Autism Science Foundation are blogging

28 May

Just a quickie. Autism Science Foundation are now blogging. So far there’s only one post up but already our very own Sullivan has got in there to comment. I’d love to see some autie opinion making a splash on there!

ASF also have their own Facebook Group for those who like to get their social media on. Oh yeah, lets not forget the website whilst I’m giving out link love.

18 Responses to “Autism Science Foundation are blogging”

  1. dr treg May 29, 2009 at 12:09 #

    Re the entry criticising Attkisson on the ASF blog.
    Risperidone for autism spectrum disorder was reviewed by the Cochrane Library in 2007. The conclusions were
    “However there are limited data available from studies with small sample sizes. In addition, there lacks a single standardised outcome measure allowing adequate comparison of studies, and long-term followup is also lacking. Further research is necessary to determine the efficacy pf risperidone in clinical practice”.
    http://www.cochrane.org/reviews/en/ab005040.html
    Although risperidone does significantly inhibit interferon-?-induced microglial activation in vitro i.e. has an anti-inflammatory effect, the clinical trials arent very convincing.
    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TC2-4NB2SKV-2&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=8f441f6fee71fb9ba06c579702302de7
    Perhaps Attkisson`s criticism of the use of risperidone treatment in autism is not unjustified.

  2. Kev May 29, 2009 at 12:20 #

    Dr Treg – maybe better leaving that comment there?

  3. dr treg May 29, 2009 at 22:56 #

    Stephen Barrett of Quackwatch defines “quackery” as : “anything involving over-promotion in the field of health.”
    Does this apply to risperidone in autism – see above links.

    Having followed the link on this site to ASF I was a bit disappointed that Sullivan`s entry on ASF is not as critical of risperidone treatment in autism as other “quack” treatments which are not tested in double-blind controlled trials which are large enough and long enough to achieve a meaningful statistical significance.

    Seems like personalities are becoming the issues in autism instead of looking at the evolving science – at least one significant paper every 4 months or so.

  4. Sullivan May 29, 2009 at 23:20 #

    Sorry to disappoint you.

    Risperidone, while no where near perfect, has been tested in a number of double-blind placebo controlled studies. The studies are not great in terms of time and number of participants–but they are heads and shoulders above studies done for many (any?) of the biomed treatments.

    With the database I use, I get 151 papers with risperidone and autism in the subject. I get over 7,500 for risperidone alone as the subject.

    I will not tout the wonders of risperidone–I would love to see it studied better in autistics. But, risperidone has been tested in other groups for safety. Is there a safety test of Lupron at 10x the standard dose?

    If I understand your comment, I should be more consistent in how I dole out criticism. I would point out that to be consistent in your own message you should be pointing out the failures of “therapies” like Lupron. Just a nudge.

  5. dr treg May 30, 2009 at 00:26 #

    The comment was not related to the quackery of Lupron treatment.

    The comment was related to the lack of critical analysis of the use of risperidone in autism ( the Cochrane Library conclusion) which on the face of it seems to amount to quackery as defined above.

    Critical analysis of all autism treatments is a characteristic and the strength of this site.

    Risperidone as a treatment in autism seems to have escaped the usual critical analysis.

    Placebos are appropriate for patients with autism as long as the child is not harmed. Risperidone treatment is not without harm.

  6. Sullivan May 30, 2009 at 01:09 #

    Critical analysis of all autism treatments is a characteristic and the strength of this site.

    I can’t speak for the others who blog here. But, I have never laid claim to understand or analyze all autism treatments.

    The comment was not related to the quackery of Lupron treatment.

    But you referenced my comment on the other blog and took me to task for not being consistent. On that other blog, I did reference Lupron as an example of bad science applied to autism.

    Placebos are appropriate for patients with autism as long as the child is not harmed. Risperidone treatment is not without harm.

    This statement doesn’t make sense to me. While he studies of risperidone as applied to autistic individuals are small, there are two well cited studies that do, in fact, include placebo control and double-blind. McCracken (2002) states in the abstract “We conducted a multisite, randomized, double-blind trial of risperidone as compared with placebo for the treatment of autistic disorder accompanied by severe tantrums, aggression, or self-injurious behavior in children 5 to 17 years old.”. McDougle (1998) is also a placebo-controlled. Both are small studies.

    Since the Cochrane review you linked to makes it clear that they are using placebo controlled studies to make their analysis, I really don’t understand the first sentence of your comment at all.

    The second sentence also does not follow. The point of a placebo “as long as the child is not harmed” is that you do not withhold a medical procedure and use a placebo where this could lead to harm. I.e. you would never do a placebo controlled study of removal of a cancer tumor–doing all of the surgery except for the tumor extraction–as that would be harmful.

    One of the reasons I do not spend much time considering Risperodal is precisely because they acknowledge the side effects.

    Lastly, this comment does not really seem clear to me:

    The comment was related to the lack of critical analysis of the use of risperidone in autism ( the Cochrane Library conclusion) which on the face of it seems to amount to quackery as defined above.

    The first sentence of the Cochrane review conclusion is, “Risperidone can be beneficial in some features of autism.”

    If you want to use a conclusion that something is beneficial as evidence that something is quackery, you will leave people like me puzzled.

  7. dr treg May 30, 2009 at 01:48 #

    The whole conclusion of the Cochrane review was “Risperidone can be beneficial in some features of autism. However there are limited data available from studies with small sample sizes. In addition, there lacks a single standardised outcome measure allowing adequate comparison of studies, and long-term followup is also lacking. Further research is necessary to determine the efficacy of risperidone in clinical practice”.
    Usually this site is quite good at critical analysis but seemingly not in the case of risperidone in autism.

    I have not heard of sham cancer surgery.

  8. Joseph May 30, 2009 at 02:25 #

    What differentiates quackery from non-quackery? Quackery usually involves a doctor promoting a treatment that is not part of the standard of care, and making grandiose claims that are not supported by the evidence. Since Risperidone is FDA-approved for autism, it’s not quackery. Additionally, there are replicated double-blind studies that support its efficacy (with statistically significant findings.)

    Now, whether it’s a good idea to use Risperdal, and whether the FDA did the right thing, is a different matter. That’s a question of ethics. There’s the side-effects, but also, we just don’t know what happens if a child takes Risperdal for, say, 5 years. What is the adult outcome of children who’ve taken Risperdal throughout their childhood? We simply don’t know.

    ABA is similar, except with much lower quality of evidence. It can’t really be called quackery, because it’s considered the standard of care, but it doesn’t live up to its “evidence-based” label.

  9. Sullivan May 30, 2009 at 02:36 #

    “I have not heard of sham cancer surgery.”

    Precisely my point. I am sorry if it is not getting communicated well.

  10. María Luján May 30, 2009 at 13:17 #

    The reported adverse effects of Risperidone- my comment is awaiting moderation-are by far much more wide in impact that only hyperprolactinemia and liver enzymes increase- and weight gain . From Pubmed there are reports of association of Risperidone- from Jan 2008 to May 2009 ONLY – in different ages with
    Hypertriglyceredemia in adult
    Neuroleptic malignant syndrome NMS – in a child with also Joubert syndrome
    Tardive dyskinesia in a child with Tourette syndrome-Parkinsonism
    Thrombocytopenia
    Severe diabetes ketoacidosis
    Extreme elevation of creatine phosphokinase levels
    A review demonstrated that atypical antipsychotics can cause NMS even when prescribed in monotherapy.
    Olanzapine and risperidone may impair glucose tolerance due in part to increased insulin resistance
    leukopenia
    catatonia
    Gastrointestinal bleeding
    Somnolence
    Headaches
    Pseudotumor cerebri
    Metabolic dysfunction
    Encephalopathy- in combination with litium
    Pulmonary thromoboembolism
    Transient ischemic attack
    and more
    and from a recent manuscript on a model of the impact in neuronal migration

    “This is the first report that antipsychotic drugs interfere with neuronal migration and axonal outgrowth in a developing nervous system. Other antipsychotic drugs, e.g., haloperidol, quetiapine, olanzapine, risperidone and aripiprazole, mainly affected ALM migration with little perturbation of PLM axonal outgrowth”

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18282677

  11. dr treg May 30, 2009 at 18:37 #

    “McCracken (2002) states in the abstract “We conducted a multisite, randomized, double-blind trial of risperidone as compared with placebo for the treatment of autistic disorder accompanied by severe tantrums, aggression, or self-injurious behavior in children 5 to 17 years old.”.

    McCracken`s study of 49 children who were treated with risperidone only lasted 8 weeks, and the risperidone caused significant drowsiness and weight gain. It is no surprise that the irritability and temper tantrums decreased.
    http://content.nejm.org/cgi/content/abstract/347/5/314
    It seems like a chemical cosh similar to Lupron. In another study when the risperidone was discontinued the behaviour returned.
    Now risperidone has a FDA licence for the long-term treatment of autism.
    Perhaps occassional diazepam treatment would probabably be as effective without all of the risperidone side-effects.

  12. rajensen088 May 30, 2009 at 20:43 #

    “What differentiates quackery from non-quackery? Quackery usually involves a doctor promoting a treatment that is not part of the standard of care, and making grandiose claims that are not supported by the evidence”.

    Like the claims made by Dr.Hakornan the author of the P14 study which claimed to have discovered the genetic mutation that is present in 65% of all autism cases? He claims that if the mutation could be eliminated, 15% of autism would just disappear. This new Autism research blog also posted on the hyper inflated meaning of this paper and also failed to also note that the same genetic mutation is present in 60% of the general population.

    The only people giving this paper any importance are the authors themselves and their groupies in the neurodiversity movement.

  13. dr treg May 30, 2009 at 22:56 #

    In 2004, the Committee of Safety in Medicine advised GP`s not to treat the behavioural symptoms of dementia with risperidone because of the increased risk of stroke.
    http://www.nelm.nhs.uk/en/NeLM-Area/News/494717/494897/494908/
    I hope someone is performing post-marketing surveillance on children being treated with risperidone. Autism is not associated with reduced longevity and so it will be interesting to see if the long-term analysis shows earlier strokes or increased strokes in those treated for longer than 8 weeks.

  14. María Luján May 30, 2009 at 23:41 #

    Hi raj and dr treg
    There is a recent manuscript on the role of Se in heart lessions induced by neuroleptics in rabbit

    http://www.ncbi.nlm.nih.gov/pubmed/17631667?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
    The cardiac effects of neuroleptics are being under active research

    Neuropsychopharmacol Hung. 2004 Mar;6(1):5-12.
    [Cardiac effects of antipsychotics: mechanism of arrhythmias and sudden cardiac death]
    Kecskeméti V.
    The review summarizes experimental and clinical data showing the cardiac side effects of antipsychotic drugs. Some antipsychotics may correlate with prolongation of QT interval, induce ventricular tachycardia, torsades de pointes, TdP, and sudden death. The author surveys the cellular actions of the drugs, the electrophysiological mechanisms and the recent data referring the drug’s effects on ionic currents, mainly potassium currents. Most antipsychotics are associated with the inhibition of delayed rectifier K+ channels. Comparing the potency on K+ channel inhibition and the prolongation of the QT interval with the therapeutic plasma levels of the drugs, the difference between the inhibitory potency and the therapeutic dose is the highest in the case of quetiapine, olanzepine and risperidone, while thioridazine shows the smallest difference. All drugs that cause TdP prolong the QT interval and inhibit the K+ rectifier channel, but the relationship is not precise. Some additional cellular effects of particular agents, modulating conditions, factors (diseases, electrolytes disturbances, genetic damage, drug interactions) make the individual vulnerable to arrhythmia. The paper highlights drug interactions causing risk of arrhythmia during chronic treatment of psychiatric patients.

    There is some info on longer times than 8 weeks in aSD, but the info is limited
    J Am Acad Child Adolesc Psychiatry. 2005 Nov;44(11):1137-44. Links
    Long-term effects of risperidone in children with autism spectrum disorders: a placebo discontinuation study.Troost PW, Lahuis BE, Steenhuis MP, Ketelaars CE, Buitelaar JK, van Engeland H, Scahill L, Minderaa RB, Hoekstra PJ.
    Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands.

    OBJECTIVE: The short-term benefit of risperidone in ameliorating severe disruptive behavior in pediatric patients with autism spectrum disorders is well established; however, only one placebo-controlled, long-term study of efficacy is available. METHOD: Thirty-six children with an autism spectrum disorder (5-17 years old) accompanied by severe tantrums, aggression, or self-injurious behavior, started 8-week open-label treatment with risperidone. Responders (n = 26) continued treatment for another 16 weeks, followed by a double-blind discontinuation (n = 24; two patients discontinued treatment because of weight gain) consisting of either 3 weeks of taper and 5 weeks of placebo only or continuing use of risperidone. Relapse was defined as a significant deterioration of symptoms based on clinical judgment and a parent questionnaire. RESULTS: Risperidone was superior to placebo in preventing relapse: this occurred in 3 of 12 patients continuing on risperidone versus 8 of 12 who switched to placebo (p = .049). Weight gain, increased appetite, anxiety, and fatigue were the most frequently reported side effects. CONCLUSIONS: This study indicates the effectiveness of risperidone during a period of several months, reducing disruptive behavior in about half of the children with autism spectrum disorders. The results provide a rationale for the continuing use of risperidone beyond 6 months, although considerable weight gain can limit the use of this agent.

    Now, with the anecdotic and reported Se defficiency in autism, the interaction of nutrients- minerals, vitamins and aminoacids- and neuroleptics should be more carefully studied, as dr treg says, considering short and long term treatment. In ASD it has been research the impact on intake of calcium, vitamin D , etc using a quantitative Food Frequency Questionnaire (FFQ)- in 2006-but not clinical testing on time.

  15. Joseph May 31, 2009 at 03:16 #

    The only people giving this paper any importance are the authors themselves and their groupies in the neurodiversity movement.

    What in the world are you talking about? Your anti-neurodiversity evangelism, RAJ, is making you say things that are not based in reality at all.

  16. Kev May 31, 2009 at 09:58 #

    Dr Treg – gonna suggest it again – how about commenting on the blog where the issue is being discussed?

  17. Sullivan May 31, 2009 at 18:15 #

    What in the world are you talking about? Your anti-neurodiversity evangelism, RAJ, is making you say things that are not based in reality at all.

    It is interesting to see his attack method change. He started by trying to discount the paper based on a mismatch in the control group. Since he was unwilling to contact the authors for comment, I did it for him and showed his argument was baseless.

    Also, I guess that the editors of Nature (who have placed at least two commentaries on this paper) as well as a large number of news outlets must be “neurodiverse” by RAJ’s definition–since they have given this paper significant air time.

    Autism Speaks also must be Neurodiverse. That is an interesting claim to me.

    We will watch for who cites this paper in the future–those must be neurodiverse researchers.

    I could go on and on, but the point is clear–RAJ’s assertion (again) is baseless.

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