Autism – Pearls

– poor eye contact
– poor appreciation for humor, sarcasm
– need for predictability, organization
– idiosyncratic behaviors
Goals of treatment:  maximize function, work toward independence, improve QOL, assist family in long-term planning/goals, improve social function, communication, negative behaviors, academic function.
Why do we screen:  Early intervention seems to improve ability to mobilize local resources
There is no single treatment for autism spectrum disorders.
Early intervention, however, does affect behaviors, communication, functional skills and socialization
Oxytocin:  clinical trials show it improved social, emotional and behavioral issues, tested in young children with autism.
 – nasal spray, first study in Australia in 2015, published in Molecular Psychiatry
 – side-effects constipation, thirst
Other medical therapies, usually focused at non-core symptoms such as:
 – ADHD:  methylphenidate, atomoxetine, alpha-agonists (often on twice-daily dosing to avoid dysregulation at home)
 – anxiety, depression:  SSRIs, SNRIs
 – aggression, self-injury:  risperidone, aripiprazole; may consider SSRI, alpha-agonists if aggression secondary to anxiety, ADHD.
 – repetitive behaviors:  SSRIs, ?NAC (N-acetyl cysteine – takes pretty high doses, 1200-1800mg a day)
 – dysregulated mood:  atypical antipsychotic or SSRI
 – insomnia:  melatonin and other sleep meds – avoid zolpidem and other members of the class because they’ll cause parasomnias
Under 3 yo:  refer to Child Find, a multi-assessment and multi-intervention resource
 – have to have failed 2 sections on Ages & Stages, or MCHAT
 – can also refer to OT/PT if higher functioning
 – Strive:  in-home OT/PT, working on getting them into preschool by age 3
 – > 3 yo:  school based programs, services through the school district
 – Audissey:  local autism diagnostic resource, but overwhelmed – not taking anyone over age 7
 – Child Development Unit at Children’s Hospital – also has a 9 mo waiting list

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