Treatment of irritability in children with autism spectrum disorder

Poremećaj iz spektra autizma neurorazvojni je poremećaj obilježen teškoćama u socijalnoj komunikaciji i interakciji te ograničenim, ponavljajućim obrascima ponašanja, interesa i aktivnosti. Etiologija ovog poremećaja još nije u potpunosti jasna i pokušava se objasniti utjecajem genetskih i okolišnih čimbenika. U otprilike 20 % djece s poremećajem mogu se prepoznati simptomi razdražljivosti koji predstavljaju dodatno opterećenje kako za djecu, ometajući njihov razvoj i napredovanje u socijalnim interakcijama, tako i za njihove obitelji i skrbnike. Nekoliko je definicija razdražljivosti, a prema neuroznanstvenim istraživanjima najbolje bi bilo reći kako se radi o neuobičajenoj reakciji na frustraciju koja proizlazi iz nemogućnosti postizanja cilja i agresivnom odgovoru na prijetnju. Kada metode kojima se pokušava djelovati na glavne karakteristike poremećaja ne poluče dovoljan uspjeh u ublažavanju teških simptoma razdražljivosti, pokušavaju se uvesti intervencije koje će olakšati teret dodatnih simptoma. Risperidon i aripiprazol su zasad jedina dva lijeka odobrena za ovu indikaciju, i to u SAD-u, dok se u Europi propisuju neodobreno. Osim risperidona i aripiprazola koji pripadaju skupini antipsihotika, postoje istraživanja i izvještaji o upotrebi drugih psihotropnih lijekova. Kako se ipak radi o djeci, trebalo bi težiti tome da se razdražljivost najprije pokuša reducirati nekim nefarmakološkim metodama kojima bismo izbjegli pojavu neželjenih nuspojava koje ovi lijekovi mogu izazvati pa tako postoje pokušaji uvođenja treninga roditelja, terapijskog jahanja te novih tehnologija u program liječenja. Ove bi metode mogle biti naročito korisne kada simptomi razdražljivosti nisu još toliko izraženi jer bi tako spriječile njihovo pogoršanje.Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and social interaction and restricted, repetitive patterns of behavior, interests, or activities. The etiology of the disorder is still not entirely known, and there are efforts to explain its roots in genetic and environmental factors. About 20 % of children with this disorder are experiencing difficulties because of irritability which is being recognized as an additional symptom of the disorder and is burdensome for the child's development and progress in the field of social interactions, as well as for their families and caregivers. Literature offers several definitions of irritability, but according to neuroscientific research, it would be best to define it as aberrant responses to frustration (i.e., blocked goal attainment) or aberrant approach responses to threat. When methods targeting core symptoms of ASD fail to improve severe symptoms of irritability, clinicians are trying to introduce new methods to yield improvements. Risperidone and aripiprazole are currently the only two medications approved for this indication in the USA, but they are sometimes also prescribed in European countries, although off label. Except for risperidone and aripiprazole, which are antipsychotics, there are research studies and reports on usage of some other psychoactive medications. When treating children, it is preferred to begin the attempt to reduce symptoms of irritability with nonpharmacological treatments to avoid side effects of medications. To this end, efforts are being made in implementation of parent training, therapeutic horse riding and new technologies in the treatment program. These methods could be particularly useful in preventing exacerbation of symptoms of irritability when they are still mild