Edited by
Eric Hollander, M.D.
Esther and Joseph Klingenstein Professor and
Chair, Department of Psychiatry;
Director, Seaver and New York Autism Center of Excellence
Mount Sinai School of Medicine
New York, New York
Evdokia Anagnostou, M.D.
Child Neurologist and Assistant Professor,
Department of Psychiatry;
Clinical Director, Seaver and New York Autism Center of Excellence
Mount Sinai School of Medicine
New York, New York
Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
1 Clinical Diagnosis of Autism. . . . . . . . . . . . . . . . . 1
Fred R. Volkmar, M.D., and
Marc Woodbury-Smith, M.D., Ph.D.
Historical Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
The DSM-IV Field Trial . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Alternative Approaches to Classification. . . . . . . . . . . . . .9
Areas of Diagnostic Controversy . . . . . . . . . . . . . . . . . . .13
Clinical Diagnostic Assessment and
Differential Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
2 Evaluation and Testing for Autism. . . . . . . . . . . 27
Audrey Thurm, Ph.D., Latha Soorya, Ph.D., and
Ann Wagner, Ph.D.
Diagnostic Evaluations . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Assessment of Core Autism Spectrum Disorder
Domains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Other Critical Domains for Assessment . . . . . . . . . . . . .40
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Treatment of Autism With Selective Serotonin
Reuptake Inhibitors and Other
Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Melissa L. Schapiro, B.A.S., Stacey Wasserman, M.D., and
Eric Hollander, M.D.
Mechanism of Action . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Rationale for Use of Selective Serotonin Reuptake
Inhibitors in the Treatment of Autism . . . . . . . . . . . . .53
Serotonin Reuptake Inhibitors: Clomipramine . . . . . . .55
Selective Serotonin Reuptake Inhibitors. . . . . . . . . . . . .57
Serotonin-Norepinephrine Reuptake Inhibitors. . . . . . .64
Conclusions and Future Directions . . . . . . . . . . . . . . . . .65
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76
4 Treatment of Autism With Anticonvulsants
and Mood Stabilizers. . . . . . . . . . . . . . . . . . . . . . 81
Evdokia Anagnostou, M.D., Aaron Jason Fisher, B.A., and
Eric Hollander, M.D.
Comorbid Disorders in Autism . . . . . . . . . . . . . . . . . . . .82
Mechanism of Action of Anticonvulsants . . . . . . . . . . . .84
Clinical Evidence for Anticonvulsant Efficacy
in Autism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93
5 Treatment of Autism With Antipsychotics. . . . . 99
David J. Posey, M.D., Kimberly A. Stigler, M.D.,
Craig A. Erickson, M.D., and Christopher J. McDougle, M.D.
Mechanism of Action . . . . . . . . . . . . . . . . . . . . . . . . . . .100
Rationale for the Use of Antipsychotics in Autism. . . .100
Conventional Antipsychotics . . . . . . . . . . . . . . . . . . . . .101
Atypical Antipsychotics . . . . . . . . . . . . . . . . . . . . . . . . . .104
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116
References . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Cholinesterase Inhibitor Therapy in
Patients With Autism Spectrum Disorders . . . 121
Michael G. Chez, M.D., Carolyn Coughlin, and
Matthew Kominsky
History of Cholinesterase Inhibitors . . . . . . . . . . . . . . .122
Cholinergic Mechanisms in Autism. . . . . . . . . . . . . . . .123
Treatment Experience With Cholinesterase Inhibitors
in Autism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128
7 Stimulants and Nonstimulants in the
Treatment of Hyperactivity in Autism . . . . . . . 131
Yann Poncin, M.D., and Lawrence Scahill, M.S.N., Ph.D.
Stimulants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134
Alpha-Adrenergic Agonists . . . . . . . . . . . . . . . . . . . . . . .137
Antidepressants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
Amantadine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142
Naltrexone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143
Antipsychotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .144
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147
8 Applied Behavior Analysis in the Treatment
of Autism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Tristram Smith, Ph.D., Dennis Mozingo, Ph.D.,
Daniel W. Mruzek, Ph.D., and Jennifer R. Zarcone, Ph.D.
Research on Applied Behavior Analysis and
Models of Service Delivery. . . . . . . . . . . . . . . . . . . . . .155
Applied Behavior Analysis Providers . . . . . . . . . . . . . . .161
Applied Behavior Analysis Intervention Methods . . . .161
Manuals and Curriculum Guides. . . . . . . . . . . . . . . . . .169
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170
9 The Developmental Individual-Difference,
Relationship-Based (DIR/Floortime) Model
Approach to Autism Spectrum Disorders . . . .179
Stanley I. Greenspan, M.D., and Serena Wieder, Ph.D.
The DIR/Floortime Model . . . . . . . . . . . . . . . . . . . . . . .180
The DIR/Floortime Assessment . . . . . . . . . . . . . . . . . . .182
Core Psychological Deficit in Autism and the
Developmental Pathways to Joint Attention,
Pattern Recognition, Theory of Mind, Language,
and Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183
The DIR/Floortime Intervention Program. . . . . . . . . . .189
Selected Research on the DIR/Floortime Model and
Outcome Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . .196
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205
10 Educational Approaches for Autism—TEACCH. . 211
Lee Marcus, Ph.D., and Eric Schopler, Ph.D.
Background and Structure of TEACCH . . . . . . . . . . . . .212
Core Principles and Values . . . . . . . . . . . . . . . . . . . . . .214
Applications of TEACCH Methods and Strategies . . . .217
Treatment Effectiveness . . . . . . . . . . . . . . . . . . . . . . . . .226
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229
11 Peer Relationships of Children With Autism:
Challenges and Interventions. . . . . . . . . . . . . . 235
Connie Kasari, Ph.D., and Erin Rotheram-Fuller, Ph.D.
Peer Interaction Challenges for Children
With Autism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .236
Peer Relations, Social Acceptance, and Inclusion . . . .239
Peer Interventions and Autism . . . . . . . . . . . . . . . . . . .241
Predictors and Correlates of Treatment Response . . .249
Outcomes of Peer Interventions . . . . . . . . . . . . . . . . . .250
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .251
12 Complementary and Alternative Therapies for
Autism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Michelle Zimmer, M.D., and
Cynthia A. Molloy, M.D., M.S.
Helping Parents Make Informed Choices
About CAM Treatments . . . . . . . . . . . . . . . . . . . . . . . .260
Specific CAM Therapies . . . . . . . . . . . . . . . . . . . . . . . . .263
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .280
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .280
13 Promising New Avenues of Treatment and
Future Directions for Patients With Autism . . 289
Evdokia Anagnostou, M.D., Geoffrey Collins, B.A., and
Eric Hollander, M.D.
Pharmacological Treatments . . . . . . . . . . . . . . . . . . . . .290
Educational and Psychosocial Interventions . . . . . . . .294
Advocacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .294
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .295
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
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