Biopsychological Methods of Treating Autism

Biopsychological Methods of Treating Autism

            Autism spectrum disorder (ASD) is considered a neurodevelopmental condition, (commonly referred to as autism), which impairs an individual’s ability to competently interact and communicate to varying degrees.  More specifically, social interaction, behavior, and language are afflicted.  Among the symptoms associated with autism are resistance, poor eye contact, unawareness, unresponsiveness, sensitivity to light, abnormal or underdeveloped speech, and hyperactivity or repetitive, uncontrolled movement.  Typically, these problems appear during early childhood (Mayo Clinic, 2012).  Prior to the 1990s this disease was quite rare.  However, in March of 2012 the Autism Research Institute determined 1 out of 88 eight year old children in the United States are affected by ASD and 60 children out of every 10,000 worldwide.  With an irresolute 70 plus percent increase of global cases over the past 10 years, research investigating the causes and treatments associated with autism are prevalent (Autism Research Institute, 2012).  The causes are generally centered on genetic problems and environmental factors, while the treatment has been offered from a behavioral, communicative, educational, or medicinal aspect (Mayo Clinic, 2012).  In effort to effectively administer treatment of sensorimotor disorders such as autism, biopsychological means such as psychopharmacology and psychophysiology are progressively employed (Pinel, 2011).  The following will analyze, compare, and contrast these approaches as utilized within relative case studies.

            The first study to consider incorporates pharmacological treatment which “can effectively target problem behaviors associated with autism” (Hollander, Phillips, & Yeh, 2003).  Often, drug treatment is viewed as complementary and integral to fostering a therapeutic relationship with the client, promoting compliance, improving domestic and educational environments, and enhancing parental involvement or concern (Hollander et al., 2003).  Accordingly, researchers introduced citalopram (Celexa), an antidepressant, to children and adolescents for 14 – 624 days (mean 219).  Once administered citalopram, 66% displayed significant improvement in functionality and nearly half showed improvements in attitude, aggression, and irritability.  Furthermore, it was determined that subjects treated with the drug for longer periods (not dosage) were positively affected.  Subjects experiencing negative or void reactions stopped prematurely (Hollander et al., 2003).

            Although psychopharmacological treatments are advantageous, they offer complications as well.  Drug abuse, improper diagnosis, prescription, informed consent, and school monitoring and caretaking are plausible issues impeding such methods (Hollander et al., 2003).  In terms of the case study, a third of the clients experienced one or more of the following side effects: headaches, sedation, aggressiveness, agitation, and lip dyskinesia.  Again, these individuals withdrew from treatment within three months (Hollander et al., 2003).

            The next case study employed an invasive electrophysiological recording method, referred to as quantitative EEG (QEEG), to examine autistic patients.  This procedure is defined as an electroencephalogram of brain function, enabling practitioners to observe brain waves of afflicted patients in comparison to healthy individuals or a control group (Abshier & Abshier, 2012).  In this particular instance, researchers used QEEG to compare a control group of wait-listed subjects to the neurofeedback provided by subjects (the experimental group) throughout 20 sessions.  They hypothesized that QEEG neurofeedback would provide superior insight to symptom based neurofeedback.  A comprehensive QEEG assessment grants practitioners the ability to identify regions of abnormality and provide proper guidance.  Additional measurements observed were neuropsychological data and neurobehavioral rating scales (Coben & Meyers, 2010).  The results confirmed that 76% of the experimental group reduced their hyperconnectivity and discovered a 40% decrease in ASD symptoms as 89% of the experimental group’s parents reported symptom improvement, all indicating improved treatment.  Of those in the control group, 83% remained unaffected.  In addition, from a neuropsychological aspect, patients’ attention, language, as well as visual perceptual and executive functioning improved. “This was the first published study to demonstrate the effectiveness of coherence training for reducing the symptoms of autism” (Coben & Meyers, 2010).

            While quantitative EGG is effective in the investigation and treatment of autistic symptoms, various factors hinder widespread usage.  From the practitioner’s perspective, there exists a lack of information and education concerning the method.  Hence, it is time consuming to gather and comprehend relative research.  From the client’s perspective, these procedures are not cost or time efficient and may be deemed unethical.  Furthermore, concerning both parties, QEEG has a minute potential of resulting in brain damage or additional brain malfunction.

            In summary, it may be concluded that neither of the aforementioned biopsychological means, psychopharmacological therapy nor quantitative EGG testing, establish an obvious advantage over the other in terms of treating an escalating disorder, autism.  Both methods possess the potential to provide effective results as well as adverse conditions on a case by case basis affecting all parties involved.  There are several factors to consider when diagnosing or selecting a particular treatment technique.  In these instances, the practitioner, the afflicted child, and the parents must be direct, well informed, and compliant in order to enhance the probability to achieve favorable outcomes. 

             

References:

Abshier, T.L., & Abshier, M.D. (2012). Gateway to health; QEEG & neurofeedback therapy.

            Retrieved April 30, 2012, from http://www.naturedox.com/qeegneurofeedback.html.

Autism Research Institute. Autism. Retrieved April 30, 2012, from

            http://www.autism.com/.

Coben, R., & Meyers, T.E. (2010). The relative efficacy of connectivity guided and symptom

based EEG biofeedback for autistic disorders. Applied Psychophysiology & Biofeedback,

35, 13-23.   

Hollander, E., Phillips, A.T., & Yeh, C. (2003). Targeted treatments for symptom domains in

            child and adolescent autism. The Lancet, 362, 732-734.

Mayo Clinic. Autism. Retrieved April 30, 2012, from

            http://www.bing.com/health/article/mayo-MADS00348/Autism?q=autism&qpvt=autism.

Pinel, J.P.J. (2011). Biopsychology (8th ed.). Boston, MA: Pearson Education, Inc.

Biopsychological Research Methods in ADHD

Biopsychological Research Methods in ADHD

The most prevalent childhood disorder, attention deficit hyperactivity disorder (ADHD), impedes the ability to focus, maintain attention, control behavior, and causes overzealous activity (NIMH, 2012).  “Approximately 4.4 million children in the United States meet criteria for the disorder and half are receiving pharmacological treatment” (Martin, Hymer, Poprawski, & Associates, 2010).  The symptoms range from mild to severe functional deviations of the central nervous system, inclusive of boredom, daydreaming, excessive or disruptive talking and playing, anxiety, and impatience.  Although ADHD was once exclusively considered a childhood disease, modern research indicates that individuals are prone to retain such symptoms throughout adolescence and into adulthood.  Those afflicted with the disorder are typically proficient, lacking significant neurologic or psychiatric disturbance (Remedy Health Media, 2012).  However, the disorder tends to impede concentration, hence, academic performance, career stability, and safety measures may be compromised.  The causes of ADHD are extensively regarded as inheritance, environment, brain injury, sugar, and food additives.  Furthermore, as several of the symptoms associated with this disorder are common among all children, it may be difficult to diagnose.  Thus, licensed health professionals must gather the subject’s personal and familial information and consider his or her behavior and environment (NIMH, 2012).  Major components to managing ADHD, as with most disorders and diseases, are early detection and adequate treatment which may improve work performance, social interaction, and overall quality of life (Mayo Clinic, 2012).  Treatments ranging from medication, psychotherapy, instruction or training, or a combination of techniques are employed to reduce symptoms and progress functioning (NIMH, 2012).  Of these, the foremost method of treatment is a pharmacological approach, yet practitioners have sought invasive electrophysiological recording methods and magnetic resonance imaging (MRI) as well (Pinel, 2011).  When implementing these methodologies, the practitioner must consider the advantages and disadvantages or side effects in relation to the individual.  In effort to examine these methods the following case studies have been reviewed. 

The first study explores the usage and effect of medication in treating ADHD, a pharmacological approach.  Stimulant drugs such as methylphenidate (MPH) and amphetamine, typically Ritalin and Adderall, are commonly prescribed.  “Since the 1990s there has been a precipitous increase in pharmacotherapy for treating this disorder in young children.  In fact, the use of stimulants for preschool children enrolled in state Medicaid programs doubled over the 6-year period 1992–1998” (DuPaul & Kern, 2011, p. 149).  Historically, these means have consistently proven to augment one’s attention span and impulse control.  However, in more recent times, nonstimulant meds such as Strattera, Catapres, and Intuniv are utilized.  Thus far, the side effects of nonstimulants are less harmful than those of stimulant drugs, while enhancing educational and social functioning.  Yet, the effects of nonstimulants are inconclusive as they are not widely utilized.  Hence, the focal point of ADHD treatment remains on stimulant medications.  The leading research of such is the Preschool ADHD Treatment Study (PATS) (DuPaul & Kern, 2011).  Initially, this study included 303 participants (76% boys, 24% girls) age 3 to 5.5 years.  Once the children were screened and their parents were trained over a 10 week period, 147 participants remained.  Over the next 9 weeks, the children were administered MPH, of which the first 5 weeks consisted of dosage levels of placebo, 1.25mg, 2.5mg, 5mg, and 7.5mg, as each dosage was used for each week.  Once the most appropriate dosage per child was determined, the last 4 weeks the participants were randomly given either the placebo or their optimal dosage.  During this time, researchers utilized parent and teacher ratings in conjunction with the observation of behavior in a classroom setting.  Results during the initial 5 weeks indicated that ADHD symptoms significantly declined with the 3 highest dosages although they did not fluctuate among those dosages.  Additionally, 12% of participants demonstrated no response or a more favorable response to placebo as opposed to their full dose of MPH.  These participants along with 26 others who demonstrated faltered behavior or extreme adverse side effects were excluded from the remaining 4 weeks, leaving a sample of 114 children.  Of these, 77 participants completed the remainder of the study.  Again, it was determined that optimal levels of MPH resulted in fewer ADHD symptoms than placebo dosages.  Moreover, participants receiving optimal doses exemplified more social competence and overall improvement as opposed to participants receiving placebo.  Furthermore, nearly 30% of remaining participants experienced moderate to severe side effects including decreased appetite, trouble sleeping, and weight loss.  The potential of stunted growth was a concern as well.  These effects occurred more often after MPH dosage versus placebo.  Post-study, 95 PATS children participated in a 10 month open-trial period in which they continued to receive their optimal dosage, 14-20mg per day, inclusive of observation and necessary adjustments.  Results held constant.  However, 45 additional children who exclusively participated in the 10 month trial phase ceased treatment due to adverse side effects, poor behavior, or switching to alternative stimulants (DuPaul & Kern, 2011).  These findings indicate that gradually introducing medication is more favorable than initially administering higher dosages.  In general, utilizing pharmacological methods inclusive of stimulant medications such as MPH to treat children with ADHD may effectively reduce ADHD symptoms increasing the child’s social function, although, recipients and parents should be aware of relative adverse side effects.

Next, practitioners must implement additional biopsychological means to study ADHD.  One method to consider is brain imaging, more specifically magnetic resonance imaging (MRI).  This procedure utilizes high-resolution images “constructed from the measurement of waves that hydrogen atoms emit when they are activated by radio-frequency waves in a magnetic field” (Pinel, 2011, p. 104).  This three dimensional imagery illustrates variances in spatial location.  In a particular instance, researchers from the National Institute of Mental Health concluded that individuals suffering from ADHD maintained lower rates of glucose, the brain’s chief energy source, predominantly in regions controlling attention, handwriting, motor control, and inhibition reactions (Remedy Health Media, 2012).  Additional research concludes that “the claustrophobic and anxiety inducing environment of MRI machines result in greater attrition for subjects who are younger, female, and anxiety sensitive, such as ADHD subjects” (Czarnolewski, 2011, p. 2). 

Another means of treating ADHD is the invasive electrophysiological recording method. 

These processes enable practitioners to examine the function and dysfunction of the neural system (Aston-Jones & Siggins, 2000).  More specifically, electrophysiological measures of activity in the central and the autonomic nervous systems are analyzed to determine the core deficits in ADHD (Barry, Clark, & Johnstone, 2005).  Utilizing this methodology, researchers from the Chicago School of Professional Psychology, Loyola University Psychology, and First Chicago Neuroscience Research observed ADHD amongst children.  The study included 30 participants, 17 males and 13 females, aged 6-17, as they completed both an initial baseline and post-medication observation to examine brain electrophysiology through quantitative electroencephalography (qEEG).  Furthermore, they self-evaluated their mood, inclusive of depression and anxiety testing, were given IVA + Visual and Auditory Attention Testing in order to calculate attention and response capacities, and orally received Adderall or Ritalin.  As the children were seperated into electrophysiological clusters, researchers examined their response to the stimulants.  The results indicated that the participants did not replicate traditional data.  The majority of the children demonstrated surplus amounts of frontal-central bilateral beta in their qEEG and additional irregular blends of fast and slow wave movement.  Additionally, two new electrophysiological clusters were introduced.  The participants illustrating positive responses to the medications, regardless of Adderall or Ritalin, proved to have enhanced frontal lobe beta suppression and decreased negative dispositions.  Consequently, overall attention and response levels were increased or normalized.  In comparing the participants to those afflicted with ADHD in traditional research, the participants exemplified varied hyperactive behaviors and more severe symptoms (Martin et al., 2010).  Moreover, as opposed to other brain imaging methods such as PET, SPECT, MRI and MRS, the qEEG method enables practitioners to perform simultaneous tasks and is considered an effective, safe, and inexpensive means of examining cortical electrophysiological dysfunction in neuropsychiatric disorders such as ADHD (Song, Shin, Jon, & Ha, 2005).

            In closing, ADHD encompasses functional deviations of the central nervous system affecting an individual’s attention span and impulse control as well as hyperactivity (Remedy Health Media, 2012).  While it affects approximately seven percent of children in the U.S., it has the potential to exist throughout adolescence and into adulthood.  As ADHD has become more common in modern times, practitioners are increasingly implementing biopsychological methodologies to diagnose, evaluate, and provide treatment.  Hence, pharmacological, invasive electrophysiological recording and magnetic resonance imaging are utilized.  Furthermore, neuropsychological research is applied.  As the causes vary from altered brain function and anatomy, heredity, maternal smoking, drug use, environmental toxins, sugar and food additives, these methods assist practitioners in their efforts to identify and observe such as well as the behaviors associated with the ADHD (Mayo Clinic, 2012).  Currently, numerous variants and genetic phenomena are yet to be discovered.  Therefore these methods will remain beneficial in the explanation, diagnosis, and treatment of the condition. 

References:

Aston-Jones, G.S. & Siggins, G.R. (2000). Electrophysiology. Retrieved May 21, 2012, from

            http://www.acnp.org/g4/GN401000005/CH005.html.

Barry, R.J., Clark, A.R., & Johnstone S.J. (2005). Electrophysiology in attention deficit /

hyperactivity disorder. [Electronic version]. International Journal of Psychophysiology 58, 1-3.

Czarnolewski, M. (2011). Further ADHD differences identified with a false discovery test.

            Washington, DC: American Psychological Association.

DuPaul, G.J. & Kern, L. (2011). Psychotropic medication treatment. In G.J. DuPaul & L. Kern,

            Young children with ADHD: Early identification and intervention (pp. 149-165).

            Washington, DC: American Psychological Association.

Martin, C.N., Hymer, J., Poprawski, T.J., Paciora, R.A., & Konopka, L.M. (2010). Childhood

ADHD: translating electrophysiological laboratory findings into a clinical setting. American Psychological Association 2010 Convention Presentation. Retrieved May 21, 2012, from http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=da778f01-4630-4125-8786-5968ab89e65e%40sessionmgr113&vid=29&hid=123.

Mayo Clinic. Attention deficit / hyperactivity disorder (ADHD) in children. Retrieved May 21,

2012, from http://www.mayoclinic.com/health/adhd/DS00275.

NIMH. Attention Deficit Hyperactivity Disorder. Retrieved May 21, 2012, from

http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml.

Pinel, J.P.J. (2011). Biopsychology (8th ed.). Boston, MA: Pearson Education, Inc.

Remedy Health Media. Attention deficit / hyperactivity disorder. Retrieved May 21, 2012,

from http://www.healthcentral.com/encyclopedia/408/639.html.

Song, D.H., Shin, D.W., Jon, D.I., & Ha, E.H. (2005). Effects of methylphenidate on quantitative

EEG of boys with attention-deficit hyperactivity disorder in continuous performance test. [Electronic version]. Yonsei Medical Journal, 46(1), 34-41.