Popular autism treatment found ineffective!

Study: Antidepressant didn’t stop repetitive behaviors, caused side effects...

CHICAGO - An antidepressant that is among the most popular kinds of medicine used for treating autism didn't work for most kids and caused nightmares and other side effects, new research found.

Results showed risks with Celexa outweighed any benefits in the largest published study of medication versus dummy pills for autism. That's according to the lead author, Dr. Bryan King, director of child and adolescent psychiatry at Seattle Children's Hospital and the University of Washington medical school.

The drug is not approved for treating autism. However, many doctors have prescribed it, thinking it might help prevent repetitive behaviors such as spinning, twirling and head-banging that are hallmark autism symptoms. Similar antidepressants have been shown to help treat repetitive actions in people with obsessive-compulsive disorder.

But in the autism study, Celexa worked no better than dummy pills. In fact, compared with kids on placebo, those on Celexa were more than twice as likely to develop repetitive behaviors, as well as other side effects including sleep problems and hyperactivity.

Celexa is in a class of antidepressants known as selective serotonin reuptake inhibitors, or SSRIs, which are among the most widely used medicines given for autism.
The new research could "change this practice," said prominent Yale University autism researcher Dr. Fred Volkmar. He commented in an editorial released with the study Monday in the June issue of Archives of General Psychiatry.

The results echo a separate study reported in February that showed a low-dose form of Prozac, another SSRI, also did not reduce repetitive behaviors in autism.

The overall global market for drug treatment in autism is at least $2 billion and SSRI antidepressants account for nearly 60 percent of that, the study authors said.
Celexa's maker, Forest Laboratories Inc., issued a statement saying the company "was not involved in this study and therefore cannot provide comment."
The National Institutes of Health paid for the research.

‘Biology of autism’Geraldine Dawson, chief science officer of the advocacy group Autism Speaks, said the new results underscore the difficulty in treating a condition with an uncertain cause and symptoms that range from mild to severe.

"We are still so challenged to come up with medications that can address core symptoms," she said, "largely because we still don't understand the biology of autism."
The study involved 149 autistic children aged 5 to 17 who were randomly given either up to 20 milligrams daily of Celexa for 12 weeks or dummy pills.

Doctors rated children's symptoms during treatment on a scale of 1 to 7, with high scores reflecting worsening symptoms. The rating method allowed doctors to evaluate improvements in repetitive actions and also other behaviors.

Only about one-third of children on Celexa showed substantial improvement; most showed little or no improvement or got worse.

Celexa is among antidepressants labeled with a warning about the potential for increasing risks for suicidal thoughts and behavior in children, but these symptoms didn't occur in the study.
About one-third of children on dummy pills also improved. King said reasons for that are uncertain. It could be they expected to get better with any kind of pill — the well-known "placebo effect." Or it could just have been a coincidence since autism symptoms tend to fluctuate over time.

That tendency might also explain why many kids on placebo also developed new or worse symptoms, he said.

Source: The Associated Press 2010.

Brain Imaging May Help Diagnose Autism

Children with autism spectrum disorders (ASDs) process sound and language a fraction of a second slower than children without ASDs, and measuring magnetic signals that mark this delay may become a standardized way to diagnose autism.

Researchers at The Children's Hospital of Philadelphia report their findings in an online article in the journal Autism Research, published today.

"More work needs to be done before this can become a standard tool, but this pattern of delayed brain response may be refined into the first imaging biomarker for autism," said study leader Timothy P.L. Roberts, Ph.D., vice chair of Radiology Research at Children's Hospital. ASDs are a group of childhood neurodevelopmental disorders that cause impairments in verbal communication, social interaction and behavior.

ASDs are currently estimated to affect as many as one percent of U.S. children, according to a recent CDC report.

Like many neurodevelopmental disorders, in the absence of objective biological measurements, psychologists and other caregivers rely on clinical judgments such as observations of behavior to diagnose ASDs, often not until a child reaches school age. If researchers can develop imaging results into standardized diagnostic tests, they may be able to diagnose ASDs as early as infancy, permitting possible earlier intervention with treatments. They also may be able to differentiate types of ASDs (classic autism, Asperger's syndrome or other types) in individual patients.

In the current study, Roberts and colleagues used magnetoencephalography (MEG), which detects magnetic fields in the brain, similar to the way electroencephalography (EEG) detects electrical fields. Using a helmet that surrounds the child's head, the team presents a series of recorded beeps, vowels and sentences. As the child's brain responds to each sound, noninvasive detectors in the MEG machine analyze the brain's changing magnetic fields.

The researchers compared 25 children with ASDs, having a mean age of 10 years, to 17 age-matched typically developing children. The children with ASDs had an average delay of 11 milliseconds (about 1/100 of a second) in their brain responses to sounds, compared to the control children. Among the group with ASDs, the delays were similar, whether or not the children had language impairments.

"This delayed response suggests that the auditory system may be slower to develop and mature in children with ASDs," said Roberts. An 11-millisecond delay is brief, but it means, for instance, that a child with ASD, on hearing the word 'elephant' is still processing the 'el' sound while other children have moved on. The delays may cascade as a conversation progresses, and the child may lag behind typically developing peers."

A 2009 study by Roberts and colleagues sheds light on how changes in brain anatomy may account for the delays in sound processing. The study team used MEG to analyze the development of white matter in the brains of 26 typically developing children and adolescents. Because white matter carries electrical signals in the brain, signaling speed improves when neurons are better protected with an insulating sheath of a membrane material called myelin.

In this previous study, the researchers showed that normal age-related development of greater myelination corresponds with faster auditory responses in the brain. "The delayed auditory response that we find in children with ASDs may reflect delayed white matter development in these children," said Roberts.

Roberts says his team's further studies will seek to refine their imaging techniques to determine that their biomarker is specific to ASDs, and will investigate other MEG patterns found in children with ASDs in addition to auditory delays.

Grants from National Institute of Health, the Nancy Lurie Marks Family Foundation, Autism Speaks, and the Pennsylvania Department of Health supported this research. In addition, Roberts holds an endowed chair, the Oberkircher Family Chair in Pediatric Radiology at The Children's Hospital of Philadelphia. Roberts' co-authors were from Children's Hospital, including the Hospital's Center for Autism Research.

Source: The Children's Hospital of Philadelphia