THE EVIDENCE-BASED APPROACH TO DIAGNOSING AND TREATING AUTISM
"Though not approved by the United States Food and Drug Administration for the treatment of autism, a common class of antidepressants is often prescribed to treat the symptoms of autism in children. The selective serotonin reuptake inhibitors (SSRIs) are among the most widely used drugs for autism treatment, even though the effectiveness to date has been questionable. A new study published in the June issue of Archives of General Psychiatry reports that, not only are SSRIs ineffective, they may actually cause unintended side effects." From Dr. Jennifer Gibson's (Pharmacist) Brain Blogger article called Common Treatment Ineffective for Autism
"Antipsychotics are the most efficacious drugs for the treatment of irritability in ASDs, and may be useful in the treatment of other symptoms. Psychostimulants demonstrate some benefit for the treatment of hyperactivity and inattention in individuals with ASDs, but are less efficacious and associated with more adverse effects compared with individuals with ADHD." From Harvard's 2012 study called Pharmacologic Treatments for the Behavioral Symptoms Associated with Autism Spectrum Disorders Across the Lifespan and published in a 2012 issue of Dialogues in Clinical Neuroscience
"Our most effective interventions for ASD are currently educational and behavioral approaches." Dr. Sally Rogers, professor of psychiatry and behavioral sciences at UC Davis MIND Institute, being quoted by Francesca Happé for last May's LiveScience Op-Ed piece called Autism Truths and Myths: The State of the Science.
The June 20 issue of the Psychiatric Times carried an article called Autism Spectrum Disorders and Psychiatry: Update on Diagnostic and Treatment Considerations. Diagnosing AUTISM SPECTRUM DISORDERS (ASD) is about what you would expect.
"The most reliable early markers for ASD are failure to respond to one’s name; lack of social smiling and shared attention; delays in babbling and lack of words by 16 to 18 months or phrases by 24 months; and failure to use gestures such as pointing, showing, or reaching. Any loss of language or social skills is cause for concern. Primary ASD features in middle childhood often relate to difficulty engaging in age-appropriate peer relationships, collaborative and imaginative play, back-and-forth conversation on a flexible range of topics, and age-appropriate interests. Whereas repetitive motor mannerisms (eg, toe walking, hand flapping) are common in typically developing younger children, when these behaviors persist into later years, they are increasingly indicative of ASD. For adolescents and adults who present for a first-time evaluation for ASD, it is important to determine whether social withdrawal and difficulties with peer interactions are truly due to a long-standing ASD or to more recent-onset mood or anxiety disorder. Schizophrenia and other psychotic disorders should also be considered. Among patients with ASD, comorbid anxiety and depression commonly emerge in adolescence and may require an additional diagnosis to inform targeted treatment."
Diagnosis is one thing, but successfully addressing those suffering with some form of Autism Spectrum Disorder is where the rubber meets the road. Much of this has to do with drugs. Allow me to explain. For the most part, physicians heavily rely on various forms of DRUG THERAPY for treating almost everyone who walks in their clinic. What does this paper say about this approach in relationship to Autism? Despite 'evidence' to the contrary (see the final quote from the top of the page), these authors admit that, "There are no medications that effectively target the core social symptoms of ASD". However, this does not prevent them from recommending any number of drugs and touting them as "evidence-based" for treating Autism. Despite suggesting a wide array of drugs that can be used to treat symptoms in those with ASD, they reveal that, "strong evidence exists for adverse effects, such as weight gain, sedation, and extrapyramidal effects."
The sad truth is that virtually all psyche drugs (drugs that affect the brain) lead to OBESITY. The "extrapyramidal effects" include fun things like restlessness pacing, foot-tapping, uncontrolled and severe muscle contractions of the head, neck, trunk, and tongue, tremors, stiff postures, lack of arm swing when walking, uncontrolled tongue, jaw, lip, or face movement, constant chewing or blinking, uncontrolled movements of appendages such as fingers or toes, head swaying or nodding, pelvic thrusting, weak voice, lack of facial expression, drool, grunting, groaning, or irregular breathing, etc, etc, etc......
Of course the article also touts SSRI ANTI-DEPRESSANTS --- drugs that are known to dramatically increase hallucinations / nightmares and suicides in children --- for children with Autism. They even admit that, "all other medications are used off-label for ASD." Off-label simply means that the drugs are being used in ways that have either never been studied, or have been studied and shown to be ineffective or dangerous (or more often than not, both). Oh, and naturally they recommend "STIMULANTS" for those with symptoms of ADHD. Despite the bleakness of outcomes when using drugs to treat those with Autism, the authors continue to recommend them throughout one's lifespan. "As children age, a variety of..... psychopharmacological interventions may be necessary."
As far as actually addressing problem via some sort of therapy, the authors say that, "early, intensive, individualized behavioral intervention is highly recommended for toddlers and young children with ASD." Although the older, "guidelines recommended 25 or more hours per week of direct intervention between a child and a trained clinician; newer models increasingly utilize parents in the role of interventionist to maximize the number of engaged, face-to-face hours a child receives." This is not surprising when you couple the EXPLOSION OF DIAGNOSED AUTISM with the cost over-runs (UNSUSTAINABILITY) that are almost ubiquitous to our current healthcare system.
Some of the specific forms of therapy mentioned by the authors include (everything is cherry-picked due to restraints on time and space), "speech and language therapy, intensive speech and behavioral interventions that target the development of alternative communication systems. Supplemental use of visual communication strategies, teaching and rehearsing social rules and scripts, manualized social skills programs, behavioral interventions, functional behavioral analyses, support for transitioning from school to community and vocational settings, assistance to connect with disability services, support options, group home settings, mental health clinicians, social and academic support, psychotherapy and job coaching, guidance, exploration and navigation of sexuality and relationship issues......"
When it comes to alternative forms of treatment for Autsim, they listed a slew of them. Unfortunately, they lumped them all into one broad category (CAM --- Complimentary and Alternative Medicine) and made sure everyone was aware that they are little more than snake oil --- "empirical support for most CAM interventions is limited." What is the most important thing these authors wanted you to take away concerning alternative forms of treatment for Autism?
"It is critical that mental health professionals inquire about and maintain an ongoing dialogue with families about their use of CAM and provide information about evidence-based adverse effects. The principle of “do no harm” applies to CAM as in all other aspects of medicine. If the child is not being harmed physically or mentally and the resource burden CAM interventions place on the family is not detracting from other, evidence-based interventions, then clinicians can support families in trying various treatments. Maintaining a dialogue about what treatments are being pursued and ensuring decisions are made in consultation with a physician are of utmost importance."
The authors act as though alternatives such as GLUTEN FREE DIETS or approaches that involve GUT HEALTH are dangerous --- a particularly egregious assertion when compared to the knon DANGERS OF DRUGS. And as bizarre as it might sound, they throw our nation's single biggest destroyer of Gut Health --- ANTIBIOTIC THERAPY --- in the same list as things like DIETARY SUPPLEMENTS, OXYGEN-BASED THERAPIES, and WHOLE FOOD NUTRITION. All of this (not to mention the constant talk of "BEST EVIDENCE" otherwise known as EBM or Evidence-Based Medicine) helps one understand why the general population's trust in the medical community continues to wane. It's painfully obvious that these recommendations are based more on protecting their professional turf, than helping autistic children.
If you or someone you love is struggling with problems that seem insurmountable --- including Autism --- why not at least take five minutes to learn what it would take for you to step out of the box. By dealing with underlying INFLAMMATION and abnormal BRAIN FUNCTION (not to mention cool new forms of treatment such as FMT), you have the potential make great strides in helping your loved ones trapped by the disease we call Autism. For a more comprehensive (and free) plan, you might want to take a look at THIS POST.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).