Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication/interaction and restricted, repetitive behaviors, interests, and activities that cause significant impairment in functioning.1,2 The terminology and diagnostic criteria of ASD have changed several times since the disorder was first described in 1943, which has made it challenging to standardize research and identification.3 Yet in recent years, the prevalence of ASD has been markedly increasing, and the demographics of those diagnosed with ASD has been changing.1 Understanding the basic facts about ASD and the latest statistics and trends is essential for identifying patients early and providing them with optimal care.
Causes of Autism Spectrum Disorder
Although researchers have not identified a single, unifying cause of ASD, it is believed to result from a combination of genetic and environmental factors that affect the developing brain.4,5
Limited evidence suggests individuals with ASD have anatomical changes in the layers of their cortex. Patients with ASD exhibit differences in limbic areas involved in fear and emotional regulation, such as the amygdala. The brains of individuals with ASD frequently have “overgrowth” of their cortical areas and increased cerebral spinal fluid. They also have changes in the balance of excitatory and inhibitory neurotransmission and signs of abnormal cellular differentiation.4 Extensive evidence has demonstrated thatthe measles, mumps and rubella vaccine and other childhood vaccines do not cause ASD.5
Risk Factors for ASD
Many risk factors are associated with developing ASD. Older maternal and paternal age have each been associated with an increased risk of ASD.4
The use of certain medications during pregnancy has also been associated with the risk of having a child with ASD. Maternal antidepressant use — specifically selective serotonin reuptake inhibitors — during the second or third trimester has been associated with an increased risk of ASD, even after adjusting for maternal depression.6 Prenatal use of thalidomide and valproic acid also have been linked to an increased risk of ASD in offspring.4 Conversely, taking prenatal folic acid while also taking an antiepileptic medication might decrease the risk of ASD.4
Genetics may play a role in ASD risk. Siblings of a person with ASD have a higher chance of developing the disorder.4 One monozygotic twin have a higher chance of developing ASD if the other twin has it. Several chromosome-linked disorders, including Fragile-X and Down syndrome, have also been associated with the occurrence of ASD.4,7
What Are the Most Common Signs?
The current American Psychiatric Association diagnostic criteria for ASD are published in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision.2 Those criteria include 2 primary categories of symptoms: deficits in social communication/social interaction, and restricted, repetitive patterns of behavior, interests, or activities.2
Many people with ASD have atypical social behaviors. They may have impaired verbal and nonverbal communication, as well as difficulty making friends and maintaining relationships.2,7 Individuals with ASD tend to avoid eye contact and have difficulty interpreting normal social cues.7 They have trouble understanding implications or hidden meanings and engaging in the back-and-forth of a conversation.
Repetitive behaviors commonly exhibited by people with ASD include the following2:
Repetitive motor movements or speech (such as body rocking, arm or hand flapping, repeating words just spoken by another person); and
Insisting on sameness, inflexibly adhering to routine, or performing ritualized patterns of behavior (such as having difficulty with transitions, having rigid thinking patterns, needing to eat the same food each day).
Behaviors associated with ASD also may include a strong preoccupation with minute details or obsessions with certain topics or objects, such as a type of toy. Lining up objects in a specific manner or order can be a characteristic behavior of ASD.2,8
Individuals with ASD may be hyperreactive or hyporeactive to sensory input. They may be uncomfortable or upset by certain sounds. They may also display high sensitivity to certain types of visual or tactile stimuli, such as textures, lights, or movement.2,8
For an individual to receive an ASD diagnosis, their symptoms need to significantly impair their functioning. This could include their ability to focus at school, communicate with others, or hold a job and live independently.2,8
Comorbid Conditions
Autism spectrum disorder can co-occur with many other conditions, particularly neurological or psychiatric conditions.4 Approximately 37% of children with ASD also have an intellectual disability.9 Psychiatric disorders such as anxiety disorders, attention deficit/hyperactivity disorder, mood disorders, disruptive behavior disorders, and obsessive-compulsive disorder are also highly comorbid with ASD.4 Most adults with ASD have at least 1 comorbid psychiatric condition.10 Other common comorbidities include seizures, sleep disorders, gastrointestinal problems, and immune dysfunction.4,11
When Is Autism Spectrum Disorder Diagnosed?
Autism spectrum disorder is usually diagnosed during childhood, generally during the first 2 years of life.7 Social deficits typically are noticeable in the toddler years, and parents may recognize that their children miss developmental milestones. Early diagnosis is critical for the implementation of early interventions, including psychological and behavioral therapies.7 Earlier ASD diagnoses are associated with improved quality of life compared to those in whom the diagnosis is delayed.12
A person's sex may play a role in the age of diagnosis. A study that compared the age at diagnosis of ASD in 208 people found that males were more likely to be diagnosed before they were age 18 years, and females were more likely to be diagnosed in adulthood.12
In the United States, early diagnosis of ASD may be improving. According to the Centers for Disease Control and Prevention (CDC), in 2020, children born in 2016 were 1.6 times as likely as children born in 2012 to be identified as having ASD by age 4.9
Autism Spectrum Disorder Statistics
Autism spectrum disorder is an increasingly common condition. The CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network published its most recent surveillance report in 2023; it focused on data from 2020.1,13 The ADDM Network found approximately 1 in 36 children in the United States was estimated to have ASD.1,13 This prevalence has increased steadily over the last 20+ years. The estimated prevalence of ASD was 1 in 150 children in 2000, and 1 in 44 in 2018.1,13
The World Health Organization estimates that worldwide, approximately 1 in 100 people have ASD.5 This is not likely to be accurate, however, because many low-income countries have limitations with consistent reporting methods. In developing countries, there also may be less overall awareness of ASD and access to consistent medical care.5
Autism spectrum disorder affects people of all racial and ethnic groups.13 In the ADDM Network report, the estimated prevalence of ASD in 2020 was highest among Hispanic (3.3%) and Asian/Pacific Islander (3.2%) children, were followed by Black (2.9%), American Indian (2.7%), and White (2.4%) children.1,14 Children of 2 or more races had the lowest incidence of ASD (2.3%).1,14 These data differ from previous estimates, in which the prevalence was highest among White children.9
In the ADDM Network report, the prevalence of ASD also varied by geographic location. Of 11 state sites included in the report (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin), the overall prevalence was highest in California (4.5%), while the estimated prevalence was lowest in Maryland (2.3%).1,9
The prevalence of ASD varies greatly by sex. In the United States, boys are about 4 times more likely than girls to receive a diagnosis of ASD.1,9 However, 2020 was the first time the ADDM Network estimated that the prevalence in girls was greater than 1%.
Author Bio
Hannah Actor-Engel, PhD, earned a BS in Neural Science at New York University and her PhD in Neuroscience at the University of Colorado. She is a multidisciplinary neuroscientist who is passionate about scientific communication and improving global health through biomedical research.
Our easy-to-read fact sheets provide clinicians with reliable information to share with patients and their caregivers.
Postpartum depression is defined as the onset of major depression associated with childbirth that negatively affects the mood and behavior of the parent.1 During pregnancy, an individual undergoes considerable hormonal fluctuations, including increased levels of estrogen and progesterone. After childbirth, these hormone levels drop rapidly, which can contribute to the onset of postpartum depression. Additionally, the postpartum period is often accompanied by increased stress due to the demands of caring for a newborn, sleep deprivation, and hormonal changes.
For new parents battling postpartum depression, finding the right medication to manage your condition can be a critical step towards healing and supporting your mental health. Our helpful guide aims to inform patients about the risks, benefits, and considerations associated with postpartum depression medication as they begin their recovery.
"
For new parents battling postpartum depression, finding the right medication to manage your condition can be a critical step towards healing and supporting your mental health.
Major Depressive Disorder
Depression is a general term for a common psychiatric disorder that presents with symptoms such as sadness, irritability, loss of interest in activities, feelings of worthlessness, hopelessness, guilt or anxiety, concerns over death, and/or suicidal ideation. Individuals with depression may also experience fatigue, difficulty concentrating, and changes in their appetite weight, and sleep.2
Major depressive disorder, or MDD, is characterized by a sad mood and/or lack of interest in activities. A diagnosis of MDD requires the presence of at least 5 of the key symptoms for most of the day, nearly every day, or for at least 2 weeks.1,3
Postpartum Depression
Postpartum depression is classified as a major depressive disorder that begins during or after childbirth, typically within the first 3 months and up to 1 year after childbirth. Approximately 15% to 20% of childbearing individuals develop postpartum depression each year. Although it is one of the most common complications of the postpartum period, it is often underdiagnosed and undertreated.1,4
Symptoms of postpartum depression may overlap with MDD, but include unstable mood, anxiety, irritability, extreme sadness, decreased pleasure, low energy, as well as obsessive worry – typically about the baby’s health, feeding, and safety. More serious symptoms that require immediate evaluation by a provider are thoughts about self-harm, suicide, or harming one’s child.1,3,4
While the exact cause of postpartum depression is not fully understood, several key factors contribute to its development:5,6
Hormonal Changes: Hormonal fluctuations during and after pregnancy can impact neurotransmitter levels in the brain, which play crucial roles in regulating mood
Genetic Predisposition: Individuals who have a family history of depression or mood disorders are at higher risk for postpartum depression
Psychological Factors: Psychological factors, such as a history of depression or anxiety, can increase the risk of developing postpartum depression. Additionally, stressors related to childbirth, such as difficult labor, pregnancy complications, or concerns about parenting, can contribute to the onset of depression
Social Support and Stress: Lack of social support, relationship difficulties, financial strain, and other stressors can exacerbate the risk for postpartum depression
Physical Health: Vitamin D deficiency, gestational diabetes, obesity, chronic health conditions, sleep disturbances, or health complications during pregnancy or childbirth can also contribute to the development of PPD
Medication Options
If you are experiencing symptoms of postpartum depression, speak with your provider to discuss treatment options. Currently, antidepressants in combination with psychotherapy are recommended to treat moderate-to-severe depression.1 Commonly used postpartum depression medication options include the following:
Nortriptyline is a TCA that inhibits reuptake of norepinephrine and serotonin into the neurons to increase their levels, as well as inhibit the activity of other agents.
Mirtazapine is an atypical antidepressant that works as an antagonist at central presynaptic a2-adrenergic receptors to enhance noradrenergic and serotonergic activity.
Sleepiness or drowsiness Increased appetite Weight gain Dizziness
Brexanolone and zuranolone are medications approved for treatment of postpartum depression. They work on the GABAA receptors to regulate mood and behavior.
Sleepiness or drowsiness Dry mouth Passing out Flushing of the skin or face Dizziness Fatigue Diarrhea Common cold Urinary tract infection
It's important to recognize that postpartum depression is a complex and multifaceted condition that varies from person to person. Although the transition to parenthood can be challenging for many individuals, when symptoms persist and significantly impact daily functioning, it may indicate the presence of postpartum depression. Seeking professional help is crucial for diagnosis and treatment.
Frequently Asked Questions
How can I tell if I’m experiencing postpartum depression?
If you think you may have postpartum depression, it is important to speak with your provider. Your provider can provide a clinical assessment or utilize self-report tools, such as the Edinburgh Postnatal Depression Scale (EPDS) – a widely and reliably used screening tool for postpartum depression.15 Physicians are encouraged to screen for postpartum depression at the first postnatal obstetrical visit. If you or a loved one are experiencing symptoms of postpartum depression, follow-up with your provider to discuss diagnostic and treatment options.
Are these medications safe for me to take while breastfeeding?
It is recommended that patients who are currently breastfeeding, or planning on breastfeeding, should first speak with their provider to discuss the potential risks and benefits of different medication options. The decision to use antidepressants during postpartum while breastfeeding involves careful consideration of both the potential risks and benefits for both the parent and the baby.
Treating postpartum depression with antidepressants can improve parental mental health and reduces the risk for paternal self-harm or harm to their child. However, some medications can pass into breast milk.10-13 There is ongoing research regarding the long-term effects of antidepressant exposure during breastfeeding on infant development. While some studies have suggested potential concerns, the overall consensus is that the benefits of breastfeeding typically outweigh the potential risks for antidepressant exposure.
For example, sertraline and paroxetine have a better safety profile for infants during breastfeeding, but there is less available data for other serotonin reuptake inhibitors such as escitalopram and duloxetine.1,8 When taking fluoxetine, it is recommended to monitor infants for agitation, irritability, poor feeding, and poor weight gain.16 Research also indicates that zuranolone has potential risk for harm to the infant. It is recommended to use effective contraception during zuranolone treatment and for 1 week after the final dose.14
In many cases, the benefits of treating postpartum depression with antidepressants outweigh the potential risks, but it's important to carefully consider all factors and explore alternative treatments if appropriate.
When should I stop taking my medication?
It is important to consult your provider before discontinuing treatment. Discontinuation during pregnancy may increase your likelihood of a depression relapse, compared with individuals who continue antidepressants.11,12 However, if you experience new or worsening depression, anxiety, irritability, insomnia, mania, or suicidal thoughts and behavior, you should speak with your provider to determine if this is a side effect of your medication.
Newer postpartum depression medications such as Brexanolone and Zuranolone have specific durations of therapy. Zuranolone should only be taken once daily for 14 days while brexanolone is administered as a continuous infusion over 60 hours (2.5 days).13,14
You should stop taking your medication and seek immediate medical help if you experience a seizure or an allergic reaction such as development of skin rash, hives, chest pain, edema, and shortness of breath.
A 39-year-old man presents with right shoulder pain that has been present for 3 months. He has not experienced an injury or precipitating event. The patient reports that the pain is in the posterior shoulder at the periscapular region. He has tried oral steroids with only minimal relief. The pain is not associated with shoulder motion and seems to be relentless at times, even at rest. On physical examination, he has a positive Spurling test with radiation of pain to the right periscapular region. He has no shoulder impingement signs and active range of motion of the shoulder is without pain or weakness. Radiographs taken in the office do not show any arthritic changes or abnormalities. Sagittal magnetic resonance imaging (MRI) of the cervical spine is taken (Figure).
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Our easy-to-read fact sheets provide clinicians with reliable information to share with patients and their caregivers.
Biomedical therapy for autism spectrum disorder (ASD) is becoming increasingly popular as a complementary treatment option to traditional medication regimes, yet many patients are still unclear about what biomedical therapy entails. Therefore, the following fact sheet provides a helpful overview of biomedical therapy for ASD and answers commonly asked questions.
Autism Spectrum Disorder
Autism spectrum disorder (ASD) is a neurodevelopmental disorder associated with impairment in social communication and interactions as well as the presence of restricted, repetitive behaviors.1 It is influenced by both genetic and environmental factors, though the direct cause is still unknown.2
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) is considered the gold standard for ASD diagnosis. The diagnostic criteria for ASD are graded on a severity scale by the level of support needed, in which Level 1 requires support, Level 2 requires substantial support, and Level 3 requires very substantial support.2
Common Treatment Options for Autism
Because ASD occurs on a spectrum, treatment options can vary with each patient depending on their unique set of symptoms. There is no curative treatment for ASD, but the management of ASD takes on a multifaceted approach that includes occupational, behavioral, speech, and play therapies. Psychosocial interventions can also help improve specific behaviors, such as language and social engagement.3
Although there are no medications directly indicated for the treatment of ASD specifically, many individuals receive medication for comorbidities associated with their diagnosis. Patients with ASD may take medication for irritability, aggression, hyperactivity, and seizures that may co-present with the condition.2 Some examples of the common medications used to manage these other symptoms and disorders may include:4
Biomedical therapy is a specific treatment approach that considers the underlying biological basis of a condition and targets physiological impairment.5 The goal of biomedical therapy for autism is to optimize physiological factors impacting brain function and development to treat symptoms and improve patient functioning.
Research indicates that ASD is associated with deficits in mitochondrial metabolism and oxidative stress as well as abnormalities in the regulation of the following essential metabolites:6
Folate
Tetrahydrobiopterin
Glutathione
Cholesterol
Carnitine
Branch chain amino acids
Biomedical therapy can be categorized based on the pathophysiological process they target.
Mitochondrial Dysfunction
The mitochondria generate energy for cellular processes. When the mitochondria is impaired, it can lead to developmental delays, muscle weakness, and neurological problems.6 Individuals with ASD who have mitochondrial dysfunction often have more severe behavioral and cognitive deficits, relative to those with typical mitochondrial function. Treatments may include:6
Antioxidants, such as vitamin C and N-acetyl-L-cysteine
L-carnitine
Multivitamins containing vitamin B, vitamin E, co-enzyme Q10
Folate Metabolism
Folate is naturally found in the human body and helps to regulate the absorption of vitamin B. However, individuals with ASD may have genetic modifications in the folate pathway which leads to a decrease in available folate in the brain, known as cerebral folate deficiency. Lack of folate causes symptoms such as fatigue and muscle weakness. Patients with folate irregularity are treated with folinic acid for neurological, behavioral, and cognitive improvements.6
Redox Metabolism
Redox reactions are necessary for many biological functions. Evidence has shown that individuals with ASD may have abnormal redox metabolism which could lead to oxidative damage in areas of the brain responsible for speech, emotion, and social behavior. Several treatments for oxidative stress are available, including:6
Vitamin or mineral supplements containing antioxidants, co-enzyme Q10, and vitamin B
Subcutaneous injections of methylcobalamin (a form of vitamin B12)
Oral folinic acid
Tetrahydrobiopterin supplementation
N-acetyl-L-cysteine
These treatment options can help improve many common ASD symptoms, including hyperactivity, tantrums, sensory-motor skills, irritability, and even sleep and gastrointestinal symptoms.
Tetrahydrobiopterin Metabolism
Tetrahydrobiopterin (BH4) is naturally found in the body and is necessary for multiple important metabolic pathways. Abnormalities in BH4 are prominent in ASD, as the disorder is associated with a lack of oxidative stress needed for BH4 pathways. Treatment for BH4 metabolic dysfunction is primarily the use of sapropterin, a synthetic form of BH4. Sapropretin has been shown to improve cognitive ability, communication, adaptability, verbal expression, and social function in patients with ASD.6
Frequently Asked Patient Questions
At what stage should I consider biomedical therapy for autism?
Because ASD is a lifelong condition that occurs on a spectrum, there is no standard timeline for when a treatment should be started.7 Interventions are tailored to the patient’s specific needs. Although supplements are generally safe and well tolerated, they can have interactions with certain medications. Speak with your healthcare provider when making decisions on treatment options as it is important to keep track of your medications to monitor improvement and prevent adverse medication interactions.
How long does it take to see improvement?
When evaluating treatment success, it is important to consider what symptoms or conditions are being targeted. For example, some patients may be seeking treatment to sleep better or decrease their repetitive behaviors. Tracking progress by logging symptoms and improvements can help you and your provider gain an accurate measure of your treatment response. Improvements may not be seen immediately, especially as certain medications can take time to show measurable effects. Your symptoms may fluctuate over time, so consistent medication adherence is necessary to improve your chances of overall improvement.8
Are there side effects associated with these treatments?
All of the biomedical treatments mentioned throughout this fact sheet are generally considered safe and well-tolerated. However, there are minor side effects for some of these treatments, as detailed below:
Patients taking L-carnitine have expressed slight gastrointestinal issues. Symptoms such as nausea, vomiting, and abdominal cramps are usually experienced when the supplement is taken at night on an empty stomach. To minimize these symptoms, these supplements can be taken after a meal and your time of dosing can be adjusted.6
Some patients taking high-dose folinic acid may experience increased irritability, insomnia, or gastroesophageal reflux when co-administered with other medications, such as antipsychotics.6
Individuals taking N-acetyl-L-cysteine may experience mild side effects such as constipation, fatigue, daytime drowsiness, or increased appetite.6
Not all patients respond to treatment options in the same way. Patients should speak with their providers to discuss their treatment plan and any potential side effects they may experience.
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