivity, irritability, outbursts, impulsivity, and repetitive behaviors) in young people on the autism spectrum.

Potential side-effects include – but are not limited to – the following:
  • constipation
  • decreased blood pressure
  • dizziness
  • drowsiness
  • dry mouth
  • irritability
  • sedation

Atomoxetine—

Studies have suggested that atomoxetine may be effective for ADHD–like symptoms in kids and teens on the spectrum. Appetite suppression, dizziness, fatigue, liver injury, mood swings, nausea, and suicidal ideation are among the potential side-effects of atomoxetine.

Melatonin—

Studies suggest that sleep disorders affect 50 to 70 million individuals in the U.S. Sleep disorders exist whenever a lower quality of sleep results in impaired functioning or extreme lethargy. Difficulties initiating and maintaining sleep are very common in young people on the spectrum, affecting about 15-25% of this population.

A large study revealed several of melatonin’s sleep-enhancing benefits. Reviewing 15 studies of sleep in healthy individuals, researchers noted that melatonin significantly reduced sleep latency (i.e., the amount of time needed to fall asleep), while boosting sleep efficiency (i.e., the percentage of time in bed spent asleep) and increasing total sleep duration. Studies demonstrate an important characteristic of melatonin: the hormone exerts its hypnotic (i.e., sleep-inducing) and sedative (i.e., anxiety-relieving) effects, regardless of dosage time.

Produced by the pineal gland, melatonin is a noteworthy hormone that works both as a sleep aid and a potent antioxidant/immune booster. Also, melatonin is a natural sleeping pill that shifts the body clock into the desired direction. When taken between 3:00 and 6:00 PM, melatonin tricks the body into thinking that dusk comes sooner. Thus, AS and HFA kids become sleepy earlier, helping them fall asleep at 10:00 or 11:00 PM, rather than tossing and turning all night.

Potential side-effects include – but are not limited to – the following:
  • abdominal discomfort
  • confusion
  • daytime sleepiness 
  • dizziness 
  • headaches
  • irritability
  • mild anxiety
  • short-lasting feelings of depression

In addition, melatonin supplements can interact with other medications, including:  
  • birth control pills
  • blood-thinning medications (i.e., anticoagulants) 
  • diabetes medications
  • medications that suppress the immune system (i.e., immunosuppressants)

It will be important for future research to address the need for more rigorous evaluation of safety and effectiveness of medication for kids and teens on the spectrum. When medications are used, baseline data regarding behaviors and somatic complaints should be collected, informed consent should be obtained, potential benefits and side-effects should be explained, and potential strategies for dealing with treatment failure or partial response should be reviewed. Also, it is important to have some quantifiable means of assessing the effectiveness of the medication and to obtain input from a variety of sources (e.g., moms and dads, educators, therapists, etc).

Consistent use of validated, treatment-sensitive rating scales and medication side-effect scales is necessary. A wide variety of outcome measures have been used in research studies and in clinical practice to measure problematic behavior treatment effects (e.g., Nisonger Child Behavior Rating Form, Clinical Global Impression Scale, and Aberrant Behavior Checklist).

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