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Neuropsych Conditions: Autism cont.

Diagnosing Autism

There are no medical tests for diagnosing autism. An accurate diagnosis must be based on observation of the individual's communication, behavior, and developmental levels. However, because many of the behaviors associated with autism are shared by other disorders, various medical tests may be ordered to rule out or identify other possible causes of the symptoms being exhibited. At first glance, some persons with autism may appear to have mental retardation, a behavior disorder, problems with hearing, or even odd and eccentric behavior. To complicate matters further, these conditions can co-occur with autism. However, it is important to distinguish autism from other conditions, since an accurate diagnosis and early identification can provide the basis for building an appropriate and effective educational and treatment program.

A brief observation in a single setting cannot present a true picture of an individual's abilities and behaviors. Parental (and other caregivers' and/or teachers) input and developmental history are very important components of making an accurate diagnosis.

Early Diagnosis
Research indicates that early diagnosis is associated with dramatically better outcomes for individuals with autism. The earlier a child is diagnosed, the earlier the child can begin benefiting from one of the many specialized intervention approaches (see treatment and education).</ The characteristic behaviors of autism spectrum disorders may or may not be apparent in infancy (18 to 24 months), but usually become obvious during early childhood (24 months to 6 years). As part of a well-baby/well-child visit, your child's doctor should do a "developmental screening" asking specific questions about your baby's progress. The National Institute of Child Health and Human Development (NICHD) lists five behaviors that signal further evaluation is warranted: Does not babble or coo by 12 months Does not gesture (point, wave, grasp) by 12 months Does not say single words by 16 months Does not say two-word phrases on his or her own by 24 months Has any loss of any language or social skill at any age. Having any of these five "red flags" does not mean your child has autism. But because the characteristics of the disorder vary so much, a child showing these behaviors should have further evaluations by a multidisciplinary team. This team may include a neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant, or other professionals knowledgeable about autism. (See Consulting with Professionals.) While there is no one behavioral or communications test that can detect autism, several screening instruments have been developed that are now being used in diagnosing autism: CARS rating system (Childhood Autism Rating Scale), developed by Eric Schopler in the early 1970s, is based on observed behavior. Using a 15-point scale, professionals evaluate a child's relationship to people, body use, adaptation to change, listening response, and verbal communication. The Checklist for Autism in Toddlers (CHAT) is used to screen for autism at 18 months of age. It was developed by Simon Baron-Cohen in the early 1990s to see if autism could be detected in children as young as 18 months. The screening tool uses a short questionnaire with two sections, one prepared by the parents, the other by the child's family doctor or pediatrician. The Autism Screening Questionnaire is a 40 item screening scale that has been used with children four and older to help evaluate communication skills and social functioning. The Screening Test for Autism in Two-Year Olds is being developed by Wendy Stone at Vanderbilt and uses direct observations to study behavioral features in children under two. She has identified three skills areas that seem to indicate autism - play, motor imitation, and joint attention. Whether you or your child's pediatrician is the first to suspect autism, your child will need to be referred to someone who specializes in diagnosing autism spectrum disorders. This may be a developmental pediatrician, a psychiatrist or psychologist, and other professionals that are better able to observe and test your child in specific areas. This multidisciplinary assessment team may include some or all of the following professionals (they may also be involved in treatment programs): Developmental pediatrician - Treats health problems of children with developmental delays or handicaps. Child psychiatrist - A medical doctor who may be involved in the initial diagnosis. He/she can also prescribe medication and provide help in behavior, emotional adjustment and social relationships). Clinical psychologist - Specializes in understanding the nature and impact of developmental disabilities, including autism spectrum disorders. May perform psychological and assessment test, as well as help with behavior modification and social skills training. Occupational therapist - Focuses on practical, self-help skills that will aid in daily living such as dressing and eating. May also work on sensory integration, coordination of movement, and fine motor skills. Physical therapist - Helps to improve the use of bones, muscles, joints, and nerves to develop muscle strength, coordination and motor skills. Speech/language therapist - Involved in the improvement of communication skills, including speech and language. Social Worker - May provide counseling services or act as case manager helping to arrange services and treatments. It is important that parents and professionals work together for the child's benefit. While professionals will use their experience and training to make recommendations about your child's treatment options, you have unique knowledge about his/her needs and abilities that should be taken into account for a more individualized course of action. <b>Treatments</b>

Once a treatment program is in place, communication between parents and professionals is essential in monitoring the child's progress. Here are some guidelines for working with professionals:
Be informed. Learn as much as you can about your child's disability so you can be an active participant in determining care. If you don't understand terms used by professionals, ask for clarification.
Be prepared. Be prepared for meetings with doctors, therapists, and school personnel. Write down your questions and concerns, and then note the answers.
Be organized. Many parents find it useful to keep a notebook detailing their child's diagnosis and treatment, as well as meetings with professionals.
Communicate. It's important to ensure open communication - both good and bad. If you don't agree with a professional's recommendation, speak up and say specifically why you don't.
Getting Past the Diagnosis
Often, the time immediately after the diagnosis is a difficult one for families, filled with confusion, anger and despair. These are normal feelings. But there is life after a diagnosis of autism. Life can be rewarding for a child with autism and all the people who have the privilege of knowing the child. While it isn't always easy, you can learn to help your child find the world an interesting and loving place.

The Autism Society of America's Panel of Professional Advisors has developed Guidelines to evaluate theories and practices related to autism. Listed here are a few of the things to consider as you evaluate treatment options:

Will the treatment result in harm to the child?
How will failure of the treatment affect my child and family?
Has the treatment been validated scientifically?
Are there assessment procedures specified?
How will the treatment be integrated into the child's current program? Do not become so infatuated with a given treatment that functional curriculum, vocational life and social skills are ignored.
In addition, consider the following questions when asking about specific treatments (compiled by the National Institute of Mental Health):
How successful has the program been for other children?
How many children have gone on to placement in a regular school and how have they performed?
Do staff members have training and experience in working with children and adolescents with autism?
How are activities planned and organized?
Are there predictable daily schedules and routines?
How much individual attention will my child receive?
How is progress measured?
Will my child's behavior be closely observed and recorded?
Will my child be given tasks and rewards that are personally motivating?
Is the environment designed to minimize distractions?
Will the program prepare me to continue the therapy at home?
What is the cost, time commitment, and location of the program?
Learn more about:
General Standards of Care
Early Intervention
Parent's Choice/Options Policy

Treatment

Treatment approaches are evolving as more is learned about autism. There are many therapeutic programs, both conventional and complementary, that focus on replacing dysfunctional behaviors and developing specific skills.

As a parent, it's natural to want to do something immediately. However, it is important not to rush in with changes. Your child may have already learned to cope with his or her current environment and changes could be stressful. You should investigate various treatment approaches and gather information concerning various options before proceeding with your child's treatment.

You will encounter numerous accounts from parents about successes and failures with many of the treatment approaches mentioned. You will also discover that professionals differ in their theories of what they feel is the most successful treatment for autism. It can be frustrating! But you will learn to sift through them and make rational, educated decisions on what is appropriate for your child. You live with your child every day and you know his/her needs. And in time, you will come to know his/her autism. Trust your instincts as you explore various options.

Again, please keep in mind that the descriptions of treatment approaches provided here are for informational purposes only. They are meant to give you an overview of an approach. To find additional resources and books, click here. The Autism Society of America does not endorse any specific treatment or therapy. For more information about the ASA's policy on options, click here.

During your research, you will hear about many different treatments approaches, such as auditory training, discrete trial training, vitamin therapy, anti-yeast therapy, facilitated communication, music therapy, occupational therapy, physical therapy, and sensory integration. These approaches can generally be broken down into three categories:
Behavioral & Communication Approaches
Biomedical & Dietary Approaches
Complimentary Approaches
Some of these treatment approaches have research studies that support their efficacy; others may not. Some parents will only want to try treatment methods that have undergone research and testing and are generally accepted by the professional community. But keep in mind that scientific studies are often difficult to do since each individual with autism is different.

For others, formal testing might not be a pre-requisite for them to try a treatment with their child. Even for those with "scientific" proof, we recommend that the family or caregiver investigate all options available to determine the appropriateness to their child.

Experts agree though, that early intervention is important in addressing the symptoms associated with autism. The earlier treatment is started, the better the chance the child will reach normal functioning levels. Many of the approaches described can be used on children as young as age 2 or 3. They may also continue to be used in conjunction with special education programs or traditional elementary school for children who are mainstreamed.

The Autism Society of America recognizes the importance of intensive early intervention for young children across the autism spectrum, including those labeled with autism, Asperger's syndrome, and other pervasive developmental disorders. While these children share a common diagnostic label, each has individual needs. Because of the individual differences among these children, the Autism Society of America supports an individualized approach that addresses the core deficits of autism spectrum disorders (e.g., communication, social, sensory, academic difficulties) and that matches each family's preferences and needs. In designing effective programs, the Autism Society of America encourages professionals and family members to consider the following components:
A curriculum which addresses deficit areas, which focuses on long-term outcomes, and which considers the developmental level of each child. Deficit areas include:
Inability to attend to relevant aspects of the environment, to shift attention, and to imitate language and the actions of others;
Difficulty in social interactions including appropriate play with toys and others, and symbolic and imaginative play; and
Difficulty with language comprehension and use, and functional communication.
Programs which capitalize on children's natural tendency to respond to visual structure, routines, schedules, and predictability.
Focus on generalization and maintenance of skills, using technology such as incidental teaching approaches.
Effective and systematic instructional approaches which utilize technology associated with applied behavior analysis, including chaining, shaping, discrete trial format, and others.
Coordinated transitions between service delivery agencies, including 0-2 programs, early intervention/preschool programs, and kindergarten environments.
Use of the technology associated with functional behavioral assessment and positive behavioral supports when involved with a child who presents behavioral challenges.
Family involvement, including coordination between home and involved professionals, an in-home training component, and family training and support.
The Autism Society of America encourages applied research to determine those interventions and approaches that are most effective for all children with autism spectrum disorders, and to encourage common usage of these practices for each child with an autism spectrum disorder, regardless of geographical location.

- Prepared by the Autism Society of America Panel of Professional Advisors. Approved: Autism Society of America Board of Directors, April 2000

The Autism Society of America promotes the active and informed involvement of family members and the individual with autism in the planning of individualized, appropriate services and supports. The Board of the Autism Society of America believes that each person with autism is a unique individual. Each family and individual with autism should have the right to learn about and then select, the options that they feel are most appropriate for the individual with autism. To the maximum extent possible, we believe that the decisions should be made by both the parents and the individual with autism.

Services should enhance and strengthen natural family and community supports for the individual with autism and the family whenever possible. The service option designed for an individual with autism should result in improved quality of life. Abusive treatment of any kind is not an option.

We firmly believe that no single type of program or service will fill the needs of every individual with autism and that each person should have access to support services. Selection of a program, service or method of treatment should be on the basis of a full assessment of each person's abilities, needs and interests. We believe that services should be outcome based to insure that they meet the individualized needs of a person with autism.

With appropriate education, vocational training and community living options and support systems, individuals with autism can lead dignified, productive lives in their communities and strive to reach their fullest potential.

The ASA believes that all individuals with autism have the right to access appropriate services and supports based on their needs and desires. (Adopted by the ASA Board of Directors 4/1/1995)

The behaviors exhibited by children with autism are frequently the most troubling to parents and caregivers. These behaviors may be inappropriate, repetitive, aggressive and/or dangerous, and may include:
Hand-flapping
Finger-snapping
Rocking
Placing objects in one's mouth
Head-banging.
Children with autism may also engage in self-mutilation, such as eye-gouging or biting their arms; they may show little or no sensitivity to burns or bruises; and may physically attack someone without provocation. The reasons for these behaviors are complex, but some professionals think that sensory integration issues contribute to them.

Communication skills, both the spoken and written word, are also an issue for children with autism. They have difficulty understanding how communication works and may have difficulty with reciprocal conversation. Many also have language difficulties, either being nonverbal throughout their lives or having delayed speech. Some children use language in unusual ways, such as repeating the words or sentences said to them (echolalia) or using only single words to communicate. Language difficulties may contribute to behavioral problems a child with autism may resort to screaming (because of an inability to use language to communicate his/her needs).

Many treatment approaches have been developed to address the range of social, language, sensory, and behavioral difficulties.

These include Discrete Trial Training (discrete trials), as part of:
Applied Behavior Analysis (ABA)
Treatment & Education of Autistic and Related Communication of Handicapped Children (TEACCH)
Picture Exchange Communication Systems (PECS)
Pivotal Response Treatment
Floor Time
Social Stories
Sensory Integration
Facilitated Communication
Complementary Approaches

Many of the interventions used to treat children with autism are based on the theory of Applied Behavior Analysis (ABA) - that behavior rewarded is more likely to be repeated than behavior ignored. Although ABA is a theory, many people use the term to describe a specific treatment approach with subsets that include discrete trial training or Lovaas. While the terms discrete trial and Lovaas have been used interchangeably, only practitioners who are affiliated with Lovaas can be said to implement "Lovaas Therapy."

In discrete trial training, every task given to the child consists of a request to perform a specific action, a response from the child, and a reaction from the therapist. It is not just about correcting behaviors but is designed to teach skills from basic ones such as sleeping and dressing, to more involved ones, such as social interaction. Discrete trial training is an intensive approach. Children usually work for 30 to 40 hours a week one-on-one with a trained professional. Tasks are broken down into short simple pieces, or trials. When a task has been successfully completed, a reward is offered, reinforcing the behavior or task. This method is not without controversy. Some practitioners feel it is emotionally too difficult for a child with autism, that the time requirement of 30 to 40 hours a week is too intensive and intrusive on family life; and that while it may change a particular behavior, it does not prepare a child with autism to respond to new situations. However, research has shown that ABA techniques show consistent results in teaching new skills and behaviors to children with autism.

The first statewide program for treatment and services for people with autism, TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children) was developed at the School of Medicine at the University of North Carolina in the 1970s. TEACCHuses a structured teaching approach based on the idea that the environment should be adapted to the child with autism, not the child to the environment. It uses no one specific technique, but rather a program based around the child's functioning level. The child's learning abilities are assessed through the Psycho Educational Profile (PEP), and teaching strategies are designed to improve communication, social and coping skills. Rather than teach a specific skill or behavior, the TEACCH approach aims to provide the child with the skills to understand his or her world and other people's behaviors. For example, some children with autism scream when they are in pain. The TEACCH approach would search for the cause of the screaming and then teach the child how to signal pain through communication skills.

There have been criticisms that the TEACCH approach is too structured, that children with autism, particularly high-functioning individuals, become too focused on the charts, organizational aids, and schedules, and that it discourages mainstream behavior (meaning that they may only respond to specific stimuli as taught in their curriculum and not everyday situations). Others feel that, in an environment conducive to learning, ultimately the child with autism understands what is expected and how to respond.

One of the main areas affected by autism is the ability to communicate. Some children with autism will develop verbal language, while others may never talk. An augmented communication program, such as Picture Exchange Communication Systems (PECS), is helpful to get language started as well as to provide a way of communicating for those children that do not talk.

PECS was developed at the Delaware Autistic Program to help children and adults with autism to acquire functional communication skills. It uses ABA-based methods to teach children to exchange a picture for something they want - an item or activity.

The advantage to PECS is that it is clear, intentional, and initiated by the child. The child hands you a picture, and his or her request is immediately understood. It also makes it easy for the child with autism to communicate with anyone - all they have to do is accept the picture.

PIVOTAL RESPONSE TREATMENT top
(www.education.ucsb.edu/autism)

Regarded as one of the top state-of-the-art treatments for autism in the United States*, Pivotal Response Treatment (PRT) is a naturalistic intervention model producing positive changes in critical behaviors, leading to generalized improvement in communication, social, and behavioral areas. Rather than target individual behaviors one at a time, PRT targets pivotal areas of a child's development, such as motivation, responsivity to multiple cues, self-management, and social initiations. By targeting these critical areas, PRT results in widespread, collateral improvements in other social, communicative, and behavioral areas.

The underlying motivational strategies of PRT are incorporated throughout intervention as often as possible, and they include child choice, task variation, interspersing maintenance tasks, rewarding attempts, and the use of direct and natural reinforcers. The child plays a crucial role in determining the activities and objects that will be used in the PRT exchange. For example, intentful attempts at functional communication are rewarded with a natural reinforcer (e.g, if a child attempts a request for a stuffed animal, the child receives the animal, not a piece of candy or other unrelated reinforcer). Pivotal Response Treatment is used to teach language, decrease disruptive/self-stimulatory behaviors, and increase social, communication, and academic skills.

* National Research Council of the National Academy of Sciences, 2001

An educational model developed by child psychiatrist Stanley Greenspan, Floor Time is much like play therapy in that it builds an increasingly larger circle of interaction between a child and an adult in a developmentally-based sequence. Greenspan has described six stages of emotional development that children meet to develop a foundation for more advanced learning - a developmental ladder that must be climbed one rung at a time. Children with autism may have trouble with this developmental ladder for a number of reasons, such as over-and under-reacting to senses, difficulty processing information, or difficulty in getting their body to do what they want.

Through the use of Floor Time, parents and educators can help the child move up the developmental ladder by following the child's lead and building on what the child does to encourage more interactions. Floor Time does not treat the child with autism in separate pieces for speech development or motor development, but rather addresses the emotional development, in contrast to other approaches that tend to focus on cognitive development. It is frequently used for a child's daily playtime in conjunction with other methods such as ABA.

Social Stories were developed in 1991 by Carol Gray as a tool for teaching social skills to children with autism. They address "Theory of Mind" deficits, that is, the ability to understand or recognize feelings, points of view or plans of others. Through a story developed about a particular situation or event, the child is provided with as much information as possible to help him or her understand the expected or appropriate response. The stories typically have three sentence types: descriptive sentences addressing the where, who, what and why of the situation; perspective sentences that provide some understanding of the thoughts and emotions of others; and directive sentences that suggest a response. The stories, which can be written by anyone, are specific to the child's needs, and are written in the first person, and present tense. They frequently incorporate the use of pictures, photographs or music.

Before developing and using social stories, it is important to identify how the child interacts socially and to determine what situations are difficult and under what circumstances. Situations that are frightening, produce tantrums or crying, or make a child withdraw or want to escape, are all appropriate for social stories. However, it is important to address the child's misunderstanding of the situation. A child who cries when his/her teacher leaves the room may be doing so because he/she is frightened or frustrated. A story about crying won't address the reason for the behavior. Rather a story about what scares the child and how he can deal with those feelings will be more effective.

Children with autism frequently have sensory difficulties. They may be hypo- or hyper-reactive or lack the ability to integrate the senses. Sensory integration therapy, usually done by occupational, physical or speech therapists, focuses on desensitizing the child and helping him or her reorganize sensory information. For example, if a child has difficulties with the sense of touch, therapy might include handling a variety of materials with different textures.

Temple Grandin, Ph.D., who herself has autism, developed a "squeeze machine" to help her learn to tolerate touching through regulated deep pressure stimulation.

Auditory integration therapy reduces over-sensitivity to sound. It may involve having the child listen to a variety of different sound frequencies coordinated to the level of impairment.

Before proceeding with any sensory integration therapy, it is important that the therapist observe the child and have a clear understanding of his/her sensitivities.

Facilitated Communication (FC) was developed in the 1970s in Australia by an aide who was trying to help a patient with cerebral palsy to communicate. It is based on the idea that the person is unable to communicate because of a movement disorder, not because of a lack of communication skills. FC involves a facilitator who, by supporting an individual's hand or arm, helps the person communicate through the use of a computer or typewriter. It has not been scientifically validated; critics claim it is actually the ideas or thoughts of the facilitator that are being communicated. FC is very controversial and organizations such as the American Association of Mental Retardation, and the American Academy of Child & Adolescent Psychiatry, have adopted formal positions opposing the acceptance of FC.

While early educational intervention is key to improving the lives of individuals with autism, some parents and professionals believe that other treatment approaches may play an important role in improving communications skills and reducing behavioral symptoms associated with autism. These complementary therapies may include music, art or animal therapy and may be done on an individual basis or integrated into an educational program. All of them can help by increasing communication skills, developing social interaction, and providing a sense of accomplishment. They can provide a non-threatening way for a child with autism to develop a positive relationship with a therapist in a safe environment.

Art and music are particularly useful in sensory integration, providing tactile, visual and auditory stimulation. Music therapy is good for speech development and language comprehension. Songs can be used to teach language and increase the ability to put words together. Art therapy can provide a nonverbal, symbolic way for the child with autism to express him or herself.

Animal therapy may include horseback riding or swimming with dolphins. Therapeutic riding programs provide both physical and emotional benefits, improving coordination and motor development, while creating a sense of well-being and increasing self-confidence. Dolphin therapy was first used in the 1970s by psychologist David Nathanson. He believed that interactions with dolphins would increase a child's attention, enhancing cognitive processes. In a number of studies, he found that children with disabilities learned faster and retained information longer when they were with dolphins, compared to children who learned in a classroom setting.

As with any therapy or treatment approach, it is important to gather information about the treatment and make an informed decision. Keep in mind however, as with most complementary approaches, there will be little scientific research that has been conducted to support the particular therapy.

Because autism is a spectrum disorder and no one method alone is usually effective in treating autism, professionals and families have found that a combination of treatments may be effective in treating symptoms and behaviors that make it hard for individuals with autism to function. These may include psychosocial and pharmacological interventions.

While there are no drugs, vitamins or special diets that can correct the underlying neurological problems that seem to cause autism, parents and professionals have found that some drugs used for other disorders are sometimes effective in treating some aspects of behaviors associated with autism.

Changes to diet and the addition of certain vitamins or minerals may also help with behavioral issues. Over the past 10 years, there have been claims that adding essential vitamins such as B6 and B12 and removing gluten and casein from a child's diet, may improve digestion, allergies and sociability. Not all researchers and experts agree about whether these therapies are effective or scientifically valid.

There are a number of medications, developed for other conditions, that have been found effective in treating some of the symptoms and behaviors frequently found in individuals with autism. Some of these include: hyperactivity, impulsivity, attention difficulties, and anxiety. The goal of medications is to reduce these behaviors to allow the individual with autism to take advantage of educational and behavioral treatments.

When medication is being discussed or prescribed, it's important to:
Ask about the safety of its use in children with autism
What is the appropriate dosage?
How is it administered (pills, liquid)?
What are the long-term consequences?
Are there possible side effects?
How will my child be monitored and by whom?
What laboratory tests are required before starting the drug and during treatment?
Are there possible interactions with other drugs, vitamins or foods?
Given the complexity of medications, drug interactions, and the unpredictability of how each patient may react to a particular drug, parents should seek out and work with a medical doctor with an expertise in the area of medication management.

What Medications are Available?
There are a number of medications that are frequently used for individuals with autism to address certain behaviors or symptoms. Some have studies to support their use, while others do not.

The Autism Society of America does not endorse any specific medication. The information provided here is meant as an overview of the types of medications sometimes prescribed. Be sure to consult a medical professional for more information.

Serotonin re-uptake inhibitors have been effective in treating depression, obsessive-compulsive behaviors, and anxiety that are sometimes present in autism. Because researchers have consistently found elevated levels of serotonin in the bloodstream of one-third of individuals with autism, these drugs could potentially reverse some of the symptoms of serotonin dysregulation in autism. Three drugs that have been studied are clomipramine (Anafranil), fluvoxamine (Luvox) and fluoxetine (Prozac). Studies have shown that they may reduce the frequency and intensity of repetitive behaviors, and may decrease irritability, tantrums and aggressive behavior. Some children have also shown improvements in eye contact and responsiveness.

Other drugs, such as Elavil, Wellbutrin, Valium, Ativan and Xanax have not been studied as much but may have a role in treating the behavioral symptoms. However, all these drugs have potential side effects, which should be discussed before treatment is started.

Anti-psychotic medications have been the most widely studied of the psychopharmacologic agents in autism over the past 35 years. Originally developed for treating schizophrenia, these drugs have been found to decrease hyperactivity, stereotypical behaviors, withdrawal, and aggression in individuals with autism. Four that have been approved by the FDA are clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa) and quetiapine (Seroquel). Only risperidone has been investigated in a controlled study of adults with autism. Like the antidepressants, these drugs all have potential side effects, including sedation.

Stimulants, such as Ritalin, Adderall, and Dexedine, used to treat hyperactivity in children with ADHD have also been prescribed for children with autism. Although few studies have been done, they may increase focus, and decrease impulsivity and hyperactivity in autism, particularly in higher-functioning children. However, dosages need to be carefully monitored, because behavioral side effects are often dose-related.

Increased use of medications to treat autism has highlighted the need for more studies of these drugs in children. The National Institute of Mental Health has established a network of Research Units on Pediatric Psychopharmacology (RUPPs) that combine expertise in psychopharmacology and psychiatry. Located at several research centers, they are intended to become a national resource that will expedite clinical trials in children. Five groups are specifically funded to evaluate treatments for autism, studying dose range and regimen of medications, as well as their mechanisms of action, safety, efficacy, and effects on cognition, behavior, and development. For example, the RUPP at Kennedy Krieger Institute is conducting a study on the efficacy of methylphenidate (Ritalin) in children and adolescents with Pervasive Developmental Disorders (PDD).

If you are considering the use of medications, contact a medical professional experienced in treating autism to learn of possible side effects. People with autism may have very sensitive nervous systems and normally recommended dosage may need to be adjusted. Even the use of large doses of vitamins should be done under the supervision of a medical doctor.

Over the past 10 years or more, claims have been made that vitamin and mineral supplements may improve the symptoms of autism, in a natural way. While not all researchers agree about whether these therapies are scientifically proven, many parent, and an increasing number of physicians, report improvement in people with autism when using individual or combined nutritional supplements.

Malabsorption problems and nutritional deficiencies have been addressed in several, as-of-yet, unreplicated studies. A few studies conducted in 2000 suggest that intestinal disorders and chronic gastrointestinal inflammation may reduce the absorption of essential nutrients and cause disruptions in immune and general metabolic functions that are dependent upon these essential vitamins. Other studies have shown that some children with autism may have low levels of vitamins A, B1, B3, B5, as well as biotin, selenium, zinc, and magnesium, while others may have an elevated serum copper to plasma zinc ratio, suggesting that people with autism should avoid copper and take extra zinc to boost their immune system. Other studies have indicated a need for more calcium.

Perhaps the most common vitamin supplement used in autism is vitamin B, which plays an important role in creating enzymes needed by the brain. In 18 studies on the use of vitamin B and magnesium (which is needed to make vitamin B effective), almost half of the individuals with autism showed improvement. The benefits include decreased behavioral problems, improved eye contact, better attention, and improvements in learning. Other research studies have shown that other supplements may help symptoms as well. Cod liver oil supplements (rich in vitamins A and D) have resulted in improved eye contact and behavior of children with autism. Vitamin C helps in brain function and deficiency symptoms like depression and confusion. Increasing vitamin C has been shown in a clinical trial to improve symptom severity in children with autism. And in a small pilot study in Arizona, using a multivitamin/mineral complex on 16 children with autism, improvements were observed in sleep, gastrointestinal problems, language, eye contact, and behavior.

Using Vitamins and Minerals
If you are considering the addition of vitamins or minerals to your child's diet, a laboratory and clinical assessment of nutritional status is highly recommended. The most accurate method for measuring vitamin and mineral levels is through a blood test. It is also important to work with someone knowledgeable in nutritional therapy. While large doses of some vitamins and minerals may not be harmful, others can be toxic. Once supplements are chosen, they should be phased in slowly (over several weeks) and then the effects should be observed for one to two months.

Individuals with autism may exhibit low tolerance or allergies to certain foods or chemicals. While not a specific cause of autism, these food intolerances or allergies may contribute to behavioral issues. Many parents and professionals have reported significant changes when specific substances are eliminated from the child's diet.

Individuals with autism may have trouble digesting proteins such as gluten. Research in the U.S. and England has found elevated levels of certain peptides in the urine of children with autism, suggesting the incomplete breakdown of peptides from foods that contain gluten and casein. Gluten is found in wheat, oats and rye, and casein in dairy products. The incomplete breakdown and the excessive absorption of peptides may cause disruption in biochemical and neuroregulatory processes in the brain, affecting brain functions. Until there is more information as to why these proteins are not broken down, the removal of the proteins from the diet is the only way to prevent further neurological and gastrointestinal damage.

It is important not to withdraw gluten/casein food products at once from a child's diet, as there can be withdrawal symptoms. Parents wishing to pursue a gluten/casein free diet should consult a gastroenterologist or nutritionist, who can help ensure proper nutrition.

Some hypothesize that children with autism have what is referred to as a "leaky gut" -- tiny holes in their intestinal tract that may be caused by an overgrowth of yeast. Some believe that this overgrowth may contribute to behavioral and medical problems in individuals with autism, such as confusion, hyperactivity, stomach problems, and fatigue. The use of nutritional supplements, anti-fungal drugs and/or a yeast-free diet may reduce the behavioral problems. However, caution should be paid to the fact that just as antibiotics can lead to bacterial resistance, antifungals can lead to fungal resistance.

Secretin is a hormone produced by the small intestine that helps in digestion. The hormone can be administered and used as a single dose to diagnose gastrointestinal problems. In 1996, a young boy with autism was given secretin for an endoscopy and showed improvements in some of his symptoms of autism. Other parents and professionals who tried secretin on children with autism reported similar results, including improvements in sleep patterns, eye contact, language skills, and alertness. However, several studies funded by the National Institute of Child Health and Human Development (NICHD) in the past three years have found no statistically significant improvements in the core symptoms when compared to patients who received a placebo. It is also important to remember that secretin is approved by the FDA for a single dose; there is no data on the safety of repeated doses over time.
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