Medication Use in Youth With Autism and Attention-Deficit/Hyperactivity Disorder.
Rast JE, Anderson KA, Roux AM, Shattuck PT. Acad Pediatr. 2021 Mar;21(2):272-279. [PMID: 32492579]
Children with both autism and ADHD take more medication than those with only autism or only ADHD and may have distinct care needs.
Background: No clear guidelines are available for how and when to provide prescription medications to treat common co-occurring conditions in children on the autism spectrum. Children with autism often have co-occurring conditions such as anxiety and attention-deficit/hyperactivity disorder (ADHD). There are well-established protocols for the use of brain-chemical altering medications, known as psychotropic medications, for treatment of these conditions in the neurotypical population. The utility of these medications in children with autism, however, is not clear. While there are no FDA-approved medications that address the core traits of autism, two drugs are approved for use in individuals with ASD to modify challenging behaviors that can occur with autism (e.g., aggression, irritability). Despite the limited number of medications approved for individuals on the autism spectrum, previous studies indicate that children with ASD commonly take psychotropic medications. This study aimed to explore how many children with autism are currently taking psychotropic medications using recent, nationally representative data.
Methods & Findings: This study compared the use of medication in three groups: children with autism only, children with autism and ADHD, and children with ADHD only. Researchers used 2016 and 2017 data from the National Survey of Children's Health, which provides information about children's medication usage based on reports from their caregivers. The researchers focused on children aged 6-11 and 12-17. They analyzed medication usage for autism, for ADHD, and/or more generally for emotion regulation, concentration, or behavior. The study found that 68% of children ages 6-11 with autism and ADHD and 76% of youth ages 12-17 with autism and ADHD were taking at least one psychotropic medication. In comparison, this was 73% and 70% for children and youth with ADHD alone, respectively, and 13% and 22% for children and youth with autism alone. Although some children and youth with autism alone took a medication to improve emotion regulation, concentration, or behavior, children and youth with autism and ADHD were more likely to take these medications, and youth with autism and ADHD were more likely to take these medications than youth with ADHD alone.
Implications: This study provides up-to-date national estimates on psychotropic medication usage in children and youth with autism. In particular, the results suggest a surprisingly high use of medications by children with autism and ADHD. This finding requires further investigation to understand what drives the high rates of medication use in this group and to determine whether children and youth with both autism and ADHD have unique medication or other support needs.
Intranasal Oxytocin in Children and Adolescents with Autism Spectrum Disorder.
Sikich L, Kolevzon A, King BH, McDougle CJ, Sanders KB, Kim SJ, Spanos M, Chandrasekhar T, Trelles MDP, Rockhill CM, Palumbo ML, Witters Cundiff A, Montgomery A, Siper P, Minjarez M, Nowinski LA, Marler S, Shuffrey LC, Alderman C, Weissman J, Zappone B, Mullett JE, Crosson H, Hong N, Siecinski SK, Giamberardino SN, Luo S, She L, Bhapkar M, Dean R, Scheer A, Johnson JL, Gregory SG, Veenstra-VanderWeele J. N Engl J Med. 2021 Oct 14;385(16):1462-1473. [PMID: 34644471]
Use of an oxytocin nasal spray in children and adolescents with autism does not result in improved social interactions or behavior.
Background: Individuals on the autism spectrum experience various challenges related to social behaviors and may often display increased irritability and hyperactivity. Some studies have suggested that reduced levels of a hormone called oxytocin, which is known for its role in promoting social bonding, may be responsible for difficulties in social interactions in autism. Oxytocin therapy has been used off-label in some individuals on the autism spectrum as a potential intervention to improve social behavior, but previous studies have not been able to confirm its efficacy. Earlier clinical trials examining oxytocin in autism have shown widely varying results. This large randomized controlled trial sought to resolve the previous contradictory findings and determine whether extended use of oxytocin can help to improve social behaviors in children and teenagers on the autism spectrum.
Methods & Findings: This study evaluated whether a nasal oxytocin spray could affect social interactions and other behaviors (e.g., irritability, social withdrawal, and hyperactivity) in children and adolescents on the autism spectrum during a 24-week clinical trial. Individuals between the ages of 3 and 17 were assessed by trained researchers and were selected for participation if they met the criteria for autism. Participants were then randomly assigned to receive either a nasal oxytocin spray or a placebo (i.e., a comparison nasal spray that did not contain oxytocin) every day at a series of gradually increasing doses. Participants received social interaction scores every 4 weeks based on multiple assessments that were completed by caregivers or the participant. Separate analyses were performed in groups of individuals with minimal verbal fluency and high verbal fluency. This study found no difference in social interaction scores between the oxytocin group and the placebo group and no difference between the groups with differing levels of verbal ability.
Implications: The findings of this study demonstrate that extended use of a nasal oxytocin spray over a 24-week period does not make a detectable difference in measured social interactions or behaviors in children and adolescents with autism. While this study showed no observable social benefit with the use of intranasal oxytocin, there are remaining questions around issues such as the ideal dose, whether current formulations are able to penetrate the blood-brain barrier, and whether a longer intervention time course could reveal effects. In addition, future studies that use techniques such as brain imaging may reveal new information on how oxytocin might be used in autism.
Effect of Preemptive Intervention on Developmental Outcomes Among Infants Showing Early Signs of Autism: A Randomized Clinical Trial of Outcomes to Diagnosis.
Whitehouse AJO, Varcin KJ, Pillar S, Billingham W, Alvares GA, Barbaro J, Bent CA, Blenkley D, Boutrus M, Chee A, Chetcuti L, Clark A, Davidson E, Dimov S, Dissanayake C, Doyle J, Grant M, Green CC, Harrap M, Iacono T, Matys L, Maybery M, Pope DF, Renton M, Rowbottam C, Sadka N, Segal L, Slonims V, Smith J, Taylor C, Wakeling S, Wan MW, Wray J, Cooper MN, Green J, Hudry K/ JAMA Pediatr. 2021;175(11):e213298. [PMID: 34542577]
An intervention teaching parents how to encourage social skills in infants showing early behaviors associated with autism can reduce their child's future likelihood of an autism diagnosis.
Background: Signs of autism generally emerge early in development, but clinical diagnosis often does not occur until a child is at least 3 years old, and interventions are typically offered only after that point. One early intervention, the iBASIS Video Interaction to Promote Positive Parenting (iBASIS-VIPP), involves training parents to use a sequence of positive social interaction strategies, videotaping caregiver-infant interactions using those strategies, and then meeting with a therapist to receive feedback and support on how to enhance parent-infant interactions. The goal of the intervention is to teach the parent to understand and actively engage in increasing their infant's social engagement. Previous research evaluations of the iBASIS-VIPP have had significant shortcomings due to relatively small numbers of participants and short durations of follow-up observation. The present study aimed to resolve these flaws by enrolling more participants and lengthening the study duration to two years.
Methods & Findings: This study gave one of two interventions to 104 one-year-old infants who showed early potential signs of autism. The infants received either usual care or usual care plus iBASIS-VIPP for five months. Between the end of the intervention and by the time participants reached 3 years of age, a difference gradually emerged between the usual care group and usual care plus iBASIS-VIPP group. The infants who received iBASIS-VIPP showed fewer traits associated with autism when tested, and fewer children in the iBASIS-VIPP group were later diagnosed with ASD compared to those in the usual care group. In addition, caregiver sensitivity to infant needs was higher in the iBASIS-VIPP group.
Implications: These results show that an early intervention targeted to infants and caregiver interactions can improve developmental outcomes and reduce the likelihood of meeting criteria for an ASD diagnosis for at least 18 months. The findings suggests that some early life interventions may be able to influence the brain and social developmental processes associated with autism. To fully assess the impact of interventions such as the iBASIS-VIPP, researchers need to analyze longer-term child- and adulthood outcomes. Furthermore, there is a need to assess the cost-effectiveness of this intervention to determine its feasibility and value. Still, given the evidence of some impact and the absence of adverse effects, these findings support the use of iBASIS-VIPP or similar early interventions for infants showing early signs of autism.