engleski

The Medical Treatment of Autism Disorders

The decision to use medications early in the treatment plan for children with autism may be a long-lasting good decision. Antipsychotics as drugs are intended primarily for the treatment of adult patients with psychotic disorders, but showed the favorable effects on the symptoms in autistic children, especially risperidone. Risperidone has been approved by the US Food and Drug Administration for the symptomatic treatment of irritability (including symptoms of aggression toward others, deliberate self-injuries, temper tantrums, and quickly changing moods) in children and adolescents with autistic disorder. Some studies suggest that the earlier use of antipsychotics in autistic children may have protective effect on IQ, which further justifies the use of these drugs in early childhood. Research on the use of risperidone in the treatment of autistic disorders among children in Croatia are rare, given the limited use of risperidone in children younger than 15 years, the question arises about the need to expand the scope of application of risperidone in younger age groups. Also, it may be worth to explore some alternative treatments, such as behavioural interventions, to try to avoid long-term medications. Also it is important to known that although these psychotropic medications have many beneficial effects, they all come with some risk in terms of adverse effects. It is well established that the early detection and treatment of side effects helps reduce their long-term adverse effects on health. Family members are the ones most likely to recognize those reactions such as: weight gain or fatigue. Also it is need for psychoeducational programs for families or individuals with autism that teach parents about medications and the signs and symptoms of potential side effects. Atypical antipsychotic agents are widely used psyscopharmacological interventions for autism spectrum disorders and among them risperidone has demonstrated considerable benefits in reducing several behavioral symptoms associated with autism spectrum disorders. Althought risperidone has several adverse effects, most are manageable or extremely rare. An exception is rapid weight gain, which is common and can create significant health problems. Aripiprazole, a third generation of atypical antipsychotics, is relatively new drug that has a unique mechanism of action different from other antypshotices. After treatment with aripiprazole children showed less irritability, hyperactivity and stereotypes (repetitive, purposeless actions). Notable side effects must be considered such as weight gain, sedation, drooling and tremor. Autism comprises a clinically heterogeneous group of disorders-named „autism spectrum disorders“ ASD. They share common features or impaired social relationships, impaired language and communications, and repetative behaviours or a narrow range of interests. Management of an autism involves educational, behavioral and medical therapies to promote conversational language and social interactions while mitigating repetitive self-stimulatory behaviours, tantrums, aggression and self- injuries behaviours. Medications, especially atypical antipsychotics can ameliorate specific symptoms such as aggressive or self-injured behaviour. Children treated early can usually be taught, to varying degrees, to communicate, recognize and respond to social interactions, developing imaginative play, and curb all consuming repetative self-stimulatory behaviors. Although most children with autism are healthy, evidence is mounting that medical disorders have a significant effect on behaviours, level of functioning and response to educational therapies. Sensory issues including a blunted pain response, inability to tell others when they are uncomfortable and poor tolerance of medical evaluations can lead to suboptimal medication care. The use of medications has increased as newer medications, especially the atypical antipsychotics, which affect both serotonin and dopamine systems and serotonin reuptake inhibitors (SRIs) which modulate the serotonin system, have been studied in children. In 1997. year the National institute of Mental Health Research Units on Pediatrics Psychopharmacology Autism Network investigated the safety and efficacy of drugs for treating the behaviours associated with autism. Some of conclusions are: no medications are autism specific, marked differences exist in the efficacy of drugs in adults vs. children, individual antipsychotics medications within the same class may differ with respect to their potency and side effect profile, affected individuals may respond differently to the same medication, medication management should be integrated into family centered, multi-modal behavioral and educational program. Typically, first line treatment for children with autism include psychosocial treatments and educational interventions with the goal of maximizing language acquisition, improving social and communications skills and extinguishing of maladaptive behaviours. Currently there are no available standard medication treatments, addressing the core symptoms of autism. There are no pharmacological treatments currently approved by US Food and Drug Administration for autism. When used, pharmacological interventions usually target specific symptoms, accompanying the core symptoms, and severely impairing the individual’s functioning, often not allowing for „first line“ educational and behavioral interventions to take place (aggression, self- injurious behavior, compulsive rituals, low frustration tolerance with explosive outbursts, hyperactivity). The newer psychotropics, ecpecially the atypical antipsychotics and the selective serotonin reuptake inhibitors (SSRIs) have more benign side effects profiles than older agents. Despite increased support for pediatric psychotropic use, there is a need for more long-term safety and efficacy studies of existing medications and newer, safer, and more effective agents with fewer side effects for the pharmacological treatment of all childhood disorders in which aggression is prominent. Prescription of antipsychotics drugs requires careful monitoring because of the safety risks and the likelihood of a long-term use. Drug administration should be initiated at low dosages and subsequent dosage changes sholud be based on tolerability and clinical response. Also children using risperidone may need to be monitored more often than adults.

autism disorder, children, adolescents, medical treatment

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