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Trew S, Russell DH. A Rapid Evidence Assessment on The Effectiveness of Interventions for Autistic Adolescents with Harmful Sexual Behaviors. TRAUMA, VIOLENCE & ABUSE 2024; 25:3149-3163. [PMID: 38551117 PMCID: PMC11370164 DOI: 10.1177/15248380241241024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2024]
Abstract
The management and treatment of harmful sexual behaviors (HSBs) in autistic adolescents is a complex area of research and clinical practice. Autistic adolescents face unique challenges in understanding social and sexual interactions, putting them at a higher risk of engaging in HSBs. Existing research on interventions for HSBs among autistic adults is growing, but evidence for adolescents is not well understood. Thus, understanding the effectiveness of interventions targeting HSBs in autistic adolescents is crucial. We conducted a rapid evidence assessment to review peer-reviewed research on the effectiveness of interventions for autistic adolescents at risk of or engaging in HSBs. In all, 12 studies met the criteria for review. Inclusion criteria required articles to be published in a peer-reviewed journal, be related to HSB prevention and intervention in adolescents aged 12 to 18 with autism spectrum disorder, be written in English, and include original data. Six databases were used, and we screened the titles and abstracts of 34 studies. The reviewed studies described cognitive-behavioral therapy, pharmacological interventions, family involvement, and multidisciplinary team approaches in addressing HSBs. However, the literature has significant limitations and we suggest that the literature is not robust enough to indicate a promising evidence-based approach for interventions for autistic adolescents who are at risk of or who display and engage in HSBs, and the findings are not transferable to practice. Additional research is required to better prepare healthcare professionals for addressing HSBs in autistic adolescents.
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Tampi RR, Tampi DJ, Farheen SA, Ochije SI, Joshi P. Propranolol for the management of behavioural and psychological symptoms of dementia. Drugs Context 2022; 11:2022-8-3. [PMID: 36544625 PMCID: PMC9753600 DOI: 10.7573/dic.2022-8-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022] Open
Abstract
Propranolol is a β-adrenergic antagonist used in the management of hypertension, cardiac arrhythmia, and angina pectoris. There is some evidence that propranolol may benefit individuals with behavioural and psychological symptoms of dementia (BPSD). A total of three case series, one randomized controlled trial and one case report were identified (from a literature search of three major databases: PubMed, Ovid, and Cochrane collaboration) that assessed the use of propranolol for the management of BPSD. From these studies, it appears that propranolol improves BPSD, including agitation and aggression. Propranolol is also well tolerated with no significant bradycardia or hypotension noted in these studies. Current data on the use of propranolol for the management of BPSD are limited in comparison to other pharmacological agents (atypical antipsychotics, antidepressants, acetylcholinesterase inhibitors, memantine, and cannabinoids) and treatment modalities (repetitive transcranial magnetic stimulation and electroconvulsive therapy). The efficacy and safety of these treatments among individuals with BPSD has been evaluated in multiple controlled studies. In clinical practice, the routine use of propranolol among people with BPSD cannot be recommended at this time given the limited data. However, propranolol can be trialled among individuals with BPSD when symptoms have not responded adequately to other medications. Propranolol may also be used prior to embarking on trials of repetitive transcranial magnetic stimulation and electroconvulsive therapy among people with BPSD given the greater acceptance of this medication in the general population.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry, Creighton University School of Medicine, Omaha, NE, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH, USA
| | - Deena J Tampi
- Co-Founder and Managing Principal, Behavioral Health Advisory Group, Princeton, NJ, USA
| | - Syeda Arshiya Farheen
- Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH, USA
| | - Sochima I Ochije
- Department of Psychiatry, Emory University Hospital, Atlanta GA, USA
| | - Pallavi Joshi
- Department of Psychiatry, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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Maggio MG, Calatozzo P, Cerasa A, Pioggia G, Quartarone A, Calabrò RS. Sex and Sexuality in Autism Spectrum Disorders: A Scoping Review on a Neglected but Fundamental Issue. Brain Sci 2022; 12:1427. [PMID: 36358354 PMCID: PMC9688284 DOI: 10.3390/brainsci12111427] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/16/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2023] Open
Abstract
ASD consists of a set of permanent neurodevelopmental conditions, which are studded with social and communication differences, limited interests, and repetitive behaviors. Individuals with ASD have difficulty reading eye gestures and expressions, and may also have stereotyped or repetitive language, excessive adherence to routines, fixed interests, and rigid thinking. However, sexuality in adolescents and young adults with ASD is still a poorly studied and neglected issue. This review aims to evaluate sexual function and behavior in individuals with ASD to foster a greater understanding of this important, although often overlooked, issue. This review was conducted by searching peer-reviewed articles published between 01 June 2000 and 31 May 2022 using the following databases: PubMed, Embase, Cochrane Database, and Web of Science. A comprehensive search was conducted using the terms: "Autism" OR "ASD" AND "Sexuality" OR "Romantic relation" OR "sexual behavior" AND/OR "sexual awareness". After an accurate revision of 214 full manuscripts, 11 articles satisfied the inclusion/exclusion criteria. This review found that, although individuals with ASD may have sexual functioning, their sexuality is characterized by higher prevalence rates of gender dysphoria and inappropriate sexual behavior. Furthermore, sexual awareness is reduced in this patient population, and the prevalence of other variants of sexual orientation (i.e., homosexuality, asexuality, bisexuality, etc.) is higher in adolescents with ASD than in non-autistic peers. Sexual health and education should be included in the care path of patients with ASD in order to improve their quality of life and avoid/reduce inappropriate and risky behaviors.
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Affiliation(s)
- Maria Grazia Maggio
- Department of Biomedical and Biotechnological Science, University of Catania, 95123 Catania, Italy
| | - Patrizia Calatozzo
- Studio di Psicoterapia Relazionale e Riabilitazione Cognitiva, 98124 Messina, Italy
| | - Antonio Cerasa
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), 98164 Messina, Italy
- Sant’Anna Institute, 88900 Crotone, Italy
- Pharmacotechnology Documention and Transfer Unit, Preclinical and Traslation Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Calabria, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), 98164 Messina, Italy
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Szeleszczuk Ł, Frączkowski D. Propranolol versus Other Selected Drugs in the Treatment of Various Types of Anxiety or Stress, with Particular Reference to Stage Fright and Post-Traumatic Stress Disorder. Int J Mol Sci 2022; 23:10099. [PMID: 36077489 PMCID: PMC9456064 DOI: 10.3390/ijms231710099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/21/2022] Open
Abstract
Propranolol, a non-cardioselective β1,2 blocker, is most commonly recognised for its application in the therapy of various cardiovascular conditions, such as hypertension, coronary artery disease, and tachyarrhythmias. However, due to its ability to cross the blood-brain barrier and affinity towards multiple macromolecules, not only adrenoreceptors, it has also found application in other fields. For example, it is one of the very few medications successfully applied in the treatment of stage fright. This review focuses on the application of propranolol in the treatment of various types of anxiety and stress, with particular reference to stage fright and post-traumatic stress disorder (PTSD). Both mechanisms of action as well as comparison with other therapies are presented. As those indications for propranolol are, in most countries, considered off-label, this review aims to gather information that can be useful while making a decision about the choice of propranolol as a drug in the treatment of those mental conditions.
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Affiliation(s)
- Łukasz Szeleszczuk
- Department of Physical Chemistry, Chair and Department of Physical Pharmacy and Bioanalysis, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1 Street, 02-093 Warsaw, Poland
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Adjuvant Therapy With β-Adrenergic Blockers in Psychiatry. Am J Ther 2020; 28:e697-e701. [PMID: 31939749 DOI: 10.1097/mjt.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stark R, Klucken T, Potenza MN, Brand M, Strahler J. A Current Understanding of the Behavioral Neuroscience of Compulsive Sexual Behavior Disorder and Problematic Pornography Use. Curr Behav Neurosci Rep 2018. [DOI: 10.1007/s40473-018-0162-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Schöttle D, Briken P, Tüscher O, Turner D. Sexuality in autism: hypersexual and paraphilic behavior in women and men with high-functioning autism spectrum disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2018. [PMID: 29398933 PMCID: PMC5789215 DOI: 10.31887/dcns.2017.19.4/dschoettle] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Like nonaffected adults, individuals with autism spectrum disorders (ASDs) show the entire range of sexual behaviors. However, due to the core symptoms of the disorder spectrum, including deficits in social skills, sensory hypo- and hypersensitivities, and repetitive behaviors, some ASD individuals might develop quantitatively above-average or nonnormative sexual behaviors and interests. After reviewing the relevant literature on sexuality in high-functioning ASD individuals, we present novel findings on the frequency of normal sexual behaviors and those about the assessment of hypersexual and paraphilic fantasies and behaviors in ASD individuals from our own study. Individuals with ASD seem to have more hypersexual and paraphilic fantasies and behaviors than general-population studies suggest. However, this inconsistency is mainly driven by the observations for male participants with ASD. This could be due to the fact that women with ASD are usually more socially adapted and show less ASD symptomatology. The peculiarities in sexual behaviors in ASD patients should be considered both for sexual education and in therapeutic approaches.
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Affiliation(s)
- Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Daniel Turner
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ; Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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Frye RE. Social Skills Deficits in Autism Spectrum Disorder: Potential Biological Origins and Progress in Developing Therapeutic Agents. CNS Drugs 2018; 32:713-734. [PMID: 30105528 PMCID: PMC6105175 DOI: 10.1007/s40263-018-0556-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Autism spectrum disorder is defined by two core symptoms: a deficit in social communication and the presence of repetitive behaviors and/or restricted interests. Currently, there is no US Food and Drug Administration-approved drug for these core symptoms. This article reviews the biological origins of the social function deficit associated with autism spectrum disorder and the drug therapies with the potential to treat this deficit. A review of the history of autism demonstrates that a deficit in social interaction has been the defining feature of the concept of autism from its conception. Abnormalities identified in early social skill development and an overview of the pathophysiology abnormalities associated with autism spectrum disorder are discussed as are the abnormalities in brain circuits associated with the social function deficit. Previous and ongoing clinical trials examining agents that have the potential to improve social deficits associated with autism spectrum disorder are discussed in detail. This discussion reveals that agents such as oxytocin and propranolol are particularly promising and undergoing active investigation, while other agents such as vasopressin agonists and antagonists are being activity investigated but have limited published evidence at this time. In addition, agents such as bumetanide and manipulation of the enteric microbiome using microbiota transfer therapy appear to have promising effects on core autism spectrum disorder symptoms including social function. Other pertinent issues associated with developing treatments in autism spectrum disorder, such as disease heterogeneity, high placebo response rates, trial design, and the most appropriate way of assessing effects on social skills (outcome measures), are also discussed.
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Affiliation(s)
- Richard E Frye
- Division of Neurodevelopmental Disorders, Department of Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, 1919 E Thomas St, Phoenix, AZ, 85016, USA.
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, 85004, USA.
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Sagar-Ouriaghli I, Lievesley K, Santosh PJ. Propranolol for treating emotional, behavioural, autonomic dysregulation in children and adolescents with autism spectrum disorders. J Psychopharmacol 2018; 32:641-653. [PMID: 29484909 DOI: 10.1177/0269881118756245] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To date, there is no single medication prescribed to alleviate all the core symptoms of Autism Spectrum Disorder (ASD; National Institute of Health and Care Excellence, 2016). Both serotonin reuptake inhibitors and drugs for psychosis possess therapeutic drawbacks when managing anxiety and aggression in ASD. This review sought to appraise the use of propranolol as a pharmacological alternative when managing emotional, behavioural and autonomic dysregulation (EBAD) and other symptoms. MATERIALS AND METHODS Sixteen reports examined the administration of propranolol in the context of ASD. RESULTS Sixteen reports broadly covered cognitive domains, neural correlates, and behavioural domains. From the eight single-dose clinical trials, propranolol led to significant improvements in cognitive performance - verbal problem solving, social skills, mouth fixation, and conversation reciprocity; and changes in neural correlates - improvement in semantic networks and functional connectivity. The remaining eight case series and single case reports showed improvements in EBAD, anxiety, aggressive, self-injurious and hypersexual behaviours. Additionally, propranolol significantly improved similar behavioural domains (aggression and self-injury) for those with acquired brain injury. CONCLUSION This review indicates that propranolol holds promise for EBAD and cognitive performance in ASD. Given the lack of good quality clinical trials, randomised controlled trials are warranted to explore the efficacy of propranolol in managing EBAD in ASD.
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Affiliation(s)
| | - Kate Lievesley
- 1 Department of Child and Adolescent Psychiatry, King's College London, UK.,3 HealthTracker Ltd., Gillingham, UK
| | - Paramala J Santosh
- 1 Department of Child and Adolescent Psychiatry, King's College London, UK.,2 Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, UK.,3 HealthTracker Ltd., Gillingham, UK
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Frye RE, Wynne R, Rose S, Slattery J, Delhey L, Tippett M, Kahler SG, Bennuri SC, Melnyk S, Sequeira JM, Quadros EV. Thyroid dysfunction in children with autism spectrum disorder is associated with folate receptor α autoimmune disorder. J Neuroendocrinol 2017; 29. [PMID: 28199771 DOI: 10.1111/jne.12461] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 12/11/2022]
Abstract
Folate receptor α (FRα) autoantibodies (FRAAs) are prevalent in autism spectrum disorder (ASD). FRAAs disrupt folate transport across the blood-brain barrier by binding to the FRα. Thyroid dysfunction is frequently found in children with ASD. We measured blocking and binding FRAAs and thyroid-stimulating hormone (TSH), free thyroxine (T4) (FT4), total triiodothyronine (T3) (TT3), reverse T3 (rT3), thyroid-releasing hormone (TRH) and other metabolites in 87 children with ASD, 84 of whom also underwent behaviour and cognition testing and in 42 of whom FRAAs, TSH and FT4 were measured at two time points. To better understand the significance of the FRα in relation to thyroid development, we examined FRα expression on prenatal and postnatal thyroid. TSH, TT3 and rT3 were above the normal range in 7%, 33% and 51% of the participants and TRH was below the normal range in 13% of the participants. FT4 was rarely outside the normal range. TSH concentration was positively and the FT4/TSH, TT3/TSH and rT3/TSH ratios were inversely related to blocking FRAA titres. On repeated measurements, changes in TSH and FT4/TSH ratio were found to correspond to changes in blocking FRAA titres. TSH and the FT4/TSH, TT3/TSH and rT3/TSH ratios were related to irritability on the Aberrant Behavior Checklist and several scales of the Social Responsiveness Scale (SRS), whereas TT3 was associated with SRS subscales and TRH was related to Vineland Adaptive Behavior Scale subscales. The thyroid showed significant FRα expression during the early prenatal period, although expression decreased significantly in later gestation and postnatal thyroid tissue. The results of the present study suggest that thyroid dysfunction in ASD may be related to blocking FRAA. The high expression of FRα in the early foetal thyroid suggests that foetal and neonatal exposure to maternal FRAAs could affect the development of the thyroid and may contribute to the pathology in ASD.
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Affiliation(s)
- R E Frye
- Department of Pediatrics, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R Wynne
- Department of Pediatrics, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Rose
- Department of Pediatrics, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Slattery
- Department of Pediatrics, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - L Delhey
- Department of Pediatrics, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Tippett
- Department of Pediatrics, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S G Kahler
- Department of Pediatrics, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S C Bennuri
- Department of Pediatrics, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Melnyk
- Department of Pediatrics, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J M Sequeira
- Department of Medicine, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
| | - E V Quadros
- Department of Medicine, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
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Coshway L, Broussard J, Acharya K, Fried K, Msall ME, Lantos JD, Nahata L. Medical Therapy for Inappropriate Sexual Behaviors in a Teen With Autism Spectrum Disorder. Pediatrics 2016; 137:peds.2015-4366. [PMID: 26936858 DOI: 10.1542/peds.2015-4366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 11/24/2022] Open
Abstract
Teens with autism spectrum disorder often exhibit sexual behaviors in public that are disturbing to parents, teachers, and peers. Some have proposed that such behaviors can be curtailed with hormonal suppression. There is information on the Internet suggesting that such medications work, and some reports in the peer-reviewed medical literature support these claims. Such medications can have serious side effects. In this paper, we present a case in which parents requested such treatment of their teenage son with autism spectrum disorder.
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Affiliation(s)
- Loyal Coshway
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio
| | - Julia Broussard
- Children's Mercy Hospital-Kansas City, Kansas City, Missouri
| | - Kruti Acharya
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, Illinois
| | - Karen Fried
- Advocate Health Care System, Chicago, Illinois; and
| | | | - John D Lantos
- Children's Mercy Hospital-Kansas City, Kansas City, Missouri;
| | - Leena Nahata
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio
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Fosdick C, Mohiuddin S. Case Report: Resolution of Severe Sexual Aggression in a Developmentally Disabled Adolescent During Leuprolide Acetate Use. J Autism Dev Disord 2016; 46:2267-2269. [DOI: 10.1007/s10803-016-2739-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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