AAAP Today

Reported by Lirio Sobrevinas-Covey, Ph.D.

Wandering or “elopement” from their habitual and safe settings is a behavior commonly seen among children with autism spectrum disorder (ASD). These behaviors are often a form of communication — the person’s means of expressing a need, a want, or a state of anxiety. Accidental drowning, traffic injuries, falls, encounters with strangers, heat stroke, dehydration, are some of the dangers associated with wandering.

Most children with ASD who are wanderers outgrow this behavior; however, wandering also occurs in autistics older than 16 years. Wandering sometimes occurs in group homes for autistic adults, requiring these settings to install preventive procedures such as door alarms.

Here are some facts about elopement listed by Dr. Patty Huang, M.D. from a survey of parents of more than 1,200 kids with ASD and her suggestions on how to reduce the risk of wandering.

• Nearly half of parents reported that their kids with ASD tried to elope at least once after the age of 4 years.

• Frequency of elopement peaked around age 5 years.
• Almost three fourths of the time, elopement occurred from the family’s house or a friend’s house.
• The purpose of elopement varied with specific diagnosis. Kids who were described as running away for the sake of running (and tended to be happy and playful) were more likely to have a diagnosis of autism or autism spectrum disorder. On the other hand, kids with Asperger syndrome were more likely to be reported as eloping to run away from an anxious situation and tended to be either anxious or sad while eloping.

• The first step in managing and reducing the risk of wandering is to help families figure out why their kids are eloping. I always recommend that a behaviorist perform a functional behavioral assessment to determine both the triggers and the reinforcement behaviors that might occur when kids elope. Only then can the behaviorist develop an informed behavioral plan, which should be included in the child’s Individualized Education Plan.
• An individual aide can be particularly important, particularly if elopement is occurring at school. Pennsylvania has a state-funded behavioral service that can send therapists and therapeutic staff support workers to the home, to the school, and to the community- to wherever the child is. This can be a really useful service for kids where elopement is a concern.
• I may recommend medication to reduce either impulsivity or even anxiety, if that’s determined to be the trigger for the elopement behavior.

• Adults should be assigned specific roles in the event of an elopement situation and should rehearse regularly.
• Identification tags should be worn, especially if kids have communication and/or cognitive deficits and cannot relay their name and/or address.
• Police and fire departments should be notified in advance that a child with special needs lives or attends school in the neighborhood.

Source: Patty Huang, M.D. Newsletter of the The Children’s Hospital of Philadelphia, Center for Injury Research and Prevention.

CANCER TREATMENT MIGHT BE "RE-PURPOSED" TO TREAT AUTISM

Reported by Lirio Sobrevinas-Covey, Ph.D.

Individuals diagnosed with autism spectrum disorder (ASD) have much higher rates of cancer- related gene mutations. In a study involving a genomic database analysis, investigators initially found that autistic individuals have markedly increased rates of DNA mutations in genes associated with the development of cancer. A later study by Darbro and colleagues confirmed that earlier finding and, additionally, found that autistic patients have lower rates of cancer. It appears that children and adults with ASD exhibit a protective effect against cancer; this effect also appears to affect both males and females, although diminishing with age.

The significance of this finding is that certain cancer therapies may be “re-purposed” to treat autism. A possible explanatory mechanism is the presence of certain common cellular pathways for the development of cancer and of autism. Drugs that target cancer pathways might prove to have therapeutic value for treating autism. Some early suggestive evidence already exists. In a study of mice, rapamycin, a drug found to have anti-tumor properties was also found to prevent the development of autism. A trial of rapamycin in humans to study the benefits of rapamycin for patients with autism is underway. This is an exciting research direction towards a treatment for a condition for which an effective drug has yet to be discovered.

Reference: Benjamin Darbro, et al, Autism linked to increase oncogene mutations but decreased cancer rate. 2016, PLOS One.

​

IMPULSE CONTROL FINDINGS WITH ABILIFY

By Lirio Sobrevinas-Covey, Ph.D.

In a recent post on AAAP (May 1, 2016), I had cited research findings indicating the efficacy of risperidone (Risperdal) and aripirazole (Abilify) for reducing irritability and aggression in children and adolescents with autism (Fung LK et al, 2016). This conclusion was based on findings from 46 randomized clinical trials involving these drugs and other anti-psychotic medications showing significantly greater symptom improvement among those who received the drug than those who received the placebo (Fung LK, 2016). Only Risperdal and Ability have been approved by the FDA.

My post included the cautionary statement from the meta-analysis that – “Both risperidone and aripiprazole when compared with placebo showed higher rates of sedation, somonolence, weight gain, and extrapyramidal symptoms.”

Further adverse effects of Ability, although rare and not specifically cited in the meta-analysis, have resulted in warnings from the FDA regarding impulse control problems associated with the drug.

“The FDA has become aware of other compulsive behaviors associated with aripiprazole, such as compulsive eating, shopping, and sexual actions. These compulsive behaviors can affect anyone who is taking the medicine. As a result, FDA is adding new warning about all of these compulsive behaviors to the drug labels and the patient Medication Guidelines for all aripiprazole products.”

The FDA recommends that clinicians make their patients and caregivers aware of these impulse control risks, and that they should specifically ask patients about the emergence of new or increased urges while they are using Abilify. As also suggested in my May 1 post in AAAP Today, the FDA advises clinicians to consider reducing the dose or stopping the medication if such urges develop. Patients should not make these changes without consulting their prescribing physician.

Reference: Catherine Cassels, Psychiatry and Mental Health, May 3, 2016.