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Treatment

Both psychosocial and pharmacological interventions can improve the behavioral and cognitive functioning of individuals with ASDs.⁴² The increasing use of psychotropic medications to treat symptoms of autism and other childhood-onset psychiatric disorders has spotlighted an urgent need for more studies of such drugs in children. To meet this need, NIMH established a network of Research Units on Pediatric Psychopharmacology (RUPPs) in 1997 that combined expertise in psychopharmacology and psychiatry at several research sites. The network was expanded to include psychosocial interventions with the funding of additional network projects called the RUPP-PI (Research Units on Pediatric Psychopharmacology and Psychosocial Interventions) network. The RUPP and RUPP-PI networks are intended to become a national resource that will expedite clinical trials in children.^43,44,45 They include five groups specifically funded to evaluate treatments for autism. Studies are examining dose range and regimen of medications, and their mechanisms of action, safety, efficacy, and effects on cognition, behavior, and development. The RUPP network is nearing completion of a study examining the efficacy of methylphenidate for treating hyperactivity and impulsivity in children and adolescents with a variety of behavioral disorders. In one recent study, risperidone, one of a newer class of anti-psychotic medications, was successful and well tolerated for the treatment of serious behavioral disturbance in children with autism aged 5-17.⁴⁶

The RUPP-PI network has launched a multi-site study investigating the effect of combined parent training and medication treatment on disruptive behavior in children with autism spectrum disorders. The study will test whether adding a program to teach parents behavior management techniques to a regimen of risperidone will add to treatment response and/or maintain treatment effects after discontinuation of the medication.^{47,48, 49}

Among other studies of psychosocial treatments in autism, two NIMH-funded research teams are evaluating parent training interventions that are tailored to the particular characteristics of the child and family. The investigators have demonstrated that an individualized approach enhances the effectiveness of their Pivotal Response Model, and that this, in turn, leads to positive changes in parents’ confidence and feelings of empowerment.^50,51,52 The investigators are continuing their line of research on interventions development with a study investigating the efficacy of visual augmentation strategies for teaching communication skills to nonverbal children with autism.^53,54,55

The NIH Autism Coordinating Committee (NIH/ACC) coordinates efforts of NIMH, NICHD, NINDS, NIDCD, and NIEHS to facilitate research on interventions for individuals with autism and autism spectrum disorders. In November 2000, six grants were funded in response to an RFA (Request for Applications)⁵⁶ for innovative methods and feasibility studies. These projects included behavioral and pharmacological treatments and are nearing completion. The STAART Centers funded in 2002 and 2003 (described above) include eight treatment projects that are in development or underway. Foci of the intervention projects include efficacy of early interventions, efficacy of treatments for social deficits, efficacy trials for pharmacotherapy, and understanding the variability of response to treatments. Through these and other initiatives, the Institutes hope to encourage multi-disciplinary partnerships to develop and improve treatments for individuals with autism spectrum disorders.

The NIH/ACC sponsored a workshop “Research on Psychosocial and Behavioral Interventions in Autism: Confronting the Methodological Challenges” in September 2002.³⁷ The purpose of the meeting was to review the state-of-the-science with regard to psychosocial, behavioral, and educational interventions for children with autism; to examine the barriers to progress in the field; and to discuss potential strategies for overcoming the barriers. An outcome of the meeting was the formation of ongoing working groups of scientists focusing on methodology and design issues.

Services

As part of its initiative on Child and Adolescent Interdisciplinary Research Networks, NIMH awarded a grant in FY03 to the University of California-Davis, “Enhancing Mental Health Services to Children with Autism.” This innovative effort will create, for the first time, a formal, interdisciplinary research network of faculty and community representatives focused on an understudied population, children with autism and their families in rural communities. The network will review barriers and develop guidelines for implementing telehealth technologies such as clinical telemedicine, distance learning, and information distribution for the delivery of high quality, empirically supported, coordinated mental health services.

NIH Collaboration

NIMH supports research on autism in collaboration with the National Institute of Child Health and Human Development, the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, and the National Institute of Environmental Health Sciences.

The Broad NIMH Research Program

NIMH supports and conducts a broad-based, multidisciplinary program of scientific inquiry aimed at improving the diagnosis, prevention, and treatment of mental disorders in people of all ages. Increasingly the public, as well as health care professionals, are recognizing these disorders as real and treatable medical illnesses of the brain. Still, there is a need for more research that examines in greater depth the relationships among genetic, behavioral, developmental, social, and other factors to find the causes of these illnesses. NIMH is meeting this need through a series of research initiatives.

NIMH Human Genetics Initiative

This project has compiled a large repository of clinical information and DNA obtained from families affected by schizophrenia, bipolar disorder, autism, Alzheimer’s disease, and other mental disorders. Qualified scientists are given access to these data and genetic materials in order to characterize the genetic bases of mental disorders.

Neuroinformatics: Human Brain Project

This Federal effort is using state-of-the-art computer science technologies to organize the immense amount of data being generated through neuroscience and related disciplines, and to make this information readily accessible through the World Wide Web for simultaneous study by interested investigators. Because the scope of the Human Brain Project extends to all facets of brain and behavioral research and includes a range of technology sciences, this initiative is sponsored, in a coordinated fashion, by fifteen Federal organizations across four Federal agencies: the National Institutes of Health, National Aeronautics and Space Administration, National Science Foundation, and U.S. Department of Energy.

Prevention Research Initiative

Prevention research can be broadly characterized as seeking to understand the development and expression of mental illness throughout the course of life so that appropriate interventions can be designed and applied in order to prevent mental disorders and promote mental health. Advances in biomedical, behavioral, and cognitive sciences led NIMH to formulate a plan, Priorities for Prevention Research at NIMH, which marries these sciences to prevention efforts. Focusing on the expansion of prevention research to include the prevention of relapse, disability, and co-occurring conditions, the plan provides a blueprint for NIMH prevention research in the years to come.