Christopher J McDougle

Boston Children's Hospital, Boston, Massachusetts, United States

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Publications (311)1703.89 Total impact

  • Kelli Dominick, Logan K Wink, Christopher J McDougle, Craig A Erickson
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    ABSTRACT: The purpose of this study was to assess the impact of ziprasidone monoantipsychotic treatment targeting irritability in a naturalistic outpatient autism spectrum disorder (ASD) clinical setting. We examined the use of ziprasidone, predominantly in combination with other psychotropic agents, targeting irritability in 42 youth with ASD in a large ASD-specific treatment database. Mean age at start of treatment, treatment duration, final dose, body mass index (BMI), BMI Z score, and Clinical Global Impressions-Improvement Scale (CGI-I) score at final visit were determined, and changes with treatment were analyzed using paired t tests. Cardiac corrected QT (QTc) interval data were extracted from electrocardiograms when available. Mean age at start of treatment was 11.8 years. And final mean dose of ziprasidone was 98.7 mg/day or 1.7 mg/kg/day. Seventeen (40%) participants were considered treatment responders based on the CGI-I. No changes in QTc (although only examined in nine participants), weight, BMI, or other vital signs were noted, with ziprasidone use. The rate of treatment response was less than what has been reported for the two atypical antipsychotics, risperidone and aripiprazole, approved by the Food and Drug Administration (FDA) for the treatment of irritability in autistic disorder. The response rate with ziprasidone may be more consistent with response rates for other atypical antipsychotics, although none of these agents has been studied in larger-scale double-blind, placebo-controlled trials. The lower rate of response to ziprasidone in this open-label trial is likely influenced by the treatment-refractory nature of the population studied. The weight neutrality of ziprasidone appears favorable compared with other second generation antipsychotics in this population. The response rate to ziprasidone targeting irritability may be lower than response rates associated with FDA-approved agents for this indication. Overall, ziprasidone use appeared well tolerated in youth with ASD.
    Journal of child and adolescent psychopharmacology 06/2015; 25(5):397-401. DOI:10.1089/cap.2014.0111 · 3.07 Impact Factor
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    ABSTRACT: Repetitive behavior is a core feature of autism spectrum disorder. We used 8-week data from two federally funded, multi-site, randomized trials with risperidone conducted by the Research Units on Pediatric Psychopharmacology Autism Network to evaluate the sensitivity of the Children's Yale-Brown Obsessive Compulsive Scale modified for autism spectrum disorder to detect change with treatment. Study 1 included 52 subjects assigned to placebo and 49 subjects to risperidone under double-blind conditions. In Study 2, 49 subjects received risperidone only and 75 subjects received risperidone plus parent training. The combined sample consisted of 187 boys and 38 girls (aged 4-17 years). At the medication-free baseline, the internal consistency on the Children's Yale-Brown Obsessive Compulsive Scale modified for autism spectrum disorder total score was excellent (Cronbach's alpha = 0.84) and the mean scores were similar across the four groups. Compared to placebo in Study 1, all three active treatment groups showed significant improvement (effect sizes: 0.74-0.88). There were no differences between active treatment groups. These results indicate that the Children's Yale-Brown Obsessive Compulsive Scale modified for autism spectrum disorder has acceptable test-retest as evidenced by the medium to high correlations in the placebo group and demonstrated sensitivity to change with treatment. © The Author(s) 2015.
    Autism 04/2015; DOI:10.1177/1362361315574889 · 3.50 Impact Factor
  • Brittany Crowley, Yamini J Howe, Christopher J McDougle
    Journal of Child and Adolescent Psychopharmacology 03/2015; 25(2). DOI:10.1089/cap.2014.0140 · 3.07 Impact Factor
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    ABSTRACT: This pilot study compared the pharmacologic treatment history and clinical outcomes observed in pediatric outpatients with psychiatric disorders exposed to drugs of abuse in utero to those of an age-matched, sex-matched and psychiatric disorder-matched, non-drug-exposed group. In this matched cohort study, medical records of children treated at an academic, child and adolescent psychiatry outpatient clinic were reviewed. Children with caregiver-reported history of prenatal drug exposure were compared with a non-drug-exposed control group being cared for by the same providers. Patients were rated with the Clinical Global Impressions-Severity scale (CGI-S) throughout treatment. The changes in pre-treatment and post-treatment CGI-S scores and the total number of medication trials were determined between groups. The drug-exposed group (n = 30) had a higher total number of lifetime medication trials compared with the non-drug-exposed group (n = 28) and were taking significantly more total medications, at their final assessment. Unlike the non-drug-exposed group, the drug-exposed group demonstrated a lack of clinical improvement. These results suggest that in utero drug-exposed children may be more treatment-refractory to or experience greater side effects from the pharmacologic treatment of psychiatric disorders than controls, although we cannot determine if early environment or drugs exposure drives these findings. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    Human Psychopharmacology Clinical and Experimental 03/2015; 30(3). DOI:10.1002/hup.2467 · 1.85 Impact Factor
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    ABSTRACT: Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental disorders that manifest in early childhood and persist throughout the lifespan; treatment should reflect the unique challenges for that individual at each developmental stage. In early childhood, treatment should focus on the acquisition of language, play skills, joint attention, and effective communication strategies through intensive behavioral and educational interventions, particularly Applied Behavioral Analysis (ABA). Middle childhood and adolescence presents a time for continued skills acquisition, including development of social skills, peer relationships, and maximizing supports for academic weaknesses. In older adolescence and young adulthood, developing vocational and adaptive living skills to maximize opportunities for independence becomes important. ASD are lifelong disorders, and treatment in adulthood includes ensuring opportunities for social, leisure, and vocational activities, maintaining physical health through diet and exercise, and support for transitions in caregiving as parents age. Throughout the lifespan, clinicians should remain mindful of medical complications that can affect behavior and may not be readily apparent in individuals with limited verbal abilities, including gastrointestinal problems such as reflux and constipation, seizures, and allergies. Current pharmacological interventions are primarily aimed at ameliorating the challenging emotional and behavioral symptoms that accompany ASD rather than the core symptoms of ASD themselves. However, substantial evidence-based research into most medications for ASD is lacking. Two atypical antipsychotics, risperidone and aripiprazole, have indication for the treatment of severe irritability in youths with ASD, though all other medication use in ASD is considered off-label. Behaviorally based therapies, including ABA and cognitive-behavioral therapy (CBT), may be helpful for symptoms of depression, anxiety, and impaired self-regulation. Clinicians should remain mindful that many families will seek out complementary and alternative medicine (CAM) approaches for their child, and appropriate guidance about the safety and efficacy of these interventions should be offered. Drug therapies that directly target the varied neurobiological underpinnings of ASD are an area of great interest for future research and treatment.
    03/2015; 2(1):38-56. DOI:10.1007/s40501-015-0031-z
  • Nicole R Zürcher, Anisha Bhanot, Christopher J McDougle, Jacob M Hooker
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    ABSTRACT: Non-invasive positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are techniques used to quantify molecular interactions, biological processes and protein concentration and distribution. In the central nervous system, these molecular imaging techniques can provide critical insights into neurotransmitter receptors and their occupancy by neurotransmitters or drugs. In recent years, there has been an increase in the number of studies that have investigated neurotransmitters in autism spectrum disorders (ASD), while earlier studies mostly focused on cerebral blood flow and glucose metabolism. The underlying and contributing mechanisms of ASD are largely undetermined and ASD diagnosis relies on the behavioral phenotype. Discovery of biochemical endophenotypes would represent a milestone in autism research that could potentially lead to ASD subtype stratification and the development of novel therapeutic drugs. This review characterizes the prior use of molecular imaging by PET and SPECT in ASD, addresses methodological challenges and highlights areas of future opportunity for contributions from molecular imaging to understand ASD pathophysiology. Copyright © 2015. Published by Elsevier Ltd.
    Neuroscience & Biobehavioral Reviews 02/2015; 52. DOI:10.1016/j.neubiorev.2015.02.002 · 10.28 Impact Factor
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    ABSTRACT: The purpose of this chapter is to present results from recent research on social cognition in autism spectrum disorder (ASD). The clinical phenomenology and neuroanatomical circuitry of ASD are first briefly described. The neuropharmacology of social cognition in animal models of ASD and humans is then addressed. Next, preclinical and clinical research on the neurohormone oxytocin is reviewed. This is followed by a presentation of results from preclinical and clinical studies on the excitatory amino acid glutamate. Finally, the role of neuroinflammation in ASD is addressed from the perspectives of preclinical neuroscience and research involving humans with ASD.
    Handbook of experimental pharmacology 01/2015; 228:309-34. DOI:10.1007/978-3-319-16522-6_11
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    ABSTRACT: TSPO is a neuroinflammatory biomarker and emerging therapeutic target in psychiatric disorders. We evaluated whether TSPO polymorphisms contribute to interindividual variability in schizophrenia, antipsychotic efficacy and antipsychotic-induced weight gain. We analyzed TSPO polymorphisms in 670 schizophrenia cases and 775 healthy controls. Gene-gene interactions between TSPO and other mitochondrial membrane protein-encoding genes (VDAC1 and ANT1) were explored. Positive findings were evaluated in two independent samples (Munich, n = 300; RUPP, n = 119). TSPO rs6971 was independently associated with antipsychotic-induced weight gain in the discovery (puncor = 0.04) and RUPP samples (p = 3.00 × 10(-3)), and interacted with ANT1 rs10024068 in the discovery (p = 1.15 × 10(-3)) and RUPP samples (p = 2.76 × 10(-4)). Our findings highlight TSPO as a candidate for future investigations of antipsychotic-induced weight gain, and support the involvement of mitochondrial membrane components in this serious treatment side effect. Original submitted 20 August 2014; Revision submitted 3 November 2014.
    Pharmacogenomics 01/2015; 16(1):5-22. DOI:10.2217/pgs.14.158 · 3.43 Impact Factor
  • Noha F Minshawi, Sarah Hurwitz, Danielle Morriss, Christopher J McDougle
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    ABSTRACT: The objective of this review is to consider the psychological (largely behavioral) and biological [neurochemical, medical (including genetic), and pharmacological] theories and approaches that contribute to current thinking about the etiology and treatment of self-injurious behavior (SIB) in individuals with autism spectrum disorder and/or intellectual disability. Algorithms for the assessment and treatment of SIB in this context, respectively, from a multidisciplinary, integrative perspective are proposed and challenges and opportunities that exist in clinical and research settings are discussed.
    Journal of Autism and Developmental Disorders 11/2014; 45(6). DOI:10.1007/s10803-014-2307-3 · 3.34 Impact Factor
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    ABSTRACT: A role for immunological involvement in autism spectrum disorder (ASD) has long been hypothesized. This review includes four sections describing (1) evidence for a relationship between familial autoimmune disorders and ASD; (2) results from post-mortem and neuroimaging studies that investigated aspects of neuroinflammation in ASD; (3) findings from animal model work in ASD involving inflammatory processes; and (4) outcomes from trials of anti-inflammatory/immunemodulating drugs in ASD that have appeared in the literature. Following each section, ideas are provided for future research, suggesting paths forward in the continuing effort to define the role of immune factors and inflammation in the pathophysiology of a subtype of ASD.
    Brain Research 11/2014; 1617. DOI:10.1016/j.brainres.2014.09.048 · 2.83 Impact Factor
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    ABSTRACT: Peripubertal boys with autism spectrum disorder (ASD) have lower bone mineral density (BMD) than typically developing controls. However, it is not clear whether lower BMD in ASD results in an increased fracture rate. This study examined the rate of fractures in children and adults with and without ASD using a national database of emergency room visits (Nationwide Emergency Department Sample). A higher odds ratio for hip fractures in children and young adults (3-22 years) as well as older adults (23-50 years) with ASD than those without ASD, and a higher odds ratio for forearm and spine fractures in women ages 23-50 with ASD were found. Further studies are necessary to better understand the decreased bone density in ASD and its implications for fracture development.
    Journal of Autism and Developmental Disorders 09/2014; 45(3). DOI:10.1007/s10803-014-2228-1 · 3.34 Impact Factor
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    ABSTRACT: The objective of the study was to characterize the phenotype of males and females with autism spectrum disorder born preterm versus those born at term. Descriptive statistical analyses identified differences between male and female autism spectrum disorder subjects born preterm compared to term for several phenotypic characteristics and comorbidities. Of the 115 (13.0% of 883) born preterm, a greater percentage of males had sleep apnea (13.8% vs 2.5%, p < 0.0001), seizure disorders (17.0% vs 8.5%, p = 0.01), and attention-deficit/hyperactivity disorder (14.9% vs 6.6%, p = 0.005). Females born preterm were more likely to be nonverbal (22.2% vs 4.6%, p = 0.001). In summary, phenotypic differences were observed, especially among males. The results may have implications for understanding the underpinnings of a subset of individuals with autism spectrum disorder and contribute to the development of focused treatments for autism spectrum disorder among children born preterm.
    Autism 09/2014; DOI:10.1177/1362361314547366 · 3.50 Impact Factor
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    ABSTRACT: Understanding of the pathophysiology of autism spectrum disorder (ASD) remains limited. Brain overgrowth has been hypothesized to be associated with the development of ASD. A derivative of amyloid-β precursor protein (APP), secreted APPα (sAPPα), has neuroproliferative effects and has been shown to be elevated in the plasma of persons with ASD compared to control subjects. Reduction in sAPPα holds promise as a novel molecular target of treatment in ASD. Research into the neurochemistry of ASD has repeatedly implicated excessive glutamatergic and deficient GABAergic neurotransmission in the disorder. With this in mind, acamprosate, a novel modulator of glutamate and GABA function, has been studied in ASD. No data is available on the impact of glutamate or GABA modulation on sAPPα function.
    Journal of Psychiatric Research 08/2014; 59. DOI:10.1016/j.jpsychires.2014.07.011 · 4.09 Impact Factor
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    ABSTRACT: Background: No drugs are FDA approved for use targeting the core social impairment of autism and related pervasive developmental disorders (PDDs). Glutamatergic dysregulation is implicated in the pathophysiology of PDDs, now termed ASD. D-Cycloserine (DCS) is FDA approved for the treatment of tuberculosis and the drug is known to impact NMDA glutamate receptor neurotransmission. DCS has been shown to potentiate learning when given prior to therapy sessions in the anxiety disorder literature. Objectives: We evaluated the efficacy of DCS given 30 minutes prior to peer mediated social skills training (SST) in youth aged 5 to 11 years with ASD. Methods: We conducted a double-blind, placebo-controlled trial of low dose (50mg) DCS given prior to manualized SST in 68 children aged 5 to 11 years with ASD over 10 weekly sessions. SST sessions each included 4 youth with ASD and 2 age-matched typically developing peers trainers along with two clinician group facilitators. In addition to evaluating primary and secondary outcome measures after 10 weeks of SST, we additionally conducted a follow up evaluation for each participants 3 months following the SST. Participants with ASD were required to have a full scale IQ greater than 70, meet DSM IV-TR criteria for autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified (PDD-NOS) based upon clinical interview and results from the Autism Diagnostic Interview Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS). Our primary outcome measure was the total score on the Social Responsiveness Scale (SRS). Key secondary outcome measures included the Clinical Global Impresisons Improvement (CGI-I) and Severity (CGI-S) scales, the Aberrant Behavior Checklist (ABC), Pediatric Quality of Life Inventory, 4th Edition, and the Vineland-II. We additionally compiled structure observational behavioral data coding with each session to track potential change with treatment throughout the SST. Results: Sixty-eight youth were enrolled in this trial. The results will be available in Spring 2014. Top line results reviewing the primary and key secondary outcome measures will be reported for the drug versus placebo groups in May 2014. Conclusions: Preliminary conclusions will be generated following the dissemination of top line results in May 2014.
    2014 International Meeting for Autism Research; 05/2014
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    ABSTRACT: A key area of concern in children with autism spectrum disorders (ASDs) are self-injurious behaviors (SIBs). These are behaviors that an individual engages in that may cause physical harm, such as head banging, or self-biting. SIBs are more common in children with ASD than those who are typically developing or have other neurodevelopmental disabilities. Therefore, it is important that clinicians who work with children with ASD have a solid understanding of SIB. The purpose of this paper is to review the research on the epidemiology of SIB in children with ASD, factors that predict the presence of SIB in this population, and the empirically supported behavioral treatments available.
    Psychology Research and Behavior Management 04/2014; 7:125-136. DOI:10.2147/PRBM.S44635
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    ABSTRACT: Aggression, self-injurious behavior, and severe tantrums are impairing symptoms frequently experienced by individuals with autism spectrum disorders. Despite US Food and Drug Administration approval of two atypical antipsychotics targeting these symptoms in youth with autistic disorder, they remain frequently drug refractory. We define drug-refractory aggression, self-injurious behavior, and severe tantrums in people with autism spectrum disorders as behavioral symptoms requiring medication adjustment despite previous trials of risperidone and aripiprazole or previous trials of three psychotropic drugs targeting the symptom cluster, one of which was risperidone or aripiprazole. We reviewed the medical records of individuals of all ages referred to our clinic for autism spectrum disorder diagnostic evaluation, as well as pharmacotherapy follow-up notes for all people meeting autism spectrum disorder criteria, for drug-refractory symptoms. Among 250 consecutively referred individuals, 135 met autism spectrum disorder and enrollment criteria, and 53 of these individuals met drug-refractory symptom criteria. Factors associated with drug-refractory symptoms included age 12 years or older (p < 0.0001), diagnosis of autistic disorder (p = 0.0139), and presence of intellectual disability (p = 0.0273). This pilot report underscores the significance of drug-refractory aggression, self-injurious behavior, and severe tantrums; suggests the need for future study clarifying factors related to symptom development; and identifies the need for focused treatment study of this impairing symptom domain.
    Autism 02/2014; 19(1). DOI:10.1177/1362361314524641 · 3.50 Impact Factor
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    ABSTRACT: Abstract Objective: The purpose of this study was to assess change in body mass index (BMI) and age- and gender-adjusted BMI Z-score in subjects ages 2-20 years with autism spectrum disorders (ASD), who were treated longitudinally with risperidone or aripiprazole at a tertiary care ASD clinic. Method: As part of a larger project involving longitudinal drug treatment data in ASD, detailed demographic and treatment data were collected for 142 subjects ages 2-20 years who had been started on risperidone or aripiprazole for treatment of irritability. Mean age at start of treatment, treatment duration, final Clinical Global Impressions-Improvement Scale score, BMI change per year of treatment, and BMI Z-score change per year of treatment (primary outcome measure) were calculated for each drug treatment group. Group means were compared using t tests and Wilcoxon rank sum tests. Results: There was a statistically significant BMI and BMI Z-score increase in the risperidone and aripiprazole treatment groups individually. No statistically significant difference between the two treatment groups was noted in mean BMI change per year of treatment or BMI Z-score change per year of treatment. Conclusions: In our review of long-term naturalistic treatment of irritability using risperidone versus aripiprazole in persons with ASD, a significant increase in both BMI and age- and gender-adjusted BMI Z-score was noted for each treatment group. No significant difference in BMI or BMI Z-score change was noted when the two treatment groups were compared. We conclude that in our patient population at a tertiary care ASD clinic, the effects of risperidone and aripiprazole on body weight gain in naturalistic long-term treatment are no different.
    Journal of child and adolescent psychopharmacology 02/2014; 24(2). DOI:10.1089/cap.2013.0099 · 3.07 Impact Factor
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    ABSTRACT: Williams syndrome is a relatively rare genetic disorder caused by the hemizygous microdeletion of a region in chromosome 7q11.23. Individuals with Williams syndrome typically present with a highly social, overfriendly, and empathic personality. Comorbid medical and neuropsychiatric disorders are common. Reports of effective pharmacological treatment of associated neuropsychiatric disorders are limited. The authors describe the successful treatment of interfering anger, aggression, and hair-pulling with N-acetylcysteine in a 19-year-old woman with Williams syndrome. The neuropsychiatric symptoms emerged 1 week following an upper gastrointestinal endoscopy, for which fentanyl, midazolam, and propofol were used as anesthetics. The patient's treatment course and hypothesized mechanisms underlying the clinical presentation and symptom resolution are described.
    Journal of child neurology 01/2014; 29(11). DOI:10.1177/0883073813512025 · 1.67 Impact Factor
  • Laura C Politte, Charles A Henry, Christopher J McDougle
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    ABSTRACT: Learning Objectives: After participating in this educational activity, the physician should be better able to1. Prescribe the appropriate psychotropic medication to treat symptoms of ASD.2. Identify the side effects of the psychotropic medications used to treat ASD.Autism spectrum disorders (ASDs) are characterized by core deficits in social communication and language, and restrictive and repetitive behaviors that cause significant functional impairment and distress for affected individuals and their caregivers. The increasing prevalence of ASD, most recently estimated as 1 in 88 children, presents an ever-increasing burden on families, schools, medical systems, and society at large. Individuals with ASD commonly present for treatment of associated emotional and behavioral disturbances that include anxiety, symptoms of ADHD, compulsions and other repetitive behaviors, mood lability, irritability, aggression, and sleep disturbance. Psychotropic medications are widely utilized in alleviating these symptoms, though rigorous clinical trials in ASD are lacking for most areas of impairment. Strong evidence from randomized, placebo-controlled trials supports the use of atypical antipsychotics, particularly risperidone and aripiprazole, for managing severe irritability and aggression in ASD. Serotonin reuptake inhibitors are commonly used to treat anxiety and compulsions, though reports of efficacy in the literature are mixed, and behavioral side effects in children are common. Minimal evidence supports the utility of anticonvulsants and traditional mood stabilizers in managing mood lability and aggression. Stimulant and nonstimulant ADHD medications can be effective for reducing hyperactivity, inattention, and impulsivity, though to a lesser degree than in ADHD populations without ASD and with greater risk of adverse effects. Psychopharmacological interventions in development for core symptoms of autism include those that target the glutamatergic and GABAergic neurotransmitter systems and the neuropeptide oxytocin. Further research is needed to establish evidence-based interventions in ASD populations.
    Harvard Review of Psychiatry 01/2014; 22(2):76-92. DOI:10.1097/HRP.0000000000000030 · 2.49 Impact Factor
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    ABSTRACT: The aim of this review is to summarize the recent literature regarding abnormalities in sensory functioning in individuals with autism spectrum disorder (ASD), including evidence regarding the neurobiological basis of these symptoms, their clinical correlates, and their treatment. Abnormalities in responses to sensory stimuli are highly prevalent in individuals with ASD. The underlying neurobiology of these symptoms is unclear, but several theories have been proposed linking possible etiologies of sensory dysfunction with known abnormalities in brain structure and function that are associated with ASD. In addition to the distress that sensory symptoms can cause patients and caregivers, these phenomena have been correlated with several other problematic symptoms and behaviors associated with ASD, including restrictive and repetitive behavior, self-injurious behavior, anxiety, inattention, and gastrointestinal complaints. It is unclear whether these correlations are causative in nature or whether they are due to shared underlying pathophysiology. The best-known treatments for sensory symptoms in ASD involve a program of occupational therapy that is specifically tailored to the needs of the individual and that may include sensory integration therapy, a sensory diet, and environmental modifications. While some empirical evidence supports these treatments, more research is needed to evaluate their efficacy, and other means of alleviating these symptoms, including possible psychopharmacological interventions, need to be explored. Additional research into the sensory symptoms associated with ASD has the potential to shed more light on the nature and pathophysiology of these disorders and to open new avenues of effective treatments.
    Harvard Review of Psychiatry 01/2014; 22(2):112-24. DOI:10.1097/01.HRP.0000445143.08773.58 · 2.49 Impact Factor

Publication Stats

13k Citations
1,703.89 Total Impact Points

Institutions

  • 2015
    • Boston Children's Hospital
      Boston, Massachusetts, United States
  • 2013–2015
    • Massachusetts General Hospital
      • • Lurie Center for Autism
      • • Athinoula A. Martinos Center for Biomedical Imaging
      Boston, Massachusetts, United States
  • 2012–2015
    • Harvard Medical School
      • Department of Psychiatry
      Boston, Massachusetts, United States
  • 2012–2014
    • Harvard University
      Cambridge, Massachusetts, United States
  • 1998–2013
    • Riley Hospital for Children
      Indianapolis, Indiana, United States
  • 1997–2013
    • Indiana University-Purdue University Indianapolis
      • Department of Psychiatry
      Indianapolis, Indiana, United States
  • 2007–2012
    • University of Pittsburgh
      • Department of Psychiatry
      Pittsburgh, PA, United States
  • 2001–2012
    • Indiana University Bloomington
      Bloomington, Indiana, United States
  • 2010
    • University of California, Los Angeles
      • Division of Adult Psychiatry
      Los Angeles, California, United States
  • 2007–2008
    • Indiana University-Purdue University School of Medicine
      • Psychiatry
      Indianapolis, Indiana, United States
  • 2004
    • Brown University
      • Department of Psychiatry and Human Behavior
      Providence, RI, United States
  • 1998–2004
    • Butler Hospital
      Providence, Rhode Island, United States
  • 1992–2004
    • Yale University
      • • Child Study Center
      • • Department of Psychiatry
      New Haven, CT, United States
    • Community Mental Health Consultants, Inc.
      Невада, Missouri, United States
  • 2000
    • University of Indianapolis
      Indianapolis, Indiana, United States
  • 1991–1995
    • Yale-New Haven Hospital
      • Department of Laboratory Medicine
      New Haven, Connecticut, United States
  • 1994
    • Johns Hopkins Medicine
      • Department of Psychiatry and Behavioral Sciences
      Baltimore, Maryland, United States