Autism medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

There is no pharmacologic medical therapy to completely cure autism spectrum disorder. However, pharmacologic medical therapy is recommended among patients with autism spectrum disorder to relieve common autistic symptoms such as seizures, sleep disturbances, irritability, and hyperactivity. Medical therapy must be accompanied by behavioral therapies to be more effective. Risperidone and aripiprazole are approved by FDA to control irritability for children. Antipsychotics, SSRIs, tricyclic antidepressants, and stimulants are used to control symptoms of autistic children. Supplements including high dose pyridoxine (vitamin B6) and magnesium (HPDM), dimethylglycine, vitamin C, probiotics, and melatonin might be used to alleviate the symptoms of autism. There is no scientific evidence indicating effectiveness of different diets in patients with ASD. However, many testimonials can be found describing benefits of gluten-free diet in autism-related symptoms. Hyperbaric oxygen therapy and stem cell therapy have been proposed to treat autism.

Medical Therapy

  • There is no pharmacologic medical therapy to completely cure autism spectrum disorder. However, pharmacologic medical therapy is recommended among patients with autism spectrum disorder to relieve common autistic symptoms such as seizures, sleep disturbances, irritability, and hyperactivity.[1][2]
  • Medical therapy must be accompanied by behavioral therapies to be more effective.
  • Risperidone and aripiprazole are approved by FDA to control irritability for children.[3]
  • Other drugs might be used to improve symptoms of autism. However, drugs must be prescribed on a trial basis to check their efficacy and safety.

1 Medications

  • 1.1 Antipsychotics
    • 1.1.1 Atypical antipsychotics
      • 1.1.1.1 Risperidone
        • Children 5-16 years of age and 15-20 kg
          • Preferred regimen (1): risperidone 0.25 mg PO qd for 4 days, then 0.5 mg PO qd for 14 days (gradually increase the dose in increments of 0.25 mg/d for 2 weeks interval till maximum 0.5 to 3 mg/d)
        • Children 5-16 years of age and >20 kg
          • Preferred regimen (1): risperidone 0.5 mg PO qd for 4 days, then 1 mg PO qd for 14 days (gradually increase the dose in increments of 0.5 mg/d for 2 weeks interval till maximum 0.5 to 3 mg/d)

Note: Short term side effects of risperidone are weight gain, drowsiness, and hyperglycemia.

  • Preferred regimen (1): aripiprazole 2 mg PO qd for 7 days, then 5 mg PO qd (gradually increase the dose in increments of 5 mg/d for 7 days interval till maximum 15 mg/d) (Specific population e.g. children 6-17 years of age)
  • 1.1.2.1 Haloperidol
    • Children 3-12 years of age and 15-40 kg
      • Preferred regimen (1): haloperidol 0.5 mg PO per day divided in 2-3 doses (gradually increase the dose in increments of 0.5 mg/d for 7 days interval till maximum 0.05 to 0.075 mg/kg/day)
    • Children >40 kg and adolescents
      • Preferred regimen (1): haloperidol 0.5-15 mg PO per day divided in 2-3 doses (maximum 15 mg/day)
  • 1.2 Selective serotonin reuptake inhibitors (SSRIs)[4]
    • 1.2.1 Fluoxetine
      • Children >5 years and adolescents
        • Preferred regimen (1): fluoxetine 2.5 mg PO qd for 7 days (gradually increase the dose in increments of 0.3-0.5 mg/kg/d for 7 days interval till maximum 00.8 mg/kg/day)
    • 1.2.2 Escitalopram
      • Children 6-17 years
        • Preferred regimen (1): escitalopram 2.5 mg PO qd initially (gradually increase the dose in increments of 5 mg/d for 7 days interval till maximum 20 mg/d)
    • 1.2.3 Fluvoxamine
      • Children 8-17 years
        • Preferred regimen (1): Fluvoxamine 25 mg PO qd initially (gradually increase the dose in increments of 25 mg/d for 7 days interval till maximum 200-300 mg/d)
      • Adult
        • Preferred regimen (1): Fluvoxamine 50 mg PO qd initially (gradually increase the dose in increments of 50 mg/d for 7 days interval till maximum 300 mg/d)

Note: One of the most important side effects of SSRIs in children with ASD is suicidal impulses.

2 Supplements

  • Supplements might be used to alleviate the symptoms of autism.
  • 2.1 High dose pyridoxine (vitamin B6) and magnesium (HPDM)
    • It is the most popular supplement that is used for autism. However, due to the limited data it is not scientifically proven to be more effective than placebo.[5][6][7]

Note: Side effect of high dose of pyridoxine is peripheral neuropathy in adults.

Note: Side effects of high doses of magnesium are bradycardia, weakened reflexes, and seizures.

Note: Side effects of high doses of vitamin C are kidney stones and diarrhea.

Note: Side effects of melatonin are drowsiness, headache, dizziness, nausea, and an increase in seizure frequency among susceptible children.[5]

3 Diets

  • There is no scientific evidence indicating effectiveness of different diets in patients with ASD. However, many testimonials can be found describing benefits of following diets in autism-related symptoms, notably social engagement and verbal skills.[8][9]
  • 3.1 Diet low in gluten and casein is promoted in children with ASD.[10]
  • 3.2 Elimination diets targeting salicylates, food dyes, yeast, and simple sugars might be helpful in patients with ASD.[11]

4 Hyperbaric Oxygen Therapy

5 Stem Cell Therapy

References

  1. 1.0 1.1 1.2 Levy SE, Hyman SL (2005). "Novel treatments for autistic spectrum disorders". Ment Retard Dev Disabil Res Rev. 11 (2): 131–42. doi:10.1002/mrdd.20062. PMID 15977319.
  2. Schreibman L (2005). "Critical evaluation of issues in autism" (PDF). The Science and Fiction of Autism. Harvard University Press. ISBN 0674019318.
  3. Chavez B, Chavez-Brown M, Sopko MA Jr, Rey JA (2007). "Atypical antipsychotics in children with pervasive developmental disorders". Pediatr Drugs. 9 (4): 249–66. PMID 17705564.
  4. Myers SM (2007). "The status of pharmacotherapy for autism spectrum disorders". Expert Opin Pharmacother. 8 (11): 1579–603. doi:10.1517/14656566.8.11.1579. PMID 17685878.
  5. 5.0 5.1 5.2 Angley M, Semple S, Hewton C, Paterson F, McKinnon R (2007). "Children and autism—part 2—management with complementary medicines and dietary interventions" (PDF). Aust Fam Physician. 36 (10): 827–30. PMID 17925903.
  6. Francis K (2005). "Autism interventions: a critical update" (PDF). Dev Med Child Neurol. 47 (7): 493–9. PMID 15991872.
  7. Herbert JD, Sharp IR, Gaudiano BA (2002). "Separating fact from fiction in the etiology and treatment of autism: a scientific review of the evidence". S ci Rev Ment Health Pract. 1 (1): 23–43.
  8. Dominick KC, Davis NO, Lainhart J, Tager-Flusberg H, Folstein S (2007). "Atypical behaviors in children with autism and children with a history of language impairment". Res Dev Disabil. 28 (2): 145–62. doi:10.1016/j.ridd.2006.02.003. PMID 16581226.
  9. Erickson CA, Stigler KA, Corkins MR, Posey DJ, Fitzgerald JF, McDougle CJ (2005). "Gastrointestinal factors in autistic disorder: a critical review". J Autism Dev Disord. 35 (6): 713–27. doi:10.1007/s10803-005-0019-4. PMID 16267642.
  10. Reichelt KL, Knivsberg A-M, Lind G, Nødland M (1991). "Probable etiology and possible treatment of childhood autism". Brain Dysfunct. 4: 308–19.
  11. Christison GW, Ivany K (2006). "Elimination diets in autism spectrum disorders: any wheat amidst the chaff?". J Dev Behav Pediatr. 27 (2 Suppl 2): S162–71. PMID 16685183.
  12. Rossignol DA (2007). "Hyperbaric oxygen therapy might improve certain pathophysiological findings in autism". Med Hypotheses. 68 (6): 1208–27. doi:10.1016/j.mehy.2006.09.064. PMID 17141962.
  13. Schechtman MA (2007). "Scientifically unsupported therapies in the treatment of young children with autism spectrum disorders" (PDF). Pediatr Ann. 36 (8): 497–8, 500–2, 504–5. PMID 17849608.
  14. Ichim TE, Solano F, Glenn E; et al. (2007). "Stem cell therapy for autism". J Transl Med. 5 (30). doi:10.1186/1479-5876-5-30. PMID 17597540.

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