Article

A Systematic Review of Medical Treatments for Children With Autism Spectrum Disorders

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PEDIATRICS (Impact Factor: 5.47). 04/2011; 127(5):e1312-21. DOI: 10.1542/peds.2011-0427
Source: PubMed

ABSTRACT

As many as 1 in every 110 children in the United States has an autism spectrum disorder (ASD). Many medical treatments for ASDs have been proposed and studied, but there is currently no consensus regarding which interventions are most effective.
To systematically review evidence regarding medical treatments for children aged 12 years and younger with ASDs.
We searched the Medline, PsycInfo, and ERIC (Education Resources Information Center) databases from 2000 to May 2010, regulatory data for approved medications, and reference lists of included articles. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Studies of secretin were not included in this review. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength-of-evidence ratings on the basis of predetermined criteria.
Evidence supports the benefit of risperidone and aripiprazole for challenging and repetitive behaviors in children with ASDs. Evidence also supports significant adverse effects of these medications. Insufficient strength of evidence is present to evaluate the benefits or adverse effects for any other medical treatments for ASDs, including serotonin-reuptake inhibitors and stimulant medications.
Although many children with ASDs are currently treated with medical interventions, strikingly little evidence exists to support benefit for most treatments. Risperidone and aripiprazole have shown benefit for challenging and repetitive behaviors, but associated adverse effects limit their use to patients with severe impairment or risk of injury.

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    • "However, given the exponential growth in the volume of ASD intervention research, we have narrowed the scope of the current review. We refer readers to McPheeters et al. (2011), Dove et al. (2012), and Siegel and Beaulieu (2012) for systematic reviews of empirical reports on psychopharmacological treatments. "
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    ABSTRACT: This evidence base update examines the level of empirical support for interventions for children with autism spectrum disorder (ASD) younger than 5 years old. It focuses on research published since a previous review in this journal (Rogers & Vismara, 2008119. Rogers, S. J. & Vismara, L. A. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child & Adolescent Psychology, 37, 8–38. doi:10.1080/15374410701817808[Taylor & Francis Online], [PubMed], [Web of Science ®]View all references). We identified psychological or behavioral interventions that had been manualized and evaluated in either (a) experimental or quasi-experimental group studies or (b) systematic reviews of single-subject studies. We extracted data from all studies that met these criteria and were published after the previous review. Interventions were categorized across two dimensions. First, primary theoretical principles included applied behavior analysis (ABA), developmental social-pragmatic (DSP), or both. Second, practice elements included scope (comprehensive or focused), modality (individual intervention with the child, parent training, or classrooms), and intervention targets (e.g., spoken language or alternative and augmentative communication). We classified two interventions as well-established (individual, comprehensive ABA and teacher-implemented, focused ABA + DSP), 3 as probably efficacious (individual, focused ABA for augmentative and alternative communication; individual, focused ABA + DSP; and focused DSP parent training), and 5 as possibly efficacious (individual, comprehensive ABA + DSP; comprehensive ABA classrooms; focused ABA for spoken communication; focused ABA parent training; and teacher-implemented, focused DSP). The evidence base for ASD interventions has grown substantially since 2008. An increasing number of interventions have some empirical support; others are emerging as potentially efficacious. Priorities for future research include improving outcome measures, developing interventions for understudied ASD symptoms (e.g., repetitive behaviors), pinpointing mechanisms of action in interventions, and adapting interventions for implementation with fidelity by community providers.
    Preview · Article · Nov 2015 · Journal of Clinical Child & Adolescent Psychology
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    • "ical and SHH levels which created a negative feedback response ( Al - Ayadhi , 2012 ) . A large proportion of ASD patients , including very young chil - dren , are prescribed psychoactive drugs such as antidepressants and antipsychotics ( Mandell et al . , 2008 ; Oswald and Sonenklar , 2007 ) despite lack of scientific evidence of their efficacy ( McPheeters et al . , 2011 ) . Antipsychotic drugs , especially the FDA - approved atypical antipsychotic risperidone , are prescribed to combat symptoms like irritability and aggression ( McDougle et al . , 1998 ; Posey et al . , 2008 ) . Importantly , risperidone is the first drug approved for the use in autism and the first atypical antipsychotic drug approved"
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    ABSTRACT: Neurodevelopmental disorders are a group of conditions that arises from impairments of the central nervous system during its development. The causes of the various disorders are heterogeneous and the symptoms likewise are multifarious. Most of these disorders currently have very little available treatment that is effective in combating the plethora of serious symptoms. Brain-derived neurotrophic factor (BDNF) is a fundamental neurotrophin with vital functions during brain development. Pre-clinical studies have shown that increasing BDNF signalling may be a potent way to prevent, arrest or even reverse abnormal neurodevelopmental events arising from a variety of genetic or environmental causes. However, many difficulties make BDNF problematic to administer in an efficient manner. The recent discovery of a small BDNF-mimetic, the naturally occurring flavonoid 7,8-dihydroxyflavone (7,8-DHF), may provide an avenue to allow efficient and safe activation of the BDNF pathway in tackling the symptoms of neurodevelopmental disorders. Here, evidence will be provided to support the potential of 7,8-DHF as a novel treatment for several neurodevelopmental disorders where the BDNF signalling pathway is implicated in the pathophysiology and where benefits are therefore most likely to be derived from its implementation. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Jul 2015 · Neurochemistry International
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    • "lopmental level ( American Psychiatric Association , 2013 ) . Although there is clearly a genetic basis to ASD , the majority of cases have unknown causes ( Abrahams and Geschwind , 2008 ; Geschwind , 2008 ) . It is , moreover , now widely accepted that ASD is a neurobiological disorder , but specific biological markers are yet to be established ( McPheeters et al . , 2011 ; Warren et al . , 2011 ) . Magnetic resonance spectroscopy ( MRS ) has made it possible to study the concentration of biochemical substances in the healthy and diseased brain ( Soares and Law , 2009 ) . By measuring from a volume element ( MRS voxel ) in specific regions of interest , metabolite concentrations can be estimated due to d"
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    ABSTRACT: Magnetic resonance spectroscopy (MRS) from voxels placed in the left anterior cingulate cortex (ACC) was measured from 14 boys with Autism Spectrum Disorder (ASD) and 24 gender and age-matched typically developing (TD) control group. Our main aims were to compare the concentration of γ-aminobutyric acid (GABA) between the two groups, and to investigate the relationship between brain metabolites and autism symptom severity in the ASD group. We did find a significant negative correlation in the ASD group between Autism Spectrum Screening Questionnaire (ASSQ) and GABA+/Cr, which may imply that severity of symptoms in ASD is associated with differences in the level of GABA in the brain, supporting the excitatory/inhibitory (E/I) imbalance theory. However we did not find a significant difference between the two groups in GABA levels.
    Full-text · Article · Jun 2015 · Frontiers in Human Neuroscience
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