Autism Spectrum Disorder

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A blue puzzle piece. This has become the renowned symbol for autism awareness. We all know someone who has been diagnosed with autism or is close to someone who was. Autism has actually been absorbed into a group of conditions called Autism Spectrum Disorder or ASD. Autism, Childhood Disintegrative Disorder, Rett disorder, Asperger’s syndrome, and a broad category, Pervasive Development Disorders Not Otherwise Specified (PDDNOS), are all diagnosed as a form of Autism Spectrum Disorder.  Autism Spectrum Disorder is a neurodevelopmental disorder. Its origins are unknown but it is thought to stem from a multifaceted genetic complication.  No, vaccinations do not cause autism! However, researchers have not ruled out environmental factors that may contribute to the onset of Autism. ASD covers a broad range of individuals that are affected by a variety of symptoms. The most commonly recognized symptoms are severely impaired social skills, challenges with speech and non-verbal communication, and exhibit repetitive behaviors. Commonly individuals will avoid eye contact, resist making social relationships, and will fail to show interest in the feelings of others. Autism Spectrum Disorder also has become known to be a full body disorder It is often accompanied by other serious conditions like epilepsy, gastro Intestinal disorders, sleep disruption, feeding issues, and mental health problem such as anxiety, depression, schizophrenia, ADHD, and bipolar disorder.

ASD is an unusual disorder because those affected may also have unique strengths when it comes to learning, thinking, and problem solving. Each person with ASD is likely to experience different levels of strengths and challenges. Some are high-functioning and are able to become accustomed to living day to day with autism. Others struggle to recognize emotions and social cues that make it difficult for them to interact with family and their peers on a daily basis. The signs if autism are likely to emerge and be recognized by the age of 3.  The CDC reports about 1 in every 68 children in the United States are afflicted with some sort of disorder on the Autism spectrum, a majority of which are male. The prevalence of this disorder and our lack of knowledge about it makes autism a relevant area for pharmacologic research. Behavioral therapy is usually the first treatment for ASD. Medications are currently just administered to assist patients with functioning in daily activities.

Currently the FDA has approved only two drugs, risperidone and aripiprazole, for ASD patients. These drugs are used only to manage irritability and aggression. Risperidone is an antipsychotic drug used in Autistic patients aged 5 and older. Studies of the use of this drug in children between the ages of 5 and 17 produced results that indicated risperidone was effective in reducing the number of tantrums and aggressive episodes in autistic children. While this drug has its benefits, there are also some concerning side effects like dizziness, drooling fatigue, hepatotoxicity, and weight gain.

Aripiprazole is also an antipsychotic drug used in autistic children aged 6 and older. It’s mechanism of action is not completely understood but it is suspected to involve agonist activity at dopamine type 2 and serotonin 1A receptors and antagonist activity at serotonin 2A receptors. This therapy was shown to increase the quality of life inventory scores in autistic children as well as significantly reduce irritability, hyperactivity, and repetitive actions. Aripiprazole also has some discouraging side effects that include dizziness, vomiting, fatigue, sedation, and weight gain. Many parents are most concerned with the weight gain that is associated with these drugs because of the chronic illnesses that accompany obesity such as heart disease and diabetes.

While there are only two FDA approved drugs for use in ASD cases, there are a variety of other pharmacotherapeutic options being studied for use in individuals with ASD to manage other symptoms. Anti-psychotics Clozapine and Haloperidol which are dopamine receptor antagonists also have been looked at to treat irritability is ASD patients but have harsher adverse effects like seizures and dyskinesia. Methylphenidate, which is a CNS stimulant used to treat ADD/ADHD has been studied to reduce inattention and hyperactivity in ASD patients. It is effective for those purposes at medium and high doses but alternatively increases irritability. Anxiety, repetitive behavior, and some social withdrawal symptoms seem to respond well to selective serotonin reuptake inhibitors which are intended for use as antidepressants. Melatonin, the sleep hormone has been used to reduce insomnia. A few other treatments such as Naltrexone and Oxytocin have been discussed as treatments for ASD but until the mechanism of the disorder is better understood, it will be very difficult to prove these treatments are effective against ASD not just the symptoms.

References:

“Autism Spectrum Disorder (ASD).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 26 Feb. 2015, www.cdc.gov/ncbddd/autism/signs.html.

“How Is Autism Treated?” Autism Speaks, 24 July 2012, www.autismspeaks.org/what-autism/treatment.

King, Bryan H, and Jeff Q Bostic. “An Update on Pharmacologic Treatments for Autism Spectrum Disorders.” Child & Adolescent Psychiatric Clinics of North America, vol. 15, no. 1, pp. 161–175.

LeClerc, Sheena, and Deidra Easley. “Pharmacological Therapies for Autism Spectrum Disorder: A Review.” Pharmacy and Therapeutics 40.6 (2015): 389–397. Print.

Lee, Seung Yup et al. “Is Oxytocin Application for Autism Spectrum Disorder Evidence-Based?” Experimental Neurobiology 24.4 (2015): 312–324. PMC. Web. 11 Nov. 2017.

By Jordan Wells, Master of Medical Science Student, University of Kentucky