Autism and Bipolar

Though i have not seen formal literature that supports a connection between autism and bipolar illness, i have seen too many kids with that combination. Though Bipolar illness is overly diagnosed these days, i have seen Kids with undeniable bipolar and undeniable autism. It has been noted long ago that autistic kids with aggression responded well to either lithium or antipsychitics, both of whom are treatments for bipolar.

Autism and Aspergers medication considerations

Because we don't have medications that directly affect the actual root cause of autism and Aspergers we target symptoms and treat them accordingly. Sometimes the results can be surprisingly good and at other, modest at most. The key is to find the most appropriate medicine with the least side effects. The following are my first choices, based on effficacy and side effects. There are other options but these are my favorites.

For aggression:
Antipsychotics: all are ok, look at the ones with less side effects: Abilify, Seroquel have less side effects, other may cause weight issues (Risperdal and Zyprexa) and Geodon can have cardiac conduction issues
Anti-seizure meds: Trileptal, Depakote(watch for weight gain) and Topamax (watch for cognitive/memory decline)

For perseveration:
SSRI's: Prozac, Luvox-don't use SSRI's if there is a family history of bipolar
Inosital-be patient, stick with it, it may take 6 weeks to see results, don't be afraid to push up the dose to high doses

For hyperactivity and inattention:
Focalin-xr, Adderall-xr-both can be sprinkled if swallowing issues exist
Clonidine, though potentially too sedating has been surprisingly good for some kids
Consiider Provigil, especially if the stimulants not helpful

Don't over look the benefits of a casein-free diet! Casein is the fat in milk. It can be great for many kids, especially if there has been a history of colic and intolerance to milk as an infant.

Don't overlook the benefits of a sensory diet and OT interventions! Having an outpatient OT to guide you in your management at home can be invaluable. You may need to push your insurance carrier to cover it and you may need to ask your pediatrician or child psychiatrist to give you an order for it.

Autism, Aspergers and medications

Risperdal was recently approved for treatment of aggression and mood lability with Autism. Unfortunately, for the psychiatric community it was nothing new. We have been using antipsychotics for treatment of the symptoms of autism for years. There is one positve however, there is hope that this might mean more pharmaceutical monies directed toward treatment of autism spectrum disorders.

Autism is a complex disorder that is confusing and poorly understood at the present. So far we know there are some complex genetics involved, there may be a predisposition that is triggered by something, (eg like MMR vaccine), there is a bowel connection with inflammatory bowel wall and frequent bowel issue like chronic constipation and there may be nutritional issues with casein, gluten intolerances and magnesium ?deficiency. At this point we have to address as many issues as we identify: sensory, dietary, bowel, communication, social, need for supplements, etc. Hopefully, in 5-10 years we'll look back and wonder why we had it all wrong and were grabbing at straws. We have to do the best we can with what we have.

Asperger's and casein free diets

I have been very pleased with the response of some of my Asperger's patients with casein-free diets. Casein is the protein in milk. It is not only in dairy products but used as fillers in processed foods such as hot dogs and bologna, etc. One young man (about 8 years old) who had classic symptoms of Asperger's and was quite irritable, conflictual with peers and staff, and obsessive-compulsive/perseverative, did so much better on the casein restriction and all the social difficulties and irritablitiy and perseveration diminished. Because he kept insisting he wanted his milk back, we started him back on the milk products and his symptoms all returned. What was interesting in his history was that he was colicy as an infant and after several milk/formula changes he did much better on soy milk. It is my opinion that though at some point he resumed dairy products, he was still intolerant and it created the symptoms we were seeing. While we was the results werre seen within a short period of time ( a couple of days), researchers recommend a good month trial on the diet retriction.