Treatment Of Autistic Disorder Research Articles

Treatment of a girl from Tunisia with typical autism: Evidence-based medicine and expert opinion

Background: Autistic disorders which have been increasingly known as pervasive developmental disorders since the 1980s represent a heterogeneous group of disorders that share a significant impairment in communication and social interaction. Typical autism is not associated with significant mental retardation while patients having classical autism which is also called Kanner syndrome have normal or high intelligence. Patients and methods: The mother of an eight-year-old girl from Tunisia consulted us about the possible therapies for her daughter who was thought to have autistic features. Results: The girl had the two major diagnostic features autistic as she was not responding appropriately to her name by turning her toward the voice and she had poor eye contact. The girl can count from 1 to one thousand and knows the letters of Arabic, French, and English language. She knows the colors and some other vocabulary. The girl was hyperactive and spending some time in moving purposely inside the home. Based on our extensive published experiences with treatment of autistic disorders, we recommended an initial therapeutic course which included a course of intramuscular cerebrolysin. Conclusion: An expert therapeutic recommendation for the condition is described.

Treatment of a girl from Tunisia with typical autism: Evidence-based medicine and expert opinion

Background: Autistic disorders which have been increasingly known as pervasive developmental disorders since the 1980s represent a heterogeneous group of disorders that share a significant impairment in communication and social interaction. Typical autism is not associated with significant mental retardation while patients having classical autism which is also called Kanner syndrome have normal or high intelligence. Patients and methods: The mother of an eight-year-old girl from Tunisia consulted us about the possible therapies for her daughter who was thought to have autistic features. Results: The girl had the two major diagnostic features autistic as she was not responding appropriately to her name by turning her toward the voice and she had poor eye contact. The girl can count from 1 to one thousand and knows the letters of Arabic, French, and English language. She knows the colors and some other vocabulary. The girl was hyperactive and spending some time in moving purposely inside the home. Based on our extensive published experiences with treatment of autistic disorders, we recommended an initial therapeutic course which included a course of intramuscular cerebrolysin. Conclusion: An expert therapeutic recommendation for the condition is described.

Cure of Autistic Disorders: Mission Impossible is Possible in an Illustrated Pioneering Experience.

Background: Autistic disorders have become increasingly known as pervasive developmental disorders since the 1980s. They have been recently called autism spectrum disorder mostly by the American Psychiatric Association. They include five chronic disorders marked by early impairment in socialization, communication and behavior. There is no curative therapy or therapies for autistic disorders and they continue to be regarded as lifelong disorders. The aim of this paper is to describe our extensive experiences with treatment of autistic disorders with emphasis on the possibility of curing these disorders with a new therapeutic approach. Marked improvement or disappearance of autistic features in these disorders has not been reported with any therapy before. Materials and methods: During the period from December, 2017 to November, 2019, 116 patients with various autistic disorders were observed at the pediatric psychiatry clinic of the Teaching Hospital of Baghdad Medical City. 84 (72.4%) patients were males and 32 (28.6%) female’s patients were females. The patients’ ages ranged from two years to 16 years. The patients were from several provinces in Iraq including Baghdad, Saladdin, Najaf, Wassit, Kerbalaand Erbil in the North of Iraq). The patients were reported previously in several publications. All the patients had very poor speech development except the patients with Asperger syndrome. Most of the patients with a diagnosis other than Asperger syndrome were not saying any word and few patients were saying few words. Most patients were treated with a new therapeutic approach which included injectable cerebrolysin as the main therapeutic component. Marked improvement or disappearance of autistic features in these disorders has not been reported with any therapy before. The patients were treated with a new approach which aimed at improving the cardinal features of autistic disorders which include impairment of social interaction which is mostly manifested by poor responsiveness to their name and infrequent engagement with others manifested by poor eye contact and infrequently looking to faces. It was not possible to follow all the patients regularly nor was it possible to document details of the treatment and responses of all patients. Results: Almost all the patients treated with the new therapeutic approach experienced some improvement and lessening of the autistic features during the follow-up period. Treatment was also associated with initiation of speech and improvement of repetitive behaviors. It was possible to document complete disappearance of the main autistic features in twenty patients. It seems that the patients who achieved complete disappearance of the main autistic features will need an intensive learning especially of speech to abolish the effect of the time when they were under the effect of autistic behavior and to push them toward a possible cure of their illness. Conclusion: In this paper, we have demonstrated the possibility of cure of autistic disorders including autism and Asperger syndrome with use of individualized courses of intramuscular cerebrolysin as the main therapy for the main autistic features (Impaired social interaction and communication dominated by the lack of response to their name and poor eye contact). Understanding, a cure of autism will not immediately abolish the cumulative effect of the condition on learning, behavior and speech development before cure.

Cure of Autistic Disorders: Mission Impossible is Possible in an Illustrated Pioneering Experience

Background: Autistic disorders have become increasingly known as pervasive developmental disorders since the 1980s. They have been recently called autism spectrum disorder mostly by the American Psychiatric Association. They include five chronic disorders marked by early impairment in socialization, communication, and behavior. There is no curative therapy or therapies for autistic disorders, and they continue to be regarded as life long disorders. The aim of this paper is to describe our extensive experiences with treatment of autistic disorders with emphasis on the possibility of curing these disorders with a new therapeutic approach. Marked improvement or disappearance of autistic features in these disorders has not been reported with any therapy before.

Dysregulation of Th1, Th2, Th17, and T regulatory cell-related transcription factor signaling in children with autism

Autism is a neurodevelopmental disorder characterized by stereotypic repetitive behaviors, impaired social interactions, and communication deficits. Numerous immune system abnormalities have been described in individuals with autism including abnormalities in the ratio of Th1/Th2/Th17 cells; however, the expression of the transcription factors responsible for the regulation and differentiation of Th1/Th2/Th17/Treg cells has not previously been evaluated. Peripheral blood mononuclear cells (PBMCs) from children with autism (AU) or typically developing (TD) control children were stimulated with phorbol-12-myristate 13-acetate (PMA) and ionomycin in the presence of brefeldin A. The expressions of Foxp3, RORγt, STAT-3, T-bet, and GATA-3 mRNAs and proteins were then assessed. Our study shows that children with AU displayed altered immune profiles and function, characterized by a systemic deficit of Foxp3+ T regulatory (Treg) cells and increased RORγt+, T-bet+, GATA-3+, and production by CD4+ T cells as compared to TD. This was confirmed by real-time PCR (RT-PCR) and western blot analyses. Our results suggest that autism impacts transcription factor signaling, which results in an immunological imbalance. Therefore, the restoration of transcription factor signaling may have a great therapeutic potential in the treatment of autistic disorders.

Comparing Efficacy and Side Effects of Memantine vs. Risperidone in the Treatment of Autistic Disorder.

Introduction: This study was aimed to compare the efficacy and side effects of memantine, an antagonist of the NMDA receptor of glutamate, with risperidone given the fact that glutamate has been noted for its possible effects in the pathogenesis of autism. Risperidone, an atypical antipsychotic, has been approved by FDA for the management of irritability associated with autism. Methods: 30 children, aged 4-17 years, entered an 8-week, randomized trial. Patients were randomly assigned to receive either risperidone or memantine. Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Clinical Global Impressions - Improvement (CGI-I) and Clinical Global Impression-Severity (CGI-S) scales were used to assess behavioral symptoms of the patients. Results: Both risperidone and memantine reduced the scores of 4 subscales of ABC as well as the 10-item and the total score of CARS significantly. However, differences between the 2 drugs in the scores of each evaluating scale were not found to be significant. Relatively, larger number of patients on risperidone showed "very much improvement" when assessed by CGI-I scale when compared with those on memantine. Discussion and conclusion: The present study suggests that memantine may have beneficial effects in the treatment of many core symptoms of autism. Therefore, memantine may be considered as a potential medication in the treatment of those autistic children who do not respond or cannot tolerate side effects of risperidone.

N-acetylcysteine as an adjunctive therapy to risperidone for treatment of irritability in autism: a randomized, double-blind, placebo-controlled clinical trial of efficacy and safety.

According to the proposed interference of N-acetylcysteine (NAC) with pathophysiologic processes of autistic disorders (ADs), we aimed to assess the effectiveness and safety of NAC as an adjunct to risperidone in the treatment of ADs in a randomized, double-blind, clinical trial. The participants were referred outpatients between 4 and 12 years of age with the diagnosis of ADs and a score of more than 12 on Aberrant Behavior Checklist-Community (ABC-C) Irritability subscale score. The participants were randomized into 2 groups. One group received risperidone plus NAC, and the other group received risperidone plus placebo. The dose of risperidone was titrated between 1 and 2.0 mg/d, and the dose of NAC was 600 to 900 mg/d. The main outcome was mean decrease in the ABC-C irritability subscale score from baseline at 5 and 10 weeks. Changes in other subscales were considered as secondary outcome measures. Forty patients completed the 10-week trial. Baseline characteristics including age, sex and body weight, as well as baseline scores in 5 subscales did not demonstrate statistically significant difference between the 2 groups. Repeated-measures analysis showed significant effect for time × treatment interaction in irritability (P = 0.01) and hyperactivity/noncompliance (P = 0.02) subscales. By week 10, the NAC group showed significantly more reduction in irritability (P = 0.02) and hyperactivity/noncompliance (P = 0.01) subscales scores. N-acetylcysteine can be considered as an adjuvant therapy for ADs with beneficial therapeutic outcomes.

Music Therapy and Hormonal Responses in Autism

Objective: Music therapy is used in the treatment of various psychiatric and physical disorders. This study aims to explore the efficiency of, and neurohormonal responses to, music therapy in children with autism. Methods: The effect of music therapy sessions of five hours a month on the severity of autism, verbal and social communication, behavior, and neurohormonal responses were explored in 10 children and adolescents. Autism severity was assessed using the Childhood Autism Rating Scale (CARS). Results: The results of the study indicate that music therapy decreases hyperkinetic activity and stereotypical-repetitive behaviors while increasing mutual social interaction and verbal communication. In addition, the severity of autistic symptoms assessed by CARS significantly decreased following the therapy. When pre- and post-therapy hormone levels were compared, cortisol, ACTH, adrenaline, and noradrenaline levels were not significantly different. Conclusion: Music therapy is a means of communication without words in children and adolescents with autism, and is an effective and important treatment option when accompanied by special educational support and individual psychotherapy in the treatment of autistic disorder.

2760 – Grammatical deficits in persian and english-speaking autistic children: similarities and differences

A common feature of autism spectrum disorder (ASD) is language impairment. But the existing similarities and differences of language impairment among autistic children worldwide have not been thoroughly analyzed. Recognizing such similarities and differences can lead to possible interventions designed for autistic children to target their specific language deficits and help them to communicate more efficiently. This study is an attempt to explore similarities as well as differences between Persian and English languages. It starts with a review of research, which was conducted mainly among English-speaking children and proceeds with a qualitative research (including semi-structured interviews and focus groups with specialists as well as children's mothers) conducted in a center for treatment of autistic disorders in Iran. The result reveals that Persian-speaking autistic children like English-speaking ones suffer from grammatical, pragmatic and verbal-sematic deficits, but certain differences can be noticed due to the linguistic differences between languages. The existing differences are specifically in the realm of grammatical deficit which itself is comprised of tense problems, subject/verb agreement problems (since Persian is a pro-drop language) and misuse of diectic terms. These three areas are further elaborated via relevant examples.

Double-blind, placebo-controlled trial of risperidone plus topiramate in children with autistic disorder

Background Autism is a complex neurodevelopmental disorder that forms part of a spectrum of related disorders referred to as Autism Spectrum Disorders. The present study assessed the effects of topiramate plus risperidone in the treatment of autistic disorder. Method Forty children between the ages of 4 and 12 years with a DSM IV clinical diagnosis of autism who were outpatients from a specialty clinic for children were recruited. The children presented with a chief complaint of severely disruptive symptoms related to autistic disorder. Patients were randomly allocated to topiramate + risperidone (Group A) or placebo + risperidone (Group B) for an 8-week, double-blind, placebo-controlled study. The dose of risperidone was titrated up to 2 mg/day for children between 10 and 40 kg and 3 mg/day for children weighting above 40 kg. The dose of topiramate was titrated up to 200 mg/day depending on weight (100 mg/day for < 30 kg and 200 mg/day for > 30 kg). Patients were assessed at baseline and after 2, 4, 6 and 8 weeks after starting medication. Measure of outcome was the Aberrant Behavior Checklist-Community (ABC-C) Rating Scale. Results Difference between the two protocols was significant as the group that received topiramate had a greater reduction in ABC-C subscale scores for irritability, stereotypic behavior and hyperactivity/noncompliance. Conclusion The results suggest that the combination of topiramate with risperidone may be superior to risperidone monotherapy for children with autistic disorder. However the results need to be further confirmed by a larger randomized controlled trial.

Risperidone versus haloperidol in children and adolescents with AD

The aim of the study was to compare safety, efficacy and tolerability of risperidone with haloperidol in the treatment of Autistic Disorder (AD). This study was designed as a double-blind, prospective, for a 12-week period. A total of 30 subjects, between the ages of 8 and 18 with AD based on DSM IV criteria, were included in the study. Behavioral Rating Scales were performed by the investigators and the parents. Safety assessment included vital signs, electrocardiogram, electroencephalogram, adverse events, laboratory tests, extrapyramidal symptoms and the side effects. Both treatments were applied in a once daily dosage regimen of 0.01-0.08 mg/kg/day. The reduction from baseline in Ritvo-Freeman Real Life Rating Scale (RF-RLRS), sensory motor (subscale I) and language (subscale V) scores were significant in risperidone group (P < 0.05). Compared to haloperidol, risperidone led to a significantly greater reduction in the Aberrant Behavior Checklist (ABC) and Turgay DSM-IV Pervasive Developmental Disorder (PDD) scale scores (P < 0.05 and P < 0.01). There was a greater increase of prolactin in the risperidone group, while alanine amino transferase (ALT) had further increased in the haloperidol group. Sensory motor behaviors (subscale I) and language at the end of the 12th week, RF-RLRS sensory motor and language subscale scores decreased in the risperidone group further than the other group (P < 0.05). Risperidone was found to be more effective than haloperidol in the treatment of behavioral symptoms, impulsivity, language skills, and impaired social relations in children with AD. These results demonstrated that both drugs were safe and well tolerated in the treatment of AD.

Use of Atypical Antipsychotics in the Treatment of Autistic Disorder

To review clinical trials and reports describing the efficacy and safety of atypical antipsychotics (olanzapine, ziprasidone, quetiapine, aripiprazole) in the treatment of autistic or other pervasive developmental disorders. English-language publications from the MEDLINE database (1966-February 2007) including clinical trials, case reports, and retrospective series were reviewed. Relevant data were extracted from studies of selected atypical antipsychotics in the treatment of autistic disorder in children, adolescents, and adults. Most literature found was in the form of case reports or case series; however, several open-label and double-blind trials were also identified. Autistic disorder is a chronic neurodevelopmental disorder with limited treatment options. Nonpharmacologic approaches may be the most beneficial, but pharmacologic agents are needed for some patients with significant behavioral manifestations of the disorder. The atypical antipsychotics (olanzapine, ziprasidone, quetiapine, aripiprazole) have shown some efficacy in improving certain behavioral symptoms of autistic disorder--primarily aggressiveness, hyperactivity, and self-injurious behavior. Efficacy was based on observation or changes from baseline in behavioral rating scores. Data appear to be strongest for olanzapine compared with quetiapine, with several open-label trials suggesting its efficacy. Weight gain and sedation were frequently reported adverse events with both agents. Aripiprazole has demonstrated efficacy in limited case series, with minimal adverse effects reported. Atypical antipsychotics represent a treatment option for symptoms associated with autistic disorder. However, these drugs do not affect the core symptoms of autistic disorder and are associated with potentially significant adverse effects. In addition, there is a lack of randomized controlled trials to determine the true efficacy and long-term safety of these agents in the pediatric population.

Risperidone Treatment of Autistic Disorder: Longer-Term Benefits and Blinded Discontinuation After 6 Months

Risperidone Treatment of Autistic Disorder: Longer-Term Benefits and Blinded Discontinuation After 6 Months

Niaprazine in the treatment of autistic disorder.

Niaprazine is a histamine H1-receptor antagonist with marked sedative properties. It has been employed in subjects with behavior and sleep disorders. No data concerning the use of niaprazine in subjects with autistic disorder are reported in the literature. The authors performed an open study to assess niaprazine efficacy in a sample of 25 subjects with autistic disorder and associated behavior and sleep disorders. Niaprazine was administered at 1 mg/kg/day for 60 days. A positive effect was found in 52% of patients, particularly on hyperkinesia, unstable attention, resistance to change and frustration, mild anxiety signs, heteroaggressiveness, and sleep disorders. Statistical comparison between responders and nonresponders showed no influence on niaprazine effect by age over or under 12 years, presence of neurologic signs, epilepsy, or abnormalities seen on brain imaging. Niaprazine was more efficacious in subjects with a mild or moderate degree of mental retardation. No side effects were observed. Because of its sedative effects and good tolerability, niaprazine can be used as a first-choice drug to improve behavior and sleep disorders in patients with autistic disorder.

Treatment of Autistic Disorder

To present an overview of a variety of treatment approaches in individuals with autistic disorder. Selected studies and articles are reviewed. In the past three decades, great progress has been made in the treatment of autistic disorder, particularly in the area of education and parental involvement, with the objective to transfer to home and in other situations learning acquired in school. A role for psychoactive agents, when combined with psychosocial treatments, has been identified. Although considerable advances have been made in a variety of interventions-educational, psychosocial, and biological-knowledge about the comparative and combined efficacy of the various treatment modalities is lacking. From the parents' perspective, particularly, support and continuity of services require improvement.

Autistic Disorder and Other Pervasive Developmental Disorders

Treatment of autistic disorder and other pervasive developmental disorders (PDDs) requires identification of target symptoms, such as irritability, hyperactivity, self-injurious behavior, anxiety, or depression. If the target symptoms adhere to a comorbid syndrome such as obsessive compulsive disorder, treatment is specific to that comorbid syndrome with some exceptions. It is important to distinguish hyperactivity and inattention caused by difficulty with language and social impairment or rituals of autistic disorder and other PDDs from that caused by a comorbid syndrome similar to attention-deficit hyperactivity disorder. Psychopharmacologic classes discussed include potent serotonin transporter inhibitors (e.g., clomipramine and fluoxetine), other tricyclic antidepressants, stimulants, sympatholytics (clonidine and β-blockers), naltrexone, fenfluramine, typical (e.g., haloperi- dol) and atypical (e.g., clozapine and risperidone) neuroleptics, anticonvulsants (e.g., carbamazepine and sodium valproate), lithium, anxiolytics, pyredoxine, and newer agents.

A Double-blind Comparison of Clomipramine, Desipramine, and Placebo in the Treatment of Autistic Disorder

To determine whether clomipramine hydrochloride, a serotonin reuptake blocker with unique anti-obsessional properties, is differentially effective for obsessive-compulsive and stereotyped motor behaviors in autistic disorder compared with placebo and with the noradrenergic tricyclic antidepressant agent, desipramine hydrochloride. Following a 2-week, single-blind placebo washout phase, 12 autistic subjects completed a 10-week, double-blind, crossover comparison of clomipramine and placebo, and 12 different subjects completed a similar comparison of clomipramine and desipramine. Outpatient clinic. A referral sample of 30 male and female autistic patients were enrolled, and 24 completed the study. Key outcome measures were the Autism Relevant Subscale of the Children's Psychiatric Rating Scale, the Modified Comprehensive Psychopathological Rating Scale-Obsessive-Compulsive Disorder Subscale, and the Clinical Global Impressions Scale. Clomipramine was superior to both placebo and desipramine on ratings of autistic symptoms (including stereotypies), anger, and compulsive, ritualized behaviors (P < .05), with no differences between desipramine and placebo. Clomipramine was equal to desipramine and both tricyclic agents were superior to placebo for amelioration of hyperactivity. Biological links between compulsions and stereotyped, repetitive behaviors in autistic disorder should be explored.