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How Important is a Diagnosis?

If you suspect that your child has ASD level 1 (Asperger's), even if he or she is an adult, should they seek a formal diagnosis?

Answer: It depends!



==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance
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Making Your Child's Bedroom More Conducive To Sleep

“Our 5 y.o. boy has been diagnosed with autism (high functioning). Any suggestions on how to make his bedroom more favorable for sleeping? We have been told by the therapist that he may be over-stimulated by the digital gadgets, toys, games, etc., in his room – and that these items are distracting him from falling asleep. This is a plausible theory, because he will get out of bed late into the night to play around. Also, he is easily aroused by the slightest noises through the night.”

It is important that the bed and the bedroom are associated with sleep and are not associated with activity. When young people with High-Functioning Autism or Asperger’s have sleep problems, it is highly recommended that their bed and bedroom activity be limited to sleep only. Also, it's important to make sure that extreme changes in temperature are avoided during the night.



Increasing light is associated with decreases in the release of the neuro-chemical melatonin, which triggers sleep onset. Thus, it is important to get the sunlight flowing in the child’s room as soon as possible in the morning. Conversely, darkening the room at night is critical. When a child’s fear of the dark is an issue, behavioral psychotherapy may be necessary. I also recommend moving the clock so that the child is not watching the time while lying in bed.

Here are a few additional suggestions that will help facilitate a good night’s rest:
  • Cool colors (those from the left side of the color wheel) are thought to provide a sense of calm. Choose one of these for your child’s bedroom, and avoid bright, loud colors that are more exciting than soothing.
  • If your child needs a little light to sleep comfortably, consider adding a couple of nightlights or a dimmer switch rather than having him sleep with a lamp on all the time.
  • Loud pipes might be keeping your child awake when one person makes a bathroom visit in the middle of the night. Look for the cause of any clanging and banging, particularly in a bathroom that may be adjacent to his bedroom.
  • Make sure doors and windows are solid and secure, with no drafts or rattles. 
  • Make sure that rooms adjacent to your child’s bedroom are not home to stereos, televisions or other noisy electronics. Most modern homes don't have completely soundproofed walls, and the bleed-through noise may be keeping him awake.
  • Organize closets and keep your child’s clothing and other personal items in their places. A chaotic, messy room is stressful to the mind. 
  • Select light-blocking window treatments. Even though the sun isn't out, plenty of light can sneak into the bedroom from outside, disrupting your child’s sleep patterns. 
  • Use an air purifier or humidifier to keep air quality at its best. Allergens and excessively dry air can interrupt a child’s sleep and make waking up unpleasant, too. Also, many machines create a white noise that drowns out other distracting sounds, which is often very appealing to children on the autism spectrum.
  • One mother suggests the following: "We also used either a sound machine (played nature sounds) or a CD with relaxing instrumental music to help our son get to sleep or stay asleep. That seemed to help reduce waking up from other people moving around after he went to bed." 




As a side note, many parents report that Melatonin (a hormone secreted by the pineal gland which has been shown to regulate sleep patterns) has been highly beneficial in helping their child with sleep difficulties.  For kids on the autism spectrum, the patterns of melatonin secretion may be irregular, so it is not that they don't produce it, but that they don't produce it at the right times of day. 

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Medical Treatment for the Symptoms of High-Functioning Autism

“What medications are used to treat the symptoms of high functioning autism? Which ones have the best track record? And, what are the side effects of these medications?”

There are several medications used to treat the symptoms associated with High-Functioning Autism (HFA) and Asperger’s (AS). Medications may be considered for problematic behaviors in these children and teens, for example:
  • aggression
  • anxiety
  • compulsions
  • depression
  • destructive behavior, or other disruptive behaviors
  • hyperactivity
  • inattention
  • irritability
  • mood lability
  • obsessions
  • perseveration
  • repetitive behaviors
  • self-injurious behavior
  • sleep disturbance
  • stereotypic movements



After medical causes and environmental factors have been ruled out, a trial of medication may be considered if the behavioral symptoms cause significant impairment in functioning and are responsive to behavioral interventions. In some cases, the diagnosis of a comorbid disorder (e.g., major depression, bipolar disorder, anxiety disorder, etc.) can be made reasonably, and the child can be treated with medications.

Modifications of diagnostic criteria may be necessary to account for clinical presentations of psychiatric conditions in children with developmental disabilities, and certain tools (e.g., behavior checklists, structured interviews) may be helpful. In other cases, therapists opt to target specific problematic behaviors or symptom-clusters in the absence of a clear comorbid psychiatric diagnosis.

Approximately 45% of kids and teens (and up to 75% of grown-ups) with HFA and AS are treated with psychotropic medication. Older age, lower adaptive skills and social competence, and higher levels of problematic behavior are associated with the likelihood of medication use.

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

SSRIs—

Selective serotonin-reuptake inhibitors (SSRIs), antipsychotic agents, stimulants, and α-adrenergic agonist antihypertensive agents are the most commonly prescribed classes of medications for kids on the autism spectrum. Double-blind, placebo-controlled studies have demonstrated the effectiveness of the SSRIs fluoxetine and fluvoxamine in the treatment of repetitive and other problematic behaviors in young people with HFA and AS. Studies of these and other SSRIs have shown improvements in target symptoms, for example:
  • aggression
  • anxiety
  • aspects of social interaction and language
  • depressive symptoms
  • difficulty with transitions
  • irritability
  • meltdowns
  • repetitive behaviors
  • shutdowns
  • tantrums

Potential side-effects of SSRIs include – but are not limited to – the following: 
  • abdominal discomfort
  • agitation
  • apathy
  • behavioral activation
  • constipation
  • dizziness
  • drowsiness
  • dry mouth
  • fatigue
  • headache
  • hypomania or mania
  • nausea
  • sexual dysfunction
  • sleep difficulties
  • suicidal ideation

Risperidone—

Risperidone has become the first medication for the symptomatic treatment of irritability, aggressive behavior, deliberate self-injury, and tantrums in kids and teens with HFA and AS. Controlled studies have confirmed the short-term effectiveness of risperidone for these disruptive behaviors.

Potential side-effects include – but are not limited to – the following:
  • excessive appetite
  • constipation
  • dry mouth
  • dyslipidemia
  • extrapyramidal symptoms
  • hematologic abnormalities
  • hyperprolactinemia
  • insulin resistance
  • neuroleptic malignant syndrome
  • QTc prolongation
  • sedation
  • seizures
  • tardive dyskinesia
  • urinary retention
  • weight gain

Methylphenidate—

Recent studies of methylphenidate have demonstrated improvement in hyperactivity, impulsivity, and inattention in kids with HFA and AS. Methylphenidate is effective in some of these young people, but the response rate is lower than that in kids with ADHD, adverse effects are more frequent, and it is unclear whether the results can be generalized to other stimulants.

Potential side-effects of stimulant medications include – but are not limited to – the following:
  • abdominal discomfort
  • appetite reduction
  • delayed sleep onset
  • exacerbation of tics
  • increased anxiety
  • increased blood pressure
  • increased heart rate
  • inhibition of growth
  • irritability
  • jitteriness
  • repetitive behaviors

 ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

Clonidine—

Studies have documented modest benefits of clonidine in reducing hyperarousal symptoms (e.g., hyperactivity, irritability, outbursts, impulsivity, and repetitive behaviors) in young people on the autism spectrum.

Potential side-effects include – but are not limited to – the following:
  • constipation
  • decreased blood pressure
  • dizziness
  • drowsiness
  • dry mouth
  • irritability
  • sedation

Atomoxetine—

Studies have suggested that atomoxetine may be effective for ADHD–like symptoms in kids and teens on the spectrum. Appetite suppression, dizziness, fatigue, liver injury, mood swings, nausea, and suicidal ideation are among the potential side-effects of atomoxetine.

Melatonin—

Studies suggest that sleep disorders affect 50 to 70 million individuals in the U.S. Sleep disorders exist whenever a lower quality of sleep results in impaired functioning or extreme lethargy. Difficulties initiating and maintaining sleep are very common in young people on the spectrum, affecting about 15-25% of this population.

A large study revealed several of melatonin’s sleep-enhancing benefits. Reviewing 15 studies of sleep in healthy individuals, researchers noted that melatonin significantly reduced sleep latency (i.e., the amount of time needed to fall asleep), while boosting sleep efficiency (i.e., the percentage of time in bed spent asleep) and increasing total sleep duration. Studies demonstrate an important characteristic of melatonin: the hormone exerts its hypnotic (i.e., sleep-inducing) and sedative (i.e., anxiety-relieving) effects, regardless of dosage time.

Produced by the pineal gland, melatonin is a noteworthy hormone that works both as a sleep aid and a potent antioxidant/immune booster. Also, melatonin is a natural sleeping pill that shifts the body clock into the desired direction. When taken between 3:00 and 6:00 PM, melatonin tricks the body into thinking that dusk comes sooner. Thus, AS and HFA kids become sleepy earlier, helping them fall asleep at 10:00 or 11:00 PM, rather than tossing and turning all night.

Potential side-effects include – but are not limited to – the following:
  • abdominal discomfort
  • confusion
  • daytime sleepiness 
  • dizziness 
  • headaches
  • irritability
  • mild anxiety
  • short-lasting feelings of depression

In addition, melatonin supplements can interact with other medications, including:  
  • birth control pills
  • blood-thinning medications (i.e., anticoagulants) 
  • diabetes medications
  • medications that suppress the immune system (i.e., immunosuppressants)



It will be important for future research to address the need for more rigorous evaluation of safety and effectiveness of medication for kids and teens on the spectrum. When medications are used, baseline data regarding behaviors and somatic complaints should be collected, informed consent should be obtained, potential benefits and side-effects should be explained, and potential strategies for dealing with treatment failure or partial response should be reviewed. Also, it is important to have some quantifiable means of assessing the effectiveness of the medication and to obtain input from a variety of sources (e.g., moms and dads, educators, therapists, etc).

Consistent use of validated, treatment-sensitive rating scales and medication side-effect scales is necessary. A wide variety of outcome measures have been used in research studies and in clinical practice to measure problematic behavior treatment effects (e.g., Nisonger Child Behavior Rating Form, Clinical Global Impression Scale, and Aberrant Behavior Checklist).

Click here for references…


More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

 ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

 ==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

 ==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

 ==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book
==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism
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Great Resources for the Management of Young People on the Autism Spectrum



Below is a list of resources for professionals who work with children and adolescents on the autism spectrum:

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4.    Aman MG. Management of hyperactivity and other acting-out problems in autism spectrum disorder. Semin Pediatr Neurol.2004;11 :225– 228
5.    American Academy of Pediatrics, Committee on Children With Disabilities. Auditory integration training and facilitated communication for autism. Pediatrics.1998;102 :431– 433
6.    American Academy of Pediatrics, Committee on Children With Disabilities. Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability [published correction appears in Pediatrics. 2001;108:507].Pediatrics.2001;107 :598– 601
7.    American Academy of Pediatrics, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. The medical home.Pediatrics.2004;113(5 suppl) :1545– 1547
8.    American Academy of Pediatrics. Understanding Autism Spectrum Disorders [pamphlet]. Elk Grove Village, IL: American Academy of Pediatrics; 2005
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10.    American Speech-Language-Hearing Association, Ad Hoc Committee on Autism Spectrum Disorders. Principles for speech-language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span. Available at:www.asha.org/NR/rdonlyres/D0370FEA-98EF-48EE-A9B6-952913FB131B/0/v3TR_autismLSpan.pdf. Accessed February 22,2007
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