Fred R Volkmar, MD: How Our Understanding of Autism Has Evolved

Fred R Volkmar, MD

There's a couple of interesting things about autism. The first thing is we have understood over the last decade much more both about the genetics of autism, about how autism is both a social disorder, a brain based disorder, and finally we've understood a lot more about treatment and the treatment literature has grown, and outcomes seem to be getting better, which is one of the happy news stories of the whole thing.

Physicians are involved in several phases in terms of screening and diagnosis early on, which is important because we think earlier diagnosis leads often to a better outcome. Also in terms of ongoing management, consultation, coordination of health care, and finally sometimes around behavioral issues and medications for behavioral issue.

At the moment we don't have a medicine that treats the core social vulnerability of autism, but we have medication that can help with some of the behavioral problems, and it's possible in the future we'll have something that will focus more on the core social vulnerability.

But we also know as kids get older they often develop anxiety and depression and other things. And so there's a whole nother body of work, which focuses on those conditions in adolescents and young adults.

It used to be we were limited to what were then the major tranquilizers. With the advent of the atypical neuroleptics, those actually have been approved, now in 2 cases, as approved pharmacological agents for the treatment of what's called irritability, which is a constellation of behavioral manifestations, the kind of stereotyped mannerisms, the agitation, the kind of upsetness with environmental intrusions.

Increasingly people have used SSRIs and other agents, that's actually helped in some ways, especially around the onset of the anxiety and aggression, as well as to sometimes help with the attentional problems.

And finally sometimes some of the medications we use for attentional problems like ADD can be used in kids with autism. You have to be careful because they seem to be a little more vulnerable to the side effects.