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: 2.12). 11/2008; 55(5):1147-57, viii. DOI: 10.1016/j.pcl.2008.07.006
Source: PubMed


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 is of interest neurochemically because it represents a relatively homogeneous disorder with regard to disease development, abnormal cognitive development and intellectual development disturbance. A consistent finding in autistic children is a high number of mast cells and a high level of serotonin which is also found at elevated concentrations in the urine of autistic patients. In addition, a dysfunction of clinical conditions, such as gastrointestinal and immunological symptoms, is frequently noted in autistic children, however, IgE does not appear to be prevalent in these children but probably an increase of cytokines/chemokines produced by mast cells at an early age may play an important role. Therefore an immune hypothesis, involving also autoimmunity, is one possible pathogenetic mechanism in autism. In conclusion, mast cell activation could contribute to immune and neuroinflammatory abnormalities that are evident in patients with autism spectrum disorders.
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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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