The Current State of Autism: From Etiology to Treatment

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Recent changes in our understanding of autism are driving advances in diagnosis, evidence-based treatment, and ultimately patient outcomes.
Recent changes in our understanding of autism are driving advances in diagnosis, evidence-based treatment, and ultimately patient outcomes.
The following article is part of live conference coverage from the 2017 Psych Congress in New Orleans, Louisiana. Psychiatry Advisor's staff will be reporting breaking news associated with research conducted by leading experts in psychiatry, as well as presentations from the Congress. Visit Psychiatry Advisor's conference section for continuous coverage live from Psych Congress 2017.

NEW ORLEANS — Starting at birth or very early in life, autism spectrum disorder encompasses a broad range of syndromes, and the complexity of the condition can contribute to significant difficulty in management.  However, recent changes in our understanding of this social learning disability are driving advances in diagnosis, evidence-based treatment, and ultimately patient outcomes. 

In his presentation at the 2017 Psych Congress, Fred Volkmar, MD, the Irving B. Harris Professor of Child Psychiatry, Pediatrics, and Psychology at Yale University School of Medicine, in New Haven Connecticut, explained how we now recognize the strong neural and genetic basis for autism, as well as the impact of environmental influences.  From 50 to 100 genes are involved in autism; while boys are 4- to 5-times more likely to have autism, girls are more significantly impaired by the condition. Autism is also associated with increased rates of onset of seizure disorder, notably at 2 peak time points:  one in early life (<3 years of age) and a second in early adolescence (11 to 14 years of age).

Research into autism spectrum disorders has increased significantly over the past 15 years and has resulted in the availability of evidence-based treatment models. The Applied Behavioral Analysis model focuses on positive behavioral changes and is supported by a significant volume of research that is mostly case based.  There is limited but supportive research for the Greenspan Floortime approach, which emphasizes meeting children on their level to foster communication and interactivity. The Early Start Denver Model promotes early behavioral and developmental intervention.  There is a growing body of data in favor of Pivotal Response Training, which has been found to be particularly beneficial in infants.  TEACCH is a personalized structured training model with research contributing to the evidence supporting interventions for autism.

Understanding the development of the social brain is necessary to understand the neurobiological basis of autism.  From facial recognition to the perception of sounds and orientation to human voices, the connectivity of infants to their parents allows for language development, communication, and responsivity. In the setting of autism, infants demonstrate difficulty with normal facial recognition and rely less on facial features and more on other physical characteristics. Functional magnetic resonance imaging studies have elicited group differences in individuals with autism vs controls in the fusiform gyrus on facial recognition testing. Eye tracking testing of viewers with autism demonstrated that individuals with autism focus on the lower portion of the face, thereby missing approximately 90% of relevant nonverbal cues.

These findings have led to psychotherapeutic and pharmacotherapeutic interventions that show promise in minimizing the impact of autism and maximizing developmental gains. Behavioral, social skill, and communication interventions have resulted in more adolescents with autism progressing to higher education. “We are now seeing more and more students with autism who are in college, which is great,” reported Dr Volkmar.

Although a strong placebo effect is often seen with both medications and alternative and complementary medicine approaches, double-blind, placebo-controlled studies show promising data on use of serotonin reuptake inhibitors and risperidone and other second-generation neuroleptic agents in individuals with autism. 

“Changes in outcomes are probably reflecting several factors, such as earlier diagnosis and better intervention or intensive intervention,” concluded Dr Volkmar.

Visit Psychiatry Advisor's conference section for continuous coverage live from Psych Congress 2017.

Reference

Volkmar FR. Advances in understanding and treating autism spectrum disorder. Presentation at: Psych Congress; September 16-19, 2017; New Orleans, LA.

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