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Finding the Right Autism Treatment

Early, intense therapy works, but hundreds of other treatments being used are untested.

Drug Treatments for Autism

Unfortunately, many children with autism aren't able to enter any kind of behavioral or educational treatment. Some of these kids respond with violence or tantrums to any attempt to interrupt their obsessive "stimming" behavior. For some, this self-stimulation takes the form of self-injury. Other children with autism are hyperactive.

Might psychiatric drugs calm these symptoms enough to allow such children to enter behavioral and educational programs? Yes, says Yale's Lawrence David Scahill, MSN, PhD, a leader in pediatric psychopharmacology research.

Scahill was part of an NIH-funded group that showed that the anti-psychotic drug Risperdal could calm extreme behavior in autism spectrum disorder kids.

"Some 20% to 30% of school age kids with ASD, down to age 5 years, have problems with aggression, tantrums, or self-injury -- we thought that would be a good target for Risperdal," Scahill says. "We enrolled children with autism and at least moderate levels of tantrums -- not the kid who flops a little bit, but kids with outbursts you can measure on the Richter scale. They are not going to learn to toilet themselves or to play with toys. We thought if we could give these kids a medication, maybe they would be more malleable to other interventions."

The result was surprising -- kids who got the drug had a 58% improvement in this behavior, compared with 12% getting placebo.

"It was a big difference, the kind of difference we don't see in child psychiatry very often," Scahill says. "We credit it first to the drug, but also to the fact we only enrolled children with moderate or higher levels of this behavior. "

As a result of this study, the FDA approved Risperdal for treatment of irritability in kids with autistic disorder with symptoms of aggressive behavior, deliberate self-injury, or temper tantrums. Now Scahill and colleagues are trying to find out how soon kids can be tapered off the medication -- and whether parent training improves outcomes for kids receiving the drug.

Getting off Risperdal will be important, Scahill says, because a major side effect of the treatment is unhealthy weight gain.

A subsequent study looked at whether hyperactive kids with autism respond to Ritalin as well as ADHD kids without autism. The important finding: While 75% to 80% of ADHD kids without autism do better on Ritalin, this happens in only about 50% of hyperactive kids with autism. And the improvement in kids with autism wasn't as large as the improvement in kids without autism.

A more recent study is looking at whether the antidepressant Celexa, which helps control symptoms of obsessive-compulsive disorder, can reduce repetitive behaviors in children with ASD. Results of that study are expected soon.

Scahill notes that all of these studies have looked for ASD symptoms that match symptoms for which psychiatric treatments exist. Now, however, researchers are cautiously exploring a larger goal -- treating autism itself.

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