Autism spectrum disorder: examining treatment controversies and intervention effectiveness

AUTISM 'CURES' AND TREATMENT CONTROVERSIES

Autism Cures and Treatment Controversies

Autism 'Cures' and Treatment Controversies

Autism 'Cures' and Treatment Controversies

Autism Spectrum Disorder (ASD) encompasses classical autism, Asperger syndrome, and progressive developmental disorder -- not otherwise specified (PDD-NOS) (Leonard et al., 2010, p. 548-550). Classical or typical autism represents the most severe and common of the ASD disorders, of which the main symptoms are social, attention, and behavioral deficits (Betancur, 2011, p. 43). Intellectual impairment and epilepsy are also common comorbid conditions and are present in 70% and 25% of autistic individuals, respectively.

ASD is primarily a genetic disease and approximately 90% of all cases can be thus explained (Holt and Monaco, 2011, p. 438). The risk of both monozygotic twins developing autism, who have a family history, is between 30% and 60%, but for siblings the risk is much smaller and depends on how carefully they are screened for ASD symptoms. The other known causes or risk factors are being male (4-fold), experiencing a difficult/abnormal gestation and/or labor, and spontaneous germline genetic mutations. Although the prevalence of autism is determined to a large extent by genetic susceptibility factors, of which there are many acting in complex and unknown ways, there is evidence to suggest effective interventions do exist.

Pharmaceutical Interventions

Only one prescription medication has been FDA approved for treating ASD and this is the antipsychotic medication risperidone for irritability (Rossignol, 2009, p. 213). The use of any others are generally provided 'off-label' for non-FDA-approved uses and confined to treating the symptoms associated with ASD. What is most troubling about using medications off-label is that the short-term and long-term benefits are usually unknown, especially in children, and the risk of side effects generally high.

A retrospective analysis of all known or suspected pharmaceutical treatments for ASD was performed recently and each was graded on the quality of research performed (Rossignol, 2009). The most promising treatments that were supported by well-controlled studies include melatonin, vitamin C, acetylcholinesterase inhibitors (rivastigmine, donepezil, galantine), and naltrexone. Melatonin seems to be well tolerated and one study showed improved sleep in 80% of the children studied. Vitamin C significantly reduced repetitive behaviors in a small group of children and had no adverse effects. The advantages of acetylcholinesterase inhibitors were a decrease in the severity of autistic symptoms, but the adverse side effects were sometimes significant and included nausea, diarrhea, irritability, and hyperactivity. Naltrexone also reduced the severity of symptoms and