Article

Clinical management of adolescents with autism.

Division of Adolescent Medicine, Department of Pediatrics, University of Kentucky, Lexington, KY 40536, USA.
Pediatric Clinics of North America (Impact Factor: 1.78). 11/2008; 55(5):1147-57, viii. DOI: 10.1016/j.pcl.2008.07.006
Source: PubMed

ABSTRACT Autism spectrum disorder is a spectrum of neurodevelopmental disorders that includes autistic disorder and pervasive developmental disorder-not otherwise specified. This article provides the reader with an overview of the major psychosocial issues related to adolescents with autism. This discussion is followed by an interjection of medications that may be useful in maximizing the functioning of adolescents with autism.

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    ABSTRACT: Autism spectrum disorder (ASD) is a particularly important risk factor for challenging behaviours such as aggression, tantrums, self-injury and pica. Adults with ASD have rarely been studied with respect to these problems. This is particularly disconcerting since there are far more adults than children with ASD. In addition, because of adults' increased physical size and longer history of these problems, treating these behaviours effectively is important. Psychological methods, particularly applied behaviour analysis, and pharmacotherapy have been the most frequently addressed treatments for challenging behaviours associated with ASD in the research literature. In many cases, challenging behaviours have clear environmental antecedents. In these cases, behavioural interventions, such as applied behaviour analysis, should be used to reduce the behaviours. When environmental factors cannot be identified or when challenging behaviours are very severe, pharmacological treatments may be necessary in combination with behavioural interventions. Newer antipsychotics are the most researched medications for use with this population. Currently, risperidone and aripiprazole are the only medications that have US FDA approval for the treatment of behaviours associated with ASD, specifically irritability; however, they are indicated for use in children not adults. It is important not to use medications unnecessarily, due to possible side effects associated with their use. Based on available research, some recommendations for the treatment of challenging behaviours of adults (and children) with ASD include the use of functional assessment, side-effect monitoring of medications and behavioural methods whenever possible. Additionally, future research in this area needs to focus more on adults, as most current research has used child samples.
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    ABSTRACT: Leo Kanner, an Austrian born American psychiatrist, first described autism in 1943 [1]. His observations of a small group of children with behavioral symptoms of social withdrawal, impaired language/communication, and obsession with sameness led to recognition of autism as a specific pervasive developmental disorder. At about the same time, Austrian psychiatrist Hans Asperger independently described similar symptoms in a small group of children except that the “Asperger” children were high functioning with better language and cognitive skills than those described by Kanner [2]. Both Kanner and Asperger used the word autistic to describe the pathology in the children they observed – a term rooted in the Greek “autos” (self) and coined by Swiss psychiatrist Eugen Bleuler to describe symptoms in his schizophrenic patients. Before Kanner and Asperger defined autism as a specific disorder, children with autistic symptoms were most likely classed and treated as mentally retarded or, if they were high functioning, perhaps as schizophrenic.
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    ABSTRACT: Resumen Objetivos: describir las descompensaciones conductuales y su evolución en púberes y adolescentes con trastorno generalizado del desarrollo (TGD). Métodos: se analizaron en un estudio retrospectivo descriptivo las historias clínicas de once pacientes con TGD, sus características demográficas, los síntomas de consulta, las intervenciones realizadas y la evolución. Resultados: once pacientes con TGD, 8 varones y 3 mujeres, con edades promedio de 13 años (rango 10-16 años) consultaron por periodos de descompensación conductual, con aparición y empeoramiento franco de conductas de agitación/hiperactividad (6), agresividad/autoagresiones (6), irritabilidad/la-bilidad emocional (6), gritos inapropiados (6), inflexibilidad/rituales (4) y catatonía (2 pacientes). Todos menos los adolescentes que desarrollaron catatonía recibían medicación psiquiátrica previamente. Cuatro pacientes tuvieron 2 episodios y 7 tuvieron 1 episodio en un tiempo de seguimiento promedio de 2.7 años (rango 1-6 años) a partir del primer episodio de descompensación. Ocho de los once pacientes se recuperaron en forma completa en un tiempo promedio de 4 meses con terapia e intervención farmacológica (media dos fármacos). Los dos pacientes con catatonía y un tercer paciente, permanecieron sin mejorías. Conclusiones: las descompensaciones conductuales son frecuentes en la pubertad y adolescencia en pacientes con TGD, pero en la mayoría se recuperaron con intervencio-nes combinadas, apoyo familiar y control cercano durante las crisis. Palabras clave: Autismo -Adolescencia -Conducta -Pubertad -Tratamiento. PUBERTAL BEHAVIORAL DECOMPENSATION IN PATIENTS WITH PERVASIVE DEVELOPMENTAL DISORDERS Summary Objectives: To describe behavioral descompensation in adolescents with autistic spectrum disorders (ASD). Methods: We analyzed in a prospective study the stories of 11 children and adolescents with ASD, their demographic characteristics, initial symptoms of des-compensation at pubertal or adolescence stages, interventions developed and evolution with them. Results: We studied the clinical stories of eleven patients, 8 men and 3 women, who consulted with behavioral descompensation periods at a mean age of 13 years (range 10-16 years). They presented with hyperactivity/agitation (6), injuries and aggression against others or themselves (6), irrita-bility/ emotional labiality (6), inappropriate shouting (6), inflexibility/ rituals (4) and catatonia (2). Almost all patients had received psychiatric medication before descompensation, except patients with catatonia. Four of 11 presented two episodes and seven patients only one episode during a period of 2.7 years of follow-up (range 1-6 years). Eight of 11 patients recovered with psychological and pharmacological (a medium of 2 drugs) interventions in a mean time of 4 months. Both patients with catatonia didn't recovered, and one more patient didn't improved with pharmacological treatment. Conclusions: Behavioral descompensations are very frequent complications in patients with autism at puberty or adolescence stages. Most of them recover with very close combined interventions and familial support.
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