Frontiers Journal of Neurology & Neuroscience

Autism Spectrum Disorder And Destructive Behaviors: Diagnostic And Therapeutic Challenges


Statement of the Problem: Autism spectrum disorder (ASD) is a multifactorial condition the current prevalence of which has been estimated to be at least 1.5%. It has been suggested to be the fastest growing neurodevelopmental disability worldwide affecting one in 68 births in the United States. The reasons for an increasing trend are not fully understood. Majority of children diagnosed with ASD meet criteria for intellectual disability (ID). From diagnostic and therapeutic perspective ASD and related behavioral disorders belong to the most challenging co-morbidities in ID. The purpose of this presentation is to describe those challenges we have to overcome in order to find new evidence based treatments for this patient group. Some methodological and therapeutic approaches are discussed.


Methodology & Theoretical Orientation: The basis for any new intervention lies in as accurate diagnostics as possible. This requires multidisciplinary teamwork with exclusion of treatable somatic disorders, recognition of comorbidities (incl. e.g. epilepsy, mood disorders), appropriate medication and identification of possible drug related adverse reactions, which may occasionally be, by mistake, considered as ASD related symptoms.


Findings: Risperidon is the only antipsychotic medicine in Europe that has an official indication for a 6-week use in behavioral disorders related to ID, but its use is hampered by severe adverse events. In some patients aggressive behavior subsidies always after they have an epileptic seizure (a phenomenon known as forced normalization). Sometimes the question may be of catatonic symptoms. In such cases psychiatric electroconvulsive therapy can be considered.


Conclusion & Significance: Because of the heterogenicity of this patient population conventional randomized clinical trials may not bring the much needed evidence based solutions to the challenges in clinical realm. Thus, individually designed clinical trials are suggested in search for appropriate treatment protocols for the most severe cases of ASD related behavioral disorders.