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Questions and Answers
Individuals with ASD are likely to experience fewer severe adverse effects than typically developing individuals.
Individuals with ASD are likely to experience fewer severe adverse effects than typically developing individuals.
False
It is recommended to initiate treatment with high doses of psychotropic drugs in individuals with ASD.
It is recommended to initiate treatment with high doses of psychotropic drugs in individuals with ASD.
False
There is clear evidence that pharmacological agents can effectively treat core symptoms of ASD.
There is clear evidence that pharmacological agents can effectively treat core symptoms of ASD.
False
SSRIs have been shown to be effective in reducing RRBIs in children with ASD.
SSRIs have been shown to be effective in reducing RRBIs in children with ASD.
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Risperidone has been shown to be effective in reducing RRBIs in adults with ASD.
Risperidone has been shown to be effective in reducing RRBIs in adults with ASD.
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Oxytocin has been consistently shown to improve social and communication impairments in ASD.
Oxytocin has been consistently shown to improve social and communication impairments in ASD.
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Acetylcysteine has been shown to be effective in modifying ASD core symptoms.
Acetylcysteine has been shown to be effective in modifying ASD core symptoms.
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IGF-1 has been consistently shown to improve social and communication impairments in ASD.
IGF-1 has been consistently shown to improve social and communication impairments in ASD.
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Dopamine blocking agents are recommended as first-line treatment for RRBIs in ASD.
Dopamine blocking agents are recommended as first-line treatment for RRBIs in ASD.
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All ADHD symptoms in ASD individuals merit a diagnosis of ADHD.
All ADHD symptoms in ASD individuals merit a diagnosis of ADHD.
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There is strong evidence to support the use of nutritional supplements or dietary therapies for children with ASD.
There is strong evidence to support the use of nutritional supplements or dietary therapies for children with ASD.
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Methylphenidate has been shown to be highly effective in treating ADHD symptoms in ASD individuals with minimal adverse effects.
Methylphenidate has been shown to be highly effective in treating ADHD symptoms in ASD individuals with minimal adverse effects.
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There is conclusive evidence that faecal microbiota transplants are effective in reducing ASD core symptoms.
There is conclusive evidence that faecal microbiota transplants are effective in reducing ASD core symptoms.
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Lisdexamfetamine has been extensively studied in ASD individuals with ADHD symptoms.
Lisdexamfetamine has been extensively studied in ASD individuals with ADHD symptoms.
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Amfetamines have been extensively studied in the treatment of ADHD in ASD individuals.
Amfetamines have been extensively studied in the treatment of ADHD in ASD individuals.
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Atomoxetine has been shown to be ineffective in treating ADHD symptoms in ASD individuals.
Atomoxetine has been shown to be ineffective in treating ADHD symptoms in ASD individuals.
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Clonidine has not been shown to be an effective alternative treatment for ADHD symptoms in ASD individuals.
Clonidine has not been shown to be an effective alternative treatment for ADHD symptoms in ASD individuals.
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Maternal food intake during pregnancy has been shown to have a direct correlation with the development of ASD in children.
Maternal food intake during pregnancy has been shown to have a direct correlation with the development of ASD in children.
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According to ICD-10, ASD is classified under anxiety disorders.
According to ICD-10, ASD is classified under anxiety disorders.
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Co-occurring mental health conditions are rare in individuals with ASD.
Co-occurring mental health conditions are rare in individuals with ASD.
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Risperidone is commonly used to treat anxiety in individuals with ASD.
Risperidone is commonly used to treat anxiety in individuals with ASD.
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ASD is characterized by core deficits in social communication development and cognitive abilities.
ASD is characterized by core deficits in social communication development and cognitive abilities.
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There are several validated pharmacological treatments that alleviate core ASD symptoms.
There are several validated pharmacological treatments that alleviate core ASD symptoms.
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Methylphenidate is commonly used to treat sleep problems in individuals with ASD.
Methylphenidate is commonly used to treat sleep problems in individuals with ASD.
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Intellectual disability is a rare associated problem in individuals with ASD.
Intellectual disability is a rare associated problem in individuals with ASD.
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Evaluating and optimally treating co-occurring conditions is not essential in ASD.
Evaluating and optimally treating co-occurring conditions is not essential in ASD.
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Pharmacotherapies are rarely used in individuals with ASD as adjuncts to psychological interventions.
Pharmacotherapies are rarely used in individuals with ASD as adjuncts to psychological interventions.
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The multisite RCT of extended-release guanfacine compared with placebo in children with ASD showed that it is safe and effective in managing hyperactivity in this group over a period of 12 weeks.
The multisite RCT of extended-release guanfacine compared with placebo in children with ASD showed that it is safe and effective in managing hyperactivity in this group over a period of 12 weeks.
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Risperidone and aripiprazole have been reliably shown to help with irritability and associated disruptive behaviours in ASD and have been approved for this use by the European Medicines Agency.
Risperidone and aripiprazole have been reliably shown to help with irritability and associated disruptive behaviours in ASD and have been approved for this use by the European Medicines Agency.
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The usual recommended clinical dose of aripiprazole for maintenance is between 10 and 20mg daily.
The usual recommended clinical dose of aripiprazole for maintenance is between 10 and 20mg daily.
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Olanzapine has been shown to be effective in managing irritability in ASD in adequately powered RCTs.
Olanzapine has been shown to be effective in managing irritability in ASD in adequately powered RCTs.
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Risperidone does not cause hyperprolactinaemia.
Risperidone does not cause hyperprolactinaemia.
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Aripiprazole has been shown to be effective in managing self-injurious behaviours in ASD.
Aripiprazole has been shown to be effective in managing self-injurious behaviours in ASD.
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Quetiapine has been tested in adequately powered RCTs for its effectiveness in managing irritability in ASD.
Quetiapine has been tested in adequately powered RCTs for its effectiveness in managing irritability in ASD.
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One long-term, placebo discontinuation study found that relapse rates were significantly higher in those who stayed on aripiprazole versus those randomised to switch to only placebo.
One long-term, placebo discontinuation study found that relapse rates were significantly higher in those who stayed on aripiprazole versus those randomised to switch to only placebo.
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Ziprasidone has been shown to be effective in managing irritability and hyperactivity in ASD in adequately powered RCTs.
Ziprasidone has been shown to be effective in managing irritability and hyperactivity in ASD in adequately powered RCTs.
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Benzodiazepines are recommended as a first-line treatment for irritability and aggression in ASD.
Benzodiazepines are recommended as a first-line treatment for irritability and aggression in ASD.
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Risperidone is indicated for the treatment of irritability associated with autistic disorder in children under 5 years old.
Risperidone is indicated for the treatment of irritability associated with autistic disorder in children under 5 years old.
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Melatonin has been shown to be beneficial in improving sleep onset and daytime behaviour in children with ASD.
Melatonin has been shown to be beneficial in improving sleep onset and daytime behaviour in children with ASD.
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Fluoxetine has been consistently shown to be effective in reducing OCD symptoms in children with ASD.
Fluoxetine has been consistently shown to be effective in reducing OCD symptoms in children with ASD.
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Risperidone has been shown to be effective in reducing anxiety and OCD symptoms in young people with ASD.
Risperidone has been shown to be effective in reducing anxiety and OCD symptoms in young people with ASD.
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Buspirone has been consistently shown to be effective in targeting anxiety in ASD.
Buspirone has been consistently shown to be effective in targeting anxiety in ASD.
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Propranolol has been consistently shown to be effective in reducing anxiety and OCD symptoms in ASD.
Propranolol has been consistently shown to be effective in reducing anxiety and OCD symptoms in ASD.
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Minocycline, arbaclofen, and amantadine are recommended as first-line treatments for irritability in ASD.
Minocycline, arbaclofen, and amantadine are recommended as first-line treatments for irritability in ASD.
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Clonazepam is recommended as a first-line treatment for insomnia due to hyperarousal in ASD.
Clonazepam is recommended as a first-line treatment for insomnia due to hyperarousal in ASD.
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Risperidone can be administered only once daily in children with ASD.
Risperidone can be administered only once daily in children with ASD.
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The therapeutic effect of risperidone for patients under 20kg plateaus at 1mg/day.
The therapeutic effect of risperidone for patients under 20kg plateaus at 1mg/day.
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For children weighing over 20kg, the initial risperidone dose during Days 1-3 is 1.0mg/day.
For children weighing over 20kg, the initial risperidone dose during Days 1-3 is 1.0mg/day.
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Weight gain, somnolence, and hyperglycaemia are adverse effects that require monitoring when children with ASD are treated with risperidone.
Weight gain, somnolence, and hyperglycaemia are adverse effects that require monitoring when children with ASD are treated with risperidone.
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Sufficient clinical response to risperidone typically leads to a recommendation of maintaining the same dose indefinitely without any reduction.
Sufficient clinical response to risperidone typically leads to a recommendation of maintaining the same dose indefinitely without any reduction.
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Study Notes
Autism Spectrum Disorder (ASD)
- ASD is a complex condition characterized by core deficits in social communication development and behavior, as well as sensory difficulties.
- ASDs include autism, Asperger's syndrome, and PDD-NOS, which are classified under pervasive developmental disorders (PDD) in ICD-10 and ASD in DSM-V.
- The heterogeneity of ASD poses assessment and treatment challenges.
Co-occurring Mental Health Conditions
- 69-79% of individuals with ASD experience at least one co-occurring mental health condition in their lifetime.
- Common co-occurring conditions include:
- Attention deficit hyperactivity disorder (ADHD)
- Disruptive behavioral disorders
- Anxiety
- Obsessive-compulsive disorder
- Mood disorders
- Associated problems include:
- Intellectual disability
- Epilepsy
- Sleep disturbance
- Self-harm
- Irritability
- Aggression towards others
Pharmacological Treatment
- There are no validated or licensed pharmacological treatments that alleviate core ASD symptoms.
- Targeting problem behaviors and comorbid psychiatric conditions with pharmacological interventions is common practice.
- Pharmacotherapies are commonly used as adjuncts to psychological interventions.
- Evidence suggests reasonable efficacy of:
- Risperidone for irritability and aggression
- Methylphenidate, atomoxetine, and guanfacine for ADHD
- Melatonin for sleep problems
- Evidence is limited for:
- SSRI's for anxiety, depression, and repetitive behaviors
- Antiepileptics for epilepsy
Restricted Repetitive Behaviors and Interests (RRBIs)
- RRBIs are distressing and disruptive to functioning, making them an important treatment target.
- Behavioral therapies should be used as first-line treatment.
- Pharmacotherapy can be considered for severe RRBIs with significant impact on functioning.
- Evidence suggests:
- Limited efficacy of SSRIs for RRBIs
- Risperidone is effective in reducing RRBIs in children with high levels of irritability or aggression
- Antipsychotic medication may be effective in reducing RRBIs
Social and Communication Impairment
- No drug has been consistently shown to improve core social and communication impairments in ASD.
- Risperidone may have a secondary effect through improvement in irritability.
- Glutamatergic drugs and oxytocin are currently the most promising, but require further investigation.
Pharmacological Treatment of Co-occurring Disorders and Problem Behaviors
- Inattention, overactivity, and impulsiveness in ASD:
- Methylphenidate is effective in treating ADHD symptoms, but with more adverse effects.
- Atomoxetine is a noradrenergic reuptake inhibitor with similar efficacy to methylphenidate.
- α2 agonists (clonidine and guanfacine) can be used as alternative treatments.
- Irritability (aggression, self-injurious behavior, severe disruptive behaviors):
- Second-generation antipsychotics (risperidone, aripiprazole) are the first-line pharmacological treatment for children and adolescents with ASD and associated irritability.
- Duration of treatment is difficult to derive from published evidence, but treatment appears to be beneficial for up to 6-12 months.
- Sleep difficulties:
- Melatonin is beneficial in children with ASD, with good efficacy and tolerability.
- Clonidine or clonazepam may be beneficial for insomnia due to hyperarousal.
Anxiety, OCD, and Depression
- SSRIs have yet to show specific efficacy in ASD.
- Risperidone may benefit OCD symptoms, but evidence is limited.
- Buspirone may be effective in targeting anxiety in ASD, but further evaluation is needed.
- Propranolol may show positive cognitive effects in ASD, but further evaluation is needed.
Risperidone Dosing Guidance for Children and Adolescents with Autism Spectrum Disorders
- The FDA provides dosing guidance for risperidone in children and adolescents with autism spectrum disorders.
Dosing Schedule
- Weight categories are used to determine the dosing schedule for risperidone in children and adolescents.
- The dosing schedule is divided into three phases: Days 1-3, Days 4-18, and dose increments.
- The dose range varies depending on the weight category and phase of treatment.
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Description
This quiz covers the definition and characteristics of Autism Spectrum Disorder (ASD), including its effects on social communication and behavior. It also touches on co-occurring mental health conditions in individuals with ASD.
