Management of autism spectrum disorders and ADHD 2.2.2 Flashcards
What are the three aspects to managing ASD?
Structure Educational Therapy
Behavioural therapy
Pharmacotherapy
Why is behavioural management so important in ASD? What does it consist of?
MDT –> multidisciplinary therapy –> psychologist + speech therapist + occupational therapist
- Aim to improve competent behaviours and reducing difficult and antisocial behaviours
- Antecedents and consequences of the target behaviours need to be identified
Behavioural techniques
- Positive re-enforcement
- Verbal and nonverbal prompting
- Behavioural chaining
> ABA – Applied Behavioural Analysis
> TEACCH
> Sensory integration therapy
> Augmentative communication
> Managing sensory-induced stress
> Improving co-ordination by sensory integration and motor interventions , prescribed by an OT or PT
- reducing anxiety
- modelling sequences of behaviour by example
- parent education and skills training autistic behaviours
When is medication therapy used in ASD? Why use them?
To reduce severity of symptoms after behavioural therapy and environmental modification have failed ONLY
Benefits of drug therapy vs harms to patient
Mainly used as adjunct to psychological interventions
Currently no single medication that alleviates symptoms for all 3 domains of ASD.
A very large range of medications have been studied in autism but few are well supported.
1) Restricted repetitive behaviours and interests domain (RRBI) –> why treat for ASD, what to use to treat?
Why treat: stressful to patient and people around them = affects education
SSRIs = fluoxetine 2.5mg daily with a mean dose of 10mg daily
2) Social and communication impairment domain, what to do for ASD?
No medications
Maybe risperidone, glutamatergic drugs and oxytocin
Inattention, overactivity and impulsiveness in ASD (symptoms of ADHD), what to use to treat?
Methylphenidate
Atomexetine = only small trials open labelled trials conducted
What to use to treat irritability in ASD? How long to use for?
Published data suggests treatment is of benefit for up to 6-12 months and should be reviewed after this time.
> First Line – ‘second generation’ AP
- Risperidone – side effects vs impact on cognitive performance
> administered once daily or twice daily
> patients experiencing somnolence can benefit from taking whole daily dose at bedtime
> one sufficient clinical response has been achieved and maintained, consideration may be given to gradually lower the dose to achieve optimal balance of efficacy and safety
> insuffficient evidence from controelled trails to indicate how long treatment should continue
Adverse effects: weight gain, somnolence and hyperglycaemia require monitoring, and the long-term safety of risperidone in children and adolescents with ASD remain to be fully determined.
can also use aripiprazole 5-15mg daily
What to use to treat sleep disturbance as part of ASD?
Melatonin 1-10mg at night
What must be done prior to medication implementation for ADHD? When to use medication?
Psychological, psychosocial and behavioural interventions must be embedded prior to medication implementation.
- Only use medication in severe cases –> Hyperkinetic disorder, psychological methods fail after more than 2 months.
4 options for ADHD medication management?
1) Methylphenidate – large evidence base from trials. First line for children and adults.
2) Dexamfetamine - less data on efficacy and safety than for methylphenidate . More abuse.
3) Lisdexamfetamine – pro drug and similar role to slow release methylphenidate .
4) Atomoxetine – useful for patients not responding to above or require once daily dosing
What to monitor for psychostimulants?
Monitor blood pressure, pulse, height (can stunt growth), weight (suppress appetite). Monitor for insomnia, mood and appetite change and the development of tics, although some evidence suggest tics are not associated with psychostimulants.
controlled drug –> potential abuse
