Amish and autism, good read..

Medications do not treat the disorder itself, although core symptoms in some individuals may be affected by medications. Most research to date has been conducted on children, contrary to the usual methodology in medicine. In general, medications are used to target symptoms, symptom complexes, or comorbid disorders, such as ADD, obsessive-compulsive disorder, depression, dysthymia, and tic disorders. Use of medications has become more common, with the prevalence of autistic children taking medications (psychotropics, antiseizure medications, megavitamins) rising from 42% in 1995 to 65% in 2003 (Coleman, 2005). Less evidence of efficacy exists in the other PDDs, so treatment decisions in those cases are often based on the evidence that exists in autism. As a general rule, autistic children seem to be more sensitive to psychoactive medications, so the adage of "start low and go slow" with every drug trial is particularly applicable to this population.

The newer generation antipsychotics have developed a frontline position in the treatment of autism. This is due to several well-designed studies with one of these agents, risperidone (Risperdal), showing broad effects on several of the core symptoms of autism. Dosages in these studies were low, usually in the 1-2 mg/d range, although doses as high as 4.5 mg were used in larger children. Other second-generation antipsychotics have not received as much study with autism, but many practitioners try them out with individual patients when risperidone is not effective or not tolerated. The relative lack of long-term adverse effects of the second-generation antipsychotics when compared with traditional antipsychotics makes them a more attractive option.

Antidepressants play several roles in the treatment of individuals with autism and PDDs. They are used to treat comorbid depressive disorders, obsessive-compulsive disorder, or other comorbid anxiety disorders, but they also may play a role in symptom management because of the effect they have on serotonin dysfunction, which is an issue for at least some individuals with autism. Any of the antidepressants may play a role in the treatment of depressive disorders, but the only evidence for efficacy in either anxiety symptoms or obsessive-compulsive symptoms is for the selective serotonin reuptake inhibitors (SSRIs), including clomipramine. These drugs may decrease obsessive stereotyped behaviors and also may enhance overall communication and improve social reciprocity, to minor degrees.

Stimulants have been shown to be helpful in treating ADD symptoms in the autistic spectrum disorders, but with lower efficacy (~50% vs 80-90% in nonautistic patients) and have a notably higher rate of side effects. Beta-blockers play a more limited role in the treatment of autism, and the PDDs and are used solely for the treatment of aggression and self-injurious behavior, where they can reduce the intensity and frequency of the behavior. Patients whose symptoms are characterized by overactivity, overarousal, poor frustration tolerance, and self-injurious behavior may be the most likely to benefit.

With regard to opioid antagonists, at one point, it was felt that increased opiate activity might cause the social and behavioral abnormalities in autism. Some evidence of abnormalities in this system has been found, but control of symptoms shows no effect on core symptoms of autism. Studies have shown a decrease in hyperactivity. No effect on self-injurious behavior has been shown. One study of Rett disorder showed a more rapid deterioration in the illness of those receiving naltrexone. Much hope was recently placed on the use of secretin injections; however, careful evaluation of treatment with this hormone in autism failed to find significant treatment benefits. Some small-scale studies showed positive responses to use of stimulants in autism; however, the use of stimulants is uncommon in this condition. This is because side effects are particularly frequent, with worsened irritability, aggression, and insomnia. Stimulant use is best reserved for higher functioning patients with comorbid symptoms consistent with ADHD.

No evidence exists as to whether it is better to use SSRIs, antipsychotics, alpha agonists, or stimulants as the first line of treatment for autism, so the decision must be left to the clinician's judgment and the primary behavioral target. Multiple medications may be necessary for optimal medication management. If drugs from one category are not effective, it would suggest that a trial of drugs from another category should be considered. As with any medication used in the treatment of autism, dosages used generally should be lower than those used for comparably aged healthy individuals, with more gradual dosage adjustments.

This is interesting, as i have heard "mental health professionals" refer to ADD and ADHD as being part of the "autism spectrum" (or at least, so it seemed to me)> This was in the late 1980s while i worked for a family shelter. When clients were taken into our program (and only families with children qualified), we immediately reported all the "vital statistics" of the family to a privately-owned family services center (which i won't identify for obvious reasons). This organization received aid from the municipality, the county, the state and the Federal Emergency Management Agency--the later had been given the task of resolving the homelessness problem in the late 1980s, when the economic conditions of "Reaganomics" lead to an explosion of homelessness, especially homeless families. Having reported these families to the family services center (with whom we had to cooperate in order to receive FEMA funds for our program), they reported the "intake" to all the relative municipal, county and state agencies, which invariably resulted in contacts with us by Child and Family Services case workers and representatives of the local school boards. Employees of the DCFS or of the School Boards also seemed to invariably notify us of the participation in a drug-based treatment program for any children involved. (I say that it seemed that they invariably did this, because we did not question the families we took in about drug treatments for children, so it is possible that some of them "slipped through the cracks.")

This page at the National Institute of Mental Health lists drugs of choice for the treatment of ADD and ADHD. The NIMH is described by Wikipedia as the largest research institution in the world. It is one of the National Institutes of Health supported by the Federal government in the United States. This page at NIMH describes ASD and treatments.

I would not be surprised to learn that "mental health professionals" in the United States, including and especially those retained by local school districts, make vague distinctions between developmental disability conditions and behavioral management conditions. I am not saying this is so, but i was often surprised to learn which children in our shelter were identified as "problem children," and was particularly struck in two cases by the use of the term "autism spectrum disorder" in reference to children who did not appear to me to be autistic, based on my admittedly imprecise understanding of what ought to be described as autism.

My principle objection in this issue is the ease with which "mental health professionals" (so many of whom receive no and required to have no medical training which is not referential to psychology as an academic discipline) can prescribe drugs--both for "behavioral problems" in children and "depression" in adults. As i have pointed out, it is (or once was) true that in Illinois and Ohio that people with no specific medical training were legally entitled to prescribe for mental health conditions--while even an experienced nurse-practitioner would not be able to prescribe for morbid conditions of physical trauma without the counter-signature of a physician.

This is interesting, as i have heard "mental health professionals" refer to ADD and AD
HD as being part of the "autism spectrum"...........
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My principle objection in this issue is the ease with which "mental health professionals" .........can prescribe drugs--both for "behavioral problems" in children and "depression" in adults. ..........

......In late adolescents with bipolar disorder, the most common mistaken diagnoses are schizophrenia and conduct disorder. .... The difficulty in distinguishing these two disorders is due to the high prevalence of coexisting ADHD ...