Children Diagnosed With Autism Early May Be More Likely to Receive Behavioral Intervention

A report appearing today in Psychiatric Services in Advance suggests that the older a child is when diagnosed with autism spectrum disorder (ASD), the less likely it is he or she will receive behavioral intervention, which has been shown to benefit children with the disorder. Instead, the report found older-diagnosed children appear to be more commonly prescribed psychotropic medications.

Katharine Zuckerman, M.D., M.P.H., an assistant professor of pediatrics at Oregon Health and Science University, and colleagues assessed 722 children ages six to 11 diagnosed with ASD, from the Centers for Disease Control’s Survey of Pathways to Diagnosis and Services.

The researchers found that children diagnosed with ASD at four years or older were less likely than children diagnosed at younger ages to receive behavioral intervention (25% versus 44%, respectively) and more likely to receive medications (60% versus 31%, respectively).

A delay in ASD diagnosis—defined as the amount of time between parents’ first discussion of concerns with a provider and ASD diagnosis—also appeared to influence health service use. The use of complementary and alternative medications, such as nutritional supplements, was nearly twice as common among children with longer versus shorter diagnostic delays (21% versus 11%, respectively). As diagnostic delay increased, children with functional limitations became significantly less likely than children without functional limitations to receive school-based therapy, the authors reported.

“Although the optimal type and amount of ASD therapy remain unclear, there is growing consensus that early therapy benefits children and families,” the authors wrote. “It is therefore concerning that nearly a quarter of the elementary school–aged children studied were receiving no school-based therapy, and over half were not receiving BI [behavioral intervention]. Instead, children diagnosed at older ages were more likely to receive psychotropic medications, which generally do not treat core ASD features.”

The authors concluded, “These results suggest that efforts to increase early ASD diagnosis may result in greater ASD-related therapy use and improved functional outcomes for children with ASD.”

To read about efforts to improve early ASD diagnosis, see the Psychiatric News article “Molecular Investigation of Autism May Bring Genetic Diagnosis Closer.”

(Image: iStock/Koca777)

Study Identifies Effective Weight Loss, Smoking Interventions for People With SMI

Four interventions—metformin and behavioral strategies for weight loss and bupropion and varenicline for smoking reduction—were found to be effective in people living with serious mental illness, according to a review in Schizophrenia Bulletin.

People with serious mental illness (SMI) have mortality rates two to three times higher than that of the overall U.S. population. The prevalence of cardiovascular risk factors, such as obesity and diabetes mellitus, and other conditions, such as HIV/AIDS, are particularly heightened in this group.

Based on the recommendations of a National Institute of Mental Health (NIMH) stakeholder meeting, researchers from Johns Hopkins University and NIMH conducted a comprehensive review examining the strength of the evidence surrounding interventions to address major medical conditions and health-risk behaviors among persons with SMI. A total of 108 randomized, controlled trials and observational studies testing interventions to address medical conditions and risk behaviors among persons with schizophrenia and bipolar disorder between January 2000 and June 2014 were included.

The authors found that well-designed behavioral interventions and metformin were beneficial for weight loss, and bupropion and varenicline reduced tobacco smoking among people with serious mental illness. However, the strength of the evidence was low for most other interventions reviewed.

“Future studies should test long-term interventions to cardiovascular risk factors and health-risk behaviors,” the researchers stated. “In addition, future research should study implementation strategies to effectively translate efficacious interventions into real-world settings.”

For more information, see the Psychiatric News article “What Can Psychiatrists Do for People With SMI?”

(Image: gosphotodesign/Shutterstock)