Strategies for pharmacologic treatment of high functioning autism and Asperger syndrome

Assessment of children's restricted and repetitive behaviours offers potential opportunities to improve early diagnosis of autism spectrum disorder (ASD) and timely access to interventions and support. To facilitate this requires understanding of the phenomenology of repetitive behaviours in ASD, including differentiating behaviours seen in ASD from other populations such as young typically developing and developmentally delayed children. A key factor in achieving understanding is valid and reliable measurement.

This review considers the issues in conceptualisation of repetitive behaviours which should guide the choice of measurement tool, including definition of subtypes of repetitive behaviours, associations with age and ability, and categorisation of frequency and severity. The resulting conclusions about the requirements for measurement are applied within a systematic review of quantitative interview and questionnaire measures of repetitive behaviour used with children with ASD. The conclusions of the review lead to recommendations for existing and future research on restricted and repetitive behaviours in ASD.

Pharmacotherapy is a frequently employed treatment option in the area of autism spectrum disorders (ASD). A considerable literature base has developed indicating when these medications should or could be administered. However, research on the potential side effects and cost benefit analysis of these treatments is not well understood at this time. The purpose of this review is to assess current prescription practices, to determine what is needed with respect to better understanding the cost and benefits of these prescription practices, and notions about future trends in research to better aid in our understanding of psychotropic drug side effects. Future research of this sort should further establish best practices with respect to pharmacotherapy and ASD.

The present research determined if articles describing attempts to improve the behavior of people with autism reported whether or not participants were receiving medication and, if so, whether an interaction between the intervention and the medication was mentioned. Fifty-one articles published from 2004 through 2008 were examined. Information regarding medication was provided in 18% of these articles, none of which mentioned an interaction. Very little is known regarding interactions between nonpharmacological interventions and psychotropic (or other) medications, but some studies demonstrate that interactions can occur. Given this possibility, and the fact that information regarding medications received by participants is easy to obtain and report, it appears worthwhile to include this information in published articles.

Developmental disabilities such as intellectual disability and autism are often accompanied by special sets of behaviors which are major challenges for the person and those in their community. Among the most worrisome of these are compulsions, rituals and obsessions. Often these behaviors are left untreated; however, when intervention does occur it is often with pharmacotherapy. There are psychological treatments for these issues as well but a concerted focus to develop these procedures, unlike efforts in differential diagnosis, has not occurred. Additionally, no reviews of how best to treat these problematic behaviors have been published to date. The present paper reviews what is available with respect to these treatment approaches with an eye to what appears to be effective, what has been treated and what is yet to be explored from a research point of view.

The reliability of a new scale to assess Autistic Disorder, Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS), and Asperger's Disorder in children was examined. Parents or other caregivers rated symptoms of 207 children between 2 and 16 years of age. The scale, which had 40 items in the final version, correlated highly with DSM-IV-TR and ICD-10 criteria and proved to have good inter-rater reliability and, excellent test–retest, and internal consistency reliability. These data are considered to have clinical utility given the need to establish data-based distinctions between these three subtypes of ASD. Furthermore, the measure is part of a more extensive battery measuring comorbid psychopathology and challenging behaviors. Implications for future research of this comprehensive assessment battery are discussed.