The treatment is usually carried out by a team of specialists, according to the results of recent studies, data have been obtained that attest to a certain degree of advantages in the use of intensive behavioral therapy, which stimulates interaction and expressive communication. Psychologists and educators, as a rule, concentrate on behavioral analysis, and then lead the strategy of behavioral treatment in accordance with specific behavioral problems at home and at school. Speech therapy should start early and use a number of activities such as singing, sharing pictures and talking. Physiotherapists and occupational therapists plan and apply strategies to help children to compensate for certain deficiencies in motor function and movement planning. Selective serotonin reuptake inhibitors (SSRIs) can improve control over behavior with rituals and repetitive stereotyped behavior. Antipsychotic drugs and mood stabilizers, such as valproate, can help control self-injurious behavior.
Treatment of autism, as well as treatment of mental retardation, requires a set of effects aimed at correcting various aspects of the patient's life: social, educational, psychiatric and behavioral. Some experts consider behavioral therapy as the main component of the treatment of autism. To date, more than 250 studies have evaluated the effectiveness of various behavioral therapy techniques. The "targets" to which behavioral therapy should be directed can be divided into several categories - inadequate behavior, social skills, speech, domestic skills, academic skills. To solve each of these problems, special methods are used. For example, inadequate behavior can be subjected to functional analysis to identify predisposing external factors to which psychotherapeutic intervention should be directed. Behavioral techniques can be based on positive or negative reinforcement with the effect of suppression. Other therapeutic approaches, such as functional communication and occupational therapy, can reduce symptoms and improve the quality of life of children with autism. Nevertheless, symptoms that are not directly associated with external factors or relatively independent of external conditions are often observed. Similar symptoms may respond better to pharmacotherapeutic intervention. The use of psychotropic drugs in autism involves a thorough assessment of the clinical status and a clear interaction with other therapies within the framework of an integrated multimodal approach.
When deciding on the appointment of psychotropic drugs, many psychological and family problems associated with the presence of a patient with autism should be taken into account. Carrying out medical treatment, it is necessary to respond in a timely manner to such possible psychological problems as hidden aggression directed against the child, and the insoluble guilt feelings of the parent, unrealistic expectations in connection with the beginning of pharmacotherapy and the desire for a magical cure. In addition, it is important to keep in mind that only a few of the drugs assigned to children with autism have gone through controlled trials. When psychotropic drugs are prescribed to patients with autism, it must be borne in mind that, due to communication difficulties, they are often unable to report side effects, and the discomfort they experience can be expressed in an increase in the pathological behavior to which the treatment is directed. In this regard, when using drugs to control behavior in children with autism, an assessment of the baseline condition and subsequent dynamic observation of symptoms by quantitative or semi-quantitative techniques are necessary, as well as careful monitoring of possible side effects. Since autism is often combined with mental retardation, most scales used for mental retardation can also be used in autism.
Autism and auto-aggressive actions / aggression
- Neuroleptics. Although neuroleptics have a positive effect on hyperactivity, excitation, stereotypes, autism should be used only in the most severe cases of uncontrolled behavior - with a pronounced tendency to self-harm and aggressiveness, resistant to other interventions. This is associated with a high risk of long-term side effects. In controlled studies of the efficacy of trifluoperazine (stelazine), pimozide (orapa), haloperidol in children with autism, it was noted that all three drugs cause extrapyramidal syndromes in this category of patients, including tardive dyskinesia. Risperidone (rispolept), an atypical neuroleptic, and isulpiride, a benzamide derivative, have also been used in children with autism, but with limited success.
Autism and affective disorders
The children with autism often develop marked affective disorders. They are more often observed in those patients with autism and general developmental disorders, in which the intelligence coefficient corresponds to mental retardation. Such patients account for 35% of cases of affective disorders beginning in childhood. Approximately half of these patients in the family history have cases of affective disorder or suicidal attempts. A recent study of relatives of autistic patients noted a high incidence of affective disorders and social phobia. It is suggested that changes in the limbic system, found at autopsy of patients with autism, can cause disturbance in the regulation of the affective state.
- Normotimicheskie means. Lithium was used to treat cyclical manic-like symptoms that occurred in patients with autism, such as decreased sleep demand, hypersexuality, increased motor activity, irritability. Previously conducted controlled studies of lithium drugs in autism did not allow reaching certain conclusions. However, numerous reports indicate a positive effect of lithium on affective symptoms in individuals with autism, especially if they have had a history of affective disorders in their family history.
- Anticonvulsants. Valproic acid (depakin), sodium divalproex (depakot) and carbamazepine (tegretol) are effective in cyclical symptoms of irritability, insomnia and hyperactivity. An open study of valproic acid has shown that it favorably affects behavioral disorders and EEG changes in children with autism. The therapeutic level of concentration of carbamazepine and valproic acid in the blood appeared in the upper part of the concentration range effective for epilepsy, 8-12 μg / ml (for carbamazepine) and 80-100 μg / ml (for valproic acid). When both drugs are used, a clinical blood test should be performed and the liver function tested before treatment and regularly during the treatment. Currently, clinical trials of lamotrigine (lamiktal) - anticonvulsant new generation - as a means of treating behavioral disorders in children with autism. Since approximately 33% of individuals with autism suffer epileptic seizures, it seems reasonable to prescribe anticonvulsants in the presence of EEG changes and epileptiform episodes.
, , , , , , , 
Autism and anxiety
People with autism often experience anxiety in the form of psychomotor agitation, autostimulating actions, signs of distress. It is curious that the study of the immediate relatives of autistic patients showed them a high frequency of social phobia.
- Benzodiazepines. Benzodiazepines were not systematically examined for autism, probably due to fears of excessive sedation, paradoxical arousal, development of tolerance and drug dependence. Clonazepam (antelepsin), which unlike other benzodiazepines, increases the sensitivity of serotonin 5-HT1 receptors, was used in patients with autism to treat anxiety, mania and stereotypy. Lorazepam (merlot) is usually used only in cases of acute arousal. The drug can be administered orally or parenterally.
Buspirone (buspar), a partial agonist of serotonin 5-HT1 receptors, has an anxiolytic effect. However, there is only limited experience with its use in autism.
, , , , ,
Autism and stereotypy
- Selective serotonin reuptake inhibitors. Selective serotonin reuptake inhibitors, such as fluoxetine (Prozac), sertraline (zoloft), fluvoxamine (feravin), paroxetine (paxil), citalopram (cipramil), and a nonselective clomipramine inhibitor may have a positive effect on certain behavioral disorders in patients with autism . Fluoxetine has been reported to be effective in autism. In adults with autism, fluvoxamine in a controlled study reduced the severity of repetitive thoughts and actions, inadequate behavior, aggressiveness, and improved certain aspects of social communication, especially those associated with speech. The effect of fluvoxamine was not correlated with age, severity of autism, or IQ level. The tolerability of fluvoxamine was good, only a few patients had a mild sedative effect and nausea. The use of clomipramine in children is dangerous because of the risk of a cardiotoxic effect with a possible fatal outcome. Neuroleptics (for example, haloperidol) reduce hyperactivity, stereotypes, emotional lability and the degree of social isolation in patients with autism, normalize relationships with other people. However, possible side effects limit the use of these drugs. The antagonist of dopamine receptors amisulpiride reduces the severity of negative symptoms in schizophrenia and may have some positive effects in autism, although controlled studies are needed to confirm this effect. Although efficacy and good tolerability of clozapine in pediatric schizophrenia are noted, this group of patients is significantly different from children with autism, so the question of the effectiveness of clozapine in autism remains open.
Autism and Attention Deficit Hyperactivity Disorder
- Psychostimulants. The effect of psychostimulants on hyperactivity in patients with autism is not as predictable as that of nonautical children. Usually psychostimulants reduce pathological activity in autism, but at the same time can enhance stereotyped and ritual actions. In some cases, psychostimulants cause excitation and aggravate pathological behavior. This often occurs in cases when attention deficit to the interlocutor is taken as a usual disturbance of attention in FEC and tries to treat it accordingly.
- Agonists of alpha-adrenergens. Alpha-adrenergic agonists, such as clonidine (clonidine) and guanfacine (estulik), reduce the activity of the noradrenergic neurons of the blue spot and, therefore, reduce anxiety and hyperactivity. In controlled studies, clonidine in tablet form or in the form of an epidermal patch has proven to be effective in the treatment of hyperactivity and impulsivity in children with autism. However, the sedative effect and the possibility of developing tolerance to the drug limit its use.
- Beta-blockers. Propranolol (anaprilin) may be useful for impulsivity and aggressiveness in children with autism. During treatment, you need to carefully monitor the condition of the cardiovascular system (pulse, blood pressure), especially when the dose is brought to the value that causes the hypotensive effect.
- Opioid receptor antagonists. Naltrexone may have some effect on hyperactivity in autistic children, but it does not affect communicative and cognitive defects.
, , , , , , , , , ,