medications and cam in asd

8/10/2019 Medications and CAM in ASD

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MEDICATIONS AND

ALTERNATIVE THERAPIESIN THE TREATMENT OFAUTISM

CT CHAPTER OF AAP: CRITICAL ISSUES INSCHOOL HEALTHMAY 20, 2010

Nili E. Major, M.D.I!"r#$"or, D%&%lo'(%"al)*%+a&ioralP%ia"ri$!

Yal% Ui&%r!i"- S$+ool o M%i$i%


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Di!$lo!#r%

Dr. Major +a! o $o/i$"! o i"%r%!" "oi!$lo!%

T+% o la%l #!% o (%i$a"io ill %i!$#!!%


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O#"li% o Pr%!%"a"io

I"ro#$"io "o A#"i!( S'%$"r#( Di!or%r!

Clii$al a''roa$+ "o %+a&ioral !-('"o(!

O&%r&i% o (%i$a"io! $o((ol- #!%

i ASD Clii$al #!%

E&i%$% or %3$a$-

Si% %%$"! a (oi"ori4 Co('l%(%"ar- a al"%ra"i&% "+%ra'i%!

Rol% o "+% !$+ool +%al"+ 'ro%!!ioal


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A#"i!( S'%$"r#( Di!or%r!

A#"i!( S'%$"r#( Di!or%r! 5ASD6 ar% a$oll%$"io o %&%lo'(%"al i!or%r!"+a" ar% $+ara$"%ri7% - i('air(%"! i

!o$ial i"%ra$"io a $o((#i$a"io, a!%ll a! "+% 'r%!%$% o r%!"ri$"% ar%'%"i"i&% %+a&ior! a i"%r%!"!


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A#"i!( S'%$"r#( Di!or%r!

DSM)IV)TR ia4o!"i$ $a"%4ori%! #%r8P%r&a!i&% D%&%lo'(%"al Di!or%r!9: A#"i!"i$ Di!or%r

A!'%r4%r! Di!or%r PDD)NOS

R%"" S-ro(%

C+il+oo Di!i"%4ra"i&% Di!or%r


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DSM Cri"%ria: So$ial

I('air(%" I('air(%" i #!% o o)&%ral %+a&ior!"o r%4#la"% !o$ial i"%ra$"io E-% $o"a$", a$ial %;'r%!!io!, 4%!"#r%!

Fail#r% "o %&%lo' %&%lo'(%"all-)a''ro'ria"% '%%r r%la"io!+i'!

La$< o !'o"a%o#! !%%


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DSM Cri"%ria: Co((#i$a"ioI('air(%" D%la- i, or "o"al la$< o %&%lo'(%" o

!'o


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DSM Cri"%ria: R%'%"i"i&% aS"%r%o"-'% *%+a&ior! a

I"%r%!"! S"%r%o"-'% or r%!"ri$"% 'a""%r! oi"%r%!" o aor(al i"%!i"- or o$#!

I/%;il% a+%r%$% "o o)#$"ioal

ro#"i%! or ri"#al! S"%r%o"-'% a r%'%"i"i&% (o"or

(a%ri!(!

S'ii4, +a /a''i4, ro$


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E'i%(iolo4- o ASD

Mo!" r%$%" !"#i%! r%'or" %!" %!"i(a"% o$#rr%" 'r%&al%$% i US i! > 1?110 5CDC,12?200@6 O4oi4 %a"% r%4ari4 i$r%a!i4 #(%r!

I$r%a!% (al% "o %(al% ra"io 5>.B:16 S%% a$ro!! all ra$%!, %"+i$ 4ro#'!,

!o$io%$oo(i$ !"ra"a

M%a a4% o ia4o!i! ra4% ro( ) B-r! Mor% "+a 1?2 o $+ilr% +a %&%lo'(%"al

$o$%r! r%$or% i $+ar" 'rior "o a4%


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E"iolo4- o ASD

Co('l%;, iolo4i$all- a!%%#ro%&%lo'(%"al i!or%r! r%a" '+%o"-'i$ &aria"io Li


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S$r%%i4 a Dia4o!i!

C#rr%" AAP r%$o((%a"io! 5M-%r! a Jo+!o, 200K6 ASD !#r&%illa$% a" all %ll $+il &i!i"!

ASD !'%$i$ !$r%%i4 5%.4., M)CHAT6 a" 1 a 2(o"+ &i!i"! or +% !#r&%illa$% rai!%! $o$%r

Dia4o!i! i! (a% $lii$all- - a 'ro%!!ioali"+ %;'%ri%$% i %&al#a"i4 $+ilr% or ASD

E&al#a"io (a- i$l#% (#l"i)i!$i'liar-

a!!%!!(%" Dia4o!"i$ i!"r#(%"! $o((ol- #!%: ADOS,

ADIR, CARS, ARS


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M%i$al E&al#a"io

P#r'o!% R#l%)o#" o"+%r $oi"io! 5%.4., +%ari4 i('air(%"6 E&al#a"% or $o)(ori $oi"io! 5%.4., !%i7#r%!6 S%ar$+ or #%rl-i4 %"iolo4- 5%.4., 4%%"i$

!-ro(%6 Co('o%"!

M%i$al +i!"or- 5ir"+, $#rr%" +%al"+, a(il- +i!"or-6 P+-!i$al %;a( 54ro"+, -!(or'+i$ %a"#r%!, %#ro,

!


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A''roa$+%! "o Tr%a"(%"

*%+a&ioral?E#$a"ioal I"%r&%"io! Earl- I"%r&%"io 'ro4ra(!

S'%$iali7% !$+ool 'ro4ra(!

A''li% *%+a&ior Aal-!i! D%&%lo'(%"al (o%l!: DIR, Floor"i(%,

D%&%r

S'%%$+ a la4#a4% "+%ra'-

O$$#'a"ioal "+%ra'-

So$ial !


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A''roa$+%! "o Tr%a"(%"

Fa(il- !#''or" a "raii4

M%i$al (aa4%(%" Ro#"i% %ll)$+il $ar%

Co)o$$#rri4 $oi"io! S%i7#r% i!or%r!

Sl%%' i!"#ra$%!

a!"roi"%!"ial 'rol%(!

C+all%4i4 %+a&ior!

Co('l%(%"ar- a al"%ra"i&% "+%ra'i%!


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C+all%4i4 *%+a&ioralS-('"o(! H-'%ra$"i&i"-

I('#l!i&i"-

Poor a""%"io

Irri"aili"-: T%('%r "a"r#(!

Moo laili"-

A44r%!!io S%l)ij#rio#!

%+a&ior

A;i%"-

D%'r%!!io

Sl%%' i!"#ra$%!

R%'%"i"i&%%+a&ior!: S"%r%o"-'i$

(o&%(%"!

R%'%"i"i&% 'la- I/%;il% ro#"i%!

P%r!%&%ra"i&% !'%%$+


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Clii$al A''roa$+ "o C+all%4i4*%+a&ior!

Car%#l a!!%!!(%" o "ar4%" %+a&ior! Ti(i4, i"%!i"-, "ri44%r!, r%!'o!% "o

i"%r&%"io!

U!% o %+a&ioral !$al%! O"ai i'#" ro( (#l"i'l% !o#r$%! 5+o(%,

!$+ool6

A!!%!! %;i!"i4 a a&ailal% !#''or"!

*%+a&ioral !%r&i$%! E#$a"ioal 'ro4ra(

Fa(il- !#''or"!5M-%r! a Jo+!o, P%ia"ri$!, 200K6


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S%ar$+ or (%i$al a$"or! "+a" (a- %$a#!i4 or %;a$%ra"i4 !-('"o(!

Co!i%r '!-$+o"ro'i$ (%i$a"io #!% i

S-('"o(! ar% $a#!i4 !i4i$a" i('air(%" S#o'"i(al r%!'o!% "o %+a&ioral (oi$a"io!

C+oo!% (%i$a"io a!% o Li


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E!"ali!+ 'la or (oi"ori4 %%$"! I%"i- %!ir% o#"$o(%! a a!!%!!(%"

(%a!#r%! Di!$#!! "i(% $o#r!% o %;'%$"% %%$"! Arra4% ollo)#': &i!i"!, "%l%'+o% O#"li% 'la or al"%ra"i&% o'"io! i

(%i$a"io i! o" %%$"i&% O"ai a!%li% la a"a a 'la ollo)#'

(oi"ori4

Co!i%r i"+raal o (%i$a"io a"%r )12 (o"+! o "+%ra'-


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P!-$+o'+ar(a$olo4- iASD

oal i! "o r%#$% $+all%4i4 %+a&ior! ai('ro&% r%!'o!% "o %+a&ioral a %#$a"ioali"%r&%"io!

P!-$+o"ro'i$ (%i$a"io #!% i ASD i! $o((o B,11 $+ilr% 1 -r! %roll% i % a!% r%4i!"r-

BG #!% a" l%a!" 1 '!-$+o"ro'i$ (%i$a"io

I$r%a!% #!% i"+ ol%r a4%, 'r%!%$% o ID or'!-$+ia"ri$ $o)(orii"-, r%!ii4 i 'oor%r $o#"-,

So#"+ or Mi%!" US S"i(#la"!, a"i)'!-$+o"i$!, a SSRI! (o!" $o((o

5Ro!%%r4 %" al, 20106


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S"i(#la"!: Clii$al U!%

Mo!" $o((ol- #!% i "+% "r%a"(%" oADHD

To $la!!%! %;i!": M%"+-l'+%ia"%

Ri"ali, M%"aa"%, Co$%r"a, Fo$ali, Da-"raa'a"$+

A('+%"a(i%! A%rall, D%;%ri%, V-&a!%

or< - i$r%a!i4 $o$%"ra"io! oo'a(i% a or%'i%'+ri% i "+% rai


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S"i(#la"!: Clii$al U!%

Pr%'ara"io!: Pill!, !'ri


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S"i(#la"!: E&i%$% oE%$" R%!%ar$+ Ui" o P%ia"ri$

P!-$+o'+ar(a$olo4- 5RUPP6 A#"i!( N%"orKBG i"+ (%"al r%"ara"io


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A"i)P!-$+o"i$!: E&i%$% oE%$" RUPP "rial o Ri!'%rio% 520026

R%!#l"! 5a" %%

Irri"aili"- !$or% &!. 1G %$r%a!% i 'la$%o4ro#'

@G o ri!'%rio% 4ro#' %r% 8r%!'o%r!9 &!.12G o 'la$%o 4ro#'

I('ro&%(%"! al!o !%% o H-'%ra$"i&i"- aS"%r%o"-'- !#!$al%! 5o i i So$ial i"+raal aIa''ro'ria"% S'%%$+ !$al%!6


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A"i)P!-$+o"i$!: E&i%$% oE%$" R%!#l"! 5a" %%

A&%r!% E%$"!: I$r%a!% %i4+" 4ai 52.K


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A"i)P!-$+o"i$!: E&i%$% oE%$" R%!#l"! 5a" (o"+!6:

!#j%$"! %"%r% "+% (o"+ o'% la%l'+a!%

2.BG o 'a"i%"! $o"i#% "o % ra"% a!8(#$+ i('ro&%9 or 8&%r- (#$+ i('ro&%9 oCI)I

(o"+ %i4+" 4ai o B.1


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A"i)P!-$+o"i$!: E&i%$% oE%$" Co$l#!io!:

Ri!'%rio% a! !a% a %%$"i&% or!+or")"%r( "r%a"(%" o "a"r#(!,

a44r%!!io, a !%l)ij#rio#! %+a&ior i$+ilr% i"+ a#"i!"i$ i!or%r

I('ro&%(%"! al!o !%% i +-'%ra$"i&i"-a !"%r%o"-'i$ %+a&ior

S+or" '%rio li(i"! i%r%$%! ao#" lo4)"%r( %3$a$- a !i% %%$"!


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A"i)P!-$+o"i$!: E&i%$% oE%$" Ai"ioal ri!'%rio% !"#i%!:

S+%a %" al, 200: K@ $+ilr% a4%! B)12 i"+ ASD, ri!' or 'la$%o or %%

Ari'i'ra7ol% O% %" al, 200@:

@ $+ilr% a4%! )1K i"+ A#"i!"i$ Di!or%r, %%


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A"i)P!-$+o"i$!: Si% E%$"! QMoi"ori4

I$r%a!% a''%"i"% a%i4+" 4ai

D-!li'i%(ia Dia%"%! I$r%a!% li&%r %7-(%! S%a"io Co!"i'a"io E;"ra'-ra(ial

!-('"o(! Prola$"i %l%&a"io

*a!%li% +i!"or-, PE *a!%li% la!

Fa!"i4 4l#$o!% ali'i!

Li&%r #$"io "%!"! Prola$"i

R%'%a" la! a" 12 %%

Potential Side Efects Recommended Monitoring


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SSRI!: Clii$al U!%

S%l%$"i&% S%ro"oi R%#'"a


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SSRI!: E&i%$% o E%$"

Fl#&o;a(i% 5Po!%- Q M$Do#4l%, 20006 Do#l%)li, 'la$%o $o"roll% !"#- $+ilr% i"+ ASD a4%! B)1, 12 %%

1 o 1 'a"i%"! %;'%ri%$% a&%r!% %%$"!5+-'%ra$"i&i"-, i!o(ia, a4i"a"io, a a44r%!!io6

Fl#o;%"i% 5Holla%r, 200B6 Do#l%)li, 'la$%o $o"roll% $ro!!o&%r !"#-

$+ilr% i"+ ASD a4%! B)1K, 1 %%

No i%r%$% i a&%r!% %%$"! %"%% /#o;%"i%a 'la$%o


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Ci"alo'ra( 5STAART N%"or


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Co$l#!io!: S(all, o'%)la%l !"#i%! i"+ &ario#!

SSRI! +a&% !+o !o(% %%"!

Pla$%o $o"roll% !"#i%! "o a"% !+o(i;% r%!#l"!

Lar4%!" !"#- '%ror(% ail% "o !+oi('ro&%(%" o r%'%"i"i&% %+a&ior! i"+

$i"alo'ra( Si% %%$"! ar% $o((o


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SSRI!: Si% E%$"! QMoi"ori4

Na#!%a a &o(i"i4 S%a"io %i4+" 4ai Dr- (o#"+ *%+a&ioral a$"i&a"io I#$"io o (aia I!o(ia S#i$ial i%a"io 5FDA

la$< o; ari46

*a!%li% H; Q PE

No ro#"i% a!%li%la!?!"#i%! %%%

Car%#l (oi"ori4,%!'%$iall- or

'!-$+ia"ri$ !i%%%$"!

Potential Side Efects Recommended Monitoring


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O"+%r M%i$a"io! #!% iASD Al'+a)2 ar%%r4i$ a4oi!"! 5$loii%,

4#aa$i%6 H-'%ra$"i&i"-, ia""%"io

S%a"io, r- (o#"+, %$r%a!% *P,i77i%!!, $o!"i'a"io, irri"aili"-

A"o(o;%"i%

A"i)%'il%'"i$! 5"o'ira(a"%, &al'roa"%6 Do%'%7il

M%(a"i%


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Co('l%(%"ar- Q Al"%ra"i&%T+%ra'i%!

CAM i! %% - "+% Na"ioal C%"%ror Co('l%(%"ar- a Al"%ra"i&%M%i$i% a! 8a 4ro#' o i&%r!% (%i$al

a +%al"+ $ar% !-!"%(!, 'ra$"i$%!, a'ro#$"! "+a" ar% o" 'r%!%"l-$o!i%r% "o % 'ar" o $o&%"ioal(%i$i%.9


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Co('l%(%"ar- Q Al"%ra"i&%T+%ra'i%! CAM #!% i! $o((o i $+ilr% i"+ ASD

I r%$%" !"#i%!, B0)KBG o $+ilr% i"+ ASD %r%%i4 "r%a"% i"+ CAM 5o4 %" al, 200, Ha!o %" al, 200K6

Al(o!" 1? o $+ilr% r%%rr% or ASD %&al#a"io

%r% %i4 "r%a"% i"+ i%"ar- "+%ra'i%! 5L%&- %" al,2006

Par%"! (a- % r%l#$"a" "o !+ar% ior(a"ior%4ari4 CAM #!% i"+ "+%ir $+il! o$"or 5o4 %" al,2006

Co$%r ao#" '+-!i$ia i!a''ro&al No %% or i!$lo!#r%

P+-!i$ia i o" a!

medications and cam in asd

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