While the FDA has not approved any medications for the treatment of autism, physicians commonly prescribe a variety of drugs for the management of specific severe symptoms that have not responded to other treatments, such as repetitive self-injurious behaviors. The selection of which medications may be effective for each behavior is made on largely theoretical grounds and based on our understanding of the drugs. For example, I recently talked about the use of Mirtazapine in treating public masturbation among adolescents with Aspergers. Mirtazapine was selected because of its known ability to reduce libido. The study I discussed provided preliminary evidence about its effectiveness.

Antidepressant medications, and especially selective serotonin reuptake inhibitors (SSRIs)  are one of the most common class of drugs used in the treatment of severe autism symptoms, especially repetitive behaviors. The rationale is partly that SSRIs are found effective in treating the type of repetitive behaviors observed in obsessive compulsive disorders. Thus, at least theoretically, SSRIs should be effective in the treatment of repetitive behaviors in autism. Yet, while there is some evidence that these medications work with adults with autism, the evidence for their effectiveness in children is still lacking. Read More

Diagnostic Substitution is one of the factors that have been proposed as a cause, or at least a contributing source, of the dramatic increases in autism observed during the last 10-15 years. The basic idea behind diagnostic substitution is that children that today receive a diagnosis of Autism, would have received a different diagnosis 20 years ago. Thus, the theory would suggest that there has not been an actual increase in the number of children affected, but instead simply a shift in the way conditions are classified.

Evidence for and against diagnostic substitution continue to accumulate. For example, last year I commented on a study showing that some adults that were diagnosed with pragmatic language impairment during their childhood actually meet diagnostic criteria for autism. But in an upcoming issue of the Journal of Autism and Developmental Disabilities, researchers from the California Department of Public Health report the findings of an examination in diagnostic coding practices in California during the past 20 years. Read More

Association for Psychological Science week

This past weekend I attended the Annual Convention of the Association for Psychological Science (APS). I attended several presentations on studies examining various aspects of child development and child disorders I decided to dedicate this week to several exciting preliminary studies presented at the convention.

Guest blogger and speech pathologist Nicole Hess recently commented on the use of gestures in pre-verbal babies. Specifically, she addressed the myth that using signing with preverbal babies affects the speech development of these children. At the APS Convention, a group of researchers from the University of Virginia presented a study that examined the association between gesture imitation and language development in Autism. Read More

The Autism Diagnostic Observation Schedule (The ADOS) is a diagnostic instrument that was created by the University of Michigan Professor Dr. Kathy Lord. During the last 2 decades, the ADOS has become the most accepted diagnostic tool for autism spectrum disorders. The ADOS has 4 different overlapping ‘versions’ (or modules) that were designed to be used with individuals of various ages and abilities – including non-verbal individuals. However, the original ADOS is not very useful in the diagnosis of children under the age of 3. For these children, the ADOS is not specific enough. That is, it incorrectly identifies ASD in many children who actually have a non-ASD developmental delays.

But why do we need an autism diagnostic instrument for children under 3? Read More

FOCUS ON AUTISM WEDNESDAY:

When conducting assessments with individuals with autism or other developmental disorders clinicians are often interested in examining the person’s  “adaptive functioning” or how the person actually functions in every day life, usually in specific domains such as communication, sociability, motor functioning, and daily living skills. Clinicians and researchers are also interested in exploring the factors that predict adaptive functioning. One obvious candidate factor is cognitive capacity, or IQ.  It is expected that the more cognitive skills you have, the better you would do in daily living demands. However, researchers have shown that for individuals with high functioning autism, cognitive functioning is not always correlated with adaptive functioning. That is, some individuals may present cognitive skills that are within normal levels, yet display impaired adaptive functioning. Yet, less is known about the relationship between cognitive functioning and adaptive skills among children with more severe autism. For example, do children with low cognitive skills present even lower adaptive functioning or do these kids show higher adaptive functioning than expected based on their cognitive skills? Knowing this information could have implications for treatment, especially for the manner we use cognitive skills as a proxy for prognosis and to guide expectations. Read More