Comprehensive Management of Autism: Current Evidence

The article titled "Comprehensive Management of Autism: Current Evidence" from the Indian Journal of Psychological Medicine (Nov-Dec 2017) by Manjiri Deshpande Shenoy, Vishal India, and Harish Reddy focuses on the comprehensive management of autism. Here's a summary of the major points and findings:

1. Introduction and Background:

• Autism is a neurodevelopmental disorder characterized by deficits in social interaction, verbal and nonverbal communication, and the presence of repetitive behaviors.
• The prevalence of autism has risen over the past few decades. It's uncertain if this rise is due to increased awareness of milder forms of the disorder.
• The main goals of treatment are to enhance the child's functional independence and quality of life, reduce core autism features, facilitate development, promote socialization, and educate families.
• Currently, there's no cure for autism. However, various therapies such as applied behavioral analysis, speech therapy, and sensory integration therapy are recommended. Medications are also used for behavioral symptoms.

2. Changes in Diagnostic Criteria:

• The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) made significant changes to the diagnostic criteria for autism. It eliminated sub-diagnostic categories like Asperger syndrome and introduced the term Autism Spectrum Disorder (ASD).
• The new criteria focus on persistent deficits in social communication and interaction, as well as restricted and repetitive patterns of behavior.

3. Management:

• No therapy has been proven to completely reverse the core symptoms of autism.
• Nutritional intervention and complementary and alternative medicine approaches are prevalent among children with ASD.
• The only treatment shown to ameliorate core behavioral deficits is early intensive behavioral and educational intervention therapy.
• A team of healthcare professionals, including developmental pediatricians, child psychiatrists, and behavioral therapists, is essential for managing autism.

4. Applied Behavioral Analysis (ABA):

• ABA is based on theories of learning and operant conditioning. It involves specific intervention targets paired with positive reinforcement.
• A meta-analysis revealed that ABA interventions have positive effects on intellectual functioning, language development, daily living skills, and social functioning.
• ABA techniques include task analysis, chaining, prompting, fading, shaping, and differential reinforcement.
• Despite its effectiveness, ABA has limitations, including the time required to see improvements, the generalizability of learned skills, and the cost of intensive therapies.

5. Psychopharmacological Treatments:

• The pharmacotherapy of autism targets behavioral symptoms rather than core autism features.
• Targets include hyperactivity, inattention, repetitive thoughts, self-injurious behavior, and aggression.
• Antipsychotics have been shown to improve symptoms related to aggression, social withdrawal, hyperactivity, and sleep disturbances. However, there are concerns about side effects, especially with traditional neuroleptics.