Integrating Treatment for Autism Spectrum Disorders Through the Life Cycle
Integrating Treatment for Autism Spectrum Disorders Through the Life Cycle Robert L Hendren, DO Professor of Psychiatry and Behavioral Science Idaho Autism Summit November 2, 2019 Faculty Disclosure • Grants — Curemark, Roche, Otsuka • Advisory Board — Curemark, BioMarin, Janssen, Axial Biotherapeutics • Honoraria/Royalties: Oxford University Press, Taylor & Francis • Dr. Hendren does intend to discuss the use of off- label/unapproved use of drugs Learning Objectives • Identify successes and challenges in the developmental progression through the life cycle for people with developmental disabilities and their families • Identify and effectively treat comorbid medical, emotional and behavioral symptoms associated with autism spectrum disorders (ASD) • Consider integrating biomedical treatments for ASD including conventional psychotropic medication and what has been referred to as CAM/CIM into a comprehensive program. 2010 1 in 68; 2014 1 in 59 CDC Prevalence of Autism • Possible explanations include – Diagnostic expansion and substitution – Better reporting – Increased recognition – Increasing acceptability – Immigration for services – Environmental toxins – Infectious and immune vulnerability – Epigenetic processes Rutter M. Acta Pediatr. 2005;94(1):2-15. Centers for Disease Control and Prevention. Autism Spectrum Disorders. www.cdc.gov/ncbddd/autism. Accessed June 16, 2015. Hagerman R, Hendren RL (Eds). Treatment of Neurodevelopmental Disorders: Targeting Neurobiological Mechanisms. Oxford University Press; 2014. ASD Genetic Etiology (Levels 1 & 2) • Multiple genes: NRXN12q, 7q11.23, 15q11-13, 16p11.2, SHANK 3, 2, NLGN4, MTHFR 677>T, SEMA5A, 2Q22.1, GRIN2B, 5P14.1, CDH9, 10, FRX, PTEN • Identical twins: 60% to 90% – Fraternal twins: 0% to 36% – Siblings: 4% to 19% • Clear genetic etiology accounts for 25% of autism cases • Hundreds of genetic mutations, some de novo, lead to many ways to develop and treat autism • Is Precision Medicine Possible? Weiss KM, Issues Science and Technology in 2017 Levy D, et al.
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