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Esposito D, Cruciani G, Zaccaro L, Di Carlo E, Spitoni GF, Manti F, Carducci C, Fiori E, Leuzzi V, Pascucci T. A Systematic Review on Autism and Hyperserotonemia: State-of-the-Art, Limitations, and Future Directions. Brain Sci 2024; 14:481. [PMID: 38790459 PMCID: PMC11119126 DOI: 10.3390/brainsci14050481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Hyperserotonemia is one of the most studied endophenotypes in autism spectrum disorder (ASD), but there are still no unequivocal results about its causes or biological and behavioral outcomes. This systematic review summarizes the studies investigating the relationship between blood serotonin (5-HT) levels and ASD, comparing diagnostic tools, analytical methods, and clinical outcomes. A literature search on peripheral 5-HT levels and ASD was conducted. In total, 1104 publications were screened, of which 113 entered the present systematic review. Of these, 59 articles reported hyperserotonemia in subjects with ASD, and 26 presented correlations between 5-HT levels and ASD-core clinical outcomes. The 5-HT levels are increased in about half, and correlations between hyperserotonemia and clinical outcomes are detected in a quarter of the studies. The present research highlights a large amount of heterogeneity in this field, ranging from the characterization of ASD and control groups to diagnostic and clinical assessments, from blood sampling procedures to analytical methods, allowing us to delineate critical topics for future studies.
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Affiliation(s)
- Dario Esposito
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185 Rome, Italy; (D.E.); (F.M.)
| | - Gianluca Cruciani
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy; (G.C.); (G.F.S.)
| | - Laura Zaccaro
- Department of Psychology, Sapienza University, Via dei Marsi 78, 00185 Rome, Italy; (L.Z.); (T.P.)
| | - Emanuele Di Carlo
- Department of Experimental Medicine, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; (E.D.C.); (C.C.)
| | - Grazia Fernanda Spitoni
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy; (G.C.); (G.F.S.)
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, 00179 Rome, Italy
| | - Filippo Manti
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185 Rome, Italy; (D.E.); (F.M.)
| | - Claudia Carducci
- Department of Experimental Medicine, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; (E.D.C.); (C.C.)
| | - Elena Fiori
- Rome Technopole Foundation, P.le Aldo Moro, 5, 00185 Rome, Italy;
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185 Rome, Italy; (D.E.); (F.M.)
| | - Tiziana Pascucci
- Department of Psychology, Sapienza University, Via dei Marsi 78, 00185 Rome, Italy; (L.Z.); (T.P.)
- Centro “Daniel Bovet”, Sapienza University, P.le Aldo Moro 5, 00185 Rome, Italy
- Fondazione Santa Lucia Istituto di Ricovero e Cura a Carattere Scientifico, Via Ardeatina 306, 00179 Rome, Italy
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Peacock DJSJ, Yoneda JRK, Siever JE, Vis-Dunbar M, Boelman C. Movement Disorders Secondary to Novel Antiseizure Medications in Pediatric Populations: A Systematic Review and Meta-analysis of Risk. J Child Neurol 2022; 37:524-533. [PMID: 35392704 PMCID: PMC9160953 DOI: 10.1177/08830738221089742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/15/2022] [Accepted: 03/06/2022] [Indexed: 11/26/2022]
Abstract
Novel antiseizure medications are thought to be safer than their conventional counterparts, though no dedicated analysis of movement disorder risk among pediatric populations using novel antiseizure medications has been completed. We report a systematic review with meta-analysis describing the relationship between novel antiseizure medications and movement disorders in pediatrics.MEDLINE, EMBASE, and the World Health Organization's International Clinical Trials Registry Platform were searched up to October 2020 for randomized controlled trials investigating novel antiseizure medications in pediatric populations. Antiseizure medications included lacosamide, perampanel, eslicarbazepine, rufinamide, fenfluramine, cannabidiol, and brivaracetam. Outcomes were pooled using random effects models; risk difference (RD) and 95% confidence intervals (CIs) were calculated.Twenty-three studies were selected from 1690 nonredundant manuscripts (n = 1912 total). There was a significantly increased risk of movement disorders associated with perampanel (RD 0.07, 95% CI 0.01-0.13; n = 133), though only 1 relevant trial was found. No increased risk of movement disorders was found with other antiseizure medications.Our findings indicate most novel antiseizure medications are safe to use in pediatric populations with respect to movement disorders. However, findings were limited by quality of adverse event reporting.
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Affiliation(s)
- Dakota J. S. J. Peacock
- Division of Neurology, Department of Pediatrics, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Division of Neurology, Department of Pediatrics, Faculty of
Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joshua R. K. Yoneda
- Southern Medical Program, University of British Columbia, Kelowna,
British Columbia, Canada
| | - Jodi E. Siever
- Southern Medical Program, University of British Columbia, Kelowna,
British Columbia, Canada
| | - Mathew Vis-Dunbar
- Southern Medical Program, University of British Columbia, Kelowna,
British Columbia, Canada
| | - Cyrus Boelman
- Division of Neurology, Department of Pediatrics, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Division of Neurology, Department of Pediatrics, Faculty of
Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Schoonjans AS, Roosens L, Dewals W, Paelinck BP, Ceulemans B. Therapeutic drug monitoring of fenfluramine in clinical practice: Pharmacokinetic variability and impact of concomitant antiseizure medications. Epilepsia 2022; 63:686-696. [PMID: 35032026 DOI: 10.1111/epi.17162] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study was undertaken to determine the plasma concentration and pharmacokinetic variability of fenfluramine (FFA) and its main active metabolite norfenfluramine (norFFA) in relation to the prevalence of adverse effects in patients with refractory epilepsy treated with FFA. In addition, the interaction with concomitant antiseizure medications including stiripentol (STP) is studied. METHODS Patients were recruited at our center from two open-label sources, an investigator-initiated observational study and an international multicenter extension study. Venous blood samples were collected between June 2015 and December 2020. Plasma FFA and norFFA concentrations were determined by liquid chromatography tandem spectrometric analysis. Clinical data were collected retrospectively. Intrapatient coefficient of variation was calculated for all patients with at least three samples. Interpatient variability was calculated based on the concentration to weight-adjusted dose ratio (C/D) of all patients. RESULTS We collected 321 samples from 61 patients (49 with Dravet syndrome, seven with Lennox-Gastaut syndrome, and five with a developmental and epileptic encephalopathy). With a mean daily dose of .33 mg/kg/day (SD = ±.16), the median FFA plasma concentration was 41.4 µg/L (range = 5.1-712.5) and median norFFA concentration 28.1 µg/L (range = 2.6-149.6). The FFA plasma concentration was linearly related to the daily dose (p < .001) and norFFA levels (p < .001). The C/D of FFA increased with age (p < .001). Median FFA C/D was 428% higher (p < .001), norFFA C/D 83% lower (p < .001), and norFFA/FFA 23% lower (p < .001) in patients treated with STP comedication. Higher FFA concentration was associated with fatigue (p = .001) and somnolence (p < .001), but not anorexia (p = .0619) or reduction in seizure frequency (p = .772). Gender and other ASMs were not associated with significant variations in (nor)FFA C/D ratio. SIGNIFICANCE Most FFA levels are in the lower range (<50 µg/L), although a high interpatient and intrapatient variability is present. In combination with STP, the dose of FFA should be reduced.
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Affiliation(s)
- An-Sofie Schoonjans
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Laurence Roosens
- University of Antwerp, Antwerp, Belgium.,Laboratory for TDM and Toxicology, Antwerp University Hospital, Edegem, Belgium
| | - Wendy Dewals
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | | | - Berten Ceulemans
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.,University of Antwerp, Antwerp, Belgium
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Abstract
International school psychologists play an important professional role in providing early diagnostic, consultative and treatment-planning services for autistic children and their families. Recent advances in our understanding of this complex disorder necessitates updating professionals in the etiology and treatment of autism. The article describes components of making a differential diagnosis of autism from developmental language/speech disorders, mental retardation and schizophrenia. Etiological theories based on recent neurobiological data are outlined and the psychometric properties of cognitive ability and behavioral rating instruments frequently used with this population are delineated. Specific innovative educational and pharmacological treatment approaches are reviewed.
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Abstract
Autism, Asperger and other pervasive developmental disorders (PDDs) are an increasingly commonly identified group of conditions wherein patients experience significant difficulty in social interactions, communicating with others, and inflexible adherence to unusual, unhelpful and frequently stereotyped routines and behaviour. These autism spectrum disorders are now being diagnosed earlier in life (approximately 15 months), and often remain a chronic, daily burden for those afflicted. In addition to the often profound impact on an individual's quality of life, the familial, social and economic burdens of PDDs can be enormous. No treatments are curative, and most pharmacological treatments are employed to treat specific troubling symptoms rather than the core features of the disorder itself. Therefore, more effective pharmacotherapies are desperately needed. This review describes current and emerging pharmacotherapies that may advance care of people with PDDs.
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Eigsti IM, Shapiro T. A systems neuroscience approach to autism: biological, cognitive, and clinical perspectives. MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 2004; 9:205-15. [PMID: 12953300 DOI: 10.1002/mrdd.10081] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Autism is a behaviorally defined disorder characterized by a broad constellation of symptoms. Numerous studies directed to the biological substrate demonstrate clear effects of neurodevelopmental differences that will likely point to the etiology, course, and long-term outcomes of the disorder. Consistently replicated research on the neural underpinnings of autism is reviewed. In general, results suggest several main conclusions: First, autism is a heterogeneous disorder and is likely to have multiple possible etiologies; second, structural brain studies have indicated a variety of diffuse anatomical differences, reflective of an early developmental change in the growth or pruning of neural tissue, rather than localized lesions; similarly, neurochemical studies suggest early, neuromodulatory discrepancies rather than gross or localized abnormalities; and finally, there are a number of limitations on studies of brain activity that to date preclude definitive answers to questions of how the brain functions differently in autism. The large number of active research programs investigating the cognitive neuroscience of autism spectrum disorders, in combination with the exciting development of new methodologies and tools in this area, indicates the drama and excitement of work in this area.
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Affiliation(s)
- Inge-Marie Eigsti
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
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Wheeler DM, Hazell P, Silove N, Williams K. Selective serotonin reuptake inhibitors for the treatment of autism spectrum disorders. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2004. [DOI: 10.1002/14651858.cd004677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Hollander E, Phillips A, King BH, Guthrie D, Aman MG, Law P, Owley T, Robinson R. Impact of recent findings on study design of future autism clinical trials. CNS Spectr 2004; 9:49-56. [PMID: 14999175 DOI: 10.1017/s109285290000835x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There are specific challenges to studying the design of pharmacologic trials in child/adolescent and adult autism, such as subject stratification and parallel versus crossover designs. This article describes how optimal study design is influenced by subject selection and outcome measures chosen. Lessons learned in study design from the Research Units on Pediatric Psychopharmacology Autism Network trial with risperidone, Seaver Center trials with fluoxetine and valproate, Dartmouth trials with amantadine, and National Institutes of Health secretin trials are highlighted. The Internet System for Assessing Autistic Children system for managing multicenter clinical trials in autism and statistical issues in autism research are also described.
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Affiliation(s)
- Eric Hollander
- Department of Psychiatry, Mount Sinai School of Medicine, New York City, New York 10029-6574, USA.
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9
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Volkmar FR. Pharmacological interventions in autism: theoretical and practical issues. JOURNAL OF CLINICAL CHILD PSYCHOLOGY 2001; 30:80-7. [PMID: 11294081 DOI: 10.1207/s15374424jccp3001_9] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Focused on issues of drug treatment in relation to autism. Pharmacological treatment studies in autism are complicated by various factors including a tremendous range of syndrome expression, a lack of robust animal models of the disorder, and various methodological problems. Theories have tended to follow treatments, and various neurochemical systems have been the focus of study. Neurochemical systems potentially implicated include those involving dopamine, norepinephrine, serotonin, and neuropeptides. The dopaminergic system has been the most extensively studied. Treatments developed are effective relative to certain disabling symptoms but "core" problems (e.g., in social relatedness and communication) appear less responsive to medications. The development of new approaches to assessment, including integration of behavioral and pharmacological approaches, is an important research priority.
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Affiliation(s)
- F R Volkmar
- Child Study Center, Yale University, P.O. Box 207900, New Haven, CT 06520, USA.
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10
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Potenza MN, Holmes JP, Kanes SJ, McDougle CJ. Olanzapine treatment of children, adolescents, and adults with pervasive developmental disorders: an open-label pilot study. J Clin Psychopharmacol 1999; 19:37-44. [PMID: 9934941 DOI: 10.1097/00004714-199902000-00008] [Citation(s) in RCA: 172] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This pilot study examined the efficacy and tolerability of olanzapine in the treatment of children, adolescents, and adults with pervasive developmental disorders (PDDs). Eight patients with principal diagnoses (DSM-IV) of autistic disorder (N = 5) or PDD not otherwise specified (N = 3) were given olanzapine in an open-label, prospective fashion for 12 weeks. Clinical ratings were obtained at baseline and at the end of weeks (EOWs) 4, 8, and 12. Seven of eight patients completed the 12-week trial, and six of the completers were deemed clinical responders as measured by ratings at the EOW 12 of "much improved" or "very much improved" on the global improvement item of the Clinical Global Impression Scale. Significant improvements in overall symptoms of autism, motor restlessness or hyperactivity, social relatedness, affectual reactions, sensory responses, language usage, self-injurious behavior, aggression, irritability or anger, anxiety, and depression were observed. Significant changes in repetitive behaviors were not observed for the group. The EOW 12 mean +/- SD daily dose of olanzapine was 7.8 +/- 4.7 mg/day. The drug was well tolerated with the most significant adverse effects noted to be increased appetite and weight gain in six patients and sedation in three. With respect to weight gain, the mean +/- SD weight for the group increased from 137.50 +/- 55.81 pounds (62.50 +/- 25.37 kilograms) at baseline to 155.94 +/- 55.13 pounds (70.88 +/- 25.06 kilograms) at EOW 12. No evidence of extrapyramidal side effects or liver function abnormalities was seen. These preliminary results suggest that olanzapine may be an effective and well tolerated drug in targeting core and related symptoms of PDDs in children, adolescents, and adults. Further studies, particularly those that are placebo-controlled and double-blinded, are indicated to better define the clinical use of olanzapine in these patient populations.
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Affiliation(s)
- M N Potenza
- Connecticut Mental Health Center, Department of Psychiatry, Yale University School of Medicine, New Haven, USA
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Fernell E, Watanabe Y, Adolfsson I, Tani Y, Bergström M, Hartvig P, Lilja A, von Knorring AL, Gillberg C, Långström B. Possible effects of tetrahydrobiopterin treatment in six children with autism--clinical and positron emission tomography data: a pilot study. Dev Med Child Neurol 1997; 39:313-8. [PMID: 9236697 DOI: 10.1111/j.1469-8749.1997.tb07437.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Six children, between 3 and 5 years of age, having infantile autism according to DSM-III-R, were treated for 3 months with 6R-L-erythro-5,6,7,8-tetrahydrobiopterin (R-BH4), a cofactor for tyrosine hydroxylases in the biosynthetic pathway of catecholamines and serotonin. A criterion for inclusion in the study was a relatively low level of R-BH4 in the cerebrospinal fluid. For clinical evaluation, the Parental Satisfaction Survey (PASS) was used every fourth week and the Griffiths Developmental Scales were used before starting and 3 months after completing the treatment. During the treatment period, all parents reported improvements in the child's social functioning-mainly eye contact and desire to interact-and in the number of words or sounds which the child used. Small positive changes were noted on the Griffiths Developmental Scales between the two testing occasions. R-BH4 levels in CSF increased significantly after treatment. The positron emission tomography (PET) study showed that the high value of dopamine D2 receptor binding in the caudate and putamen decreased by about 10% towards the normal level after treatment with R-BH4. The observations in this open study indicate that the drug might be useful for a subgroup of children with autism, but there is a need for a larger double-blind study with a longer treatment period.
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Affiliation(s)
- E Fernell
- Department of Paediatrics, Huddinge University Hospital, Sweden
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12
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Gillberg C, Nordin V, Ehlers S. Early detection of autism. Diagnostic instruments for clinicians. Eur Child Adolesc Psychiatry 1996; 5:67-74. [PMID: 8814412 DOI: 10.1007/bf01989498] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Autism and Asperger syndrome are disorders with early childhood onset. They are believed to exist on the same spectrum of impairments of reciprocal communication and social interaction restriction of imagination and behaviour. A number of screening and diagnostic tools have been developed in the field, and several of these are briefly reviewed here. It is concluded that autism may be screened around age 18 months and a diagnosis reliably be made around age 30 months, whereas a diagnosis of Asperger syndrome is not usually suspected, screened or made until into the child's school age.
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Affiliation(s)
- C Gillberg
- Department of Child and Adolescent Psychiatry, University of Göteborg, Annedals Clinics, Sweden
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13
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Abstract
The neurological, neurochemical, and neurotransmitter level differences as well as genetic influences associated with autism have been studied extensively in the last two decades. The varied findings from research offer hope for better understanding, effective treatment, and, perhaps, cure of this pervasive developmental disorder.
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Affiliation(s)
- J B Murray
- Department of Psychology, St. John's University, Jamaica, NY 11439, USA
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14
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Abstract
OBJECTIVE To present an overview of a variety of treatment approaches in individuals with autistic disorder. METHOD Selected studies and articles are reviewed. RESULTS In the past three decades, great progress has been made in the treatment of autistic disorder, particularly in the area of education and parental involvement, with the objective to transfer to home and in other situations learning acquired in school. A role for psychoactive agents, when combined with psychosocial treatments, has been identified. CONCLUSIONS Although considerable advances have been made in a variety of interventions-educational, psychosocial, and biological-knowledge about the comparative and combined efficacy of the various treatment modalities is lacking. From the parents' perspective, particularly, support and continuity of services require improvement.
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Affiliation(s)
- M Campbell
- Department of Psychiatry, New York University Medical Center, NY 10016, USA
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15
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Oades RD, Eggers C. Childhood autism: An appeal for an integrative and psychobiological approach. Eur Child Adolesc Psychiatry 1994; 3:159-175. [PMID: 29871423 DOI: 10.1007/bf02720323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The difficulty that a person with autism has in establishing relationships, maintaining them (communicating and responding appropriately) is a common experience of those close to them., That impaired perceptual and cognitive processing can underlie this difficulty and the interactions of people with autism with the material environment has been established in the laboratory. The consequences at a psychological level of analysis may converge in the inadequacy of second-order representations of the world. An attenuation of such endogenous monitoring processes could also indirectly account for features of withdrawal and the stereotypies often observed. At another level of analysis there are delays in neurotransmission, in the CNS and a lack of flexibility of physiological response shown by evoked potential recordings. Tomographic studies of blood flow and metabolism illustrate a lack of correlation between information processing centres in the brain that may sometimes arise from diffuse gray matter atrophy. A "stop-go" form of modulation of central processing is mediated by anomalous ascending serotonergic and dopaminergic function (transmitters with inhibitory and switching functions). On these bases it is no wonder that representations are not formed and inappropriate and repetitive behaviors follow, although the link remains somewhat speculative. Both levels of analysis are useful for an explanation. As behavioral and pharmacotherapy, though helpful, are severely limited in their efficacy, more effort is required to synthesize the different levels of analysis into a psycho-biological approach, to remedial programs and new forms of therapy.
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Affiliation(s)
| | - Christian Eggers
- Clinic for Child and Adolescent Psychiatry (RLHK), Pf 103 043, 45030, Essen, Germany
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16
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Abstract
Childhood autism is conceptualized as a behavioural syndrome with several different aetiologies. Its prevalence is estimated at about one in every thousand children born. The male:female ratio is considerably higher than in the general population, but possibly not as high as 3-4:1 (as has been suggested for almost 50 years in the literature). A number of specific medical conditions are associated with autism and a comprehensive medical work-up is required in all cases with pervasive autistic symptomatology. Genetic factors contribute to the development of autism in some cases. Recent neurobiological and psychological studies contribute to a concept of the autistic syndrome as but one of several different syndromes characterized by impaired empathy skills.
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Affiliation(s)
- C Gillberg
- Department of Child and Adolescent Psychiatry, Annedals Clinics, Göteborg, Sweden
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Aman MG, Kern RA, McGhee DE, Arnold LE. Fenfluramine and methylphenidate in children with mental retardation and ADHD: clinical and side effects. J Am Acad Child Adolesc Psychiatry 1993; 32:851-9. [PMID: 8340309 DOI: 10.1097/00004583-199307000-00022] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Each of 28 nonautistic children with attention-deficit hyperactivity disorder and mental retardation received placebo, methylphenidate (0.4 mg/kg/day), and fenfluramine (gradually increased to 1.5 mg/kg/day) for 4 weeks each in a double-blind, crossover design. Teacher ratings indicated significant improvements with both active drugs on subscales designated as Conduct Problem, Hyperactivity, and Irritability, but methylphenidate alone produced improvements on an Inattention subscale. Parent ratings indicated significant improvements with both drugs on subscales labeled Hyperactivity, Motor Excess, and Conduct Problem. Fenfluramine alone caused improved parent ratings on Irritability and Inappropriate Speech, and on Conners' Abbreviated Symptom Questionnaire. Unlike a previous study, subgroup analyses failed to show a significantly better clinical response to methylphenidate for subjects with higher mental ages, although children with higher IQs responded better than those with IQs less than 45. The active drugs had contrasting effects on heart rate and blood pressure. Fenfluramine caused significant weight reductions relative to both placebo and methylphenidate. These findings suggest that both methylphenidate and fenfluramine have useful, but somewhat different, clinical effects in certain children with attention-deficit hyperactivity disorder and mental retardation.
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Affiliation(s)
- M G Aman
- Nisonger Center for Mental Retardation and Developmental Disabilities, Ohio State University, Columbus 43210-1296
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18
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Abstract
In the past 5 years, we have witnessed the continuation of important trends in clinical research that began earlier in the decade. With regard to the treatment of specific disorders in children and adolescents, the most significant developments have been the examination of the tricyclics for the treatment of depression and the initiation of controlled studies for the treatment of Tourette syndrome. Unfortunately, the findings from the depression studies have been uniformly negative, and the results of research on both depression and tic disorders show a relatively high rate of placebo responsivity, which raises nagging questions about the role of case reports and open trials. Another important trend in pediatric psychopharmacotherapy is the search for substitutes for the neuroleptics. Potential candidates include agents such as lithium, naltrexone, fenfluramine, clonidine, and carbamazepine. The most underresearched disorders are a combination of the least common (e.g. schizophrenia, mania) and those that are apparently perceived as less serious (e.g. sleep disorders, certain anxiety disorders). Not surprisingly, the most studied disorder and treatment is hyperactivity and stimulant medication, respectively. Considerable progress has been made in understanding the social implications of the associated symptoms and their response to stimulant drugs, aided greatly by the use of direct observation procedures. Researchers are beginning to attend to the implications of comorbidity for assessing response to medication. There has been additional confirmation of efficacy of stimulant treatment for preschoolers and adolescents. Dose-response issues remain to some extent unresolved, the primary impediments being interpretive misconceptions associated with trend analysis, an overreliance on the syndromal perspective and too little attention to target behaviors and their clinical implications, and the failure to operationalize the minimal effective dose with regard to the normalization and supranormalization of target and collateral behaviors. Disagreement over whether hyperactivity is a learning or a behavior disorder (or both) and what academic underproductivity means clinically and socially is also impeding progress. With regard to developmental disorders, controlled studies indicate that fenfluramine and naltrexone are effective for managing associated symptoms in some individuals. However, given the limited amount of research on these agents, their status as clinically useful palliatives must be considered tentative.(ABSTRACT TRUNCATED AT 400 WORDS)
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Campbell M, Kafantaris V, Malone RP, Kowalik SC, Locascio JJ. Diagnostic and assessment issues related to pharmacotherapy for children and adolescents with autism. Behav Modif 1991; 15:326-54. [PMID: 1953623 DOI: 10.1177/01454455910153004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Autism involves not only developmental delays but also aberrant behavior, both of which change in nature over time. Rating instruments may be useful to assess maladaptive and adaptive behaviors of autistic children in a standardized way and, perhaps, to measure change due to treatment. With the expansion of basic science, knowledge, and technology, there is increasing evidence that autism is etiologically heterogeneous. Currently, there is no biological marker specific to autism, although hyperserotonemia is a consistent finding in one third of autistic children. An aim of basic science research has been to develop a rational pharmacotherapy based upon the underlying neurochemistry. However, at the present time, this approach has not always been successful. It is expected that the development and use of more restrictive criteria, delineation of subtypes of autism, and interaction of descriptive, behavioral, clinical, and basic research will lead to more effective planning for treatment. The relationship of assessment to treatment response is presented and discussed.
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Affiliation(s)
- M Campbell
- Department of Psychiatry, New York University Medical Center, NY 10016
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Autism: Etiology, differential diagnosis, and behavioral assessment update. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 1991. [DOI: 10.1007/bf00961426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Autism is associated with epilepsy. One third of the population of people with autism have developed seizures in early adult life. In spite of this well-known association, little is known about the treatment of epilepsy in autism. This paper reviews the sparse literature and reports a systematic case-record study of the treatment of epilepsy in autism. Some practical guidelines for clinicians are provided. Research in the field of epilepsy in autism is highly warranted.
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Affiliation(s)
- C Gillberg
- Child Neuropsychiatry Centre, University of Göteborg, Sweden
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