What is Autism? Autism is a medical condition that inhibits social interaction and communication. Patients can be diagnosed with autism, or have a disorder along the autism spectrum, including Asperger's syndrome.
What are the symptoms of Autism? Autism is categorized by many different symptoms, rather than one single symptom. Symptoms usually present within the first two years of life, and may include:
lack of response to calling a child's name
poor eye contact or social interest
repetitive behaviors or stereotypic movements
abnormal toy interest or play
communication and language delay
other atypical aspects of normal toddler development
failure to look at you, wave, or gesture or point
One third of patients who previously had communication or social interaction, like eye contact, hearing or speech, can loose these skills or they can regress over time.
When and how should a patient be screened? Patients can be screened within the first 24 months of life, perhaps by 12-15 months. The AmericanAcademy of Pediatrics recently suggested two screenings before age two. We suggest the first screening between 12-15 months and the second before 18-20 months.
Simple questionnaires may allow screening by parents, pediatricians or family physicians. A failed first screening should be followed-up by a second screening in 4-6 weeks.
How is Autism diagnosed? Diagnosis is a clinical skill based upon specific screening tools, questionnaires, observation, and documentation of core symptoms. Some research programs will also rely on confirmatory complex observational tests
There are no blood, urine, genetic, EEG, or neuroimaging tests that define autism as a diagnosis at this time. Some children with autism will also have other underlying conditions, like seizures, brain injury, genetic conditions or metabolic issues that can be diagnosed and treated. Sleep, gastrointestinal, and immunological problems can also be diagnosed with medical testing.
When should you see a child neurologist that specializes in Autism? Patients should see a neurologist that specializes in autism as early as possible once screening failure has occurred. This will ensure that there are no underlying medical problems. Postponing treatment may affect the child's long-term outcome.
What can child neurologist help with? Since other medical conditions or problems may mimic or add to severity of autistic features, the child neurologist can help evaluate a child for these issues and better determine if a regression has occurred. The other conditions may include genetic disorders that may have some autistic type behaviors, other learning or language issues, underlying brain injury or epilepsy, and sleep issues. Appropriate medical screening can then allow more appropriate medical diagnosis and treatment to begin so better therapy and outcome goals can be attained.
What are the different treatments for Autism? Autism spectrum disorders have many clinical subtypes; therefore there is no single treatment for autism and there is currently no cure for autism.
Research may lead to new treatments that may modify or alter the course of autism. For time being, treatments are aimed at improving epilepsy if present, sleep treatment, behavioral medical management, and treatment of any metabolic or gastrointestinal or immune condition that may co-exist.
Because autism is a spectrum disorder and no one method alone is usually effective in treating autism, professionals and families have found that a combination of treatments may be effective in treating symptoms and behaviors that make it hard for individuals with autism to function. These may include psychosocial and pharmacological interventions.
While there are no drugs, vitamins or special diets that can correct the underlying neurological problems that seem to cause autism, parents and professionals have found that some drugs used for other disorders are sometimes effective in treating some aspects of behaviors associated with autism.
Changes to diet and the addition of certain vitamins or minerals may also help with behavioral issues. Over the past 10 years, there have been claims that adding essential vitamins such as B6 and B12 and removing gluten and casein from a child's diet, may improve digestion, allergies and sociability. Not all researchers and experts agree about whether these therapies are effective or scientifically valid.
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Vitamins & Minerals
There are a number of medications, developed for other conditions, that have been found effective in treating some of the symptoms and behaviors frequently found in individuals with autism. Some of these include: hyperactivity, impulsivity, attention difficulties, and anxiety. The goal of medications is to reduce these behaviors to allow the individual with autism to take advantage of educational and behavioral treatments.
When medication is being discussed or prescribed, it's important to:
Ask about the safety of its use in children with autism
What is the appropriate dosage?
How is it administered (pills, liquid)?
What are the long-term consequences?
Are there possible side effects?
How will my child be monitored and by whom?
What laboratory tests are required before starting the drug and during treatment?
Are there possible interactions with other drugs, vitamins or foods?
Given the complexity of medications, drug interactions, and the unpredictability of how each patient may react to a particular drug, parents should seek out and work with a medical doctor with an expertise in the area of medication management.
What Medications are Available?
There are a number of medications that are frequently used for individuals with autism to address certain behaviors or symptoms. Some have studies to support their use, while others do not.
The Autism Society of America does not endorse any specific medication. The information provided here is meant as an overview of the types of medications sometimes prescribed. Be sure to consult a medical professional for more information.
Serotonin re-uptake inhibitors have been effective in treating depression, obsessive-compulsive behaviors, and anxiety that are sometimes present in autism. Because researchers have consistently found elevated levels of serotonin in the bloodstream of one-third of individuals with autism, these drugs could potentially reverse some of the symptoms of serotonin dysregulation in autism. Three drugs that have been studied are clomipramine (Anafranil), fluvoxamine (Luvox) and fluoxetine (Prozac). Studies have shown that they may reduce the frequency and intensity of repetitive behaviors, and may decrease irritability, tantrums and aggressive behavior. Some children have also shown improvements in eye contact and responsiveness.
Other drugs, such as Elavil, Wellbutrin, Valium, Ativan and Xanax have not been studied as much but may have a role in treating the behavioral symptoms. However, all these drugs have potential side effects, which should be discussed before treatment is started.
Anti-psychotic medications have been the most widely studied of the psychopharmacologic agents in autism over the past 35 years. Originally developed for treating schizophrenia, these drugs have been found to decrease hyperactivity, stereotypical behaviors, withdrawal, and aggression in individuals with autism. Four that have been approved by the FDA are clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa) and quetiapine (Seroquel). Only risperidone has been investigated in a controlled study of adults with autism. Like the antidepressants, these drugs all have potential side effects, including sedation.
Stimulants, such as Ritalin, Adderall, and Dexedine, used to treat hyperactivity in children with ADHD have also been prescribed for children with autism. Although few studies have been done, they may increase focus, and decrease impulsivity and hyperactivity in autism, particularly in higher-functioning children. However, dosages need to be carefully monitored, because behavioral side effects are often dose-related.
Increased use of medications to treat autism has highlighted the need for more studies of these drugs in children. The National Institute of Mental Health has established a network of Research Units on Pediatric Psychopharmacology (RUPPs) that combine expertise in psychopharmacology and psychiatry. Located at several research centers, they are intended to become a national resource that will expedite clinical trials in children. Five groups are specifically funded to evaluate treatments for autism, studying dose range and regimen of medications, as well as their mechanisms of action, safety, efficacy, and effects on cognition, behavior, and development. For example, the RUPP at Kennedy Krieger Institute is conducting a study on the efficacy of methylphenidate (Ritalin) in children and adolescents with Pervasive Developmental Disorders (PDD).
If you are considering the use of medications, contact a medical professional experienced in treating autism to learn of possible side effects. People with autism may have very sensitive nervous systems and normally recommended dosage may need to be adjusted. Even the use of large doses of vitamins should be done under the supervision of a medical doctor.
We do not recommend that parents venture in treatment with medication before exploring other available alternatives.
Vitamins & Minerals
Over the past 10 years or more, claims have been made that vitamin and mineral supplements may improve the symptoms of autism, in a natural way. While not all researchers agree about whether these therapies are scientifically proven, many parent, and an increasing number of physicians, report improvement in people with autism when using individual or combined nutritional supplements.
Malabsorption problems and nutritional deficiencies have been addressed in several, as-of-yet, unreplicated studies. A few studies conducted in 2000 suggest that intestinal disorders and chronic gastrointestinal inflammation may reduce the absorption of essential nutrients and cause disruptions in immune and general metabolic functions that are dependent upon these essential vitamins. Other studies have shown that some children with autism may have low levels of vitamins A, B1, B3, B5, as well as biotin, selenium, zinc, and magnesium, while others may have an elevated serum copper to plasma zinc ratio, suggesting that people with autism should avoid copper and take extra zinc to boost their immune system. Other studies have indicated a need for more calcium.
Perhaps the most common vitamin supplement used in autism is vitamin B, which plays an important role in creating enzymes needed by the brain. In 18 studies on the use of vitamin B and magnesium (which is needed to make vitamin B effective), almost half of the individuals with autism showed improvement. The benefits include decreased behavioral problems, improved eye contact, better attention, and improvements in learning. Other research studies have shown that other supplements may help symptoms as well. Cod liver oil supplements (rich in vitamins A and D) have resulted in improved eye contact and behavior of children with autism. Vitamin C helps in brain function and deficiency symptoms like depression and confusion. Increasing vitamin C has been shown in a clinical trial to improve symptom severity in children with autism. And in a small pilot study in Arizona, using a multivitamin/mineral complex on 16 children with autism, improvements were observed in sleep, gastrointestinal problems, language, eye contact, and behavior.
Using Vitamins and Minerals
If you are considering the addition of vitamins or minerals to your child's diet, a laboratory and clinical assessment of nutritional status is highly recommended. The most accurate method for measuring vitamin and mineral levels is through a blood test. It is also important to work with someone knowledgeable in nutritional therapy. While large doses of some vitamins and minerals may not be harmful, others can be toxic. Once supplements are chosen, they should be phased in slowly (over several weeks) and then the effects should be observed for one to two months.
Individuals with autism may exhibit low tolerance or allergies to certain foods or chemicals. While not a specific cause of autism, these food intolerances or allergies may contribute to behavioral issues. Many parents and professionals have reported significant changes when specific substances are eliminated from the child's diet.
Individuals with autism may have trouble digesting proteins such as gluten. Research in the U.S. and England has found elevated levels of certain peptides in the urine of children with autism, suggesting the incomplete breakdown of peptides from foods that contain gluten and casein. Gluten is found in wheat, oats and rye, and casein in dairy products. The incomplete breakdown and the excessive absorption of peptides may cause disruption in biochemical and neuroregulatory processes in the brain, affecting brain functions. Until there is more information as to why these proteins are not broken down, the removal of the proteins from the diet is the only way to prevent further neurological and gastrointestinal damage.
It is important not to withdraw gluten/casein food products at once from a child's diet, as there can be withdrawal symptoms. Parents wishing to pursue a gluten/casein free diet should consult a gastroenterologist or nutritionist, who can help ensure proper nutrition.
Some hypothesize that children with autism have what is referred to as a "leaky gut" -- tiny holes in their intestinal tract that may be caused by an overgrowth of yeast. Some believe that this overgrowth may contribute to behavioral and medical problems in individuals with autism, such as confusion, hyperactivity, stomach problems, and fatigue. The use of nutritional supplements, anti-fungal drugs and/or a yeast-free diet may reduce the behavioral problems. However, caution should be paid to the fact that just as antibiotics can lead to bacterial resistance, antifungals can lead to fungal resistance.
Secretin is a hormone produced by the small intestine that helps in digestion. The hormone can be administered and used as a single dose to diagnose gastrointestinal problems. In 1996, a young boy with autism was given secretin for an endoscopy and showed improvements in some of his symptoms of autism. Other parents and professionals who tried secretin on children with autism reported similar results, including improvements in sleep patterns, eye contact, language skills, and alertness. However, several studies funded by the National Institute of Child Health and Human Development (NICHD) in the past three years have found no statistically significant improvements in the core symptoms when compared to patients who received a placebo. It is also important to remember that secretin is approved by the FDA for a single dose; there is no data on the safety of repeated doses over time.