- Behavior and Communication Therapies
- Education Therapies focused on social skills, communication and behavior
- Parent Training (PT) focuses on the transfer of knowledge and information to parents to provide the skills needed to care for their child at home and in the community. Topics include: behavioral principles, behavior management techniques, play activities, social skills, augmentative communication strategies and visual communication techniques. Role playing, homework assignments and ongoing review and feedback are key components to the training
- Medication is used to manipulate chemicals in the brain (Dopamine System: attention/ planning/ deep subcortical structures. Serotonin System: involved in almost every part of the brain)
- creative therapies (art/ music/ sensory integration)
- special diets: food allergens/ probiotics/ yeast free diet/ gluten free diet/ casein free diet/ supplements: A,C, B-6, Magnesium, Folate, B-12, omega-3 fatty acids.
- Chelation therapy
Why So Many Dead Ends?
- ASD Rx has not been a priority for psychopharmacologic research.
- Complex ASD population
- Inadequate tools to determine mental health comorbidity
- Scarce outcome studies
- Disorganized multicenter approach
- Short history of ASD medication Rx
General Rules for Medication Use:
Start low and go slow/ beware of medications in combination/ simpler is almost always better.
“When there is no cure there are always many proposed treatments”
Medication does not cure any psychiatric disorder.
Medication is never a substitute for psychosocial or educational therapies.
Focus on a child’s profile and symptoms.
Target the symptoms.
Seek a balance between efficacy and tolerance and periodically re-adjust your medication plan.
Improved quality of life for your child in and out of your home is the goal.
Risperdol (risperidone)/ Abilify (aripiprazole): Irritability/ hyperactivity/ stereotypy/aggressive behavior/SIB/ ritualistic behavior/ sleep problems. FDA has approved Risperdal for the treatment of irritability and mood instability associated with autism in children ages 5-16 years (aggression/ self injury/ temper tantrums).
Dosing for Risperidol: Children weighing 14 to 20 kg started on 0.25 mg/day with gradual increases to a maximum of 1.75 mg.
For youngsters weighing 20 to 45 kg, dosing started at 0.5 mg/day and graduated to a maximum of 2.5 mg/day; for children weighing > 45 kg, dosing started at 0.5 mg/day with gradual increases to a maximum of 3.5 mg.
If fail on Risperdol consider off label use of Abilify.
Consider off label use of Geodon (ziprasidone) for refractory
Self injurious behavior (SIB) that does not respond to the other medication.
Ritalin (methylphenidate): improved inattention and overactivity (Increased SE profile: tics/ social withdrawal/ irritability/ decreased appetite).
Non-stimulant medication: clonidine/ tenex/ intuniv. Alpha 2 agonists. Possible benefits in hyperactivity/ inattention/ insomnia/ tics. SE: BP change/ drowsy/ dry mouth/ constipation/ HA/ dizziness/ vomiting/ GI upset/ rashes/ nervousness. Strattera (atmoxetine): improved hyperactivity.
Antidepressant medications: potential benefits for repetitive behaviors, mood and anxiety. (decrease in outbursts/ rituals/ repetitive thoughts/ anxiety/ depression leading to potential benefits of improved social relatedness, language usage and eye contact.
SSRI: Appears to be reasonable due to anxiety and repetitive OC-like behaviors/ used for repetitive behavior and anxiety: not proven. Study in 2009: Celexa (citalopram) no better than placebo/1/3 of patients from placebo and celexa improved/ higher rates of SE’s/ disinhibition syndromes: HA/ impulsivity/ insomnia/ decreased concentration/ increased energy levels/ stereotopies/ diarrhea.
Mood Stabilizers: commonly used in BPD/ lithium/ AED (VPA/ Tegretol/ Lamictal/ Topomax/ Keppra). Many potential side effects.