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Yılmaz Z, Al-Taie A. A cross-sectional study of community pharmacists' self-reported disease knowledge and competence in the treatment of childhood autism spectrum disorder. Int J Clin Pharm 2023; 45:1088-1097. [PMID: 36547799 DOI: 10.1007/s11096-022-01530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental disease that can cause significant social, communication, and behavioural challenges. Given the rising prevalence of autism and multiple medication use, healthcare professionals, including community pharmacists, are required to have sufficient ASD knowledge to affect positively the disease prognosis and related comorbidities. AIM To assess community pharmacists' knowledge of disease and pharmacotherapy of ASD, along with the provision of patient education and counselling provided by, community pharmacists in Turkey. METHOD This was a descriptive, cross-sectional study conducted among community pharmacists in Turkey using a structured, validated questionnaire to assess ASD knowledge, awareness, and the provision of patient education and counselling by community pharmacists. RESULTS 486 community pharmacists were included, with a mean age of 39.69 ± 13.10 years, and most (n = 151, 31.1%) in the age range between 20 and 29 years. 96.3% of community pharmacists never had training about ASD. 32.9% of the participants were aware of the medicines for ASD treatment, and 25.7% were aware of the drugs' side effects. The mean overall knowledge about childhood autism among health workers questionnaire (KCAHW) score was 11.83 ± 3.91, and there was a statistically significant KCAHW score difference between other pharmacists and those with ASD training (p = 0.006). CONCLUSION There is a lack of disease and pharmacotherapy knowledge about childhood ASD among Turkish community pharmacists, particularly about communication impairment, type, onset, and comorbidities, as well as poor knowledge about drug pharmacotherapy and patient counselling services. This potentially creates a barrier to the adequate provision of healthcare to autistic patients.
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Affiliation(s)
- Zekiye Yılmaz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Acıbadem Mehmet Ali Aydınlar, Kayışdağı Cad. No: 32, Ataşehir, 34758, Istanbul, Turkey.
| | - Anmar Al-Taie
- Department of Clinical Pharmacy, Faculty of Pharmacy, Istinye University, Istanbul, Turkey
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2
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Faraji S, Najafabadi MG, Zandi HG, Parent-Nichols J. Water-Based Exercise Therapy And Improvement In The Motor Skills And Cognitive Function Of Children With Autism Spectrum Disorder: A Commentary. RUSSIAN OPEN MEDICAL JOURNAL 2022. [DOI: 10.15275/rusomj.2022.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background — Motor and cognitive dysfunction are common impairments experienced by children with a diagnosis of autism spectrum disorder (ASD). Objective: The main aim of this study was to present suggestions for the incorporation of water-based exercises in rehabilitation for the children with ASD. Methods — Researchers collected the current available data regarding novel methods of water-based exercise therapy for the children with ASD to address motor and cognitive function. Results — Children with a diagnosis of ASD face a number of common challenges that may be addressed by the utilization of aquatic therapy in their rehabilitation plan. Challenges commonly experienced by children with ASD may be addressed by properties of water and aquatic therapies. Presently, aquatic therapy is an underutilized resource as an intervention in the population of children with ASD. Conclusions — Water-based interventions is currently underutilized as a therapeutic intervention should be considered for individuals with a diagnosis of ASD.
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DiCarlo GE, Wallace MT. Modeling dopamine dysfunction in autism spectrum disorder: From invertebrates to vertebrates. Neurosci Biobehav Rev 2022; 133:104494. [PMID: 34906613 PMCID: PMC8792250 DOI: 10.1016/j.neubiorev.2021.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 02/03/2023]
Abstract
Autism Spectrum Disorder (ASD) is a highly heterogeneous neurodevelopmental disorder characterized by deficits in social communication and by patterns of restricted interests and/or repetitive behaviors. The Simons Foundation Autism Research Initiative's Human Gene and CNV Modules now list over 1000 genes implicated in ASD and over 2000 copy number variant loci reported in individuals with ASD. Given this ever-growing list of genetic changes associated with ASD, it has become evident that there is likely not a single genetic cause of this disorder nor a single neurobiological basis of this disorder. Instead, it is likely that many different neurobiological perturbations (which may represent subtypes of ASD) can result in the set of behavioral symptoms that we called ASD. One such of possible subtype of ASD may be associated with dopamine dysfunction. Precise regulation of synaptic dopamine (DA) is required for reward processing and behavioral learning, behaviors which are disrupted in ASD. Here we review evidence for DA dysfunction in ASD and in animal models of ASD. Further, we propose that these studies provide a scaffold for scientists and clinicians to consider subcategorizing the ASD diagnosis based on the genetic changes, neurobiological difference, and behavioral features identified in individuals with ASD.
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Affiliation(s)
- Gabriella E DiCarlo
- Massachusetts General Hospital, Department of Medicine, Boston, MA, United States
| | - Mark T Wallace
- Vanderbilt University Brain Institute, Nashville, TN, United States; Department of Psychology, Vanderbilt University, Nashville, TN, United States; Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Pharmacology, Vanderbilt University, Nashville, TN, United States; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States.
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Abstract
Very little is known about the use of nutritional supplements in children with Tourette syndrome. The current study aimed to address the frequency of nutritional supplements and the use of special diets in children with Tourette syndrome and typically developing children. Additional data also sought to address the motivations behind using them, their cost and perceived benefits. A total of 76 responses from an anonymous online survey (Tourette syndrome = 42; typically developing = 34) were completed and analyzed. Fifty-six per cent of children with Tourette syndrome compared to 15% of typically developing children were currently taking nutritional supplements, with the majority take two or more. Thirty-five per cent of the Tourette syndrome compared to 6% typically developing were currently or had previously adopted a special diet. Supplements most used for children with TS included probiotics, omega-3, multivitamins and magnesium. For children with TS, supplementation often began around the age of eight, for a duration on average of 35 months. The average cost was £32.44 a month compared to £8.25 for typically developing children. Seventy-five per cent of supplement users in the Tourette syndrome group noted improvement, mainly in motor and vocal tics, sleep quality and anxiety reduction. Most caregivers learned of supplements through the Internet. In almost 42% of the Tourette syndrome group, their pediatrician was unaware of the supplement use and this rose to 65% for special diets. Given the popularity of nutritional supplements, more research on the effectiveness and safety of such interventions is crucial.
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Affiliation(s)
- Bobbie L Smith
- Department of Psychology, Sport & Geography, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Amanda K Ludlow
- Department of Psychology, Sport & Geography, University of Hertfordshire, Hatfield, Hertfordshire, UK
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5
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Rana M, Kothare S, DeBassio W. The Assessment and Treatment of Sleep Abnormalities in Children and Adolescents with Autism Spectrum Disorder: A Review. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:25-35. [PMID: 33552170 PMCID: PMC7837521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To summarize causes, evaluation methods, and treatment of sleep disturbance in children and adolescents with autism spectrum disorder (ASD). METHODS A narrative literature and synthesis approach was used. RESULTS/DISCUSSION Sleep disturbances in this population are common and include insomnia, parasomnias, circadian rhythm disorders, and sleep-related movement disorders. Multiple factors may contribute to the higher rates of sleep disturbances in persons with ASD. Unfortunately, there are not evidence-based guidelines specific for the management of these sleep disorders in this population. There is also a lack of controlled clinical studies. Nevertheless, assessment of sleep problems using both subjective and objective methods are recommended to develop an individualized approach. Behavioural interventions are preferred first line treatment for insomnia. As adjunctive measures, pharmacotherapy may be warranted and choice should be guided based on accompanying symptoms. The most commonly used pharmacotherapy for sleep disturbance, primarily insomnia, include melatonin and alpha agonists. Not all currently used medications are approved for use for children and adolescents.
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Affiliation(s)
- Mandeep Rana
- Department of Pediatrics, Division of Pediatric Neurology and Sleep Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Sanjeev Kothare
- Department of Pediatrics, Division of Pediatric Neurology, Cohen Children's Medical Center, Zucker School of Medicine Hofstra/Northwell, New York, USA
| | - William DeBassio
- Department of Pediatrics, Division of Pediatric Neurology and Sleep Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
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6
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An S, Kanderzhanova A, Akhmetova A, Foster F, Chan CK. "Chasing hope": Parents' perspectives on complementary and alternative interventions for children with autism in Kazakhstan. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1817-1828. [PMID: 32498539 DOI: 10.1177/1362361320923494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT The article reports the findings of a qualitative research study on how and why parents of autistic children in Kazakhstan utilize complementary and alternative medicine. We found that parents turn to complementary and alternative medicine because of the lack of professional care options available to them and in pursuit for hope and opportunities for their children with ASD.
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Affiliation(s)
- Sofiya An
- Nazarbayev University, Republic of Kazakhstan
| | | | | | - Faye Foster
- Nazarbayev University, Republic of Kazakhstan
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7
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Casanova MF, Frye RE, Gillberg C, Casanova EL. Editorial: Comorbidity and Autism Spectrum Disorder. Front Psychiatry 2020; 11:617395. [PMID: 33329163 PMCID: PMC7714785 DOI: 10.3389/fpsyt.2020.617395] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Manuel F Casanova
- University of South Carolina School of Medicine Greenville, Greenville, SC, United States
| | | | | | - Emily L Casanova
- University of South Carolina School of Medicine Greenville, Greenville, SC, United States
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8
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Shaltout E, Al-Dewik N, Samara M, Morsi H, Khattab A. Psychological Comorbidities in Autism Spectrum Disorder. ADVANCES IN NEUROBIOLOGY 2020; 24:163-191. [PMID: 32006360 DOI: 10.1007/978-3-030-30402-7_6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Autism spectrum disorder (ASD) is characterized by impairment in behavior, communication, and social interaction. Thus, accurate identification, regular behavioral and other nonmedical interventions would improve the diagnosis, management, and treatment of this condition.In this chapter, we investigate the importance of diagnosing and identifying comorbid psychiatric disorders that occur with ASD as these conditions can often complicate treatment, and failure to recognize them can result in deficits that can persist into adolescence and adulthood. In addition, we explore the impact of comprehensive psychological intervention in ASD patients with comorbid psychiatric disorders with the ultimate goal of improving overall quality of life.
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Affiliation(s)
- Eman Shaltout
- Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar.,Department of Psychology, Kingston University London, Kingston upon Thames, UK
| | - Nader Al-Dewik
- Clinical and Metabolic Genetics, Pediatrics Department, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha, Qatar.,College of Health and Life Sciences, Hamad Bin Khalifa University (HBKU), Doha, Qatar
| | - Muthanna Samara
- Department of Psychology, Kingston University London, Kingston upon Thames, UK.
| | - Hisham Morsi
- Department of Psychology, Kingston University London, Kingston upon Thames, UK.,Quality of Life Unit, National Center for Cancer Care and Research, (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Azhar Khattab
- Qatar Rehabilitation Institute, Pediatric Rehabilitation, Hamad Medical Corporation (HMC), Doha, Qatar
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9
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Dietary and Supplement-Based Complementary and Alternative Medicine Use in Pediatric Autism Spectrum Disorder. Nutrients 2019; 11:nu11081783. [PMID: 31375014 PMCID: PMC6724073 DOI: 10.3390/nu11081783] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 12/26/2022] Open
Abstract
Previous literature has shown that complementary and alternative medicine (CAM) is steadily increasing in autism spectrum disorder (ASD). However, little data is currently available regarding its use, safety, and efficacy in children with ASD. Thus, the purpose of this study is to describe the use of supplement-based CAM therapies in children between the ages of 4 to 17 years with ASD. This population-based, cross-sectional study evaluated children with ASD regarding supplement use. A total of 210 participants were recruited from a variety of sources including educational and physical activity programs, and social media to complete a questionnaire. Primary caregivers provided information on current supplement based CAM use. Data evaluated the proportion of children that used supplement therapies, the types of supplements used, reasons for use, perceived safety, and demographic factors associated with use (e.g., income, parental education, severity of disorder). Seventy-five percent of children with ASD consumed supplements with multivitamins (77.8%), vitamin D (44.9%), omega 3 (42.5%), probiotics (36.5%), and magnesium (28.1%) as the most prevalent. Several supplements, such as adrenal cortex extract, where product safety has not yet been demonstrated, were also reported. A gluten free diet was the most common specialty diet followed amongst those with restrictions (14.8%). Health care professionals were the most frequent information source regarding supplements; however, 33% of parents reported not disclosing all their child’s supplements to their physician. In conclusion, the use of supplement therapies in children with ASD is endemic and highlights the need for further research concerning public health education surrounding safety and efficacy.
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Khalaj M, Saghazadeh A, Shirazi E, Shalbafan MR, Alavi K, Shooshtari MH, Laksari FY, Hosseini M, Mohammadi MR, Akhondzadeh S. Palmitoylethanolamide as adjunctive therapy for autism: Efficacy and safety results from a randomized controlled trial. J Psychiatr Res 2018; 103:104-111. [PMID: 29807317 DOI: 10.1016/j.jpsychires.2018.04.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 11/25/2022]
Abstract
Inflammation as well as glutamate excitotoxicity have been proposed to participate in the propagation of autism. Palmitoylethanolamide (PEA) is an endocannabinoid proven to prevent glutamatergic toxicity and inhibit inflammatory responses simultaneously. The present randomized, parallel group, double-blind placebo-controlled trial is the first study depicted to probe the efficacy of co-treatment with risperidone and PEA over 10 weeks in children with autism. Seventy children (aged 4-12 years) with autism and moderate to severe symptoms of irritability were randomly assigned to two treatment regimens. The study outcomes were measured using the Aberrant Behavior Checklist-Community Edition (ABC-C). At trial endpoint (week 10), combination of PEA and risperidone had superior efficacy in ameliorating the ABC-irritability and hyperactivity/noncompliance symptoms (Cohen's d, 95% confidence interval (CI) = 0.94, 0.41 to 1.46, p = 0.001) compared with a risperidone plus placebo regimen. Interestingly, effect of combination treatment on hyperactivity symptoms was also observed at trial midpoint (week 5) but with a smaller effect size (d = 0.53, p = 0.04) than that at the endpoint (d = 0.94, p = 0.001). Meanwhile, there was a trend toward significance for superior effect of risperidone plus PEA over risperidone plus placebo on inappropriate speech at trial endpoint (d = 0.51, p = 0.051). No significant differences existed between the two treatment groups for the other two ABC-C subscales (lethargy/social withdrawal and stereotypic behavior). The findings suggest that PEA may augment therapeutic effects of risperidone on autism-related irritability and hyperactivity. Future studies are warranted to investigate whether PEA can serve as a stand-alone treatment for autism.
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Affiliation(s)
- Mona Khalaj
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Amene Saghazadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Shirazi
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Shalbafan
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Kaveh Alavi
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Mitera Hakim Shooshtari
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Yousefi Laksari
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Maryamalsadat Hosseini
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Mohammadi
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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11
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Lindly OJ, Thorburn S, Heisler K, Reyes NM, Zuckerman KE. Parents' Use of Complementary Health Approaches for Young Children with Autism Spectrum Disorder. J Autism Dev Disord 2018; 48:1803-1818. [PMID: 29243100 PMCID: PMC6431080 DOI: 10.1007/s10803-017-3432-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Knowledge of why parents use complementary health approaches (CHA) for children with autism spectrum disorder (ASD) is limited. We conducted a mixed methods study to better understand factors influencing parents' decision to use CHA for ASD. Parent-reported data about CHA use were collected on a probability sample of 352 young children with ASD in Denver, Colorado; Los Angeles, California; or Portland, Oregon. Follow-back interviews were conducted with 31 parents. CHA use was negatively associated with older child age and positively associated with parents' belief ASD has major consequences, living in Portland or Denver, and medication use. Nine themes help explain these results. Study findings may have utility for healthcare providers working with children with ASD and their families regarding CHA.
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Affiliation(s)
- Olivia J Lindly
- Department of General Academic Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, 125 Nashua Street, Boston, MA, 02114, USA.
- Division of General Pediatrics, School of Medicine, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR, 97239, USA.
| | - Sheryl Thorburn
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR, 97331, USA
| | - Karen Heisler
- Childhood Health Associates of Salem, Oregan, Salem, USA
| | - Nuri M Reyes
- Department of Psychiatry, School of Medicine, University of Colorado, 13121 E. 17th Avenue, 5th Floor, Aurora, CO, 80045, USA
| | - Katharine E Zuckerman
- Division of General Pediatrics, School of Medicine, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR, 97239, USA
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12
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Weeding Out the Justification for Marijuana Treatment in Patients with Developmental and Behavioral Conditions. J Dev Behav Pediatr 2018. [PMID: 28622159 DOI: 10.1097/dbp.0000000000000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Alex is a 13-year-old adolescent with high-functioning autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD)-combined type, anxiety, and depression. He has been resistant to engaging in therapy and treatment with various medications has been unsuccessful. Alex's parents are concerned about his anxiety, isolation, oppositional behaviors, academic underachievement, truancy, and substance use. A recent altercation with his stepfather led to a police intervention and a brief removal of Alex from the home. Alex previously used alcohol and other drugs; at present, he reports that his current drug use consists of frequently smoking pot. Alex states that he uses marijuana to relieve his anxiety and does not understand why this is problematic as marijuana is now legal in his state.Kevin is a 24-year-old adult man with diagnoses of autism spectrum disorder, mild intellectual disability, and schizoaffective disorder. He has a long history of challenging and problematic behaviors including aggression toward self and others, property destruction, inappropriate sexual behaviors, elopement, emotional outbursts, anxiety, and suicidal ideation. Past diagnoses include bipolar affective disorder, depression, and intermittent explosive disorder. Kevin is notably obese and somnolent. His current medications include 8 psychotropic medications, 3 antiallergy medications, levothyroxine, and a fish oil supplement. His father reports that medications have gradually been added and dosages increased over time. Two weeks ago, his new psychiatrist initiated a trial of medical marijuana. His father hopes that the marijuana will allow Kevin's other medications to be decreased or discontinued.Linda is an 11-year-old girl with high-functioning autism spectrum disorder, anxiety, and ADHD-inattentive subtype. Anxiety has been her most impairing condition, and Linda has been responding well to a treatment with cognitive behavioral therapy and a selective serotonin reuptake inhibitor. She is also working with her therapist on strategies to address her symptoms of ADHD. Linda has had no side effects from her medication and she and her family have been pleased with her progress. At a follow-up appointment, her mother brings an article from the lay press authored by a parent who claims that marijuana "saved" her autistic son. Linda's mother asks if marijuana should be considered for her daughter.
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Lindly O, Thorburn S, Zuckerman K. Use and Nondisclosure of Complementary Health Approaches Among US Children with Developmental Disabilities. J Dev Behav Pediatr 2018; 39:217-227. [PMID: 29570567 PMCID: PMC5868424 DOI: 10.1097/dbp.0000000000000536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Many US children use complementary health approaches (CHAs), including some modalities that may be ineffective, unsafe, and/or costly. Yet, little is known about the prevalence and correlates of CHA use among children with developmental disabilities (DDs), as well as parent nondisclosure of CHAs used for children with DDs to health care providers. We, therefore, aimed to profile the use and nondisclosure of CHAs among US children with DDs. METHODS We analyzed data from the 2012 National Health Interview Survey, which included the most recent Child Complementary and Alternative Medicine Supplement. The study sample was comprised of 2141 children with DDs aged 4 to 17 years. RESULTS Nearly one-quarter (23%) of US children with DDs used CHAs. Among those with a personal health provider, 42% of parents did not disclose some or all CHAs used to the child's provider. The adjusted odds ratios of using CHAs were greater among those with female sex, higher household income, residences not in the South, difficulty accessing care, or comorbid conditions. CHA was most commonly used because "it is natural." Nondisclosure was associated with female sex, older age, having no functional limitations, less conventional services use, and use of fewer CHAs. The most common reason for nondisclosure was that the child's provider did not ask. CONCLUSION Complementary health approach use is prevalent among US children with DDs, and nondisclosure is likely among those who use CHAs. Future intervention targeting education and communication about CHAs for parents of children with DDs and their health care providers may promote disclosure.
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Affiliation(s)
- Olivia Lindly
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, 125 Nashua Street, Boston, MA 02114
- Divison of General Pediatrics, Oregon Health & Science University, 707 SW Gaines Road, Portland, OR 97239
| | - Sheryl Thorburn
- School of Social and Behavioral Health Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR 97331
| | - Katharine Zuckerman
- Divison of General Pediatrics, Oregon Health & Science University, 707 SW Gaines Road, Portland, OR 97239
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14
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Lindly O, Thorburn S, Heisler K, Reyes N, Zuckerman K. Parent disclosure of complementary health approaches used for children with autism spectrum disorder: Barriers and facilitators. Complement Ther Med 2017; 35:47-52. [PMID: 29154066 PMCID: PMC5726576 DOI: 10.1016/j.ctim.2017.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/11/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Complementary health approaches (CHA) are widely used among children with autism spectrum disorder (ASD). As part of shared treatment decision-making, healthcare providers are encouraged to discuss CHA with parents of children with ASD. Yet prior research suggests that parents often do not disclose CHA used for children, and their reasons for nondisclosure are poorly understood. We, therefore, aimed to identify barriers and facilitators to parent disclosure of CHA used for children with ASD. DESIGN AND SETTING In-depth interviews were conducted with 31 parents who reported that they were currently using CHA for their child's ASD in Denver, Colorado or Portland, Oregon. RESULTS We used content analysis to identify six main themes indicating that the following factors play a role in disclosure: parents' drive to optimize their child's health, parent self-efficacy discussing CHA with healthcare providers, parent beliefs about the effectiveness of CHA, parent-provider relationship quality, provider attitudes and knowledge regarding CHA and ASD, and visit characteristics. CONCLUSIONS Study findings suggest that family and health system factors, together, influence parent disclosure of CHA used for children with ASD. Multifaceted intervention concurrently targeting the CHA-related knowledge, beliefs, and self-efficacy of parents whose children have been recently diagnosed with ASD, in addition to the CHA-related attitudes and knowledge of their healthcare providers may promote disclosure and shared treatment decision-making about the use of CHA.
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Affiliation(s)
- Olivia Lindly
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR, 97331, United States; Division of General Pediatrics, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR, 97239, United States.
| | - Sheryl Thorburn
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR, 97331, United States
| | - Karen Heisler
- Division of General Pediatrics, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR, 97239, United States
| | - Nuri Reyes
- Department of Pediatrics, University of Colorado School of Medicine, 13121 E. 17th Ave, Aurora, CO 80045 United States
| | - Katharine Zuckerman
- Division of General Pediatrics, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR, 97239, United States; School of Public Health, OHSU-PSU, 3181 SW Sam Jackson Park Road; Portland, OR 97239, United States
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15
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Okuda PMM, Klaiman C, Bradshaw J, Reid M, Cogo-Moreira H. Assessing Risk of Bias in Randomized Controlled Trials for Autism Spectrum Disorder. Front Psychiatry 2017; 8:265. [PMID: 29238311 PMCID: PMC5712530 DOI: 10.3389/fpsyt.2017.00265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/16/2017] [Indexed: 01/08/2023] Open
Abstract
AIM To determine construct validity and reliability indicators of the Cochrane risk of bias (RoB) tool in the context of randomized clinical trials (RCTs) for autism spectrum disorder (ASD). METHODS Confirmatory factor analysis was used to evaluate a unidimensional model consisting of 9 RoB categorical indicators evaluated across 94 RCTs addressing interventions for ASD. RESULTS Only five of the nine original RoB items returned good fit indices and so were retained in the analysis. Only one of this five had very high factor loadings. The remaining four indicators had more measurement error than common variance with the RoB latent factor. Together, the five indicators showed poor reliability (ω = 0.687; 95% CI: 0.613-0.761). CONCLUSION Although the Cochrane model of RoB for ASD exhibited good fit indices, the majorities of the items have more residual variance than common variance and, therefore, did not adequately capture the RoB in ASD intervention trials.
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Affiliation(s)
| | - Cheryl Klaiman
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, GA, United States
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Jessica Bradshaw
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, GA, United States
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Morganne Reid
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, GA, United States
| | - Hugo Cogo-Moreira
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
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Factors Associated with Developmental Behavioral Pediatricians Prescribing Psychotropic Medication to Children with Autism Spectrum Disorder: A Study of Three DBPNet Sites. J Dev Behav Pediatr 2017; 38:584-592. [PMID: 28816917 DOI: 10.1097/dbp.0000000000000488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Psychotropic medications are frequently prescribed to children with autism spectrum disorder (ASD), but little is known about the prescribing practices of developmental-behavioral pediatricians (DBPs). Our objective was to determine whether clinical site, age, insurance, or comorbidities influenced DBPs prescribing psychotropic medication for children with ASD. METHODS A retrospective analysis was performed using electronic health record data of all patients with ASD seen at 3 academic developmental-behavioral pediatrics (DBP) clinical programs from January 2010 to December 2011. Data included age, diagnoses, primary insurance, and medications prescribed. Factors associated with prescribing psychotropic medication were examined using generalized estimating equations. RESULTS Sites varied in the frequency with which they prescribed psychotropic medication for children with ASD (site 1: 33.1%, site 2: 49.3%, site 3: 4.0%; p < .001). We found that the following factors predicted prescribing of psychotropic medications: comorbidities (odds ratio [OR]: 2.87; 95% confidence interval [CI], 2.58-3.18), age, and primary insurance. However, the impact of insurance depended on age. For 3- to 5-year-old children, those on Medicaid were more likely to be prescribed psychotropic medications than those with private insurance (OR: 1.65; 95% CI, 1.29-2.12). This was particularly true for alpha-2-adrenergic agonists (OR: 2.48; 95% CI, 1.56-3.92) and atypical antipsychotics (OR: 2.57; 95% CI, 1.46-4.55). CONCLUSION There are large variations in prescribing psychotropic medication to children with ASD at 3 academic DBP programs. Further research is needed to understand factors that contribute to higher use of psychotropic medication in young children with Medicaid.
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Caron V, Bérubé A, Paquet A. Implementation evaluation of early intensive behavioral intervention programs for children with autism spectrum disorders: A systematic review of studies in the last decade. EVALUATION AND PROGRAM PLANNING 2017; 62:1-8. [PMID: 28189054 DOI: 10.1016/j.evalprogplan.2017.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 12/02/2016] [Accepted: 01/13/2017] [Indexed: 05/22/2023]
Abstract
UNLABELLED For young children with autism spectrum disorders, one of the choice interventions is Early Intensive Behavioral Intervention. Over the past ten years, its effectiveness has been abundantly evaluated based on various parameters, including the intensity and duration of the intervention. Despite major advances in effectiveness evaluation, data concerning the implementation of the intervention are often described briefly, and the active ingredients of the intervention are but rarely linked to the documented effects. OBJECTIVES This study aims at reviewing with a systematic method, the studies pertaining to EIBI provided to children with autism spectrum disorders over the past ten years (2005-2015) and at documenting the program implementation components described in the studies, based on Dane and Schneider's (1998) model in accordance with PRISMA guidelines. RESULTS The results show that, although the variables related to intervention dosage and protocol are relatively well described, the authors do not always consider them in the effects analysis. Furthermore, the majority of the studies did not report information on intervention participation, differentiation or quality. CONCLUSIONS Data concerning the implementation of the intervention are partially described in the articles retained. In this regard, a better description of the intervention provided and a more systematic evaluation of its implementation seem necessary to detect the subtle differences in the effects of the intervention.
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Affiliation(s)
- Valérie Caron
- Université du Québec à Trois-Rivières, Département de psychoéducation, 3351 Boulevard des Forges, Trois-Rivières, QC G9A 5H7, Canada.
| | - Annie Bérubé
- Université du Québec en Outaouais, Département de psychoéducation, Pavillon Alexandre Taché, 283 Boulevard Alexandre-Taché, Gatineau, QC J9A 1L8, Canada.
| | - Annie Paquet
- Université du Québec à Trois-Rivières, Département de psychoéducation, 3351 Boulevard des Forges, Trois-Rivières, QC G9A 5H7, Canada.
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Dalwai S, Ahmed S, Udani V, Mundkur N, Kamath SS, Nair MKC. Consensus statement of the Indian academy of pediatrics on evaluation and management of autism spectrum disorder. Indian Pediatr 2017; 54:385-393. [DOI: 10.1007/s13312-017-1112-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Deal LS, DeMuro C, DiBenedetti D, Lewis S. Development of the Observable Behaviors of Autism Spectrum Disorder Scale. Ther Innov Regul Sci 2017; 51:372-379. [PMID: 30231702 DOI: 10.1177/2168479016680258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The objective of this research was to develop a caregiver-reported clinical outcome assessment (COA) measure designed to assess observable behaviors of children, ages 4 to 12 years, with autism spectrum disorder (ASD) for supporting labeling claims of treatment benefit. METHODS Development of the measure included a review of the literature and existing instruments, conceptual disease model development, concept elicitation focus groups, item generation, and cognitive debriefing interviews. RESULTS Predominant characteristics and behaviors of ASD identified by the literature and instrument reviews included sociability, communication deficits, stereotypy, inattention and hyperactivity, irritability, anxiety, and familial impact. In each of the 10 instruments reviewed, evidence of content validity was limited or nonexistent. Predominant themes arose across 8 major categories during concept elicitation. A total of 27 concepts were identified through focus group feedback and formed the basis for item development and cognitive pre-testing. Revisions to the items yielded a final version of a daily diary containing 21 items assessing observable behaviors and characteristics of ASD in children 4 to 12 years old. CONCLUSIONS The Observable Behaviors of ASD Scale (OBAS) was developed as a self-administered, caregiver-reported measure containing 8 predominant themes. Items are scored on one of two 5-point ordinal categorical response scales, and the recall period for each item is "the past 24 hours." This research provides evidence that the OBAS is content valid for assessing treatment benefit, which was found to be lacking in other instruments.
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Affiliation(s)
| | - Carla DeMuro
- 2 RTI Health Solutions, Research Triangle Park, NC, USA
| | | | - Sandy Lewis
- 2 RTI Health Solutions, Research Triangle Park, NC, USA
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Poling A, Ehrhardt K, Li A. Psychotropic Medications as Treatments for People with Autism Spectrum Disorder. HANDBOOK OF TREATMENTS FOR AUTISM SPECTRUM DISORDER 2017. [DOI: 10.1007/978-3-319-61738-1_25] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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21
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Satoh M, Obara T, Nishigori H, Ooba N, Morikawa Y, Ishikuro M, Metoki H, Kikuya M, Mano N. Prescription trends in children with pervasive developmental disorders: a claims data-based study in Japan. World J Pediatr 2016; 12:443-449. [PMID: 27286689 DOI: 10.1007/s12519-016-0036-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/19/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND The only drug approved for pervasive developmental disorders (PDD) in Japan is pimozide. Several psychotropic drugs are also prescribed for offlabel use in Japan, but details regarding their prescription and use are largely unknown. The purpose of this study was to clarify the use of drug treatment in Japanese children with PDD. METHODS Data were extracted from claims data from the Japan Medical Data Center for children younger than 18 years of age who were newly diagnosed with PDD (International Classification of Diseases version 10 codes: F84) from 2005 to 2010 (total of 3276 patients as of 2010). The prescription rates were presented as the percentage of PDD patients who were prescribed each drug. RESULTS Prior to 2010, the prescription rates for atypical antipsychotics, other antipsychotics, psychostimulants, all other central nervous system drugs, anticovnvulsants, non-barbiturates, and Parkinson's disease/syndrome drugs significantly increased among the Anatomical Therapeutic Chemical classifications defined as the "nervous system" (trend P≤0.02). The prescription rate for risperidone consistently increased, reaching 6.9% in 2010 (trend P<0.0001), the highest rate of the surveyed drugs among the antipsychotics. The prescription rate for aripiprazole also increased (trend P<0.0001), reaching 1.9% in 2010. The prescription rate for pimozide showed no annual changes, with a low rate of 0.4% in 2010. CONCLUSION Compared with pimozide, the prescription rates for risperidone, aripiprazole and other psychotropic drugs have increased. Because safety data for these drugs in Japanese children are sparse, there is a need for future safety evaluations of these drugs in Japanese children.
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Affiliation(s)
- Michihiro Satoh
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, 980-8575, Japan
| | - Taku Obara
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, 980-8575, Japan. .,Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-cho, Aoba-ku, Sendai, Japan. .,Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Hidekazu Nishigori
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Yoshihiko Morikawa
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Mami Ishikuro
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-cho, Aoba-ku, Sendai, Japan.,Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirohito Metoki
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Masahiro Kikuya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-cho, Aoba-ku, Sendai, Japan.,Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nariyasu Mano
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, 980-8575, Japan
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Davis JM, Finke E, Hickerson B. Service Delivery Experiences and Intervention Needs of Military Families with Children with ASD. J Autism Dev Disord 2016; 46:1748-61. [DOI: 10.1007/s10803-016-2706-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Parent-Reported Shared Decision Making: Autism Spectrum Disorder and Other Neurodevelopmental Disorders. J Dev Behav Pediatr 2016; 37:20-32. [PMID: 26703325 DOI: 10.1097/dbp.0000000000000242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Assess differences in parent-reported shared decision making (SDM) based on diagnostic group in a national sample of children with neurodevelopmental disorders (autism spectrum disorder [ASD], cerebral palsy [CP], or Down syndrome [DS]). Assess contribution of medical home and child functional impairment. METHODS Secondary analysis of 2009 to 2010 National Survey of Children with Special Health Care Needs explored reports of 3966 children with ASD, CP, or DS. SDM was defined categorically (SDMcat, present or absent) and continuously (SDMcont, score range 0-12). Regression models were adjusted for child/family characteristics, medical home, functional impairment, and diagnostic group. RESULTS SDMcat and SDMcont were significantly lower in the ASD group (56.7% [95% confidence interval = CI, 53.4-59.9] and mean 8.7 [95% CI, 8.5-9.0]), compared with the CP group (70.5% [95% CI, 63.4-76.7] and mean 9.7 [95% CI, 9.3-10.1]), or the DS group (70.8% [95% CI, 61.2-78.8] and mean 10.0 [95% CI, 9.5-10.4]). In adjusted analyses of SDMcat and SDMcont, SDM was more likely among children with a medical home (adjusted odds ratio 6.6, p < .001, mean = 11.9, and p < .001), and less likely for children with greatest functional impairment (adjusted odds ratio 0.4, p = .002, mean = 10.1, and p = .001). Adjusted analysis of SDMcont also showed differences based on diagnostic group with lower SDMcont scores in the ASD group (mean = 10.1 and p = .005) compared with the DS group. CONCLUSION A medical home was associated with higher SDM, whereas greater functional impairment and ASD diagnosis were associated with lower SDM.
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Owen-Smith AA, Bent S, Lynch FL, Coleman KJ, Yau VM, Pearson KA, Massolo ML, Quinn V, Croen LA. Prevalence and Predictors of Complementary and Alternative Medicine Use in a Large Insured Sample of Children with Autism Spectrum Disorders. RESEARCH IN AUTISM SPECTRUM DISORDERS 2015; 17:40-51. [PMID: 26366192 PMCID: PMC4562462 DOI: 10.1016/j.rasd.2015.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE The purpose of the present study was to examine the prevalence and predictors of complementary and alternative medicine (CAM) use as well as parental perceptions of CAM efficacy in a large, geographically diverse sample of children with Autism Spectrum Disorders (ASD). METHODOLOGY Data were obtained from a web-based survey administered to parents of children with ASD at four sites participating in the Mental Health Research Network (MHRN). The web survey obtained information about services and treatments received by children with ASD as well as the caregivers' experiences with having a child with ASD. RESULTS Approximately 88% of the sample had either used CAM in the past or had recently used some type of CAM. The following characteristics were associated with CAM use: greater parental education, younger child age, a mix of regular and special classroom settings and prescription drug use in the past three months. CONCLUSIONS The use of CAM was very prevalent in this large, geographically diverse sample of children with ASD. It is critical that providers be prepared to discuss the advantages and potential side effects with families to help them make well-informed health care decisions and prevent possible CAM-drug interactions.
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Affiliation(s)
- Ashli A Owen-Smith
- Georgia State University, Division of Health Management and Policy, Atlanta, Georgia, USA; Kaiser Permanente Georgia, Center for Clinical and Outcomes Research, Atlanta, Georgia, USA
| | - Stephen Bent
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Frances L Lynch
- The Center for Health Research/Northwest, Kaiser Permanente Northwest (KPNW), Portland, Oregon, USA
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California (KPSC), Pasadena, CA, USA
| | - Vincent M Yau
- Division of Research, Kaiser Permanente Northern California (KPNC), Oakland, CA, USA
| | - Kathryn A Pearson
- The Center for Health Research/Northwest, Kaiser Permanente Northwest (KPNW), Portland, Oregon, USA
| | - Maria L Massolo
- Division of Research, Kaiser Permanente Northern California (KPNC), Oakland, CA, USA
| | - Virginia Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California (KPSC), Pasadena, CA, USA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California (KPNC), Oakland, CA, USA
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Harfterkamp M, Buitelaar JK, Minderaa RB, van de Loo-Neus G, van der Gaag RJ, Hoekstra PJ. Atomoxetine in autism spectrum disorder: no effects on social functioning; some beneficial effects on stereotyped behaviors, inappropriate speech, and fear of change. J Child Adolesc Psychopharmacol 2014; 24:481-5. [PMID: 25369243 DOI: 10.1089/cap.2014.0026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
UNLABELLED Abstract Objective: The objective of this study was to investigate the short-term treatment effects of atomoxetine on autism spectrum disorder (ASD) symptoms in children and adolescents with both ASD and attention-deficit/hyperactivity disorder (ADHD). METHODS A total of 97 patients 6-17 years of age, with ASD and ADHD, were treated with 1.2 mg/kg/day of atomoxetine during an 8 week double-blind placebo-controlled period. Here, we investigated effects on two parent-based secondary outcome measures, the Aberrant Behavior Checklist (ABC) and the Children's Social Behavior Questionnaire (CSBQ). RESULTS After 8 weeks of double-blind treatment, atomoxetine administration was associated with significant treatment effects on the ABC subscales Hyperactivity, Inappropriate Speech, and Stereotypic Behavior, and on the CSBQ subscale Fear for Changes. CONCLUSIONS Our study results indicate no beneficial effects of atomoxetine on social functioning. However, atomoxetine may ameliorate restricted and stereotyped behaviors and communication. This study has been registered in ClinicalTrials.gov ( www.clinicaltrials.gov ) under registration number NCT00380692.
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Affiliation(s)
- Myriam Harfterkamp
- 1 Department of Psychiatry, University of Groningen, University Medical Center Groningen , The Netherlands
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Erickson CA, Veenstra-Vanderweele JM, Melmed RD, McCracken JT, Ginsberg LD, Sikich L, Scahill L, Cherubini M, Zarevics P, Walton-Bowen K, Carpenter RL, Bear MF, Wang PP, King BH. STX209 (arbaclofen) for autism spectrum disorders: an 8-week open-label study. J Autism Dev Disord 2014; 44:958-64. [PMID: 24272415 DOI: 10.1007/s10803-013-1963-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STX209 (arbaclofen), a selective GABA-B agonist, is hypothesized to modulate the balance of excitatory to inhibitory neurotransmission, and has shown preliminary evidence of benefit in fragile X syndrome. We evaluated its safety, tolerability, and efficacy in non-syndromic autism spectrum disorders, in an 8-week open-label trial enrolling 32 children and adolescents with either Autistic Disorder or Pervasive Developmental Disorder-Not Otherwise Specified, and a score ≥17 on the Aberrant Behavior Checklist (ABC)-Irritability subscale. STX209 was generally well-tolerated. The most common adverse events were agitation and irritability, which typically resolved without dose changes, and were often felt to represent spontaneous variation in underlying symptoms. Improvements were observed on several outcome measures in this exploratory trial, including the ABC-Irritability (the primary endpoint) and the Lethargy/Social Withdrawal subscales, the Social Responsiveness Scale, the CY-BOCS-PDD, and clinical global impression scales. Placebo-controlled study of STX209 is warranted.
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Affiliation(s)
- Craig A Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Abstract
OBJECTIVE Autism spectrum disorders (ASDs) were once considered lifelong disorders, but recent findings indicate that some children with ASDs no longer meet diagnostic criteria for any ASD and reach normal cognitive function. These children are considered to have achieved "optimal outcomes" (OO). The present study aimed to retrospectively examine group differences in the intervention history of children and adolescents with OO and those with high-functioning autism (HFA). METHOD The current study examined intervention histories in 25 individuals with OO and 34 individuals with HFA (current age, 8-21 years), who did not differ on age, sex, nonverbal intelligence, or family income. Intervention history was collected through detailed parent questionnaires. RESULTS Children in the OO group had earlier parental concern, received earlier referrals to specialists, and had earlier and more intensive intervention than those in the HFA group. Substantially more children with OO than HFA received applied behavior analysis (ABA) therapy, although for children who received ABA, the intensity did not differ between the groups. Children in the HFA group were more likely to have received medication, especially antipsychotics and antidepressants. There were no group differences in the percent of children receiving special diets or supplements. CONCLUSION These data suggest that OO individuals generally receive earlier, more intense interventions, and more ABA, whereas HFA individuals receive more pharmacologic treatments. Although the use of retrospective data is a clear limitation to the current study, the substantial differences in the reported provision of early intervention, and ABA in particular, is highly suggestive and should be replicated in prospective studies.
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Granich J, Hunt A, Ravine D, Wray J, Whitehouse AJ. High use of complementary and alternative medication among children with autism is not associated with the severity of core symptoms. ACTA ACUST UNITED AC 2014. [DOI: 10.7243/2054-992x-1-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Utilization patterns of conventional and complementary/alternative treatments in children with autism spectrum disorders and developmental disabilities in a population-based study. J Dev Behav Pediatr 2014; 35:1-10. [PMID: 24399100 PMCID: PMC3896860 DOI: 10.1097/dbp.0000000000000013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare the utilization of conventional treatments and utilization of complementary and alternative medicine in preschoolers with autism spectrum disorders (ASD) and other developmental disabilities (DD). METHODS Participants were 578 children who were part of an ongoing population-based, case-control study of 2- to 5-year olds with ASD, DD, and the general population. Parents completed an interview on past and current services. RESULTS Four hundred fifty-three children with ASD and 125 DD children were included. ASD families received more hours of conventional services compared with DD families (17.8 vs 11; p < .001). The use of psychotropic medications was low in both groups (approximately 3%). Overall, complementary and alternative medicine (CAM) use was not significantly different in ASD (39%) versus DD (30%). Hispanic families in both groups used CAM less often than non-Hispanic families. Variables such as level of function, immunization status, and the presence of an identified neurogenetic disorder were not predictive of CAM use. A higher level of parental education was associated with an increased CAM use in ASD and DD. Families who used >20 hours per week of conventional services were more likely to use CAM, including potentially unsafe or disproven CAM. Underimmunized children were marginally more likely to use CAM but not more likely to have received potentially unsafe or disproven CAM. CONCLUSION Use of CAM is common in families of young children with neurodevelopmental disorders, and it is predicted by higher parental education and non-Hispanic ethnicity but not developmental characteristics. Further research should address how health care providers can support families in making decisions about CAM use.
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Wang X, Bey AL, Chung L, Krystal AD, Jiang YH. Therapeutic approaches for shankopathies. Dev Neurobiol 2013; 74:123-35. [PMID: 23536326 DOI: 10.1002/dneu.22084] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 03/21/2013] [Indexed: 12/13/2022]
Abstract
Despite recent advances in understanding the molecular mechanisms of autism spectrum disorders (ASD), the current treatments for these disorders are mostly focused on behavioral and educational approaches. The considerable clinical and molecular heterogeneity of ASD present a significant challenge to the development of an effective treatment targeting underlying molecular defects. Deficiency of SHANK family genes causing ASD represent an exciting opportunity for developing molecular therapies because of strong genetic evidence for SHANK as causative genes in ASD and the availability of a panel of Shank mutant mouse models. In this article, we review the literature suggesting the potential for developing therapies based on molecular characteristics and discuss several exciting themes that are emerging from studying Shank mutant mice at the molecular level and in terms of synaptic function.
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Affiliation(s)
- Xiaoming Wang
- Department of Pediatrics, Duke University School of Medicine Durham, North Carolina, 27710
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Rue HC, Knox M. CAPACITY BUILDING: EVIDENCE-BASED PRACTICE AND ADOLESCENTS ON THE AUTISM SPECTRUM. PSYCHOLOGY IN THE SCHOOLS 2013. [DOI: 10.1002/pits.21712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mire SS, Nowell KP, Kubiszyn T, Goin-Kochel RP. Psychotropic medication use among children with autism spectrum disorders within the Simons Simplex Collection: are core features of autism spectrum disorder related? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2013; 18:933-42. [PMID: 24031086 DOI: 10.1177/1362361313498518] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psychotropic medication use and its relationship to autism spectrum core features were examined in a well-characterized but nonstratified North American sample (N = 1605) of children/adolescents diagnosed with autism spectrum disorders utilizing the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised, from the multisite Simons Simplex Collection. Analyses included (a) prevalence of psychotropic use (overall, and by classes), (b) correlations between prevalence of use and autism spectrum core features, age, and cognitive functioning, and (c) logistic regression to identify whether these factors were predictive of psychotropic use. Results indicated 41.7% ever used one or more classes of psychotropic medications, with attention deficit hyperactivity disorder medications used most. Small but significant correlations between psychotropic medication use and (a) social impairment (p < .001) and (b) repetitive behaviors (p < .001) were found. Overall, however, autism spectrum disorder core features are weakly related to medication use. Older children used more psychotropics (p < .001), and higher cognitive functioning was associated with less overall psychotropic use (p < .001). Logistic regression indicated that use of psychotropics was predicted by repetitive behaviors (both clinician-observed and parent-reported), age, and cognitive ability level. Limitations inherent to the Simons Simplex Collection sample, methodology, and the correlational analyses are discussed. Directions for future research include investigation of factors more influential than core symptoms on psychotropic treatment (e.g. parent perceptions, comorbid symptoms).
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Louw KA, Bentley J, Sorsdahl K, Adnams CM. Prevalence and patterns of medication use in children and adolescents with autism spectrum disorders in the Western Cape, South Africa. J Child Adolesc Ment Health 2013; 25:69-79. [DOI: 10.2989/17280583.2013.767265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Klaiman C, Huffman L, Masaki L, Elliott GR. Tetrahydrobiopterin as a treatment for autism spectrum disorders: a double-blind, placebo-controlled trial. J Child Adolesc Psychopharmacol 2013; 23:320-8. [PMID: 23782126 DOI: 10.1089/cap.2012.0127] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if tetrahydrobiopterin (BH4) reduced core symptoms of autism spectrum disorder (ASD). METHOD In this study, 46 children, 3-7 years of age diagnosed with an ASD were randomly assigned to double-blind treatment with 20 mg/kg/day BH4 or placebo for 16 weeks. The primary outcome measure was the Clinical Global Impressions Improvement and Severity Scales (CGI-I and CGI-S); secondary outcomes were the Preschool Language Scale-4 (PLS-4), Social Responsiveness Scale (SRS), Aberrant Behavior Checklist (ABC), and Vineland Adaptive Behavior Scales (Vineland). RESULTS Overall, no differences were found on global improvement as measured with the CGI-I or CGI-S. Secondary measures indicated significant improvements for BH4 relative to placebo with regard to social awareness, autism mannerisms, hyperactivity, and inappropriate speech. Side effects were minimal and similar between both active medication and placebo. CONCLUSIONS These results indicate that BH4 offers promise in reducing symptoms of ASD. Clinical Trials.gov Identifier: NCT00850070.
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Affiliation(s)
- Cheryl Klaiman
- Marcus Autism Center, Children's Healthcare of Atlanta and Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
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Abstract
PURPOSE OF REVIEW To provide an updated overview of autism spectrum disorders (ASDs), with particular attention to the pediatrician's role in assessing and managing patients with ASDs. RECENT FINDINGS Clinical perspectives on ASDs continue to evolve. The prevalence of ASDs in the United States continues to rise, and pediatricians are being tasked with the responsibility for universal screening. Further changes in its epidemiology will undoubtedly result from anticipated changes in the diagnostic criteria put forth in the upcoming revision to the Diagnostic and Statistical Manual (5th edition). Although there have been considerable advances in identifying a genetic cause in many more cases, the cause remains elusive in most cases. Recent studies of concordant twins suggest there is a stronger environmental component than previously believed. Research suggests earlier diagnosis may be feasible in some cases, and a new treatment approach has been shown to be effective in very young children. Although there have not been any large-scale advances in the medical treatment, some isolated successes have been reported and other promising therapies are now being investigated. SUMMARY Clinical guidelines for ASDs are evolving, with updated diagnostic criteria expected and revised recommendations for evaluation also imminent. This article provides pediatricians with a clinical overview of ASD - with an emphasis on the clinical considerations relating to screening, evaluation, and management.
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Manning-Courtney P, Murray D, Currans K, Johnson H, Bing N, Kroeger-Geoppinger K, Sorensen R, Bass J, Reinhold J, Johnson A, Messerschmidt T. Autism spectrum disorders. Curr Probl Pediatr Adolesc Health Care 2013; 43:2-11. [PMID: 23332397 DOI: 10.1016/j.cppeds.2012.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 08/30/2012] [Accepted: 08/31/2012] [Indexed: 10/27/2022]
Abstract
Autism spectrum disorders are being diagnosed with increasing frequency. The likelihood that a primary care provider will see a patient with autism spectrum disorder in their clinic is high. In this article, current diagnostic criteria and expected changes in DSM criteria, as well as prevalence rates and epidemiologic studies are reviewed. Recommendations for screening, including early warning signs, and best practices for diagnosis are discussed. Comprehensive evidence based intervention for ASD as well as the findings of the National Standards Project are reviewed. Medication management is also described, as are the roles of other treating professionals.
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Canitano R. Novel treatments in autism spectrum disorders: from synaptic dysfunction to experimental therapeutics. Behav Brain Res 2012. [PMID: 23202136 DOI: 10.1016/j.bbr.2012.11.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Recent discoveries and advances in genetics and neuroscience have provided deeper understanding of the complex neurobiology of ASD. The development of novel treatments is strictly dependent on these findings in order to design new strategies in the pharmacotherapy of ASD. At this time, therapeutics are limited to treating associated core, symptoms. Studies of single gene disorders, such as Phelan-McDermid syndrome, Fragile X and Tuberous Sclerosis, might be of significant help since the neurobiology of these disorders is clearer and clinical trials are already underway for these conditions. The pathogenesis paradigm shift of ASD towards synaptic abnormalities has led to current research of the pathways to disease, which involves multiple dynamic systems. Interest in oxytocin is growing as it has been recognized to be implicated in social development and affiliative behaviours. In the future, progress is expected in possible new options for therapeutics in ASD. Children and adolescents with ASD and their families can provide vital information about their experiences with new treatments, which should be a priority for future research.
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Affiliation(s)
- Roberto Canitano
- Division of Child Neuropsychiatry, University Hospital of Siena, Italy.
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A review of complementary and alternative treatments for autism spectrum disorders. AUTISM RESEARCH AND TREATMENT 2012; 2012:870391. [PMID: 23243505 PMCID: PMC3515887 DOI: 10.1155/2012/870391] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 08/08/2012] [Accepted: 09/07/2012] [Indexed: 12/30/2022]
Abstract
Given the severe and chronic problems associated with Autism Spectrum Disorders (ASD) and the limitations of available treatments, there exists a large public health need for additional interventions. As more parents are inquiring about complementary and alternative treatments (CATs), both parents and practitioners require up-to-date information about them and whether and how to integrate them into treatment. After presenting data on CAT usage patterns for ASD, we review 13 ingestible (i.e., orally administered) and 6 noningestible (i.e., externally administered) CATs for ASD. For each CAT we briefly describe its definition; rationale for use; current research support, limitations, and future directions; safety issues; and whether we currently recommend, not recommend, or find it acceptable for the treatment of ASD. We conclude this paper with recommendations for future research and ten clinical recommendations for practitioners.
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Perrin JM, Coury DL, Hyman SL, Cole L, Reynolds AM, Clemons T. Complementary and alternative medicine use in a large pediatric autism sample. Pediatrics 2012; 130 Suppl 2:S77-82. [PMID: 23118257 DOI: 10.1542/peds.2012-0900e] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Children and adolescents with autism spectrum disorder (ASD) often use complementary and alternative medicine (CAM), usually along with other medical care. This study aimed to determine associations of ASD diagnostic category, co-existing conditions, and use of medications with use of CAM. METHODS We used the Autism Speaks Autism Treatment Network patient registry, which collects information on CAM use, medical conditions, and psychotropic medication at enrollment. CAM was categorized as special diets versus "other" CAM; ASD was defined as autism, pervasive developmental disorder (PDD), or Asperger's. Gastrointestinal symptoms, seizure disorders, sleep problems, and medication use were determined from parent report. Child Behavior Checklist (CBCL) scores were used to measure behavioral symptoms. Logistic regression was used to determine associations of diagnostic category, other medical conditions, and medication use with CAM treatments, controlling for demographic characteristics. RESULTS Of 3413 subjects in the registry as of April 2011, 3173 had complete data on CAM use: 896 (28%) reported any use; 548 (17%), special diets; and 643 (20%), other CAM. Higher rates of CAM use were associated with gastrointestinal symptoms (odds ratio [OR] = 1.88), seizures (OR = 1.58), and CBCL total score >70 (OR = 1.29). Children with PDD (OR = 0.62), Asperger's (OR = 0.66), or using medications (0.69) had lower rates. CONCLUSIONS Children with ASD use more CAM when they have co-existing gastrointestinal symptoms, seizure disorders, and behavior problems. This study suggests the importance of asking about CAM use in children with ASD, especially those with complex symptoms.
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Affiliation(s)
- James M Perrin
- Department of Pediatrics, Harvard Medical School, MassGeneral Hospital for Children, 100 Cambridge St, #1542, Boston, MA 02114, USA.
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Bregman JD. Evidence-based integrated treatment in autism spectrum disorders. J Am Acad Child Adolesc Psychiatry 2012; 51:1113-5. [PMID: 23101737 DOI: 10.1016/j.jaac.2012.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022]
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Abstract
OBJECTIVE Fractures and pain, secondary to low bone mineral density (BMD), have been reported in pediatric patients with autistic spectrum disorders (ASD). The purpose of this study was to assess the BMD of a clinical sample of 10- to 18-year olds with ASD, and the nutrition and physical activity correlates of skeletal health in this population. METHODS Twenty-six patients with ASD were recruited from an outpatient multidisciplinary child-development clinic. Lumbar bone density was measured using dual-energy x-ray absorptiometry. Data collection included anthropometries, serum nutrient levels, parent interview, and 72-hour diet, screen-time, and physical activity records. RESULTS Four patients (15%) met criteria for pediatric low BMD with z scores less than or equal to -2.0; another 4 were at risk with z scores less than or equal to -1.0. Approximately 54% of participants had insufficient serum 25-hydroxy vitamin D. Mean electronic media use was 251 minutes/day; mean physical activity 69 minutes/day. Fewer than 50% of participants met daily reference intake of vitamins A, B3, D, E, K, zinc, calcium, folate, potassium, and fiber. Bone density correlated positively with body mass (r = .47), calcium intake (r = .46), and calorie intake (r = .58). CONCLUSIONS Children aged 10 to 18 years old with ASD are at risk for occult low bone density. In this study, those with low body mass index and insufficient calcium and calorie intake were at greater risk. Other unhealthy behaviors in this population included a high screen-time to physical activity ratio and multiple nutrient deficiencies.
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Abstract
The prevalence of autism spectrum disorder (ASD) has increased considerably in the past decades. The primary care paediatrician plays an important role not only in the early recognition of ASD but also in its chronic management. Paediatricians need to be comfortable with the global care of children with ASD. The diagnostic assessment of children with ASD comprises the medical investigations to identify associated or underlying medical conditions. The most important associated conditions are seizures, feeding and gastrointestinal problems, sleep disturbances and dental abnormalities. The care of ASD patients is very demanding since along with the purely medical issues there are challenging behavioural and psychiatric conditions that need consideration and professional skills.
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Périsse D, Guinchat V, Hellings J, Baghdadli A. Traitement pharmacologique des comportements problématiques associés aux troubles du spectre autistique : revue de la littérature. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.neurenf.2011.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hampson DR, Gholizadeh S, Pacey LKK. Pathways to Drug Development for Autism Spectrum Disorders. Clin Pharmacol Ther 2011; 91:189-200. [DOI: 10.1038/clpt.2011.245] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Anagnostou E, Hansen R. Medical treatment overview: traditional and novel psycho-pharmacological and complementary and alternative medications. Curr Opin Pediatr 2011; 23:621-7. [PMID: 22001766 PMCID: PMC4871706 DOI: 10.1097/mop.0b013e32834cba3e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Up to 35% of children and youth with autism spectrum disorder (ASD) receive at least one psychotropic medication. 50-70% of this population also receives biologically based complementary and alternative medicine (CAM). The data evaluating such practices are being reviewed. RECENT FINDINGS There are accumulating data to suggest that atypical antipsychotics and stimulants may be useful for the treatment of irritability and hyperactivity in children and youth with ASD. The data for the use of selective serotonin reuptake inhibitors are less promising. New avenues of pharmacologic research targeting molecular targets identified by genomics, animal models and neuropathology are being evaluated. Areas of interest include glutamate/gamma-aminobutyric acid systems, neuropeptides such as oxytocin, and immune dysfunction, among others. In the case of biologically based CAM, a few compounds have been shown to be well tolerated, although efficacy is still being evaluated, such as melatonin, certain vitamins, and omega 3 fatty acids. Others have safety concerns without demonstrated efficacy, such as chelation therapies. SUMMARY Accumulating data suggest a series of existing medications may be useful in ASD and large randomized clinical trials are necessary to evaluate safety and efficacy of both pharmaceuticals and alternative treatments.
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Affiliation(s)
- Evdokia Anagnostou
- Bloorview Research Institute, Department of Pediatrics, University of Toronto, 555 University Avenue, Toronto, Canada.
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Frazier TW, Shattuck PT, Narendorf SC, Cooper BP, Wagner M, Spitznagel EL. Prevalence and correlates of psychotropic medication use in adolescents with an autism spectrum disorder with and without caregiver-reported attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2011; 21:571-9. [PMID: 22166171 PMCID: PMC3279713 DOI: 10.1089/cap.2011.0057] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Many youths with an autism spectrum disorder (ASD) benefit from psychotropic medication treatment of co-morbid symptom patterns consistent with attention-deficit/hyperactivity disorder (ADHD). The lack of clear indications and algorithms to direct clinical practice has led to a very poor understanding of overall medication use for these youths. The present study examined the prevalence of psychotropic medication use compared across individuals with an ASD without a caregiver-reported ADHD diagnosis (ASD-only), ADHD without ASD (ADHD-only), and an ASD with co-morbid ADHD (ASD+ADHD). Correlates of medication use were also examined. METHODS Data on psychotropic medication from the first wave of the National Longitudinal Transition Study 2, a nationally representative study of adolescents ages 13-17 in special education, were used to compare the prevalence of medication use across the three groups, overall and by class. Separate logistic regression models were constructed for each group to examine the correlates of psychotropic medication use. Poisson regression models were used to examine correlates of the number of medications. RESULTS Youths with ASD+ADHD had the highest rates of use (58.2%), followed by youths with ADHD-only (49.0%) and youths with ASD-only (34.3%). Youths with an ASD, both ASD-only and ASD+ADHD, used medications across a variety of medication classes, whereas stimulants were dominant among youths with ADHD-only. African American youths with ASD-only and with ASD+ADHD were less likely to receive medication than white youths, whereas race was not associated with medication use in the ADHD-only group. CONCLUSIONS Clearer practice parameters for ADHD have likely contributed to more consistency in treatment, whereas treatment for ASD reflects a trial and error approach based on associated symptom patterns. Additional studies examining the treatment of core and associated ASD symptoms are needed to guide pharmacologic treatment of these youths. Interventions targeting African American youths with ASD and the physicians who serve them are also warranted.
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Affiliation(s)
- Thomas W Frazier
- Center for Autism and Center for Pediatric Behavioral Health, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Hampson DR, Adusei DC, Pacey LKK. The neurochemical basis for the treatment of autism spectrum disorders and Fragile X Syndrome. Biochem Pharmacol 2011; 81:1078-86. [PMID: 21333634 DOI: 10.1016/j.bcp.2011.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 01/29/2023]
Abstract
Autism spectrum disorders (ASD) and Fragile X Syndrome (FXS) are neurodevelopmental disorders that share overlapping behavioral characteristics. While FXS is known to result from a specific genetic mutation, the causes of the majority of cases of ASD are unknown. Animal models of FXS have revealed new insight into the cellular and biochemical changes that occur in the central nervous system in this disorder, while human genetic studies on individuals with autism have identified sets of genes that may increase susceptibility to the disorder. Together these discoveries suggest overlapping biochemical characteristics and reveal new directions for the potential development of pharmacological therapies that might prove useful in the treatment of both FXS and ASD. In particular, delayed synaptic maturation, abnormal synaptic structure and/or function and alterations in intracellular signaling pathways have been linked to the pathogenesis of FXS and ASD. Aberrations in GABA(A) receptor ion channels and the G-protein coupled metabotropic glutamate and GABA(B) transmitter systems are also linked to both disorders and these receptors are currently at the forefront of preclinical and clinical research into treatments for both autism and Fragile X Syndrome.
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Affiliation(s)
- David R Hampson
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Toronto, Toronto, Ontario M5S3M2, Canada.
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