Autism medical therapy: Difference between revisions

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==Overview==
==Overview==
Many medications are used to treat problems associated with ASD.<ref>{{cite journal |journal= Harv Rev Psychiatry |date=2008 |volume=16 |issue=2 |pages=97–112 |title= Pharmacological treatment options for autism spectrum disorders in children and adolescents |author= Leskovec TJ, Rowles BM, Findling RL |doi=10.1080/10673220802075852 |pmid=18415882}}</ref> More than half of U.S. children diagnosed with ASD are prescribed [[psychoactive drug]]s or [[anticonvulsant]]s, with the most common drug classes being [[antidepressant]]s, [[stimulant]]s, and [[antipsychotic]]s.<ref>{{cite journal |journal= J Child Adolesc Psychopharmacol |date=2007 |volume=17 |issue=3 |pages=348–55 |title= Medication use among children with autism spectrum disorders |author= Oswald DP, Sonenklar NA |doi=10.1089/cap.2006.17303 |pmid=17630868}}</ref> Aside from antipsychotics,<ref>{{cite journal |journal= J Clin Invest |date=2008 |volume=118 |issue=1 |pages=6–14 |title= Antipsychotics in the treatment of autism |author= Posey DJ, Stigler KA, Erickson CA, McDougle CJ |doi=10.1172/JCI32483 |pmid=18172517 |url=http://jci.org/cgi/content/full/118/1/6}}</ref> there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD.<ref>Lack of research on drug treatments:
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 [[Seizure|seizures]], [[Sleep disorder|sleep disturbances]], [[irritability]], and [[hyperactivity]]. Medical therapy must be accompanied by [[Behaviour therapy|behavioral therapies]] to be more effective. [[Risperidone]] and [[aripiprazole]] are approved by [[FDA]] to control irritability for children. [[Antipsychotics]], [[Selective serotonin reuptake inhibitor|SSRIs]], [[Tricyclic antidepressant|tricyclic antidepressants]], and [[stimulant]]s 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 [[Diet (nutrition)|diets]] in patients with ASD. However, many testimonials can be found describing benefits of [[gluten-free diet]] in autism-related symptoms. [[Hyperbaric medicine|Hyperbaric oxygen therapy]] and [[stem cell therapy]] have been proposed to treat autism.
*{{cite journal |journal= Aust Fam Physician |year=2007 |volume=36 |issue=9 |pages=741–4 |title= Children and autism—part 1—recognition and pharmacological management |author= Angley M, Young R, Ellis D, Chan W, McKinnon R |pmid=17915375 |url=http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys/2007issues/afp200709/200709angley.pdf |format=PDF}}
*{{cite journal |journal=Autism |date=2007 |volume=11 |issue=4 |pages=335–48 |title= Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder |author= Broadstock M, Doughty C, Eggleston M |doi=10.1177/1362361307078132 |pmid=17656398}}</ref> A person with ASD may respond atypically to medications, the medications can have [[Adverse effect (medicine)|adverse effects]], and no known medication relieves autism's core symptoms of social and communication impairments.<ref name=Strock>{{cite paper |author=Strock M |date=2008 |title= Autism spectrum disorders (pervasive developmental disorders) |publisher= National Institute of Mental Health |url=http://nimh.nih.gov/health/publications/autism/complete-publication.shtml |accessdate=2008-03-24}}</ref><ref>{{cite journal |journal= Novartis Found Symp |date=2003 |volume=251 |pages= 235–44; discussion 245–9, 281–97 |title= Why have drug treatments been so disappointing? |author= Buitelaar JK |doi=10.1002/0470869380.ch14 |pmid=14521196}}</ref>
==Medical Therapy==
==Medical Therapy==
Drugs, supplements, or diets are often used to alter physiology in an attempt to relieve common autistic symptoms such as seizures, sleep disturbances, irritability, and hyperactivity that can interfere with education or social adaptation or (more rarely) cause autistic individuals to harm themselves or others.<ref name=Levy/> There is plenty of anecdotal evidence to support medical treatment; many parents who try one or more therapies report some progress, and there are a few well-publicized reports of children who are able to return to mainstream education after treatment, with dramatic improvements in health and well-being. However, this evidence may be confounded by improvements seen in autistic children who grow up without treatment, by the difficulty of verifying reports of improvements, and by the lack of reporting of treatments' negative outcomes.<ref>{{cite book |author= Schreibman L |title= The Science and Fiction of Autism |date=2005 |publisher= Harvard University Press |isbn=0674019318 |chapter= Critical evaluation of issues in autism |chapterurl=http://www.hup.harvard.edu/pdf/SCHSCI_excerpt.pdf}}</ref> Only a very few medical treatments are well supported by scientific evidence using controlled experiments.<ref name=Levy/>
* 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 [[Seizure|seizures]], [[Sleep disorder|sleep disturbances]], [[irritability]], and [[hyperactivity]].<ref name="Levy" /><ref>{{cite book |author= Schreibman L |title= The Science and Fiction of Autism |date=2005 |publisher= Harvard University Press |isbn=0674019318 |chapter= Critical evaluation of issues in autism |chapterurl=http://www.hup.harvard.edu/pdf/SCHSCI_excerpt.pdf}}</ref>
* Medical therapy must be accompanied by [[Behaviour therapy|behavioral therapies]] to be more effective.
* [[Risperidone]] and [[aripiprazole]] are approved by [[FDA]] to control irritability for children.<ref>{{cite journal |journal= Pediatr Drugs |year=2007 |volume=9 |issue=4 |pages=249–66 |title= Atypical antipsychotics in children with pervasive developmental disorders |author= Chavez B, Chavez-Brown M, Sopko MA Jr, Rey JA |pmid=17705564}}</ref>
* 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.


===Prescription Medication===
=== 1 Medications ===
Medications are often used to treat problems associated with ASD. More than half of U.S. children diagnosed with ASD are prescribed [[psychoactive drug]]s or [[anticonvulsant]]s, with the most common drug classes being [[antidepressant]]s, [[stimulant]]s, and [[antipsychotic]]s.<ref name=Oswald>{{cite journal |journal= J Child Adolesc Psychopharmacol |date=2007 |volume=17 |issue=3 |pages=348–55 |title= Medication use among children with autism spectrum disorders |author= Oswald DP, Sonenklar NA |doi=10.1089/cap.2006.17303 |pmid=17630868}}</ref> Only the antipsychotics have clearly demonstrated efficacy.<ref name=Posey/>
*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]].
::*1.1.1.2 [[Aripiprazole]]
:::*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 [[Typical antipsychotic|Typical antipsychotics]]
::*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 inhibitor|Selective serotonin reuptake inhibitors]] ([[Selective serotonin reuptake inhibitor|SSRIs]])<ref name="pharmacotherapy">{{cite journal |journal= Expert Opin Pharmacother |year=2007 |volume=8 |issue=11 |pages=1579–603 |title= The status of pharmacotherapy for autism spectrum disorders |author= Myers SM |doi=10.1517/14656566.8.11.1579 |pmid=17685878}}</ref>
** 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 [[Selective serotonin reuptake inhibitor|SSRIs]] in children with ASD is [[Suicide|suicidal]] impulses.
* 1.3 [[Tricyclic antidepressant]]
** 1.3.1 [[Clomipramine]]
****'''Children >10 years'''
*****Preferred regimen (1): [[Clomipramine]] 25 mg PO qd initially (gradually increase the dose in increments of 3 mg/kg/d or 100 mg/d for 14 days interval till maximum 3 mg/kg/d or 200 mg/d)
****'''Adult'''
*****Preferred regimen (1): [[Clomipramine]] 25 mg PO qd initially (gradually increase the dose in increments of 100 mg/d for 14 days interval till maximum 250 mg/d)
* 1.4 [[Psychostimulant]]
** 1.5.1 [[Methylphenidate]]
*** Preferred regimen (1): [[Methylphenidate]] 0.43-0.60 mg/kg/dose PO


Research has focused on [[atypical antipsychotics]], especially [[risperidone]], which has the largest amount of evidence that consistently shows improvements in irritability, self-injury, aggression, and tantrums associated with ASD.<ref>{{cite journal |journal= Pediatr Drugs |year=2007 |volume=9 |issue=4 |pages=249–66 |title= Atypical antipsychotics in children with pervasive developmental disorders |author= Chavez B, Chavez-Brown M, Sopko MA Jr, Rey JA |pmid=17705564}}</ref> In the United States, [[risperidone]] is approved for treating symptomatic irritability in autistic children and adolescents aged 5–16 years. In short-term trials (up to 6 months) most adverse events were mild to moderate, with [[weight gain]], [[drowsiness]], and [[high blood sugar]] requiring monitoring. Its long term efficacy and safety have not been fully determined.<ref name=Scott>{{cite journal |journal= Pediatr Drugs |year=2007 |volume=9 |issue=5 |pages=343–54 |title= Risperidone: a review of its use in the treatment of irritability associated with autistic disorder in children and adolescents |author= Scott LJ, Dhillon S |pmid=17927305}}</ref> It is unclear whether risperidone improves autism's core social and communication deficits.<ref name=Posey>{{cite journal |journal= J Clin Invest |date=2008 |volume=118 |issue=1 |pages=6–14 |title= Antipsychotics in the treatment of autism |author= Posey DJ, Stigler KA, Erickson CA, McDougle CJ |doi=10.1172/JCI32483 |pmid=18172517 |url=http://www.jci.org/cgi/content/full/118/1/6}}</ref>
===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.<ref name="Angley2">{{cite journal |journal= Aust Fam Physician |year=2007 |volume=36 |issue=10 |pages=827–30 |title= Children and autism—part 2—management with complementary medicines and dietary interventions |author= Angley M, Semple S, Hewton C, Paterson F, McKinnon R |pmid=17925903 |url=http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys/2007issues/afp200710/200710angley.pdf |format=PDF}}</ref><ref name="Francis">{{cite journal |journal= Dev Med Child Neurol |date=2005 |volume=47 |issue=7 |pages=493–9 |title= Autism interventions: a critical update |author= Francis K |pmid=15991872 |url=http://journals.cambridge.org/production/action/cjoGetFulltext?fulltextid=313204 |format=PDF}}</ref><ref name="Herbert">{{cite journal |author=Herbert JD, Sharp IR, Gaudiano BA |title=Separating fact from fiction in the etiology and treatment of autism: a scientific review of the evidence |journal=S ci Rev Ment Health Pract |volume=1 |issue=1 |pages=23–43 |year=2002 |url=http://www.srmhp.org/0101/autism.html}}</ref>
Note: Side effect of high dose of [[pyridoxine]] is [[peripheral neuropathy]] in adults.


Other drugs are prescribed [[off-label]] in the U.S., which means they have not been approved for treating ASD. Large [[placebo]]-controlled studies of [[olanzapine]] and [[aripiprazole]] were underway in early 2008.<ref name=Posey/> Some [[selective serotonin reuptake inhibitor]]s (SSRIs) and [[dopamine]] blockers can reduce some maladaptive behaviors associated with ASD.<ref name=pharmacotherapy>{{cite journal |journal= Expert Opin Pharmacother |year=2007 |volume=8 |issue=11 |pages=1579–603 |title= The status of pharmacotherapy for autism spectrum disorders |author= Myers SM |doi=10.1517/14656566.8.11.1579 |pmid=17685878}}</ref> The limited data for SSRIs suggest that they may be helpful for obsessions/compulsions, but that children may have a worse response than adults and may suffer more adverse affects, such as suicidal impulses.<ref name=Angley1/> One study found that the psychostimulant [[methylphenidate]] was efficacious against hyperactivity associated with ASD, though with less response than in neurotypical children with ADHD.<ref name=Angley1/> A 1998 study of the hormone [[secretin]] reported improved symptoms and generated tremendous interest, but several controlled studies since have found no benefit.<ref name=Francis/>
Note: Side effects of high doses of [[magnesium]] are [[bradycardia]], weakened [[Neurological examination|reflexes]], and [[Seizure|seizures]].
* 2.2 [[Dimethylglycine]] (DMG)
** It is used to improve [[speech]] and reduce autistic behaviors.


There is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD.<ref name=Angley1>{{cite journal |journal= Aust Fam Physician |year=2007 |volume=36 |issue=9 |pages=741–4 |title= Children and autism—part 1—recognition and pharmacological management |author= Angley M, Young R, Ellis D, Chan W, McKinnon R |pmid=17915375 |url=http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys/2007issues/afp200709/200709angley.pdf |format=PDF}}</ref> Results of the handful of [[randomized control trial]]s that have been performed suggest that risperidone, the SSRI [[fluvoxamine]], and the typical antipsychotic [[haloperidol]] may be effective in reducing some behaviors, that haloperidol may be more effective than the tricyclic antidepressant [[clomipramine]], and that the opiate antagonist [[naltrexone hydrochloride]] is not effective.<ref name=Broadstock>{{cite journal |journal=Autism |date=2007 |volume=11 |issue=4 |pages=335–48 |title= Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder |author= Broadstock M, Doughty C, Eggleston M |doi=10.1177/1362361307078132 |pmid=17656398}}</ref> A person with ASD may respond atypically to medications, the medications can have adverse side effects, and no known medication relieves autism's core symptoms of social and communication impairments.<ref>{{cite paper |author=Strock M |date=2007 |title= Autism spectrum disorders (pervasive developmental disorders) |publisher= National Institute of Mental Health |url=http://www.nimh.nih.gov/health/publications/autism/complete-publication.shtml |accessdate=2007-10-05}}</ref>
* 2.3 [[Vitamin C]]
** In one study [[vitamin C]] decreased stereotyped behavior.
'''Note''': Side effects of high doses of [[vitamin C]] are [[Kidney stone|kidney stones]] and [[diarrhea]].
* 2.4 [[Probiotic]]s
** They are used to relieve some symptoms of autism by minimizing [[yeast]] overgrowth in the [[Colon (anatomy)|colon]].<ref name="Levy">{{cite journal |journal= Ment Retard Dev Disabil Res Rev |year=2005 |volume=11 |issue=2 |pages=131–42 |title= Novel treatments for autistic spectrum disorders |author= Levy SE, Hyman SL |doi=10.1002/mrdd.20062 |pmid=15977319}}</ref>


===Supplements===
* 2.5 [[Melatonin]]
Many parents give their children vitamin and other nutritional supplements in an attempt to treat autism or to alleviate its symptoms. The range of supplements given is wide; few are supported by scientific data, but most have relatively mild side effects.<ref name=Levy/><ref name=Angley2/>  
** It is used to manage [[sleep]] problems in [[Developmental disorder|developmental disorders]].
'''Note''': Side effects of [[melatonin]] are [[Somnolence|drowsiness]], [[headache]], [[dizziness]], [[Nausea and vomiting|nausea]], and an increase in [[seizure]] frequency among susceptible children.<ref name="Angley2" />
* 2.6 Several other supplements have been hypothesized to relieve autism symptoms which include [[carnosine]], [[cyproheptadine]], [[D-cycloserine]], [[folic acid]], [[glutathione]], [[metallothionein]] promoters, [[oxytocin]], [[polyunsaturated fatty acid]]s (PUFA) such as [[omega-3]] or [[omega-6]] fatty acids, [[tryptophan]], [[tyrosine]], thiamine (see [[#Chelation therapy|Chelation therapy]]), [[vitamin B12]], and [[zinc]].<ref name="Levy" /><ref name="Angley2" />


Nutritional supplementation with high dose [[pyridoxine]] ([[vitamin B6]]) and [[magnesium]] (HPDM) is claimed to alleviate the symptoms of autism and is one of the most popular complementary and alternative medicine choices for autism. Three small [[randomized controlled trial]]s have studied this therapy; the smallest one (with 8 individuals) found improved verbal IQ in the treatment group and the other two (with 10 and 15 individuals, respectively) found no significant difference.<ref name=Angley2/> Due to the limited data it is difficult to tell whether this treatment approach has effects greater than placebo.<ref name=Francis/> The short-term side effects seem to be mild, but there may be significant long-term side effects, as high doses of pyridoxine cause [[peripheral neuropathy]] in adults,<ref name=Angley2>{{cite journal |journal= Aust Fam Physician |year=2007 |volume=36 |issue=10 |pages=827–30 |title= Children and autism—part 2—management with complementary medicines and dietary interventions |author= Angley M, Semple S, Hewton C, Paterson F, McKinnon R |pmid=17925903 |url=http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys/2007issues/afp200710/200710angley.pdf |format=PDF}}</ref> high doses of magnesium can cause reduced heart rate and weakened reflexes,<ref name=Herbert>{{cite journal |author=Herbert JD, Sharp IR, Gaudiano BA |title=Separating fact from fiction in the etiology and treatment of autism: a scientific review of the evidence |journal=S ci Rev Ment Health Pract |volume=1 |issue=1 |pages=23–43 |year=2002 |url=http://www.srmhp.org/0101/autism.html}}</ref> and high magnesium concentrations are associated with seizures.<ref name=Schechtman/> Magnesium should always be taken along with high doses of pyridoxine to prevent side effects such as irritability and sensitivity to sound.<ref name=Francis>{{cite journal |journal= Dev Med Child Neurol |date=2005 |volume=47 |issue=7 |pages=493–9 |title= Autism interventions: a critical update |author= Francis K |pmid=15991872 |url=http://journals.cambridge.org/production/action/cjoGetFulltext?fulltextid=313204 |format=PDF}}</ref>
===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.<ref name="Dominick">{{cite journal |journal= Res Dev Disabil |year=2007 |volume=28 |issue=2 |pages=145–62 |title= Atypical behaviors in children with autism and children with a history of language impairment |author= Dominick KC, Davis NO, Lainhart J, Tager-Flusberg H, Folstein S |doi=10.1016/j.ridd.2006.02.003 |pmid=16581226}}</ref><ref>{{cite journal |journal= J Autism Dev Disord |date=2005 |volume=35 |issue=6 |pages=713–27 |title= Gastrointestinal factors in autistic disorder: a critical review |author= Erickson CA, Stigler KA, Corkins MR, Posey DJ, Fitzgerald JF, McDougle CJ |doi=10.1007/s10803-005-0019-4 |pmid=16267642}}</ref>
* 3.1 Diet low in [[gluten]] and [[casein]] is promoted in children with ASD.<ref>{{cite journal |author= Reichelt KL, Knivsberg A-M, Lind G, Nødland M |title= Probable etiology and possible treatment of childhood autism |journal= Brain Dysfunct |year=1991 |volume=4 |pages=308–19}}</ref>
* 3.2 Elimination diets targeting [[salicylates]], [[food dye]]s, [[yeast]], and simple sugars might be helpful in patients with ASD.<ref name="Christison">{{cite journal |journal= J Dev Behav Pediatr |date=2006 |volume=27 |issue=2 Suppl 2| pages=S162–71 |title= Elimination diets in autism spectrum disorders: any wheat amidst the chaff? |author= Christison GW, Ivany K |pmid=16685183}}</ref>


[[Dimethylglycine]] (DMG) is hypothesized to improve speech and reduce autistic behaviors,<ref name=Angley2/> and is a commonly used supplement.<ref name=Levy/> Two double-blind, placebo-controlled studies found no statistically significant effect on autistic behaviors,<ref name=Angley2/> and reported few side effects. No peer-reviewed studies have addressed treatment with the related compound [[trimethylglycine]].<ref name=Levy/>
===4 Hyperbaric Oxygen Therapy===
* 4.1 [[Hyperbaric oxygen therapy]] ([[Hyperbaric oxygen therapy|HBOT]])<ref>{{cite journal |journal= Med Hypotheses |year=2007 |volume=68 |issue=6 |pages=1208–27 |title= Hyperbaric oxygen therapy might improve certain pathophysiological findings in autism |author= Rossignol DA |doi=10.1016/j.mehy.2006.09.064 |pmid=17141962}}</ref>
** It can increase the [[oxygen]] content of the body. [[Hyperbaric oxygen therapy|HBOT]] might relieve some of the core symptoms of autism. However, scientific evidence is lacking for the use of [[Hyperbaric oxygen therapy|HBOT]] to treat autism.<ref name="Schechtman">{{cite journal |journal= Pediatr Ann |year=2007 |volume=36 |issue=8 |pages=497–8, 500–2, 504–5 |title= Scientifically unsupported therapies in the treatment of young children with autism spectrum disorders |author= Schechtman MA |pmid=17849608 |url=http://www.pediatricannalsonline.com/showPdf.asp?rID=23083 |format=PDF}}</ref>


[[Vitamin C]] decreased stereotyped behavior in a small 1993 study. The study has not been replicated, and vitamin C has limited popularity as an autism treatment. High doses might cause kidney stones or gastrointestinal upset such as diarrhea.<ref name=Levy/>
===5 Stem Cell Therapy===
* [[Mesenchymal stem cells]] and [[cord blood]] [[CD34]]+ cells<ref>{{cite journal |journal=J Transl Med |year=2007  |volume=5 |issue=30 |title= Stem cell therapy for autism |author= Ichim TE, Solano F, Glenn E ''et al.'' |doi=10.1186/1479-5876-5-30 |pmid=17597540 |url=http://www.translational-medicine.com/content/5/1/30}}</ref>
** They have been proposed to treat autism.


[[Probiotic]]s containing potentially beneficial [[bacteria]] are hypothesized to relieve some symptoms of autism by minimizing yeast overgrowth in the colon. The hypothesized yeast overgrowth has not been confirmed by [[endoscopy]], the mechanism connecting yeast overgrowth to autism is only hypothetical, and no clinical trials to date have been published in the peer-reviewed literature. No negative side effects have been reported.<ref name=Levy>{{cite journal |journal= Ment Retard Dev Disabil Res Rev |year=2005 |volume=11 |issue=2 |pages=131–42 |title= Novel treatments for autistic spectrum disorders |author= Levy SE, Hyman SL |doi=10.1002/mrdd.20062 |pmid=15977319}}</ref>
[[Melatonin]] is sometimes used to manage sleep problems in developmental disorders. One small open trial found a statistically significant reduction in sleep latency in children with ASD. Adverse effects are generally reported to be mild, including drowsiness, headache, dizziness, and nausea; however, an increase in seizure frequency is reported among susceptible children.<ref name=Angley2/>
Several other supplements have been hypothesized to relieve autism symptoms, including [[carnosine]], [[cyproheptadine]], [[D-cycloserine]], [[folic acid]], [[glutathione]], [[metallothionein]] promoters, [[oxytocin]], [[polyunsaturated fatty acid]]s (PUFA) such as [[omega-3]] or [[omega-6]] fatty acids, [[tryptophan]], [[tyrosine]], thiamine (see [[#Chelation therapy|Chelation therapy]]), [[vitamin B12]], and [[zinc]]. None of these have reliable scientific evidence of efficacy or safety in treatment of autism.<ref name=Levy/><ref name=Angley2/>
===Diets===
{{see|Gluten-free, casein-free diet}}
Atypical eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur;<ref name=Dominick>{{cite journal |journal= Res Dev Disabil |year=2007 |volume=28 |issue=2 |pages=145–62 |title= Atypical behaviors in children with autism and children with a history of language impairment |author= Dominick KC, Davis NO, Lainhart J, Tager-Flusberg H, Folstein S |doi=10.1016/j.ridd.2006.02.003 |pmid=16581226}}</ref> this does not appear to result in [[malnutrition]]. Although some children with autism also have [[gastrointestinal]] (GI) symptoms, there is a lack of published rigorous data to support the theory that autistic children have more or different GI symptoms than usual;<ref>{{cite journal |journal= J Autism Dev Disord |date=2005 |volume=35 |issue=6 |pages=713–27 |title= Gastrointestinal factors in autistic disorder: a critical review |author= Erickson CA, Stigler KA, Corkins MR, Posey DJ, Fitzgerald JF, McDougle CJ |doi=10.1007/s10803-005-0019-4 |pmid=16267642}}</ref> studies report conflicting results, and the relationship between GI problems and ASD is unclear.<ref name=CCD>{{cite journal |journal=Pediatrics |date=2007 |volume=120 |issue=5 |pages=1162–82 |title= Management of children with autism spectrum disorders |author= Myers SM, Johnson CP, Council on Children with Disabilities |doi=10.1542/peds.2007-2362 |pmid=17967921 |url=http://pediatrics.aappublications.org/cgi/content/full/120/5/1162 |laysummary=http://www.aap.org/advocacy/releases/oct07autism.htm |laysource=AAP |laydate=2007-10-29}}</ref>
In the early 1990s it was hypothesized that autism can be caused or aggravated by [[opioid peptide]]s like [[casomorphine]] that are metabolic products of [[gluten]] and [[casein]].<ref>{{cite journal |author= Reichelt KL, Knivsberg A-M, Lind G, Nødland M |title= Probable etiology and possible treatment of childhood autism |journal= Brain Dysfunct |year=1991 |volume=4 |pages=308–19}}</ref> Based on this hypothesis, diets that eliminate foods containing either gluten or casein, or both, are widely promoted, and many testimonials can be found describing benefits in autism-related symptoms, notably social engagement and verbal skills.
Studies supporting these claims have had significant flaws, so the data are inadequate to guide treatment recommendations.<ref name=Christison>{{cite journal |journal= J Dev Behav Pediatr |date=2006 |volume=27 |issue=2 Suppl 2| pages=S162–71 |title= Elimination diets in autism spectrum disorders: any wheat amidst the chaff? |author= Christison GW, Ivany K |pmid=16685183}}</ref>
Other elimination diets have also been proposed, targeting [[salicylates]], [[food dye]]s, [[yeast]], and simple sugars. No scientific evidence has established the efficacy of such diets in treating autism in children. An elimination diet may create nutritional deficiencies that harm overall health unless care is taken to assure proper nutrition.<ref name=Angley2/>
===Chelation Therapy===
Based on the speculation that [[heavy metals|heavy metal poisoning]] may trigger the symptoms of autism, particularly in small subsets of individuals who cannot excrete toxins effectively, some parents have turned to [[alternative medicine]] practitioners who provide detoxification treatments via [[chelation therapy]]. However, evidence to support this practice has been [[anecdote|anecdotal]] and not rigorous. There is strong [[epidemiology|epidemiological]] evidence that refutes links between environmental triggers, in particular [[thimerosal]] containing [[vaccine]]s, and the onset of autistic symptoms. No scientific data supports the claim that the mercury in the vaccine preservative [[thiomersal]] causes autism<ref>{{cite journal |journal= Can J Neurol Sci |date=2006 |volume=33 |issue=4 |pages=341–6 |title= Immunizations and autism: a review of the literature |author= Doja A, Roberts W |pmid=17168158}}</ref> or its symptoms,<ref>{{cite journal |journal= N Engl J Med |volume=357 |issue=13 |pages=1281–92 |year=2007 |title= Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years |author= Thompson WW, Price C, Goodson B ''et al.'' |pmid=17898097 |url=http://content.nejm.org/cgi/content/full/357/13/1281}}</ref> and there is no scientific support for chelation therapy as a treatment for autism.<ref name=Weber>{{cite journal |journal= Pediatr Clin North Am |date=2007 |volume=54 |issue=6 |pages=983–1006 |title= Complementary and alternative medical therapies for attention-deficit/hyperactivity disorder and autism |author= Weber W, Newmark S |doi=10.1016/j.pcl.2007.09.006 |pmid=18061787}}</ref>
Chelation therapy can be hazardous. In August 2005, botched chelation therapy killed a 5-year-old autistic boy, a nonautistic child died in February 2005 and an nonautistic adult died in August 2003. These deaths were due to [[cardiac arrest]] caused by [[hypocalcemia]] during chelation therapy.<ref name=hypocalcemia>{{cite journal |journal=Pediatrics |date=2006 |volume=118 |issue=2 |pages=e534-6 |title= Deaths resulting from hypocalcemia after administration of edetate disodium: 2003–2005 |author= Brown MJ, Willis T, Omalu B, Leiker R |doi=10.1542/peds.2006-0858 |pmid=16882789 |url=http://pediatrics.aappublications.org/cgi/content/full/118/2/e534}}</ref>
[[Thiamine]] tetrahydrofurfuryl disulfide (TTFD) is hypothesized to act as a chelating agent in children with autism. A 2002 pilot study administered TTFD rectally to ten [[autism spectrum]] children, and found beneficial clinical effect.<ref>{{cite journal |author=Lonsdale D, Shamberger RJ, Audhya T |title=Treatment of autism spectrum children with thiamine tetrahydrofurfuryl disulfide: a pilot study |journal=Neuro Endocrinol. Lett |volume=23 |issue=4 |pages=303–8 |year=2002 |pmid=12195231 |url=http://www.nel.edu/pdf_w/23_4/NEL230402A02_Lonsdale_rw.pdf |format=PDF |accessdate=2007-08-10}}</ref> This study has not been replicated and a 2006 review of thiamine by the same author did not mention thiamine's possible effect on [[autism]].<ref>{{cite journal |journal= Evid Based Complement Alternat Med |date= 2006 |volume= 3 |issue= 1 |pages= 49–59 |title= A review of the biochemistry, metabolism and clinical benefits of thiamin(e) and its derivatives |author= Lonsdale D |10.1093/ecam/nek009 |pmid= 16550223 |url=http://ecam.oxfordjournals.org/cgi/content/full/3/1/49}}</ref> There is not sufficient evidence to support the use of thiamine (vitamin B1) to treat autism.<ref name=Angley2/>
===Craniosacral Therapy===
[[Craniosacral therapy]] is based on the theory that restrictions at [[cranial sutures]] of the skull affect rhythmic impulses conveyed via [[cerebrospinal fluid]]. Practitioners, who include physical therapists, chiropractors, dentists, osteopaths, medical, and naturopathic physicians, hypothesize that gentle pressure on external areas can improve the flow and balance of the supply of this fluid to the brain, relieving symptoms of many conditions.<ref name=Green/> There is no scientific support for major elements of the underlying model, there is little scientific evidence to support the therapy, and research methods that could conclusively evaluate the therapy's effectiveness have not been applied.<ref name=Green>{{cite journal |journal=Complement Ther Med |year=1999 |volume=7 |issue=4 |pages=201–7 |title= A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness |author= Green C, Martin CW, Bassett K, Kazanjian A |doi=10.1016/S0965-2299(99)80002-8 |pmid=10709302}} An earlier version of the paper is available without a subscription: {{cite paper |title= A systematic review and critical appraisal of the scientific evidence on craniosacral therapy |author= Green C, Martin CW, Bassett K, Kazanjian A |url=http://www.chspr.ubc.ca/files/publications/1999/bco99-01J_cranio.pdf |format=PDF |date=1999 |accessdate=2007-10-08 |version= BCOHTA 99:1J |publisher= British Columbia Office of Health Technology Assessment}}</ref>
===Hyperbaric Oxygen Therapy===
[[Hyperbaric oxygen therapy]] (HBOT) can compensate for decreased blood flow by increasing the oxygen content in the body. It has been postulated that HBOT might relieve some of the core symptoms of autism.<ref>{{cite journal |journal= Med Hypotheses |year=2007 |volume=68 |issue=6 |pages=1208–27 |title= Hyperbaric oxygen therapy might improve certain pathophysiological findings in autism |author= Rossignol DA |doi=10.1016/j.mehy.2006.09.064 |pmid=17141962}}</ref> However, scientific evidence is lacking for the use of HBOT to treat autism.<ref name=Schechtman>{{cite journal |journal= Pediatr Ann |year=2007 |volume=36 |issue=8 |pages=497–8, 500–2, 504–5 |title= Scientifically unsupported therapies in the treatment of young children with autism spectrum disorders |author= Schechtman MA |pmid=17849608 |url=http://www.pediatricannalsonline.com/showPdf.asp?rID=23083 |format=PDF}}</ref>
===Stem Cell Therapy===
[[Mesenchymal stem cells]] and [[cord blood]] [[CD34]]+ cells have been proposed to treat autism, but this proposal has not been tested.<ref>{{cite journal |journal=J Transl Med |year=2007  |volume=5 |issue=30 |title= Stem cell therapy for autism |author= Ichim TE, Solano F, Glenn E ''et al.'' |doi=10.1186/1479-5876-5-30 |pmid=17597540 |url=http://www.translational-medicine.com/content/5/1/30}}</ref>
==References==
==References==


Latest revision as of 22:50, 1 April 2018

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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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