Using Drugs to Fight Autism

Brian Pingree was a beautiful child, but his mother knew something was terribly wrong. For hours, the three-year-old would sit rocking back and forth aimlessly, oblivious to his brothers and sisters who played nearby. When Carmen Pingree hugged and kissed her son, he would stiffen and turn his face away. He rarely spoke, and when he did, his voice had the flat tone of a science-fiction robot. Although he could open latches and locks with uncanny ease, he had trouble using a fork.

Mrs. Pingree later learned that Brian was autistic, the victim of the most bizarre and complicated of all childhood disorders. Until recently, it was also the most misunderstood by doctors and psychologists. According to classical Freudians, autism was a severe emotional disease caused by the mother's unconscious rejection of her baby. Some experts considered autistics irredeemably retarded and urged that they be institutionalized, while others suggested that these children were schizophrenic and should be lobotomized. But today, most specialists agree that autism is a neurologic disease. And while they have yet to fully understand it, they are developing better -- and more humane -- ways to treat autism, including most recently the use of drug therapy.

From 100,000 to 200,000 U.S. youngsters and adults are autistic. The first symptoms of the terrifying disorder invariably appear before the age of three. Typically, the child interacts abnormally with people: he may smile at his mother one day, but coldly withdraw from her the next. Autistics develop a peculiar pattern of speech. They may echo the last few words of someone else's sentence, a condition known as echolalia, or they may not talk at all. Such children also respond strangely to sensations. Brian Pingree, for example, wouldn't cry when he bumped his head, but when his mother caressed him, he would arch his back as though he had been burned. Autistics almost always develop stereotyped movements, such as back-and-forth rocking, twirling on their toes or flapping their hands in front of them. Finally, most autistic children test as though mentally retarded, with IQ's usually below 70. In autism, for some unexplained reason, boys outnumber girls three or four to one. Among the many myths about the disorder was the notion that it occurred mostly in well-educated, affluent families. In fact, autism can be found in all socioeconomic groups.

Improved Learning: The new notion that autism is a physical disorder underlies attempts to treat it with drugs. None are cures by any means, but some drug experiments have shown promise. In one study, Dr. Magda Campbell of New York University Medical Center gave autistic children Haldol, a standard drug for schizophrenia. Given at four-week intervals, the drug seemed to reduce stereotyped behavior and also seemed to improve learning ability. "Many young children are helped by Haldol for periods of up to four years," says Campbell. At least some autistics have an excess of the biochemical neurotransmitter dopamine in their central nervous systems and Haldol, animal studies show, works by blocking the action of dopamine. Long-term use of Haldol, however, can cause a serious muscular disorder called tardive dyskinesia, so experts are wary of the drug.

Dr. Edward Ritvo of the University of California, Los Angeles, is testing the drug fenfluramine in autism. Early results suggest that it may improve a child's IQ score, as well as his behavior. Currently, the drug is being tried at 24 centers in the United States and Canada to establish its true value in the treatment of autism. "A big question with fenfluramine is whether it's different from Haldol," says Dr. Thomas Gualtieri of the University of North Carolina School of Medicine. "It might simply be zonking the kids out, calming them down."

Behavior Therapy: However effective drugs may prove to be, intensive special education remains the mainstay of treatment. "These children need a highly structured program, coordinated with a good home environment," says Ritvo. "This gives the child the best chance of reaching his capacity." Behavior therapy, in which the child is constantly rewarded for his progress, is the key to the program. As adults, autistics can receive vocational training and hold down jobs, preferably ones that don't involve much interpersonal activity. Brian Pingree has benefited both from special training and fenfluramine. Now nine, he attends a regular third-grade class, with "enrichment" instruction in math and reading. And he's been taking the drug for the past two years. "It has helped him tune in to the world," says his mother, Carmen.