Tools that make a difference in mental health symptoms of autistic spectrum children Sumru Bilge-Johnson M.D. Program Director of Child Psychiatry Fellowship Associate Professor, Child Psychiatry NEOMED Akron Children s Hospital
Learning objectives: The participants of this presentation will be able to: list five most common comorbid disorders in children and teens with autism spectrum disorder describe interventions that help symptoms and comorbidities of autism spectrum disorder summarize the important factors that can make a difference in the lives of children and teens with autistic spectrum disorders from the view of a child psychiatrist
A child with autism presents with: Distractibility Forgetful Does not seem to listen Hyperactive Impulsive Can no sit still Loud when plays Seems to be on the go What could it be?
A child with autism presents with: Being very irritable Getting angry very easily Anger outbursts What could it be?
A child with autism presents with: Worrying all the time Worries about peers, school, home Obsessed about some topics Looks very nervous Unable to relax What could it be?
Most Common Comorbid Conditions seen in children with Autism Attention Deficit and Hyperactivity Disorder: 40-80% Severe irritability and aggression (mood dysregulation): 60-80% Anxiety symptoms: 60% Sleep disturbances: 44-86% Depression: 50% Developmental Disabilities: 75% This data is from outpatient psychiatry, not from public Child and adolescent psychiatry clinics of America, Oct,2008; Vol.17, Number 4
Every Autistic Child is Unique! Symptoms are only on the surface To be able to understand the deeper meaning and context of the symptoms are essential for true diagnosis The diagnoses are only diagnoses; the whole child is much more than the diagnoses he/she has
Triggers and Stressors that can be behind the symptoms Sensory dysregulation Change in structure and routine Situations challenging cognitive rigidity Socially-emotionally demanding situations Age related Challenges Pre/teen stage: increasing social demands Transition stage: middles school, moving to college
The first step to treatment of symptoms is first to understand the triggers, events, challenges, difficulties, barriers that create/feed the symptom Parents know their children the best and can gather/provide valuable & detailed information about their children to help a child psychiatrist s diagnosis
Treatment/Interventions Currently there is no valid treatment for core symptoms of autism however, there are ongoing research which holds promise But we have evidence based treatments for comorbid symptoms and disorders: ADHD, Anxiety Disorders, Depression, Mood dysregulation/irritability/aggression Sleep problems Treatments include: Medications and Therapy (ABA, Behavioral Therapy, CBT, Social Skills training, etc.)
Medications for Comorbid Disorders ADHD: Stimulants ( methylphenidate, amphetamines) Atomoxetine (Strattera) Guanfacine extended release *Also, avoiding high sugar diets, artificial dyes, transfats, giving a balanced diet and essential vitamins can also help these symptoms *Also Omega 3s have good evidence to improve some of these symptoms
Medications for Comorbid Disorders Severe irritability and aggression: Antipsychotic medications: Aripiprazole and Risperidone (FDA approved) Additionally effective managing hyperactivity and repetitive behaviors Sometime mood stabilizers are used *However, knowing a child s sensory profile and prevent overload/over stimulation, using sensory relaxing techniques can also help prevent aggressive outbursts * Omega 3s can be helpful
Medications for Comorbid Disorders Anxiety Symptoms: SSRIs: Citalopram, Sertraline, Buspirone, fluoxetine (also in adults) *However CBT (Cognitive Behavioral Therapy) is also very effective for children who can work with a therapist *Also Omega 3s have good evidence to improve some of these symptoms *Physical activity/exercise helps
Medications for Comorbid Disorders Depression symptoms: SSRIs: Citalopram, Sertraline, Fluoxetine, Escitalopram SNRIs: Venlafaxine, Mirtazapine Wellbutrin *However CBT (Cognitive Behavioral Therapy) and IPT is effective for children who can work with a therapist *Also Omega 3s have good evidence to improve some of these symptoms *Regular physical activity/exercise shows significant improvement of these symptoms
Medications for Comorbid Disorders Sleep Problems: Melatonin Clonidine Trazodone Hydroxyzine Diphenhydramine and Benzodiazepines (paradoxical reaction, disinhibition *However: Sleep hygiene, sensory relaxation and for kids who can apply sleep CBT are effective for good sleep
Medication for Comorbid Disorders Repetitive behaviors: Fluoxetine and fluvoxamine in adults Bumetanide in children Risperidone and Aripiprazole as alternative agents
Social Relationship Difficulties Social Skills Training Social Skills groups Social thinking
Many other treatments: Speech therapy: for improvement of language and communication skills Occupational Therapy Sensory Integration Music Therapy ABA Behavioral Therapy
What are the important factors that can make a difference the in the lives of children and teens with autistic spectrum disorders? Discovering each individual child s potential, specialties, gifts, interests, passion Parents: do what you can to stay healthy, reach out for help (the healthier the parent, the better prognosis of your child) Families: do not isolate yourself and your child, building a supportive system/net around the child and your family from inside and outside the family Communication is essential for health and healthy relationships, support/facilitate in any way to teach your child how to communicate When trying to change a behavior, be consistent, be consistent, be consistent More structure in daily life = more stability in autistic children Needs of siblings, other family members Be an advocate for your child and reach out to advocacy/support organizations Create ties with your community
Other resources as Handout Books: one of my favorite : Autism Spectrum ( the complete guide to understanding autism) by Chantal Sicile-Kira Apps Web resources