An estimated one-third of youngsters with autism are prescribed psychotropic drugs
Monday, April 23rd, 2007SAN FRANCISCO April 20 (UPI) — An estimated one-third of youngsters with autism are prescribed psychotropic drugs to control their behavior and outlook, scientists report.The more common pharmaceutical aids include anti-depressants like Prozac for anxiety and depression, stimulants like Ritalin for hyperactivity and impulsivity, anti-convulsants for seizures and anti-psychotic drugs, usually reserved for schizophrenia, for aggression.
In certain cases, these medications can quell such behavioral offshoots of autism as self-injury and severe tantrums, but they do not alter the underlying condition and can wreak havoc with some children’s moods and pose other potential risks, doctors say.
“There is no great drug for autism,” said Texas psychologist Steven Gutstein, developer of a behavioral treatment called relationship development intervention.
“Children with autism can have other problems that require medication like attentional problems or medical problems,” he added. “It’s a comorbid disorder, but there’s no Ritalin for autism, and there probably never will be because it’s a disorder with multiple etiologies.”
The drugs that are used are the same as those prescribed for similar symptoms in children without autism, but doctors often find the disorder affects the response, at times making the side effects much more pronounced or the medicine much less effective or both.
Most of these pharmaceuticals are not backed by sufficient science to be approved for such use, and the government acknowledges “much more research is needed” to determine what risks they pose to children and adolescents over the long haul.
The drugs’ usual aftereffects may be so exacerbated in children with autism, health authorities urge doctors to give them the lowest possible dose and monitor their reaction closely.
In a rare study of drug treatments for minors with autism, sponsored by the federal government, the anti-psychotic risperidone was found to control tantrums, aggression, repetitive behaviors, severe hyperactivity and/or self-injury for up to six months in children ages 5 to 17.
The survey of 82 boys and 19 girls, conducted at several U.S. medical centers, showed the medication — which was donated by its maker Jensen Pharmaceuticals — produced only limited side effects. However, when the drug was discontinued, symptoms rapidly returned in 62 percent of the cases.
Because the study lasted only eight months, “our data may be insufficient to estimate precisely the long-term risks of risperidone in children,” the authors concluded.
Although a variety of pharmaceutical and behavioral treatments is used to restrain violent behaviors in autistic youngsters, few scientific studies have looked into their effects, the authors noted.
Previously, the largest long-term studies of autism medications tested haloperidol, an older anti-psychotic that proved light on effectiveness but heavy on neurological and other ill effects.
In another recent study, reported in the Archives of General Psychiatry, researchers found methylphenidate, the No. 1 drug choice of doctors treating attention-deficit/hyperactivity disorder, may also be effective for calming hyperactivity in children with autism spectrum disorders.
There is a caveat, however, according to the Research Units on Pediatric Psychopharmacology Autism Network, a consortium funded by the National Institute of Mental Health, which conducted the study.
The bad news is that the percentage of takers gaining benefits from the stimulants and the level of those benefits are lower, while the frequency of unwanted effects scientists call “adverse events” is higher in autistic children than in ADHD youngsters without the disorder, the authors reported.
Seven of the 72 participants ages 5 to 14 withdrew from the study due to intolerable reactions to the drugs, including irritability, loss of appetite, sleep problems, anxiety, depression, upset stomach, diarrhea, fatigue, self-injury and social withdrawal.
Even among the children who could stomach the medicine, only half showed any improvement in symptoms, and it was modest at best, the researchers said.
Nevertheless, the authors deemed methylphenidate “a reasonable choice to target hyperactivity in the context of PDDs (pervasive developmental disorders),” although they warned caregivers to “be cautioned about the strong possibility of adverse effects” and practitioners to “be prepared to suspend treatment if considerable adverse effects are reported.”
Although no causative association has been proven, reports of some ADHD children medicated with Ritalin and other stimulants suffering strokes and heart problems and seeing snakes and other hallucinations prompted two federal regulatory advisory panels last year to urge that parents and physicians be informed of the potential risks.
The Food and Drug Administration has obliged, ordering drug makers to revise the labels for doctors and insert medical guides for patients to alert them about the adverse cardiovascular and psychiatric side effects.
Other researchers, experimenting on mice, have come up with a way that may help alleviate the debilitating effects of Rett’s disorder, a type of autism that primarily affects girls.
The investigators found deactivating a certain gene produced the rodent equivalent of the ailment, but turning it back on in animals predisposed to the syndrome forestalled its onset. The research clears the path toward developing therapies for humans, the scientists said.
Some currently available treatments may ease certain symptoms, but they fail to address the condition at a more fundamental level. The researchers from the Whitehead Institute for Biomedical Research in Cambridge, Mass., and Brandeis University in Waltham, Mass., said once they learn the molecular mechanisms underlying the disorder, they may be able to design more effective strategies against it.
(Note: In this multi-part installment, based on dozens of reports, conferences and interviews, Ped Med is keeping an eye on autism, taking a backward glance at its history and surrounding controversies, facing facts revealed by research and looking forward to treatment enhancements and expansions. Wasowicz is the author of the new book, “Suffer the Child: How the Healthcare System Is Failing Our Future,” published by Capital Books.)
