Important Note: The following information is provided for your education. It should not be relied upon for personal diagnosis or treatment. If you believe that a particular therapy applies to you or someone you care about, be sure to consult a doctor before trying it.
   

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Previous Autism Research: 2002-2006   
The Autism File also contains summaries of past research that has shown promise and may still be standard practice among many physicians. To download earlier research findings on Autism, click HERE.
   

Latest Research on Autism
     
Science. 2008 Jul 11;321(5886):218-23. Comment in: Science. 2008 Jul 11;321(5886):208-9.
Identifying autism loci and genes by tracing recent shared ancestry.
Morrow EM, Yoo SY, Flavell SW, Kim TK, Lin Y, Hill RS, Mukaddes NM, Balkhy S, Gascon G, Hashmi A, Al-Saad S, Ware J, Joseph RM, Greenblatt R, Gleason D, Ertelt JA, Apse KA, Bodell A, Partlow JN, Barry B, Yao H, Markianos K, Ferland RJ, Greenberg ME, Walsh CA.
Division of Genetics, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.

To find inherited causes of autism-spectrum disorders, we studied families in which parents share ancestors, enhancing the role of inherited factors. We mapped several loci, some containing large, inherited, homozygous deletions that are likely mutations. The largest deletions implicated genes, including PCDH10 (protocadherin 10) and DIA1 (deleted in autism1, or c3orf58), whose level of expression changes in response to neuronal activity, a marker of genes involved in synaptic changes that underlie learning. A subset of genes, including NHE9 (Na+/H+ exchanger 9), showed additional potential mutations in patients with unrelated parents. Our findings highlight the utility of "homozygosity mapping" in heterogeneous disorders like autism but also suggest that defective regulation of gene expression after neural activity may be a mechanism common to seemingly diverse autism mutations.

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Pediatrics. 2008 Jul;122(1):e202-8.
Child care problems and employment among families with preschool-aged children with autism in the United States.
Montes G, Halterman JS.
Children's Institute, 271 N Goodman St, Suite D103, Rochester, NY 14607, USA. gmontes@childrensinstitute.net

BACKGROUND: The impact of childhood autism on parental employment is largely unknown. OBJECTIVE: The purpose of this work was to describe the child care arrangements of children with autism and to determine whether families of preschool-aged children with autism are more likely to report that child care arrangements affected employment compared with typically developing children and children at high risk for developmental problems. METHODS. Parents of 16282 preschool-aged children were surveyed by the National Survey of Children's Health. An autism spectrum disorder was defined as an affirmative response to the question, "Has a doctor or health professional ever told you that [child] has any of the following conditions? Autism?" There were 82 children with autism spectrum disorder in the sample, and 1955 children at high risk on the basis of the Parent's Evaluation of Developmental Status. We used chi(2) and multivariate logistic regression analyses. RESULTS: Ninety-seven percent of preschool-aged children diagnosed with autism spectrum disorder were cared for in community settings, particularly preschool and Head Start, with only 3% in exclusive parental care. Thirty-nine percent of the parents of children with autism spectrum disorder reported that child care problems had greatly affected their employment decisions, compared with 16% of the children at high risk and 9% of those who were typically developing. In multivariate analyses, families with a child with autism spectrum disorder were 7 times more likely to state that child care problems affected employment than other families, after controlling for household and child covariates. This effect was 3 times larger than the effect of poverty. CONCLUSIONS: Developmental problems and autism spectrum disorder are associated with higher use of child care services and higher probability that child care problems will greatly affect employment. These findings warrant evaluation of the community resources available to families with children with special needs.

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J Clin Psychiatry. 2008;69 Suppl 4:15-20.
Atypical antipsychotics in children and adolescents with autistic and other pervasive developmental disorders.
McDougle CJ, Stigler KA, Erickson CA, Posey DJ.
Department of Psychiatry, Indiana University School of Medicine, Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis, IN 46202-4800, USA. cmcdougl@iupui.edu

Atypical antipsychotics are emerging as the first-line pharmacologic treatment for irritability (i.e., aggression, self-injurious behavior, and severe tantrums) in children and adolescents with autistic and other pervasive developmental disorders. Results from placebo-controlled and open-label studies of clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole in this subject population are reviewed. Additional placebo-controlled trials and studies of longer-term safety and tolerability are needed.

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Nat Rev Genet. 2008 Jul;9(7):527-40.
Psychiatric genetics: progress amid controversy.
Burmeister M, McInnis MG, Zöllner S.
Molecular and Behavioral Neuroscience Institute, University of Michigan, 5061 BSRB, 109 Zina Pitcher Place, Ann Arbor, Michigan 48109-2200, USA. margit@umich.edu

Several psychiatric disorders--such as bipolar disorder, schizophrenia and autism--are highly heritable, yet identifying their genetic basis has been challenging, with most discoveries failing to be replicated. However, inroads have been made by the incorporation of intermediate traits (endophenotypes) and of environmental factors into genetic analyses, and through the identification of rare inherited variants and novel structural mutations. Current efforts aim to increase sample sizes by gathering larger samples for case-control studies or through meta-analyses of such studies. More attention on unique families, rare variants, and on incorporating environment and the emerging knowledge of biological function and pathways into genetic analysis is warranted.

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J Sleep Res. 2008 Jun;17(2):197-206.
Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: a population-based study.
Krakowiak P, Goodlin-Jones B, Hertz-Picciotto I, Croen LA, Hansen RL.
Division of Epidemiology, Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA.

This study compared parent-reported sleep characteristics in 2- to 5-year-old children with autism spectrum disorders (ASD) to children with other developmental delays (DD) and typical development (TD). We included 529 children (303 ASD [167 males], 63 DD [46 males], and 163 TD [134 males]) enrolled in the CHARGE study, an ongoing population-based case-control study. The mean age of participants was 3.6 years (standard deviation, 0.8 years). ASD diagnosis was confirmed with Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedules (ADOS). Cognitive and adaptive functioning was assessed using Mullen Scales of Early Learning (MSEL) and Vineland Adaptive Behavior Scales (VABS), respectively. Demographic, medical and sleep history information were ascertained from California birth records, telephone interview, medical assessments at clinic visit, and parent-administered questionnaires. Fifty-three percent of children with ASD had at least one frequent sleep problem, followed by 46% of children with DD, and 32% of the TD group (P < 0.0001). Exploratory factor analyses of sleep history data yielded two factors: sleep onset problems and night waking. Children with ASD had marginally higher sleep onset factor scores and significantly higher night waking factor scores compared with the TD group. Factor scores for children with DD were intermediate between the ASD and TD groups. Cognitive or adaptive development did not predict severity of sleep problems in the ASD group.

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Psychol Rep. 2008 Feb;102(1):273-82.
An exploration of possible pre- and postnatal correlates of autism: a pilot survey.
Brown GE, Jones SD, MacKewn AS, Plank EJ.
Department of Psychology, 325 Humanities Building, University of Tennessee at Martin, Martin, TN 38238, USA. gbrown@utm.edu

Biological mothers of children, diagnosed with autism or pervasive developmental disorder, and biological mothers of children without developmental delays and matched on age and sex, were surveyed about a number of possible pre- and postnatal correlates of autism or pervasive developmental disorder. A regression analysis for boys showed the mother not vomiting in the first trimester, not having smell aversions, not craving sweets, the mother reporting fewer food aversions during the pregnancy, and having an infection while pregnant significantly predicted a later diagnosis of autism or pervasive developmental disorder. Not vomiting in the first trimester was the only significant predictor of a diagnosis of autism or a pervasive developmental disorder in girls.

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J Dev Behav Pediatr. 2008 Apr;29(2):75-81.
Stimulant medication treatment of target behaviors in children with autism: a population-based study.
Nickels K, Katusic SK, Colligan RC, Weaver AL, Voigt RG, Barbaresi WJ.
Department of Pediatric and Adolescent Medicine, Mayo clinic, College of Medicine, Rochester, MN 55905, USA.

OBJECTIVE: This study provides detailed information about stimulant medication treatment for the target symptoms of hyperactivity, impulsivity, disinhibition, and inattention in children with autism. METHODS: In a previous study, 124 subjects fulfilling DSM-IV-based research criteria for autistic disorder were identified among all 0-21 year old residents of Olmsted County, MN from 1976-1997. For each of these 124 children with research-identified autism, information was abstracted on all prescribed psychopharmacological medications. RESULTS: Psychostimulants were used to treat 52.4% (N = 65) of the 124 subjects. The median total duration of psychostimulant treatment was 4.0 years. There were 398 episodes of psychostimulant treatment. Favorable responses were associated with 69.4% of treatment episodes. Of the 398 episodes of stimulant treatment, 16.8% were associated with a documented side effect. At least one side effect was experienced by 66% of the children. CONCLUSION: These results indicate that psychostimulants are commonly prescribed for children with autism, and suggest that these medications may improve the target symptoms of hyperactivity, impulsivity, disinhibition and inattention.

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Z Kinder Jugendpsychiatr Psychother. 2008 Jan;36(1):7-14; quiz 14-5.
[The genetics of autistic disorders]
[Article in German]
Freitag CM.
Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum des Saarlandes, Homburg. christine.freitag@uniklinikum-saarland.de

Autistic disorders are heterogeneous. Affected individuals show impairments in communication and social interaction, as well as stereotypic, repetitive behaviour and special interests. The majority of autistic disorders are genetic in origin. The current article presents an overview of cytogenetic findings, as well as of results of molecular genetic linkage and association studies. Important differential diagnoses will be described. The results of genetic studies are especially relevant with regard to genetic counselling for affected families.

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J Appl Behav Anal. 2008 Spring;41(1):107-11.
Reducing rapid eating in teenagers with autism: use of a pager prompt.
Anglesea MM, Hoch H, Taylor BA.
Alpine Learning Group, Paramus, New Jersey 07652 , USA.

This study assessed the effects of a vibrating pager for increasing the duration of meal consumption in 3 teenagers with autism who were observed to eat too quickly. Participants were taught to take a bite only when the pager vibrated at predetermined intervals. A reversal design indicated that the vibrating pager successfully increased the total duration of mealtime, thereby slowing the pace of consumption for all 3 participants.

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J Child Adolesc Psychopharmacol. 2008 Apr;18(2):157-78.
Psychopharmacology of aggression in children and adolescents with autism: a critical review of efficacy and tolerability.
Parikh MS, Kolevzon A, Hollander E.
Mount Sinai School of Medicine, New York, New York.

ABSTRACT Background: Autism is characterized by a clinical triad of symptoms that affect social, language, and behavioral domains. Aggression and self-injury may be associated symptoms of autism and can result in significant harm to those affected as well as marked distress for their families. The precise nature of the relationship between aggressive or self-injurious behavior (SIB) and autism remains unclear and as a result, these symptoms are treated with a broad range of pharmacological approaches. This review seeks to systematically and critically examine the evidence for the pharmacological management of aggression and SIB in children with autism spectrum disorders. Method: The entire PubMed database was searched for English language biomedical articles on clinical trials with medication in autism spectrum disorders. Studies were selected based on the following inclusion criteria: (1) randomized placebo-controlled trials; (2) a sample population that included children and adolescents; (3) at least one standardized assessment of aggression as a primary outcome measure of the study. Results: Twenty one trials with 12 medications were identified. Five medications produced significant improvement as compared to placebo, including tianeptine, methylphenidate, risperidone, clonidine, and naltrexone. Only risperidone and methylphenidate demonstrate results that have been replicated across at least two studies. Conclusions: Although many medications have been studied under placebo-controlled conditions, few produce significant improvement. Additional placebo-controlled trials are needed to increase the number of therapeutic options available in the treatment of aggression in autism.

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J Abnorm Child Psychol. 2008 Apr 25 [Epub ahead of print]
Autism Spectrum Symptomatology in Children: The Impact of Family and Peer Relationships.
Kelly AB, Garnett MS, Attwood T, Peterson C.
School of Social Science, The University of Queensland, Brisbane, Australia, a.kelly@uq.edu.au.

This study examines the potential impact of family conflict and cohesion, and peer support/bullying on children with autism spectrum disorder (ASD). While such impacts have been established for a range of non-ASD childhood disorders, these findings may not generalize to children with ASD because of unique problems in perspective-taking, understanding others' emotion, cognitive rigidity, and social reasoning. A structural model-building approach was used to test the extent to which family and peer variables directly or indirectly affected ASD via child anxiety/depression. The sample (N = 322) consisted of parents of children with ASD referred to two specialist clinics. The sample contained parents of children with Autistic Disorder (n = 76), Asperger Disorder (n = 188), Pervasive Disorder Not Otherwise Specified (n = 21), and children with a non-ASD or no diagnosis (n = 37). Parents completed questionnaires on-line via a secure website. The key findings were that anxiety/depression and ASD symptomatology were significantly related, and family conflict was more predictive of ASD symptomatology than positive family/peer influences. The results point to the utility of expanding interventions to include conflict management for couples, even when conflict and family distress is low. Further research is needed on the potentially different meanings of family cohesion and conflict for children with ASD relative to children without ASD.

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Cochrane Database Syst Rev. 2008 Apr 16;(2):CD003498.
Gluten- and casein-free diets for autistic spectrum disorder.
Millward C, Ferriter M, Calver S, Connell-Jones G.

BACKGROUND: It has been suggested that peptides from gluten and casein may have a role in the origins of autism and that the physiology and psychology of autism might be explained by excessive opioid activity linked to these peptides. Research has reported abnormal levels of peptides in the urine and cerebrospinal fluid of people with autism. OBJECTIVES: To determine the efficacy of gluten and/or casein free diets as an intervention to improve behaviour, cognitive and social functioning in individuals with autism. SEARCH STRATEGY: The following electronic databases were searched: CENTRAL(The Cochrane Library Issue 2, 2007), MEDLINE (1966 to April 2007), PsycINFO (1971 to April 2007), EMBASE (1974 to April 2007), CINAHL (1982 to April 2007), ERIC (1965 to 2007), LILACS (1982 to April 2007), and the National Research register 2007 (Issue1). Review bibliographies were also examined to identify potential trials. SELECTION CRITERIA: All randomised controlled trials (RCT) involving programmes which eliminated gluten, casein or both gluten and casein from the diets of individuals diagnosed with an autistic spectrum disorder. DATA COLLECTION AND ANALYSIS: Abstracts of studies identified in searches of electronic databases were assessed to determine inclusion by two independent authors The included trials did not share common outcome measures and therefore no meta-analysis was possible. Data are presented in narrative form. MAIN RESULTS: Two small RCTs were identified (n = 35). No meta-analysis was possible. There were only three significant treatment effects in favour of the diet intervention: overall autistic traits, mean difference (MD) = -5.60 (95% CI -9.02 to -2.18), z = 3.21, p=0.001 (Knivsberg 2002) ; social isolation, MD = -3.20 (95% CI -5.20 to 1.20), z = 3.14, p = 0.002) and overall ability to communicate and interact, MD = 1.70 (95% CI 0.50 to 2.90), z = 2.77, p = 0.006) (Knivsberg 2003). In addition three outcomes showed no significant differ
ence between the treatment and control group and we were unable to calculate mean differences for ten outcomes because the data were skewed. No outcomes were reported for disbenefits including harms. AUTHORS' CONCLUSIONS: Research has shown of high rates of use of complementary and alternative therapies (CAM) for children with autism including gluten and/or casein exclusion diets. Current evidence for efficacy of these diets is poor. Large scale, good quality randomised controlled trials are needed.

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Expert Rev Neurother. 2008 Apr;8(4):657-69.
Co-occurrence of ADHD and autism spectrum disorders: phenomenology and treatment.
Reiersen AM, Todd RD.
Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO 63110-1093, USA. reiersea@psychiatry.wustl.edu

The Diagnostic and Statistical Manual of Mental Disorders (4th Edition) prohibits the co-diagnosis of attention-deficit/hyperactivity disorder (ADHD) and an autism spectrum disorder (ASD). However, recent studies indicate that co-occurrence of clinically significant ADHD and autistic symptoms is common, and that some genes may influence both disorders. Children with the combination of ADHD and motor coordination problems are particularly likely to have an ASD. These co-occurrences of symptoms are important since children with ASD in addition to ADHD symptoms may respond poorly to standard ADHD treatments or have increased side effects. Such children may benefit from additional classes of pharmacologic agents (i.e., alpha-agonists, selective serotonin reuptake inhibitors and neuroleptics). They may also benefit from social skills therapy, individual and family psychotherapy, behavioral therapy and other nonpharmacologic interventions.

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J Autism Dev Disord. 2008 Apr 10 [Epub ahead of print]
The Effectiveness of Parent-Child Interaction Therapy for Families of Children on the Autism Spectrum.
Solomon M, Ono M, Timmer S, Goodlin-Jones B.
Department of Psychiatry & Behavioral Sciences, University of California, Davis, 2825 50th Street, Sacramento, CA, 95817, USA, marjorie.solomon@ucdmc.ucdavis.edu.

We report the results of a pilot trial of an evidence-based treatment-Parent-Child Interaction Therapy (PCIT; Eyberg et al. Psychopharmacology Bulletin, 31(1), 83-91, 1995) for boys aged 5-12 with high functioning autism spectrum disorders and clinically significant behavioral problems. The study also included an investigation of the role of shared positive affect during the course of therapy on child and parent outcomes. The intervention group showed reductions in parent perceptions of child problem behaviors and child atypicality, as well as an increase in child adaptability. Shared positive affect in parent child dyads and parent positive affect increased between the initial and final phases of the therapy. Parent positive affect after the first phase was related to perceptions of improvement in problem behaviors and adaptive functioning.

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Int Rev Psychiatry. 2008 Apr;20(2):165-70.
Autism: the role of cholesterol in treatment.
Aneja A, Tierney E.
Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, and Department of Psychiatry, Kennedy Krieger Institute, Baltimore, MD 21211, USA. aneja@kennedykrieger.org

Cholesterol is essential for neuroactive steroid production, growth of myelin membranes, and normal embryonic and fetal development. It also modulates the oxytocin receptor, ligand activity and G-protein coupling of the serotonin-1A receptor. A deficit of cholesterol may perturb these biological mechanisms and thereby contribute to autism spectrum disorders (ASDs), as observed in Smith-Lemli-Opitz syndrome (SLOS) and some subjects with ASDs in the Autism Genetic Resource Exchange (AGRE). A clinical diagnosis of SLOS can be confirmed by laboratory testing with an elevated plasma 7DHC level relative to the cholesterol level and is treatable by dietary cholesterol supplementation. Individuals with SLOS who have such cholesterol treatment display fewer autistic behaviours, infections, and symptoms of irritability and hyperactivity, with improvements in physical growth, sleep and social interactions. Other behaviours shown to improve with cholesterol supplementation include aggressive behaviours, self-injury, temper outbursts and trichotillomania. Cholesterol ought to be considered as a helpful treatment approach while awaiting an improved understanding of cholesterol metabolism and ASD. There is an increasing recognition that this single-gene disorder of abnormal cholesterol synthesis may be a model for understanding genetic causes of autism and the role of cholesterol in ASD.

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J Dev Behav Pediatr. 2008 Apr;29(2):89-93.
Difference in Age at Regression in Children with Autism with and without Down Syndrome.
Castillo H, Patterson B, Hickey F, Kinsman A, Howard JM, Mitchell T, Molloy CA.
*Division of Developmental and Behavioral Pediatrics and †Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; ‡Division of Developmental-Behavioral Pediatrics, Greenville Hospital System Children's Hospital, Greenville, South Carolina; §University of Kentucky College of Medicine, Lexington, Kentucky; |?Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.

OBJECTIVE:: Autism occurs more frequently in individuals with Down syndrome than it does in the general population. Among children with autism and Down syndrome, regression is reported to occur in up to 50%. The aim of this study was to characterize and compare regression in children with autism with and without Down syndrome. METHODS:: In this case-control study, children with Down syndrome and autism characterized by a history of developmental regression (n = 12) were compared to children with autism with regression who did not have Down syndrome, matched for chronologic age and gender. Comparisons were made on age at acquisition of language and age at loss of language and other skills as measured by the Autism Diagnostic Interview-Revised (ADI-R). RESULTS:: The mean age at acquisition of meaningful use of single words was 40.6 months (SD = 38.0) in children with Down syndrome and autism compared to 14.9 months (SD = 8.5) in children with autism without Down syndrome (p = .
005). The mean age at language loss in children with autism with Down syndrome was 61.8 months (SD = 22.9) compared to 19.7 months (SD = 5.8) for those with autism without Down syndrome (p = .01). The mean age at other skill loss was 46.2 months (SD = 19.1) and 19.5 months (SD = 5.6), respectively (p = .006). CONCLUSIONS:: When regression occurs in children with autism and Down syndrome it is, on average, much later than is typically seen in children with autism without Down syndrome.

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J Dev Behav Pediatr. 2008 Apr;29(2):106-116.
Risperidone Use in Children with Down Syndrome, Severe Intellectual Disability, and Comorbid Autistic Spectrum Disorders: A Naturalistic Study.
Capone GT, Goyal P, Grados M, Smith B, Kammann H.
*Division of Neurology and Developmental Medicine, †Center for Genetic Disorders of Cognition and Behavior, Kennedy Krieger Institute, Baltimore, Maryland; Departments of ‡Pediatrics and §Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; and ||Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.

OBJECTIVE:: We report on an open-label, naturalistic study using risperidone to treat disruptive behaviors and self-injury in children with Down syndrome, severe intellectual disability, and comorbid autism spectrum disorders (DS+ASDs). We hypothesized that hyperactivity and disruptive behaviors would improve in response to risperidone treatment consistent with previous studies of children with ASD. METHODS:: Subjects were children (mean age, 7.8 +/- 2.6 years), consisting of 20 males and three females identified through our outpatient Down Syndrome Clinic between 2000 and 2004. RESULTS:: Using the Aberrant Behavior Checklist as the primary outcome measure, all five subscales showed significant improvement following risperidone treatment. The mean duration of treatment was 95.8 +/- 16.8 days, and mean total daily dose was 0.66 +/- 0.28 mg/day. The Hyperactivity, Stereotypy, and Lethargy subscale scores showed the most significant reduction (p < .001), followed by Irritability (p < .02), and Inappropriate Speech (p < .04). Children with disruptive behavior and self-injury showed the greatest improvement. Sleep quality improved for 88% of subjects with preexisting sleep disturbance. Subjects for whom a follow-up weight was available showed a mean weight increase of 2.8 +/- 1.5 kg during the treatment period. CONCLUSIONS:: These findings support our clinical impression of improvement on important target behaviors such as aggression, disruptiveness, self-injury, stereotypy, and social withdrawal. Low-dose risperidone appears to be well tolerated in children with DS+ASD, although concerns about weight gain and metabolic alterations may limit its usefulness over the long term in some children.

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J Altern Complement Med. 2008 Jan 16 [Epub ahead of print]
Nutritional and Environmental Approaches to Preventing and Treating Autism and Attention Deficit Hyperactivity Disorder (ADHD): A Review.
Curtis LT, Patel K.
Occupational Physician and Industrial Hygienist, Wilmette, IL.

Objectives: The purpose of this study was to concisely review the available literature of nutritional and environmental factors on autistic spectrum and attention deficit hyperactivity disorder (ADHD). Design and methods: Review of journal articles found on the PubMed database and from information from several conference proceedings. Results: Many, but not all, studies link exposure to toxins such as mercury, lead, pesticides, and in utero smoking exposure to higher levels of autism and/or ADHD. Some studies have reported many nutritional deficiencies in autism/ADHD patients. Numerous studies have reported that supplemental nutrients such as omega-3 fatty acids, vitamins, zinc, magnesium, and phytochemicals may provide moderate benefits to autism/ADHD patients. Avoidance of food allergens, food chemicals, and chelation therapy may also provide some relief to autism/ADHD patients. Conclusions: Autistic spectrum disorders and ADHD are complicated conditions in which nutritional and environmental factors play major roles. Larger studies are needed to determine optimum multifactorial treatment plans involving nutrition, environmental control, medication, and behavioral/education/speech/physical therapies.

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J Child Neurol. 2008 Jan 8 [Epub ahead of print]
Melatonin for Insomnia in Children With Autism Spectrum Disorders.
Andersen IM, Kaczmarska J, McGrew SG, Malow BA.
Vanderbilt Children’s Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee.

We describe our experience in using melatonin to treat insomnia, a common sleep concern, in children with autism spectrum disorders. One hundred seven children (2-18 years of age) with a confirmed diagnosis of autism spectrum disorders who received melatonin were identified by reviewing the electronic medical records of a single pediatrician. All parents were counseled on sleep hygiene techniques. Clinical response to melatonin, based on parental report, was categorized as (1) sleep no longer a concern, (2) improved sleep but continued parental concerns, (3) sleep continues to be a major concern, and (4) worsened sleep. The melatonin dose varied from 0.75 to 6 mg. After initiation of melatonin, parents of 27 children (25%) no longer reported sleep concerns at follow-up visits. Parents of 64 children (60%) reported improved sleep, although continued to have concerns regarding sleep. Parents of 14 children (13%) continued to report sleep problems as a major concern, with only 1 child having worse sleep after starting melatonin (1%), and 1 child having undetermined response (1%). Only 3 children had mild side-effects after starting melatonin, which included morning sleepiness and increased enuresis. There was no reported increase in seizures after starting melatonin in children with pre-existing epilepsy and no new-onset seizures. The majority of children were taking psychotropic medications. Melatonin appears to be a safe and well-tolerated treatment for insomnia in children with autism spectrum disorders. Controlled trials to determine efficacy appear warranted.

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Autism. 2008 Jan;12(1):83-98.
Improving question asking in high-functioning adolescents with autism spectrum disorders: Effectiveness of small-group training.
Palmen A, Didden R, Arts M.
Dr Leo Kannerhuis Doorwerth, The Netherlands. A.Palmen@pwo.ru.nl.

Small-group training consisting of feedback and self-management was effective in improving question-asking skills during tutorial conversations in nine high-functioning adolescents with autism spectrum disorder. Training was implemented in a therapy room and lasted 6 weeks. Sessions were conducted once a week and lasted about an hour. Experimenters collected data during tutorial conversations in a natural setting. Training of question-asking skills consisted of verbal feedback and role-play during short simulated conversations and a table game. A self-management strategy and common stimuli (e.g., flowchart) were included to promote generalization. Mean percentage of correct questions during tutorial conversations improved significantly after training. Response efficiency also increased. Participants and personal coaches evaluated the training as effective and acceptable.

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Autism. 2008 Jan;12(1):47-63.
Maternal involvement in the education of young children with autism spectrum disorders.
Benson P, Karlof KL, Siperstein GN.
University of Massachusetts, Boston, USA. paul.benson@umb.edu.

Parent involvement is widely acknowledged to be a critical ;best practice' in the education of young children with ASD. Despite its importance, no studies to date have systematically examined the relative influence of child, family, and school factors on the extent to which parents participate in the education of their children with ASD. In the present study, questionnaire and interview data collected from the mothers and teachers of 95 children receiving public school services for ASD were used to address this issue. Descriptively, wide variation was found in both type and intensity of mothers' educational involvement. Regression analyses showed involvement, both at school and at home, to be heavily influenced by the extent to which school staff actively encouraged, assisted, and provided opportunities for parent involvement. In addition, severity of child behavior problems was also found to exert a uniformly negative effect on intensity of mothers' educational involvement, while the influence of family resources and demand variables varied, depending on whether involvement occurred at school or at home. Implications of these findings for future research and for the support of parents seeking to participate in the learning and development of their children with ASD are discussed.

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J Clin Invest. 2008 Jan;118(1):6-14.
Antipsychotics in the treatment of autism.
Posey DJ, Stigler KA, Erickson CA, McDougle CJ.
Christian Sarkine Autism Treatment Center, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Atypical antipsychotics have become indispensable in the treatment of a variety of symptoms in autism. They are frequently used to treat irritability and associated behaviors including aggression and self injury. They may also be efficacious for hyperactivity and stereotyped behavior. This review presents the rationale for the use of this drug class in autism and reviews the most important studies published on this topic to date. Significant adverse effects, including weight gain and the possibility of tardive dyskinesia, are reviewed. Future research directions are discussed.

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Behav Modif. 2008 Jan;32(1):61-76.
A review of behavioral treatments for self-injurious behaviors of persons with autism spectrum disorders.
Matson JL, Lovullo SV.
Louisiana State University, Baton Rouge.

Autism spectrum disorders (ASD) are considered to be among the most serious of the mental health conditions. Concomitant with many cases of ASD is intellectual disability. Further compounding the disability is the fact that both conditions are known risk factors for self-injurious behavior (SIB). To date, the most effective intervention methods, based on the available data, appear to be variants of behavior modification. This article provides an overview of the current status of learning-based interventions for SIB in ASD and provides a review of specific studies. Although most studies describe some combination of reinforcement and punishment procedures, efforts are under way to develop more positively oriented strategies, such as functional assessment, to decrease the use of punishment. However, almost all the treatment studies employ single case designs, thus preventing a comparison of treatment efficacy. These issues are discussed along with other strengths, weaknesses, and future directions for clinical practice and treatment.

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HNO. 2007 Dec 16 [Epub ahead of print]
[Autism spectrum disorders : Current knowledge and importance for ENT specialists.]
[Article in German]
Schwemmle C, Schwemmle U, Ptok M.
Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland, schwemmle.cornelia@mh-hannover.de.

Autism is a behavioural syndrome, present from early life and defined by deficient social interaction, language and communication, and play. Variations in symptomatology and in prognosis among characteristic persons display a variety of other signs such as attention deficits, mental retardation and seizures that are not specific to autism and that denote dysfunction in other brain systems. Its aetiology is unknown in the vast majority of cases. There is a small minority of persons in whom autism has a known aetiology, such as fragile X chromosome abnormality, congenital rubella, tuberous sclerosis and a variety of structural abnormalities and metabolic diseases of the brain. A causal treatment is so far not possible, and there remains a regrettable lack of evaluated treatment standards. Prognosis depends on many factors, most notably the limiting factor provided by the severity of the underlying brain dysfunction and its consequences for communication, cognition and other behaviour. ENT specialists are confronted with children, adolescents and even adults in whom autistic disease has already been diagnosed in the course of investigations/treatment. If the suspicion of hearing impairment as the cause of problems in daily life is not confirmed in a patient not hitherto known to have autism ENT specialists should also consider autism in the differential diagnosis. In this report the diagnostic and therapeutic strategies currently applied for autism and its importance for ENT specialists are presented.

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Pediatr Clin North Am. 2007 Dec;54(6):983-1006; xii.
Complementary and alternative medical therapies for attention-deficit/hyperactivity disorder and autism.
Weber W, Newmark S.
School of Naturopathic Medicine, Bastyr University, 14500 Juanita Drive NE, Kenmore, WA 98021, USA. wendyw@bastyr.edu

Complementary and alternative medical (CAM) therapies are commonly used by parents for their children who have attention deficit hyperactivity disorder (ADHD) or autism spectrum disorders. The use of these therapies is well documented, yet the evidence of the safety and efficacy of these treatments in children is limited. This article describes the current evidence-based CAM therapies for ADHD and autism, focusing on nutritional interventions; natural health products, including essential fatty acids, vitamins, minerals, and other health supplements; biofeedback; and reducing environmental toxins. The CAM evidence in ADHD is addressed, as is the CAM literature in autism.

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Curr Opin Psychiatry. 2007 Sep;20(5):472-6.
Children with autism spectrum disorders and intellectual disability.
McCarthy J.
South London & Maudsley NHS Foundation Trust, London, UK.

PURPOSE OF REVIEW: The present article reviews the increasing literature on comorbidity, treatment and use of health service resources for children and adolescents with autism spectrum disorders and intellectual disability from January 2006 to January 2007. RECENT FINDINGS: Children and adolescents with autism spectrum disorders and intellectual disability have a high prevalence of attention-deficit/hyperactive disorder, mood disorders, catatonia and repetitive behaviours compared with children without autism. Psychopharmacology is effective in reducing symptoms of behavioural problems and attention-deficit/hyperactive disorder, although further studies are required. Autism spectrum disorders are recognized to occur with Smith-Lemli-Optiz syndrome and 22q11.2 deletion syndrome. Children and adolescents with autism spectrum disorders have a high use of mental health services. SUMMARY: There is increasing evidence of the comorbidity of psychiatric and behavioural disorders in young people with autism spectrum disorders and intellectual disability responding to established treatments. This high morbidity results in increased healthcare expenditure compared with children without autism and intellectual disability.

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Behav Modif. 2007 Sep;31(5):682-707.
Social-skills treatments for children with autism spectrum disorders: an overview.
Matson JL, Matson ML, Rivet TT.
Louisiana State University, LA, USA.

Marked advances in the treatment of children with autism spectrum disorders (ASDs) has occurred in the past few decades, primarily using applied behavior analysis. However, reviews of trends in social skills treatment for children with ASDs have been scant, despite a robust and growing empirical literature on the topic. In this selective review of 79 treatment studies, the authors note that the research has been particularly marked by fragmented development, using a range of intervention approaches and definitions of the construct. Modeling and reinforcement treatments have been the most popular model from the outset, with most studies conducted in school settings by teachers or psychologists. Investigators have been particularly attentive to issues of generalization and follow-up. However, large-scale group studies and comparisons of different training strategies are almost nonexistent. These trends and their implications for future research aimed at filling gaps in the existing literature are discussed.

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J Dev Behav Pediatr. 2007 Aug;28(4):308-316.
A Randomized, Controlled Trial of a Home-Based Intervention Program for Children with Autism and Developmental Delay.
Rickards AL, Walstab JE, Wright-Rossi RA, Simpson J, Reddihough DS.
From *Murdoch Childrens Research Institute; †Department of Child Development and Rehabilitation, Royal Children's Hospital; ‡Department of Paediatrics, University of Melbourne, Parkville, Australia.

OBJECTIVE:: This study aimed to (1) investigate whether provision of a home-based program in addition to a center-based program improves development in young children with disabilities and coping abilities of their families and (2) describe the characteristics of children and families who benefit most from the intervention. METHODS:: Fifty-nine children, aged 3-5 years, with no cerebral palsy, participated in the study. Half of the group was randomized to receive an additional program in their homes. A special education teacher provided 40 visits over 12 months working with the families to help generalize skills to the home environment and assist with their concerns. All children were assessed before and after the intervention, and families completed questionnaires assessing family stress, support, and empowerment on both occasions. Differences in change over time and between the intervention and control group were analyzed by repeated measures and the association between characteristics of children and families with improved outcome by multivariate analysis of variance. RESULTS:: Change in cognitive development and behavior (in the centers) over time favored the children who received the extra intervention (p = .007 and p = .007, respectively). The groups did not differ on any of the family measures of change. Multivariate analysis of variance revealed more improvement for children in the intervention group from higher than lower stressed families. CONCLUSIONS:: Results suggest the need for daily reinforcement of skills learned at the center-based program and the importance of involving families, especially those with few resources and relatively high stress.

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Expert Opin Pharmacother. 2007 Aug;8(11):1579-603.
The status of pharmacotherapy for autism spectrum disorders.
Myers SM.
Neurodevelopmental Pediatrician, Geisinger Health System Assistant Professor of Pediatrics, Jefferson Medical College Geisinger Medical Center, Danville, PA 17822-1339, USA. smyers1@geisinger.edu

The use of pharmacologic agents as a component of treatment for children and adults with autism spectrum disorders is common and a substantial body of literature describing controlled and open-label clinical trials now exists to guide clinical practice. Empiric evidence of efficacy of risperidone, methylphenidate and some selective serotonin re-uptake inhibitors for maladaptive behaviors commonly associated with autism spectrum disorders has increased substantially in recent years. Preliminary controlled trials of valproate, atomoxetine, alpha-2 adrenergic agonists and olanzapine are promising. In addition to traditional psychotropic medications, investigators have examined the potential role of a variety of agents with glutamatergic or cholinergic mechanisms, and the results warrant further investigation. Although psychotropic medications are effective in treating some important associated behaviors, evidence of significant impact on the core features of autism spectrum disorders is very limited.

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J Child Psychol Psychiatry. 2007 Aug;48(8):803-12.
A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders.
Magiati I, Charman T, Howlin P.
Institute of Psychiatry, King's College London, UK. Iliana.Magiati@islingtonpct.nhs.uk

BACKGROUND: This prospective study compared outcome for pre-school children with autism spectrum disorders (ASD) receiving autism-specific nursery provision or home-based Early Intensive Behavioural Interventions (EIBI) in a community setting. METHODS: Forty-four 23- to 53-month-old children with ASD participated (28 in EIBI home-based programmes; 16 in autism-specific nurseries). Cognitive, language, play, adaptive behaviour skills and severity of autism were assessed at intake and 2 years later. RESULTS: Both groups showed improvements in age equivalent scores but standard scores changed little over time. At follow-up, there were no significant group differences in cognitive ability, language, play or severity of autism. The only difference approaching significance (p = .06), in favour of the EIBI group, was for Vineland Daily Living Skills standard scores. However, there were large individual differences in progress, with intake IQ and language level best predicting overall progress. CONCLUSIONS: Home-based EIBI, as implemented in the community, and autism-specific nursery provision produced comparable outcomes after two years of intervention.

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Zhongguo Zhen Jiu. 2007 Jul;27(7):503-5.
[Effect of acupuncture on rehabilitation training of child's autism]
[Article in Chinese]
Yan YF, Wei YY, Chen YH, Chen MM.
Nanning Disabled Children's Rehabilitation Center, Guangxi, China. weiyanyufen@sohu.com

OBJECTIVE: To observe the effect of acupuncture on rehabilitation training for children's autism. METHODS: Forty autistic children receiving rehabilitation training were divided into a control group and a treatment group, 20 cases in each group. The control group received rehabilitation training including ABA training, the Conductive Education Approach and the training of sensory integration, about 90 sessions for each training; the treatment group received acupuncture treatment for 60-90 sessions after the rehabilitation training. Their results were detected by the revised Chinese version of Psycho-Educational Profile for autistic and developmentally disabled children (C-PEP). RESULTS: The markedly effective rate was 55.0% in the treatment group and 15.0% in the control group with a very significant difference between the two groups (P < 0.01); the differences before and after training in some projects such as the total score of development, imitation, oral cognition in the treatment group were very significantly different from those in the control group (P < 0.01). CONCLUSION: Acupuncture combined with scientific and effective rehabilitation training has a better therapeutic effect than that of the simple rehabilitation training for child's autism.

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Paediatr Drugs. 2007;9(4):249-66.
Atypical antipsychotics in children with pervasive developmental disorders.
Chavez B, Chavez-Brown M, Sopko MA, Rey JA.
Rutgers, State University of New Jersey, Piscataway, New Jersey, USAMonmouth Medical Center, Long Branch, New Jersey, USA.

The treatment of pervasive developmental disorders (PDDs) is a challenging task, which should include behavioral therapy modifications as well as pharmacologic therapy. There has been a lack of data on using medications in children with PDDs until recent years. Within the last 10 years, an increase in clinical research has attempted to provide efficacy and safety data to support the use of medications in children with PDDs. Double-blinded and open-label research of atypical antipsychotics has been of particular focus.Evidence shows that atypical antipsychotics (AAs) may be useful in treating certain symptoms associated with PDDs, such as aggression, irritability, and self-injurious behavior. This article reviews the literature regarding the use of AAs in children with PDDs. Of the AAs, risperidone has the largest amount of evidence with five published double-blinded, placebo-controlled trials and nine open-label trials. These risperidone trials have consistently shown improvements in aggression, irritability, self-injurious behavior, temper tantrums, and quickly changing moods associated with autistic disorder and other PDDs. Data for the other AAs are limited, but ziprasidone and aripiprazole appear to be promising treatment options. Based on clinical trials, olanzapine and quetiapine have shown minimal clinical benefit and a high incidence of weight gain and sedation. It should be noted that all AAs do have a risk of metabolic syndrome, and patients should be monitored appropriately while receiving these medications. Overall, AAs can be beneficial in alleviating behavioral symptoms, and should be considered an appropriate therapeutic option, as part of a comprehensive treatment strategy, for children with PDD.

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J Child Neurol. 2007 May;22(5):574-9.
Memantine as adjunctive therapy in children diagnosed with autistic spectrum disorders: an observation of initial clinical response and maintenance tolerability.
Chez MG, Burton Q, Dowling T, Chang M, Khanna P, Kramer C.
Department of Neurology, Rosalind Franklin University/The Chicago Medical School, Chicago, Illinois, USA. mchezmd@yahoo.net

Autism and Pervasive Developmental Disorder Not Otherwise Specified are common developmental problems often seen by child neurologists. There are currently no cures for these lifelong and socially impairing conditions that affect core domains of human behavior such as language, social interaction, and social awareness. The etiology may be multifactorial and may include autoimmune, genetic, neuroanatomic, and possibly excessive glutaminergic mechanisms. Because memantine is a moderate affinity antagonist of the N-methylD-aspartic acid (NMDA) glutamate receptor, this drug was hypothesized to potentially modulate learning, block excessive glutamate effects that can include neuroinflammatory activity, and influence neuroglial activity in autism and Pervasive Developmental Disorder Not Otherwise Specified. Open-label add-on therapy was offered to 151 patients with prior diagnoses of autism or Pervasive Developmental Disorder Not Otherwise Specified over a 21-month period. To generate a clinician-derived Clinical Global Impression Improvement score for language, behavior, and self-stimulatory behaviors, the primary author observed the subjects and questioned their caretakers within 4 to 8 weeks of the initiation of therapy. Chronic maintenance therapy with the drug was continued if there were no negative side effects. Results showed significant improvements in open-label use for language function, social behavior, and self-stimulatory behaviors, although self-stimulatory behaviors comparatively improved to a lesser degree. Chronic use so far appears to have no serious side effects.

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Autism. 2007 May;11(3):205-24.
Pilot study of a parent training program for young children with autism: The PLAY Project Home Consultation program.
Solomon R, Necheles J, Ferch C, Bruckman D.
Ann Arbor Center for Developmental and Behavioral Pediatrics, Michigan, USA. dr.ricksol@comcast.net.

The PLAY Project Home Consultation (PPHC) program trains parents of children with autistic spectrum disorders using the DIR/Floortime model of Stanley Greenspan MD. Sixty-eight children completed the 8-12 month program. Parents were encouraged to deliver 15 hours per week of 1:1 interaction. Pre/post ratings of videotapes by blind raters using the Functional Emotional Assessment Scale (FEAS) showed significant increases (p </= 0.0001) in child subscale scores. Translated clinically, 45.5 percent of children made good to very good functional developmental progress. There were no significant differences between parents in the FEAS subscale scores at either pre-or post-intervention and all parents scored at levels suggesting they would be effective in working with their children. Overall satisfaction with PPHC was 90 percent. Average cost of intervention was $2500/ year. Despite important limitations, this pilot study of The PLAY Project Home Consulting model suggests that the model has potential to be a cost-effective intervention for young children with autism.

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Child Care Health Dev. 2007 May;33(3):348-9.
A randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD.
Temple K.
Newcastle University, Newcastle upon Tyne, UK.

Purpose This randomized group experiment compared the efficacy of two communication interventions [Responsive Education and Prelinguistic Milieu Teaching (RPMT) and the Picture Exchange Communication System (PECS)] on spoken communication in 36 pre-schoolers with autism spectrum disorders (ASD). Method Each treatment was delivered to children for a maximum total of 24 h over a 6-month period. Spoken communication was assessed in a rigorous test of generalization at pretreatment, post-treatment and 6-month follow-up periods. Results Picture Exchange Communication System was more successful than RPMT in increasing the number of non-imitative spoken communication acts and the number of different non-imitative words used at the post-treatment period. Considering growth over all three measurement periods, an exploratory analysis showed that growth rate of the number of different non-imitative words was faster in the PECS group than in the RPMT group for children who began treatment with relatively high object exploration. In contrast, analogous slopeswere steeper in the RPMT group than in the PECS group for children who began treatment with relatively low object exploration.

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Behav Modif. 2007 May;31(3):264-78.
Outcome for Children with Autism who Began Intensive Behavioral Treatment Between Ages 4 and 7: A Comparison Controlled Study.
Eikeseth S, Smith T, Jahr E, Eldevik S.
Akershus University College, Norway.

This study extends findings on the effects of intensive applied behavior analytic treatment for children with autism who began treatment at a mean age of 5.5 years. The behavioral treatment group (n = 13, 8 boys) was compared to an eclectic treatment group (n = 12, 11 boys). Assignment to groups was made independently based on the availability of qualified supervisors. Both behavioral and eclectic treatment took place in public kindergartens and elementary schools for typically developing children. At a mean age of 8 years, 2 months, the behavioral treatment group showed larger increases in IQ and adaptive functioning than did the eclectic group. The behavioral treatment group also displayed fewer aberrant behaviors and social problems at follow-up. Results suggest that behavioral treatment was effective for children with autism in the study.

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Arch Pediatr Adolesc Med. 2007 Apr;161(4):392-8.
Understanding autism: parents and pediatricians in historical perspective.
Silverman C, Brosco JP.
Department of Science, Technology, and Society, Penn State University, University Park, Pa 16802, USA. cbs14@psu.edu

Both primary care providers and subspecialists in pediatrics encounter families who are actively involved in the diagnosis and treatment of their children. Parents of children with an autism spectrum disorder in particular are often aware of scientific issues, and their expertise and desire for a medical cure for autism sometimes put them at odds with the medical team. We investigated the role of parents and advocates in autism research and treatment over the last 50 years. Our review of scientific publications and archival sources documents how parents and advocacy groups have done the following: (1) organized research funding; (2) constructed clinical research networks; (3) suggested new avenues for research; (4) popularized empirically based therapies; and (5) anticipated paradigmatic shifts in the understanding of autism. We believe that this historical account will help pediatricians and researchers recognize that families can contribute to expert understanding of complex medical conditions such as autism and that the existence of partnerships with families of children with autism is a critical component of future research and treatment programs.

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Ann Pharmacother. 2007 Apr;41(4):626-34. Epub 2007 Mar 27.
Use of atypical antipsychotics in the treatment of autistic disorder.
Stachnik JM, Nunn-Thompson C.
Department of Pharmacy Practice, College of Pharmacy, University of Illinois Medical Center at Chicago, Chicago, IL 60612, USA. stachnik@uic.edu

OBJECTIVE: To review clinical trials and reports describing the efficacy and safety of atypical antipsychotics (olanzapine, ziprasidone, quetiapine, aripiprazole) in the treatment of autistic or other pervasive developmental disorders. DATA SOURCES: English-language publications from the MEDLINE database (1966-February 2007) including clinical trials, case reports, and retrospective series were reviewed. STUDY SELECTION AND DATA EXTRACTION: Relevant data were extracted from studies of selected atypical antipsychotics in the treatment of autistic disorder in children, adolescents, and adults. Most literature found was in the form of case reports or case series; however, several open-label and double-blind trials were also identified. DATA SYNTHESIS: Autistic disorder is a chronic neurodevelopmental disorder with limited treatment options. Nonpharmacologic approaches may be the most beneficial, but pharmacologic agents are needed for some patients with significant behavioral manifestations of the disorder. The atypical antipsychotics (olanzapine, ziprasidone, quetiapine, aripiprazole) have shown some efficacy in improving certain behavioral symptoms of autistic disorder--primarily aggressiveness, hyperactivity, and self-injurious behavior. Efficacy was based on observation or changes from baseline in behavioral rating scores. Data appear to be strongest for olanzapine compared with quetiapine, with several open-label trials suggesting its efficacy. Weight gain and sedation were frequently reported adverse events with both agents. Aripiprazole has demonstrated efficacy in limited case series, with minimal adverse effects reported. CONCLUSIONS: Atypical antipsychotics represent a treatment option for symptoms associated with autistic disorder. However, these drugs do not affect the core symptoms of autistic disorder and are associated with potentially significant adverse effects. In addition, there is a lack of randomized controlled trials to determine the true efficacy and long-term safety of these agents in the pediatric population.

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Pediatr Neurol. 2007 Mar;36(3):152-8.
Children with autism: effect of iron supplementation on sleep and ferritin.
Dosman CF, Brian JA, Drmic IE, Senthilselvan A, Harford MM, Smith RW, Sharieff W, Zlotkin SH, Moldofsky H, Roberts SW.
Developmental-Behavioral Pediatrics, Glenrose Rehabilitation Hospital, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. cdosman@telus.net

To determine if there is a relationship between low serum ferritin and sleep disturbance in children with autism spectrum disorder, an 8-week open-label treatment trial with oral iron supplementation was conducted as a pilot study. At baseline and posttreatment visits, parents completed a Sleep Disturbance Scale for Children and a Food Record. Blood samples were obtained. Thirty-three children completed the study. Seventy-seven percent had restless sleep at baseline, which improved significantly with iron therapy, suggesting a relationship between sleep disturbance and iron deficiency in children with autism spectrum disorder. Sixty-nine percent of preschoolers and 35% of school-aged children had insufficient dietary iron intake. Mean ferritin increased significantly (16 microg/L to 29 microg/L), as did mean corpuscular volume and hemoglobin, suggesting that low ferritin in this patient group resulted from insufficient iron intake. Similar prevalence of low ferritin at school age as preschool age indicates that children with autism spectrum disorder require ongoing screening for iron deficiency.

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J Eval Clin Pract. 2007 Feb;13(1):120-9.
Parent implemented early intervention for young children with autism spectrum disorder: a systematic review.
McConachie H, Diggle T.
School of Clinical Medical Sciences, Child Health, University of Newcastle, Newcastle, UK. h.r.mcconachie@newcastle.ac.uk

BACKGROUND: Recent estimates concerning the prevalence of autism spectrum disorder (ASD) suggest that at least one in 200 children is affected. This group of children and families have important service needs. The involvement of parents in implementing intervention strategies designed to help their autistic children has long been accepted as helpful. The potential benefits are increased skills and reduced stress for parents as well as children. METHODS: This research review focused on interventions for children aged 1-6 years, and was carried out using systematic methodology: a comprehensive search of psychological, educational and biomedical databases, as well as bibliographies and reference lists of key articles, contact with experts in the field, and hand search of key journals. Only studies which involved a concurrent element of control were included. RESULTS: The review found very few studies that had adequate research design from which to draw conclusions about the effectiveness of parent-implemented early intervention. Both randomized and controlled studies tended to suggest that parent training leads to improved child communicative behaviour, increased maternal knowledge of autism, enhanced maternal communication style and parent child interaction, and reduced maternal depression. CONCLUSION: It seems that parent training can successfully contribute to intervention for young children with ASD. However, the review highlights the need for improved research in this area.

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Biol Psychiatry. 2007 Feb 15;61(4):521-37. Erratum in: Biol Psychiatry. 2007 Mar 15;61(6):826.
Early pharmacological treatment of autism: a rationale for developmental treatment.
Bethea TC, Sikich L.
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Autism is a dynamic neurodevelopmental syndrome in which disabilities emerge during the first three postnatal years and continue to evolve with ongoing development. We briefly review research in autism describing subtle changes in molecules important in brain development and neurotransmission, in morphology of specific neurons, brain connections, and in brain size. We then provide a general schema of how these processes may interact with particular emphasis on neurotransmission. In this context, we present a rationale for utilizing pharmacologic treatments aimed at modifying key neurodevelopmental processes in young children with autism. Early treatment with selective serotonin reuptake inhibitors (SSRIs) is presented as a model for pharmacologic interventions because there is evidence in autistic children for reduced brain serotonin synthesis during periods of peak synaptogenesis; serotonin is known to enhance synapse refinement; and exploratory studies with these agents in autistic children exist. Additional hypothetical developmental interventions and relevant published clinical data are described. Finally, we discuss the importance of exploring early pharmacologic interventions within multiple experimental settings in order to develop effective treatments as quickly as possible while minimizing risks.

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J Intellect Disabil Res. 2007 Feb;51(Pt 2):142-50.
Supported employment improves cognitive performance in adults with Autism.
Garcia-Villamisar D, Hughes C.
Universidad Complutense de Madrid and Nuevo Horizonte Association,Madrid, Spain.

Background The purpose of this study was to examine the effects of a supported employment programme on measures of executive functions for 44 adults with autism, assessed at the beginning and the end of the programme period. The average length of time of the community employment was 30 months. Methods Based on their predominant work activity over the study period, participants were classified into two groups: supported employment and unemployed. At the start of the programme, the groups did not differ on any of the cognitive measures. Results Repeated measures analysis of variance (anova) demonstrated that by the end of the programme, the supported employment group showed higher scores for executive functions on variables of CANTAB (Spatial Span Task - span length recalled; Spatial Working Memory Task - strategy; Planning task 'Stockings of Cambridge'- problems solved in minimum moves; Planning task 'Stockings of Cambridge'- mean planning time) and other tasks such as Trail Making Test - part B, time; Matching Familiar Figures (first answer and errors). In contrast, the unemployed group showed no change over time in their cognitive performance. Conclusion Results of this study suggested that vocational rehabilitation programmes have a beneficial impact upon cognitive performance in people with autism.

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Cochrane Database Syst Rev. 2007 Jan 24;(1):CD005040.
Risperidone for autism spectrum disorder.
Jesner O, Aref-Adib M, Coren E.

BACKGROUND: Autistic spectrum disorder encompasses a wide variety of behavioural and communicative problems. Both the core features and non-core features of autism have been targeted in a variety of therapies. Atypical antipsychotic medications, including risperidone, have been used for symptom and behaviour improvement and have shown beneficial outcomes, particularly in certain aspects of the disorder. However, given the nature of the condition presenting in young patients, the risks of these potentially long term therapies must be weighed against the benefits. OBJECTIVES: To determine the efficacy and safety of risperidone for people with autism spectrum disorder. SEARCH STRATEGY: Electronic databases: CENTRAL (Cochrane Central Register of Controlled Trials) 2006 (Issue 3); MEDLINE (1966 to April 2006); EMBASE (1980 to April 2006);PsycINFO (1887 to April 2006); CINAHL (1982 to April 2006); LILACS (1982 to April 2006 ); Clinicaltrials.gov (USA) (accessed April 2006); ZETOC (1993 to April 2006); National Research Register (NRR) (UK) 2006 (Issue 1) were searched. In addition further data were retrieved through contact with pharmaceutical companies and authors of published trials. SELECTION CRITERIA: All randomised controlled trials of risperidone versus placebo for patients with a diagnosis of autism spectrum disorder. All trials had to have at least one standardised outcome measure used for both intervention and control group. DATA COLLECTION AND ANALYSIS: Data were independently evaluated and analysed by the reviewers. Data were evaluated at the end of each randomised controlled trial. Unpublished data were also considered and analysed. MAIN RESULTS: Only three randomised controlled trials were identified. Meta-analysis was possible for three outcomes. Some evidence of the benefits of risperidone in irritability, repetition and social withdrawal were apparent. These must however be considered against the adverse effects, the most prominent being weight gain. AUTHORS' CONCLUSIONS: Risperidone can be beneficial in some features of autism. However there are limited data available from studies with small sample sizes. In addition, there lacks a single standardised outcome measure allowing adequate comparison of studies, and long-term followup is also lacking. Further research is necessary to determine the efficacy pf risperidone in clinical practice.

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J Child Psychol Psychiatry. 2007 Jan;48(1):3-16.
Annotation: Neurofeedback - train your brain to train behaviour.
Heinrich H, Gevensleben H, Strehl U.
Child & Adolescent Psychiatry, University of Erlangen-Nurnberg, Germany.

Background: Neurofeedback (NF) is a form of behavioural training aimed at developing skills for self-regulation of brain activity. Within the past decade, several NF studies have been published that tend to overcome the methodological shortcomings of earlier studies. This annotation describes the methodical basis of NF and reviews the evidence base for its clinical efficacy and effectiveness in neuropsychiatric disorders. Methods: In NF training, self-regulation of specific aspects of electrical brain activity is acquired by means of immediate feedback and positive reinforcement. In frequency training, activity in different EEG frequency bands has to be decreased or increased. Training of slow cortical potentials (SCPs) addresses the regulation of cortical excitability. Results: NF studies revealed paradigm-specific effects on, e.g., attention and memory processes and performance improvements in real-life conditions, in healthy subjects as well as in patients. In several studies it was shown that children with attention-deficit hyperactivity disorder (ADHD) improved behavioural and cognitive variables after frequency (e.g., theta/beta) training or SCP training. Neurophysiological effects could also be measured. However, specific and unspecific training effects could not be disentangled in these studies. For drug-resistant patients with epilepsy, significant and long-lasting decreases of seizure frequency and intensity through SCP training were documented in a series of studies. For other child psychiatric disorders (e.g., tic disorders, anxiety, and autism) only preliminary investigations are available. Conclusions: There is growing evidence for NF as a valuable treatment module in neuropsychiatric disorders. Further, controlled studies are necessary to establish clinical efficacy and effectiveness and to learn more about the mechanisms underlying successful training.

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J Paediatr Child Health. 2007 Jan;43(1-2):19-24.
Drug therapy for attention-deficit/hyperactivity disorder-like symptoms in autistic disorder.
Hazell P.
Discipline of Psychiatry, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.

Problems of inattention and hyperactivity affect one half of individuals with autistic disorder. Care must be taken to ensure that inattention and hyperactivity are not manifestations of other behavioural pathology seen in association with autistic disorder, as this will affect treatment decisions. The prescribing of psychotropic agents to individuals with autistic disorder is increasing but the evidence base is limited, with some exceptions, to uncontrolled studies. Substantial benefit in reducing inattention and hyperactivity is seen with atypical antipsychotics such as risperidone and quetiapine, although weight gain and sedation are common side effects. Moderate benefit is derived from methylphenidate, atomoxetine, some anticonvulsant medications, guanfacine and donepezil. Data show dexamphetamine, clonidine, clomipramine, mirtazapine, and fluoxetine are of unlikely benefit.

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J Neuroinflammation. 2007 Jan 5;4:3.
Effect of pioglitazone treatment on behavioral symptoms in autistic children.
Boris M, Kaiser CC, Goldblatt A, Elice MW, Edelson SM, Adams JB, Feinstein DL.
77 Froehlich Farm Blvd Woodbury, New York 11797, USA. mboris@pol.net.
Free full text at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17207275

ABSTRACT: INTRODUCTION: Autism is complex neuro-developmental disorder which has a symptomatic diagnosis in patients characterized by disorders in language/communication, behavior, and social interactions. The exact causes for autism are largely unknown, but is has been speculated that immune and inflammatory responses, particularly those of Th2 type, may be involved. Thiazolidinediones (TZDs) are agonists of the peroxisome proliferator activated receptor gamma (PPARgamma), a nuclear hormone receptor which modulates insulin sensitivity, and have been shown to induce apoptosis in activated T-lymphocytes and exert anti-inflammatory effects in glial cells. The TZD pioglitazone (Actos) is an FDA-approved PPARgamma agonist used to treat type 2 diabetes, with a good safety profile, currently being tested in clinical trials of other neurological diseases including AD and MS. We therefore tested the safety and therapeutic potential of oral pioglitazone in a small cohort of children with diagnosed autism. CASE DESCRIPTION: The rationale and risks of taking pioglitazone were explained to the parents, consent was obtained, and treatment was initiated at either 30 or 60 mg per day p.o. A total of 25 children (average age 7.9 +/- 0.7 year old) were enrolled. Safety was assessed by measurements of metabolic profiles and blood pressure; effects on behavioral symptoms were assessed by the Aberrant Behavior Checklist (ABC), which measures hyperactivity, inappropriate speech, irritability, lethargy, and stereotypy, done at baseline and after 3-4 months of treatment. DISCUSSION AND EVALUATION: In a small cohort of autistic children, daily treatment with 30 or 60 mg p.o. pioglitazone for 3-4 months induced apparent clinical improvement without adverse events. There were no adverse effects noted and behavioral measurements revealed a significant decrease in 4 out of 5 subcategories (irritability, lethargy, stereotypy, and hyperactivity). Improved behaviors were inversely correlated with patient age, indicating stronger effects on the younger patients. CONCLUSION: Pioglitazone should be considered for further testing of therapeutic potential in autistic patients.

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Pediatr Nurs. 2006 Nov-Dec;32(6):545-9.
Risperidone use in the treatment of behavioral symptoms in children with autism.
West L, Waldrop J.
School of Nursing, The University of North Carolina at Chapel Hill, USA.

The overall goal of autism treatment is to help the individual function normally or near normal in society (NICHD, 2004). Children and adolescents with autism can display disruptive behaviors, which has created challenges and barriersfor teachers, caretakers, and medical professionals. In an attempt to control these behaviors, medical providers are prescribing psychotropic drugs that have not been approved by the United States Food and Drug Administration for the treatment of autism in children. Conventional neuroleptics have been used to treat the more aggressive and violent behaviors associated with autism, but many healthcare professionals and families consider their side effects unacceptable. As a result, atypical antipsychotic drugs, such as risperidone, are being studied as off-label medications to treat autism because of their increased safety and efficacy over conventional neuroleptics. This article will discuss the use of risperidone as a potentially safe and effective treatment for disruptive behavioral symptoms in children with autism.
  
Previous Autism Research: 2002-2006   
The Autism File also contains summaries of past research that has shown promise and may still be standard practice among many physicians. To download earlier research findings on Autism, click HERE.
   

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