SYMPTOMS AND TREATMENT OF CHILDREN WITH AUTISM SPECTRUM DISORDERS: INATTENTION, HYPERACTIVITY AND IMPULSIVITY
Ključne reči:
autizam, hiperaktivnost, nepažnja, iritabilnost, decaApstrakt
Uvod: Simptomi koji su obično povezani sa poremećajem hiperaktivnosti i nedostatka pažnje ADHD se mogu javiti kod autizma.Farmakoterapijom je moguće je smanjiti hiperaktivnost, impulsivnost i nepažnju i poboljšati funkcionalnost u socijalnom, akademskom i radnom okruženju.Simptomi poremećaja pažnje / hiperaktivnosti ADHD ( eng. attention deficit/hyperactivity disorder) su prisutni kod mladih sa ASD-om (engl. autism spectrum disorder) i dovode do značajnih funkcionalnih oštećenja. Pokazano je da je metilfenidat efikasan u smanjenju hiperaktivnosti; međutim, veličina efekta kod dece sa ASD je uopšteno niža, a stope neželjenih efekata veće nego kod tipično mladih u razvoju. Iznenađujuće je da postoji malo podataka o upotrebi amfetamina kod mladih sa ASD. Produženo oslobađanje guanfacina pokazalo se delotvornim u lečenju komorbidnih ADHD. Studije koje procenjuju efekat klonidina uglavnom su male, ali u celini pokazuju određenu korist. Od različitih psihostimulanata za ADHD, samo brzo-otpuštajući metilfenidat je više proučavan kod autizma.Nestimulansi koji su odobreni u Sjedinjenim Američkim državama (SAD) za lečenje ADHD su atomoksetin i alfa 2 adrenogeni agonisti, klonidin i guanfacin. Ima samo nekoliko studija koje su obuhvatile ove lekove i koje su manje i nekontrolisane.Antipsihotični lekovi su efikasni u smanjenju hiperaktivnosti kod autizma. Međutim, zbog njihovog profila neželjenih efekata njihova upotreba treba da se ograniči na slučajeve kod kojih su iritabilnost, agresija i samopovredivanje takode prisutni.
Zaključak: U ovom radu prikazan je pregled istraživanja o farmakoterapiji simptoma nepažnje, hiperaktivnosti i iritabilnosti.
Reference
Murray MJ. Attention-deficit hyperactivity disorder in the context of autism spectrum disorders. Current Psychiatry Rep 2010; 12(5): 382-388.
Lazarević M, Jovović S. Working styles of medicine professionals in emergency medical service. Opšta medicina 2015; 21(3-4): 106-112.
Quintana H, Birmaher B, Stedge D et al. Use of methylphenidate in the treatment of children with autistic disorder. Autism Dev Disord 1995; 25(3): 283-294.
Troost PW, Steenhuis MP, Tuynman-Qua H.G et al. Atomoxetine for attention-deficit/hyperactivity disorder symptoms in children with pervasive developmental disorders: a pilot study. Child Adolesc Psychopharmacol 2006; 16(5): 6116-6119.
Posey D., Wiegand RE, Wilkerson J et al. Open-label atomoxetine for attention-deficit/hyperactivity disorder symptoms associated with high-functioning pervasive developmental disorders. Child Adolesc Psychopharmacol 2006; 16(5): 599-610.
Zeiner P, Gjevik E, Weidle B. . Response to atomoxetine in boys with high-functioning autism spectrum disorders and attention deficit/hyperactivity disorder. Acta Paediatr 2011; 100(9): 1258-1261.
Arnold LE, Aman MG, Cook AM et al. Atomoxetine for hyperactivity in autism spectrum disorders: placebo-controlled crossover pilot trial. J Am Acad Child Adolesc Psychiatry 2006;45(10): 1196-1205.
Fankhauser MP, Karumanchi VC, German ML et al. A double-blind, placebo-controlled study of the efficacy of transdermal clonidine in autism. Clin Psychiatry 1992; 53(3): 77-82.
Jaselskis CA, Cook Jr, Fletcher KE, et al. Clonidine treatment of hyperactive and impulsive children with autistic disorder. Clin Psychopharmacol 1992;5: 322-327.
Posey DJ, Puntney JI, Sasher TM, et al. Guanfacine treatment of hyperactivity and inattention in pervasive developmental disorders: a retrospective analysis of 80 cases. Child Adolesc Psychopharmacol 2004; 14(2): 233-241.
Scahill L, Aman MG, McDougle CJ, et al. A prospective open trial of guanfacine in children with pervasive developmental disorders. Child Adolesc Psychopharmacol 2006; 16(5): 589-598.
Handen BL, Sahl R, Hardan AY. Guanfacine in children with autism and/or intellectual disabilities. Dev Behav Pediatr 2008; 29(4): 303-308.
Hajizadeh-Zaker R, Ghajar A, Mesgarpour B, Afarideh M, Mohammadi M, Akhondzadeh S. l-Carnosine as an adjunctive therapy to risperidone in children with autistic disorder: A randomized, double-blind, placebo-controlled trial. Journal of child and adolescent psychopharmacology 2018; 28(1): 74-81.
Kim HW, Park EJ, Kim JH, Boon-Yasidhi V, Tarugsa J, Reyes A, Joung YS. Aripiprazole for irritability in asian children and adolescents with autistic disorder: A 12-week, multinational, multicenter, prospective open-label study. Journal of child and adolescent psychopharmacology 2018; 28(6): 402-408.
Nikvarz N, Alaghband-Rad J, Tehrani-Doost M, Alimadadi A, Ghaeli P. Comparing efficacy and side effects of memantine vs. risperidone in the treatment of autistic disorder. Pharmacopsychiatry 2017; 50(01): 19-25.
Wasdell MB, Jan JE, Bomben MM et al.A randomized, placebo-controlled trial of controlled release melatonin treatment of delayed sleep phase syndrome and impaired sleep maintenance in children with neurodevelopmental disabilities. Pineal Res 2008; 44(1): 57-64.
Wirojanan J, Jacquemon S, Diaz R et al. The efficacy of melatonin for sleep problems in children with autism, fragile X syndrome, or autism and fragile X syndrome. Clin Sleep Med 2008; 5: 145-150.
Wright B, Sims D, Smart S, et al. Melatonin versus placebo in children with autism spectrum conditions and severe sleep problems not amenable to behaviour management strategies: a randomized controlled crossover trial. Autism Dev Disord 2011; 41(2): 175-184.
Ming X, Gordon, Kang N et al. Use of clonidine in children with autism spectrum disorders. Brain Dev 2008; 30 (7): 454-460.
Hollway JA, Aman MG. Sleep correlates of pervasive developmental disorders: a review of the literature. Res Dev Disabil 2011; 32: 1399-1421.
