Autism Treatments, Part 1: Using Anti-Psychotics for Autism

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This week on Family Anatomy, we’ll be focusing on treatments for autism.  Using anti-psychotic medications when there is no psychosis is considered “off-label” use. That is, physicians can prescribe it even though it has not been specifically studied and proved to be effective with a particular group of people. As a psychologist working with school-aged children, I have noticed the increasing use of off-label anti-psychotic medications for kids with severe aggressive behaviour. A small percentage of these kids are autistic.

Research reported in an August 2002 issue of the New England Journal of Medicine looked specifically at whether risperidone, a so-called “atypical antipsychotic” that is widely used to address aggressive behaviour in children, had a beneficial effect when given to autistic kids. Dr. McCracken and his colleagues studied 101 kids ages 5 to 17 with serious behavioural disturbances such as self-injurious behaviour, aggression and tantrums in response to routine demands. They assigned 52 kids to a placebo group, while the remaining 49 received risperidone therapy. What they found was that autistic kids on risperidone had almost a 57% reduction in their level of irritability, as compared to only 14% in the control group. The study showed that a significant reduction in irritability could be expected by using this drug. They also found that in two-thirds of the kids who responded well to risperidone, the positive effects were maintained six months later. At the same time, in the four months within which the study was conducted, the researchers found that increased appetite, fatigue, drowsiness, dizziness, and drooling were more common in the risperidone group than in the placebo group.

One could easily argue that, compared to the difficulty of dealing with serious aggressive behaviour, these side-effects, while unfortunate, should not prevent a physician or parent from deciding to go forward with risperidone treatment. However, the researchers do note that, given the short length of the treatment, adverse side effects such as tardive dyskinesia, could not be evaluated. Tardive dyskinesia is a neurological disease brought about by long-term or intensive use of anti-psychotic medications. It manifests as repetitive, involuntary, purposeless movements typically seen on a persons’ face as grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and/or rapid eye blinking. Psychiatrist Peter Breggin has been an advocate against the over-prescribing of anti-psychotic medications and recently wrote an article in the Huffington Post about the dangers of these medications and how concerned he is with the fact that the FDA has recently begun approving these drugs for use in children.

Dr. Breggin notes that newer anti-psychotics such as risperidone are only marginally better than some of the older drugs that resulted in 15% of patients suffering from life long tardive dyskinesia. He argues that, in children, the long-term effects of prolonged use of risperidone are likely to cause tardive dyskinesia in a certain percentage of kids. The question is not going to be if kids will end up with tardive dyskinesia, but rather what percentage of kids are likely to be effected in this way. In addition to this, Dr. Breggin states that newer antipsychotics frequently cause diabetes and pancreatitis in children. To emphasize his point, he reports that drug manufacturer Eli Lilly paid over a billion dollars to settle hundreds of diabetes cases related to Zyprexa, another one of the atypical anti-psychotics.

Parents are typically not informed of the more serious side effects of these drugs. This clearly needs to change. It is important for parents to be aware that, in a minority of cases, serious consequences are likely to result with prolonged use of these drugs. On the other hand, parents of autistic kids may still feel, that given the frequency and intensity of aggressive behaviour in their child, they have little choice but to consider at least short term treatment with these drugs. The question is not whether these drugs are effective in reducing aggressive behaviour in kids. In a majority of cases, risperidone works as advertised. The question that parents need to ask themselves is, can they live with the potential costs of long-term exposure?

You can read the New England Journal of Medicine article here.

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2 Responses to Autism Treatments, Part 1: Using Anti-Psychotics for Autism
  1. iragofsurvivorghost
    January 3, 2010 | 1:00 am

    Autism research examines high functioning Autism (and Aspergers) but continues to ignore low functioning (severely) autistic subjects. So, if research is focused exclusively, or almost exclusively, on participants with high functioning autism or Aspergers, HOW much do we REALLY know about Autistic Disorder which, by definition, includes those with low functioning autism if we don’t’ study low functioning autism? Let’s be honest, many researchers are uninterested in an autism case that doesn’t have a direct bearing on a positive grant flow. That’s why they hyper-focus on high functioning autism. Good Autism research begins at ground zero: the lowest functioning. The key to unlocking the mystery of autism will be found at ground zero: the bottom of the spectrum..there are videos on you tube if you type in autism and self injury that illuminate the most mysterous and complex side of serious, true autism. The term autistic has been misused to describe persons with anything from cerebral allergies and schizophrenia to attention deficient disorder and post traumatic disorder. Sadly, few doctors and educators understand true cases of autism to make a correct diagnosis. So they go with the latest media driven flow. Pick and choose from a broad and ever expanding spectrum. Or worse, they guess. The hallmark traits of autism are: sensitivity to sounds, specific tastes in food/drink, strange body postures, repetitive behaviors, inability to control emotions or excitement, poor reasoning skills, needs routines, resists changes, sense of direction and memory better than other skills, thinking based on association, not reasoning, once distracted by olfactory, visual or auditory stimuli, they become preoccupied. This is markedly DIFFERENT than ADHD, in that ADHD presents as easily distracted by stimuli, BUT, the person bounces focus from one thing to another. ADHD people don’t stay hyper-focused or fixate on something. That is what you will see a truly autistic person do. Fixate.

  2. henyrsdad
    February 21, 2010 | 5:59 pm

    Here’s something to ponder: Amanda Baggs, the woman who many think suffers from Dissociative Personality Disorder, really has something even more interesting, which is psychogenic autism, possibly one of her personalities. It is also possible this is a factitious disorder, as she is reported to have ’studied” other severely autistic cases in order to adopt mannerisms…Very interesting case. You Tube video: “autism epidemic out of control” and “autism spectrum seems out of control” go into this subject a tad…this is definately something on the horizon. A new phenomenon, sparked by the autism explosion and creating mass hyteria and psychogenic factors within unstable minds to adopt such a diagnosis, as they feel this will bring them attention and nurturing they so deeply need, due to often traumatic upbringings (ie…Donna Williams, a most interesting case as well). The trouble is, when these psychogenic autism cases are featured on CNN (as in case of amanda baags) then you have a case of avoidance, where the media that once promoted or featured such a person, is now unwilling to realize or accept that this was all a fraud, or fabrication of such. This is not helpful for neither the patient or the community at large.