Most meds don't help autism, studies show

Better studies that show which therapies work  best for which children with autism spectrum disorders are needed, because most of the current research used to weigh treatment options today is lacking, according to new research published Monday.

When 1 in 110 children are affected by the same disorder where there's no definitively known cause or effective cure and in many parts of the country insufficient treatment options, determining how to best treat your child can be a huge challenge.

This is what parents of young and older children with autism face every day.  People who have this neurological disorder can have multiple symptoms that affect their ability to communicate, impair their social behavior and display repetitive behavior.  Many therapies and medications are offered to help patients with this disorder which affects patients for as long as they live, but there's not necessarily a consensus on what works at all or works well.

So the Agency for Healthcare Research and Quality, a division of the Department of Health and Human Services, decided to take a deeper look at the existing research. The  AHRQ recognized that care for adolescents and young adults with autism  varies greatly from provider to provider and that the people making decisions about treatment – family and health care professionals – had little solid information on which to judge.

Three studies published Monday in the journal Pediatrics, provide some data from this very large report. One article examines the effectiveness of intense early behavioral therapy in children with ASDs;  the two others look at medications that are often prescribed to treat children with autism, with one study focusing specifically on a hormone called secretin. The research was done at Vanderbilt University in Nashville, Tennessee.

SECRETIN
Secretin is a hormone commonly used to treat peptic ulcers and test the function of the pancreas. Over a decade ago, a report was published that described three children with autism showed improved behavior after being treated with secretin. However, in recent years its efficacy has been questioned, and this new review of seven studies suggests that secretin is no more effective than placebo.

When something clearly does not work it's important to inform parents and physicians, so they don't waste precious time, possible side effects and money on something that doesn't work, says Zachary Warren, director of Vanderbilt University's Treatment and Research Institute for Autism Spectrum Disorders (TRIAD). [Secretin, he says, "is one of the few areas where we feel we have solid high evidence."

"The evidence is pretty high that that this particular intervention does not work," he says.

The article "A Systematic Review of Secretin for Children With Autism Spectrum Disorders" concludes that studying secretin as an autism treatment is no longer warranted. In a time where every research dollar is cherished, knowing where not to spend research money is helpful too.

Dr. Geraldine Dawson, chief scientific officer for the advocacy group Autism Speaks, which funds a lot of autism research including some of Warren's studies, agrees with the study authors' assessment. She says "for secretin the question has been answered."

Dawson says this and the other two studies published Pediatrics are helpful because they provide more information about what doesn't work and what needs to be further investigated. "We still have so many questions unanswered about the treatments that are available," says Dawson.

OTHER MEDICATIONS COMMONLY USED TO TREAT ASD
As part of the "Systematic Review of Medical Treatments for Children with ASD," Vanderbilt researchers focused on the commonly prescribed medications, says Warren. They include antipsychotic drugs, serotonin-reuptake inhibitors (SRIs) or antidepressants, as well as stimulants and other medications for hyperactivity. None of these drugs are used to treat what's known as the "core symptoms" of autism: communications and social impairments and repetitive behavior.

The review found that drugs do little good. "Although many children with ASD's are currently treated with medical interventions, strikingly little evidence exists to support clear benefit for most medications," the researchers said. Only two antipsychotic drugs,  risperidone and aripiprazole, which are FDA-approved to treat patients with autism, were shown to be beneficial. But Warren cautions that side effects associated with their use are so potent, even in short intervals, and include significant weight gain. Since children with autism grow up to be adults with autism, it's conceivable that they might be on drugs for a long time and taking a drug that can lead to weight gain adds to a patient's problems in the long run.

Warren says more research is needed to better weigh the risks and benefits of taking these drugs. Dawson agrees and points to a study published last year that suggests that when combining risperidone with behavioral therapy the outcome was better.

Dr. Eric Hollander, director of the Compulsive, Impulsive and Autism Spectrum Disorders Program at Montefiore Medical Center in New York, believes some patients may benefit from some antidepressants, and stimulants may work for some patients with autism. But much larger clinical trials need to be conducted to tease out which patients will see an improvement in their behavior. All the experts agree that none of these medications address the core symptoms of autism, which means research for those type of drugs needs to encouraged and supported financially as well.

EARLY INTENSIVE BEHAVIORAL INTERVENTIONS
One message that has become louder over the past few years is the need for diagnosing a child's autism as early as possible so intense therapy can begin as early as possible. The thinking is that when a child is 2 or 3 and the brain is still developing, intense behavioral therapy might reduce the disruptive behaviors and teach the child skills that will lead to greater independence as he or she gets older. The researchers who reviewed studies published between 2000 and 2010 found that two types different types of intensive behavior therapy (the Lovaas or classic Applied Behavior Analysis or ABA and the Early Start Denver Model) seemed to help children improve cognitive development, language skills. But ,the evidence that shows who benefits most is insufficient or lacking. Warren says in many cases, comparing existing studies was very difficult because in some cases the methodology was concerning and there wasn't any consistency in how the studies were conducted. For the current review, 23 out 34 studies were deemed "poor quality."
"This report points out that early intervention is effective, but we need more research to better understand which children respond and whether one model is better than another," says Dawson.