A couple of months ago Newsweek magazine published an article questioning the science of mental health services, and in particular, clinical psychology. The article was based on an opinion piece published in the journal of the Association for Psychological Science, in which a team of clinical scientists promoted a new accreditation system for clinical psychology doctoral program, which would ensure that future clinical psychologists are trained as scientists who base their clinical decisions on scientific evidence rather than perceived ‘clinical expertise,’ ideology, or tradition. Some of you may have assumed that therapists practice within specific empirically supported guidelines.  Unfortunately this is not the case. Clinical psychologists, social workers, and other therapists have been notoriously resistant, and often hostile, to the adoption of new intervention modalities in response to scientific advances. In fact, many clinicians use therapeutic modalities that simply have no empirical support. Read More

The totality of the available data on the short term effects of ADHD stimulant is relatively consistent: these medications are safe and result in significant improvement in symptoms, especially for children with severe forms of the disorder. However, little previous research on the long term effects of these medications has been used by critics of psychiatric medications to argue against the use of these drugs. Fortunately, as children who participated in the initial ADHD medication clinical trials (and similar studies) become young adults, a series of studies are finally providing much needed data on the long term safety and effects of stimulant use.

In the latest issue of Pediatrics, a team led by Dr. Joseph Biederman from Harvard Medical School published an examination of the association between ADHD medication and future psychiatric conditions. For this study, the researchers followed 112 children age 6 to 17 for approximately 10 years. All of these children had a diagnosis of ADHD. 73% of these children had a life time use of stimulant medication and 27% had never used the medication. The authors compared the probability of having a co-morbid psychiatric disorder 10 years after the start of the study among kids who had used medication against those who never used medication. Read More

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

A university-based randomized, placebo controlled research study of Concerta (methylphenidate), examines the effects of methylphenidate in regulating attention lapses.

Research studies on the neurocognitive profiles (memory, attention, executive functioning, etc) of kids with attention-deficit-hyperactivity disorder have one common denominator: there is no unified or common neuropsychological profile that characterizes ADHD. That is, there is no specific pattern of memory, language, attention, etc., deficits that are universally common in kids of ADHD. Such diverse neuropsychological profile reflects the heterogeneity and diversity of ADHD itself. However, there is one finding that is consistently observed in most studies. When compared to non-affected kids, those with ADHD have significantly variable or uneven performance across most tasks. This is noticeable on cognitive tasks that require sustained periods of attention. On these tasks, children with ADHD show marked within-task variability, oscillating between normative and impaired performance. Thus, instead of consistent impaired attention, most kids with ADHD show variable attention, or rapid “lapses” in attention.
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The issue of public masturbation in kids with autism is probably one of the most uncomfortable topics for parents to discuss with their clinicians or pediatricians. I usually can sense when a parent wants to bring up the topic, and the parents are usually relieved when I address the issue directly. Inappropriate sexual behaviors (public masturbation or nudity, sexually touching of strangers, etc) are actually not that uncommon among children with a variety of developmental disorders, including autism. Read More