Management of ASD

Dr. Tanu, Senior Resident

Department of Psychiatry
  Recommended for subjects who
 Not babbled / cooed by one year
 Not gestured / pointed / waved by one year

SCREENING  Not spoken a single word by 16 months

 Not spoken a 2-word phrase by 2 years.
 Experiences any loss of language / social at any age.
 TOOLS OF
ASSESSMEN
T
INTERVENTION
  Involves a multi-sensory, multi-disciplinary approach.
 Early intervention to yield the best outcome and results.
 Treatments include a range of behavioral, psychosocial,
educational, medical, and complementary approaches
 Goals of treatment:
 maximize functional independence and quality of life
Intervention  minimizing core deficits in social skills and
communication,
 facilitating development and learning,
 promoting socialization,
 reducing maladaptive behaviors and
 educating and supporting families.
 NON
PHARMACOLOGICA
L
  accelerate children’s development in all domains;

Early Stage  intervention targets derived from assessment of developmental

skills;
Denver  stresses social-communicative development, interpersonal
Model(ESDM): engagement, imitation-based interpersonal development, and
social attention and motivation
  Focuses on improving specific behaviors using discrete trials to
teach simple skills, then progressing to more complex skills

Applied and complex behaviours

 skills viz. social skills, communication, reading, and academics
Behavioural as well as adaptive learning skills, such as fine motor dexterity,
Analysis(ABA) hygiene, grooming, domestic capabilities, punctuality, and job
competence
:  Ideally more than 20 hours per week, under the age of 4 is
recommended.
  SC: Social Communication - Development of spontaneous,
functional communication, emotional expression and secure
and trusting relationships with children and adults.
 ER: Emotional Regulation - Development of the ability to
maintain a well-regulated emotional state to cope with
everyday stress, and to be most available for learning and
SCERTS: interacting.
 TS: Transactional Support - Development and
implementation of supports to help partners respond to the
child's needs and interests, modify and adapt the environment,
and provide tools to enhance learning (e.g., picture
communication, written schedules, and sensory supports).
INTERVENTION  Use of communication modalities such as sign language,
FOR communication boards, visual supports, Picture Exchange
Communication System(PECS), use of social stories, and social
COMMUNICATIO skills training.
N
  Treatment and education of Autistic and related
Communication-handicapped Children .
 It involves an array of teaching or treatment principles and
strategies based on the learning characteristics of individuals
with ASD, including strengths in visual information processing,
and difficulties with social communication, attention, and
executive function

TEACCH  This framework includes:

 1. Physical organization
 2. Individualized schedules
 3. Work (Activity) systems
 4. Visual structure of materials in tasks and activities
  Based on the assumption that the child is either over- or
SENSORY understimulated by the environment
INTEGRATIO  Involves placing a child in a room specifically designed to
N stimulate and challenge all of the senses.
PHARMACOLOGICA
L
 STIMULANTS:
Alpha-2 agonists:
Methylphenidate(5-60mg/d),
Guanfacine, Clonidine(0.05-
Dextroamphetamines(5-60mg/d),
0.3mg/d)
Amphetamine salts
Hyperactivity, aggression,
Hyperactivity,inattention,Impulsi and sleep dysregulation
vity
Anticonvulsants(valproate,
Naltrexone (0.5-2.0mg/kg/d)
carbamazepine) and lithium-
suppresses endogenous opiod
Aggression, self-injurious behavior
activity
(SIB),irritability.
Self-injurious behavior (SIB)

Amantadine :Hyperactivity, Melatonin

irritability, and aggression Sleep dysregulation

 Pyridoxine, the water-soluble essential vitamin B6,
has been used extensively as a pharmacological
treatment in autistic disorder.
 Tetrahydrobiopterin- Significant improvement in
social interaction score after 6 months of active
treatment.
 L-Carnosine- improved receptive speech, social
attention, less apraxia, global improvements. 2014,
JCN
SECRETIN
• A case series of three autistic
patients that showed
improvement in core symptoms
after receiving the
gastrointestinal hormone
secretin, led to a series of studies
on this substance as a possible
treatment for ASD but the results
have been disappointing so far.
OTHER AGENTS
• Music Therapy .
• Auditory Integration Therapy
(AIT)
• Gluten and casein free diet
  Autistic disorder and other pervasive developmental disorders
are complex, early-onset disorders that usually lead to
moderate-to-severe disability in domains of social,

CONCLUSIO communicative, and flexible behavior.

 Pharmacotherapy and behaviour therapy does not cure the core
N symptoms of ASD rather help in maximizing adaptive
functions.
THANK YOU!!!