ethics
02-09-2005, 05:00 PM
Some great stuff from MedScape:
Medscape: How would you define autism?
Dr. Hollander: Autism is a developmental disorder that presents before the age of 3 years. It's characterized by impairment in 3 core symptom domains, which include social deficits, communication difficulties, narrow restricted interests, and repetitive behaviors. In addition to that, there are also other associated symptoms that frequently coexist.
Medscape: What are those other symptoms?
Dr. Hollander: The other associated symptom domains can include factors like inattention and motor hyperactivity, impulsivity and aggression, mood instability, EEG abnormalities or seizure related type problems, and cognitive difficulties.
Medscape: How common is this disorder?
Dr. Hollander: It used to be felt to be very rare. The best estimates now are that about 0.6% of the population, a little under 1%, may meet criteria for the broader autism phenotype, or an autism spectrum disorder. Within that spectrum, we include autism, the Asperger syndrome, and pervasive developmental disorder or PDD NOS -- not otherwise specified.
Medscape: How do you treat autism spectrum disorders?
Dr. Hollander: There are a few different treatment approaches. There are behavioral approaches, educational approaches, and medication approaches. We intervene early. There is some evidence that the earlier you pick up the problem and start to intervene with behavioral, educational, speech, and occupational therapy, the better the long-term developmental trajectory. So the idea now is to start to identify people at around 18 months if possible and often to slide people into the educational programs that incorporate a lot of speech and occupational therapy plus behavioral interventions like acute ABA-type treatments -- applied behavioral analysis. And there is evidence that these kinds of treatments actually can be associated with better long-term outcome.
We are also finding that medicines may be very helpful in 2 types of approaches. One is a targeted treatment approach where we select a group of individuals who score high on a particular target symptom like lots of narrow, restricted interests, repetitive behaviors, self-stimulation-type behaviors, and compulsive behaviors, and then treat them, for example, with very low doses of selective serotonin reuptake inhibitors like fluoxetine or fluoxetine in a liquid form.
We found that will significantly improve the core symptom domain and improve overall functioning.
Other treatment approaches involve stratifying the population, picking up the subgroup with a lot of disruptive behavior, such as impulsivity and aggression, tantruming, self-injury, and treating them with low doses of atypical antipsychotics, such as risperidone.
We also have treatment approaches using the mood-stabilizing, anticonvulsant-type treatments like valproic acid or levetiracetam, finding that these medicines may be helpful in a lot of mood instability, a lot of the disruptive behavior like impulsive, aggressive, or self-injurious behavior. Sometimes for language-related functioning, and particularly those with some abnormal EEGs, patients have a very robust response to the anticonvulsant-type medicines.
the rest here (http://www.medscape.com/viewarticle/497979?src=mp).
There's another article titled, <i><a href="http://mp.medscape.com/cgi-bin1/DM/y/hl7M0JcCAc0DzT0GQh80Ez">Autism First-Hand: An Expert Interview With Temple Grandin, PhD</a> </i>.
Medscape: How would you define autism?
Dr. Hollander: Autism is a developmental disorder that presents before the age of 3 years. It's characterized by impairment in 3 core symptom domains, which include social deficits, communication difficulties, narrow restricted interests, and repetitive behaviors. In addition to that, there are also other associated symptoms that frequently coexist.
Medscape: What are those other symptoms?
Dr. Hollander: The other associated symptom domains can include factors like inattention and motor hyperactivity, impulsivity and aggression, mood instability, EEG abnormalities or seizure related type problems, and cognitive difficulties.
Medscape: How common is this disorder?
Dr. Hollander: It used to be felt to be very rare. The best estimates now are that about 0.6% of the population, a little under 1%, may meet criteria for the broader autism phenotype, or an autism spectrum disorder. Within that spectrum, we include autism, the Asperger syndrome, and pervasive developmental disorder or PDD NOS -- not otherwise specified.
Medscape: How do you treat autism spectrum disorders?
Dr. Hollander: There are a few different treatment approaches. There are behavioral approaches, educational approaches, and medication approaches. We intervene early. There is some evidence that the earlier you pick up the problem and start to intervene with behavioral, educational, speech, and occupational therapy, the better the long-term developmental trajectory. So the idea now is to start to identify people at around 18 months if possible and often to slide people into the educational programs that incorporate a lot of speech and occupational therapy plus behavioral interventions like acute ABA-type treatments -- applied behavioral analysis. And there is evidence that these kinds of treatments actually can be associated with better long-term outcome.
We are also finding that medicines may be very helpful in 2 types of approaches. One is a targeted treatment approach where we select a group of individuals who score high on a particular target symptom like lots of narrow, restricted interests, repetitive behaviors, self-stimulation-type behaviors, and compulsive behaviors, and then treat them, for example, with very low doses of selective serotonin reuptake inhibitors like fluoxetine or fluoxetine in a liquid form.
We found that will significantly improve the core symptom domain and improve overall functioning.
Other treatment approaches involve stratifying the population, picking up the subgroup with a lot of disruptive behavior, such as impulsivity and aggression, tantruming, self-injury, and treating them with low doses of atypical antipsychotics, such as risperidone.
We also have treatment approaches using the mood-stabilizing, anticonvulsant-type treatments like valproic acid or levetiracetam, finding that these medicines may be helpful in a lot of mood instability, a lot of the disruptive behavior like impulsive, aggressive, or self-injurious behavior. Sometimes for language-related functioning, and particularly those with some abnormal EEGs, patients have a very robust response to the anticonvulsant-type medicines.
the rest here (http://www.medscape.com/viewarticle/497979?src=mp).
There's another article titled, <i><a href="http://mp.medscape.com/cgi-bin1/DM/y/hl7M0JcCAc0DzT0GQh80Ez">Autism First-Hand: An Expert Interview With Temple Grandin, PhD</a> </i>.