Drugs Used in Autism and Other Neurological diseases Dr. Yieldez Bassiouni

Autism Spectrum Disorder The term “spectrum” refers to the wide range of symptoms, skills, and levels of impairment or disability that children with ASD can have. Some children are mildly impaired by their symptoms, while others are severely disabled ASD affect three different areas of a child's life:  Social interaction  Communication -- both verbal and non verbal  Behaviors and interests

Autistic Disorders  Autism is a complex developmental disability  appears during the first 3 years of life  a neurological disorder that affects social interaction and communication skills

What is Autism?  It is not a mental illness  Children and adults with autism have difficulties in social interactions, and leisure or play activities  In some cases, aggressive and/or self-injurious behaviors might be present

Symptoms of children with autism CommunicationSocial relationships  Act as if unaware of the coming and going of others  Are inaccessible, as if in a shell  Fail to seek comfort  Fail to develop relationships with peers Exploration of Environment  Remain fixated on a single item or activity  Are intensely preoccupied with a single subject, activity or gesture  Show distress over change  Insist on routine & Lack fear  Avoid eye contact  Act as if deaf  Develop language, then abruptly stop talking

Etiology No specific known cause, cause is likely multifactorial Neurobiological disorder Genetic influences are the most important risk factor possibly many gene mutations are likely to affect a person's risk. Autism may run in families, but not in a clear-cut way Environmental influences play a role Vaccines: Thimerosal – a preservative containing mercury used in MMR vaccine

Treatment of Autism

Autism therapies No single treatment is best, and treatment is typically tailored to the child's needs. Treatments fall into two major categories: educational interventions and medical management

Treatment of Autism Educational interventions Medical management

Parent-mediated interventions

Operate on “Their Time” Twice as much time, half as much done = A successful day Avoid rushing!

Balance the Agenda Incorporate a balance of low -stress, high-pleasure activities Include “stress-free” time in the schedule.

Floor Time Floor Time is simply the idea that a child’s communication skills can be improved by building on his/her strengths while playing together on the floor.Floor Time is simply the idea that a child’s communication skills can be improved by building on his/her strengths while playing together on the floor.

3- First/Then

4. Set the Tone Speak in a calm, relaxed voice Give facts in an unemotional tone of voice

7. Arrange schedules from top to bottom or left to right

Increase opportunities to engage in activities of high interests Allow individual work Schedule for activities individual enjoys –computer –reading –drawing

Music Therapy & Robota  Includes singing, movement to music, and playing instruments.  Autistic boy playing with Robota.

Treatment - Medical Children with autism commonly have dysfunctions of the following systems: –Digestive –Immune system –Excretory (liver, kidneys, systems that rid body of toxins/wastes) When these systems are treated, the autism also seems to be treated and behavior improves

Treating Anxiety and Depression SSRIs are prescribed for anxiety, depression, obsessive-compulsive disorder. Of these only fluoxetine has been approved for both OCD and depression in children age 7 and older. Sertraline Clomipramine

Treating Behavioral Problems Medications are often used to treat behavioral problems, such as aggression, self-injurious behavior, Antipsychotic medications ( dopamine activity in the brain) Some of the newer "atypical" antipsychotics may be a better choice, particularly for children Risperidone, Olanzapine Older antipsychotics; haloperidol for treatment of serious behavioral problems

Treating Seizures One in four people with ASD also have a seizure disorder they are treated with anticonvulsants such as carbamazepine, valproic acid, lamotrigine

Treating Inattention and Hyperactivity Stimulant medications such as methylphenidate used in ADH disorder for children with autism These medications may decrease impulsivity and hyperactivity in some hyperactive children

The drugs most commonly used in autism * Antipsychotics * Antidepressants * Stimulants * Opiate antagonists * Benzodiazepines * Alpha-2-noradrenergic agonists * Beta-blockers

Atypical Antipsychotics Block D2 and serotonin receptors Risperidone is approved by the Food and Drug Administration (FDA) for treating symptomatic irritability in autistic children and adolescents More useful in children suffering from severe and chronic autism Adverse effects: weigh gain and high blood sugar Risperidone

Typical Antipsychotics Blocks postsynaptic dopamine receptors (D2) Improves withdrawal, hyperactivity, deviant speech Side effects;  weight gain  Parkinsonism  Sedation (dose- dependent) Haloperidol

Tricylcic antidepressants Sedative, reduces aggression Relieves many of the symptoms of autism Patients' ability to interact with others is much improved Improves obsessive-compulsive behaviors Clomipramine

Selective Serotonin Reuptake Inhibit ors –Fluoxetine Blocks serotonin re-uptake Improves language, cognition, mood, compulsive symptoms Possible decrease in appetite, restlessness, anorexia, insomnia Children are less responsive

Atypical antidepressants Is a potent inhibitor of serotonin reuptake and at higher doses is an inhibitor of NE reuptake Improves attention and communication Decreases hyperactivity Side effects; nausea, headache, BP, HR Venlafaxine

Stimulants –A psychostimulant similar to amphetamine – It is one of the most prescribed drug in children with attention deficient hyperactivity disorders (ADHD) –Methylphenidate acts as a dopamine and norepinephrine reuptake inhibitor, which increases the levels of these neurotransmitters in the brain. Methyl phenidate

Opiate Antagonists –Blocks the activity of endogenous opiate system in the CNS –FDA-approved for treatment of alcohol and opioid addictions – can be used in Rx of autism ; causes less aggression and hyperactivity, more sociability, more communication –Side effects; mild sedation and GIT upset Naltrexone

Sedative hypnotics –Diazepam and lorazepam –Potentiate the action of the inhibitory neurotransmitter GABA to stabilize and decrease firing of neurons –Treat explosiveness and aggression which accompanies autism –Side effects; sedation, tolerance and dependence

Alpha-2-Noradrenergic Agonist –Pre-synaptic receptor agonist –Improvement in hyperactivity, inattention, irritability and inappropriate speech –Side effects; sedation, decrease in blood pressure and tolerance to therapeutic effects Clonidine

Beta-Blockers Propranolol (Beta blcker) –Affects the noradrenergic transmission –Decrease impulsive and aggressive behavior –Decrease in self-injurious behavior –Side effects: drop in BP and bradycardia

Vitamins and nutritional supplements Pyridoxine (vitamin B6) Magnesium Vitamin C Immune System Support Insomnia: Melatonin

Best wishes