Management of Symptoms in Children With Autism Spectrum Disorders: A Comprehensive Review of Pharmacologic and Complementary-Alternative Medicine Treatments
In the care of children with autism spectrum disorders (ASD), medical treatment is typically considered an adjunct to educational and behavioral interventions. Nonetheless, large proportions of children with ASD are managed medically and receive both pharmacologic and complementary-alternative medicine (CAM) treatments. Although many medical treatments have been studied in children with ASD, studies vary widely in terms of the sample, sample size, research design, purposes of treatment, and measurements of change. Surprisingly, comprehensive reviews of the options for medical management in ASD are lacking, particularly reviews that address both pharmacologic and CAM treatments. Furthermore, reviews to date tend to emphasize general effects of medication; this perspective contradicts medical practice, which targets particular symptoms during treatment selection and monitoring. This review of 115 studies adds to the ASD treatment literature by (1) including studies of individuals 0 to 22 years of age; (2) aggregating studies of pharmacologic treatments and CAM treatments; and importantly, (3) organizing treatment response by ASD symptoms, differentiating core and associated symptoms.
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Available from: Yvonne M Y Han
- "Furthermore, some of the methods may be hardly applicable or less effective for individuals with limited intellectual functioning or severe autistic symptoms (Kenworthy et al., 2013; Matson & Smith, 2008). Thus, for many of those cases, especially when uncontrollable emotions or behaviors and severe inattention are involved, pharmacological interventions are considered for their beneficial effects on stabilizing mood and improving attention and behavioral problems (Huffman, Sutcliffe, Tanner, & Feldman, 2011). One study estimated that psychotropic drugs were prescribed to approximately 30% of the ASD cohort, and polypharmacy was observed in one-third of the prescribed individuals (Murray et al., 2013). "
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ABSTRACT: Our animal and human studies have provided empirical evidence that a patented intranasal herbal medicine alters brain functions and neurophysiology. In particular, it reduces clinical symptoms and immunological anomalies in children with autism spectrum disorders (ASD). The present study explored whether the herbal formula can improve executive functions and the associated neuroelectrophysiological activity in ASD. Thirty children with ASD were evenly assigned to receive a daily intranasal administration of the herbal formula or no treatment. Their executive functions, behavioral problems, and electroencephalographic activity during an executive control task were measured before and after six months of treatment with the herbal formula. After treatment, the experimental group showed significantly improved inhibitory control, mental flexibility, and planning, which coincided with an event-related elevation in the activity of their prefrontal and anterior cingulate cortices (regions that are critical for executive control of behaviors) as well as reduced daily dysexecutive behaviors. In contrast, the control group showed no significant changes in executive functions or neural system activity. These findings support the administration of the intranasal herbal medicine as a possible intervention for improving executive functions in ASD.
Available from: Xiaoming Wang
- "Similar to behavioral interventions, there is little biological evidence to specifically support these treatments. Also, the safety profile and efficacy of these treatments in children with ASD remain to be further investigated (Panagiotopoulos et al., 2010; Huffman et al., 2011). "
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ABSTRACT: Despite recent advances in understanding the molecular mechanisms of autism spectrum disorders (ASD), the current treatments for these disorders are mostly focused on behavioral and educational approaches. The considerable clinical and molecular heterogeneity of ASD present a significant challenge to the development of an effective treatment targeting underlying molecular defects. Deficiency of SHANK family genes causing ASD represent an exciting opportunity for developing molecular therapies because of strong genetic evidence for SHANKs as causative genes in ASD and the availability of a panel of Shank mutant mouse models. In this article we review the literature suggesting the potential for developing therapies based on molecular characteristics and discuss several exciting themes that are emerging from studying Shank mutant mice at the molecular level and in terms of synaptic function. © 2013 Wiley Periodicals, Inc. Develop Neurobiol, 2013.
Available from: Jeremy Veenstra-VanderWeele
- "Irritability , marked by severe tantrums, aggression and selfinjury , is common and impairing, but not a core deficit of the disorder.(McPheeters et al. 2011; Huffman et al. 2011) The use of these atypical antipsychotics targeting irritability associated with autistic disorder was based on empirical extension of their effects in other disorders and previous reports on use of typical (older generation) antipsychotics in ASD, rather than specifically on a neurobiological understanding of the pathophysiology of ASD. "
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ABSTRACT: STX209 (arbaclofen), a selective GABA-B agonist, is hypothesized to modulate the balance of excitatory to inhibitory neurotransmission, and has shown preliminary evidence of benefit in fragile X syndrome. We evaluated its safety, tolerability, and efficacy in non-syndromic autism spectrum disorders, in an 8-week open-label trial enrolling 32 children and adolescents with either Autistic Disorder or Pervasive Developmental Disorder-Not Otherwise Specified, and a score ≥17 on the Aberrant Behavior Checklist (ABC)-Irritability subscale. STX209 was generally well-tolerated. The most common adverse events were agitation and irritability, which typically resolved without dose changes, and were often felt to represent spontaneous variation in underlying symptoms. Improvements were observed on several outcome measures in this exploratory trial, including the ABC-Irritability (the primary endpoint) and the Lethargy/Social Withdrawal subscales, the Social Responsiveness Scale, the CY-BOCS-PDD, and clinical global impression scales. Placebo-controlled study of STX209 is warranted.
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