Treating SID (esp sensory sensitivity) with antidepressants?

De-sensitization Techniques are a far better solution to Hyper-Sensitivity, than life-long use of anti-depressants.

As the number of children with autism grew (continues to grow?) during the 90’s the use of medication for them had to expand beyond the use of anti-psychotics.

Considering that SID is still hotly disputed by the “experts” I would be skeptical that a great number are given SSRI’s for this reasoin (I am not saying it has never occured, just that it is probably a rare thing). Far more common is the use of SSRI’s to address the anxiety issues common with autism (as championed by Temple Grandin). Of course, much of the anxiety problems Autists will have stem directly from the abusive treatment they commonly receive from the herd of typicals surrounding them, but hey, let’s medicate the spasstic, not worry about the illegal actions of all the normals.

According to a meta-analysis published this past spring, the most common drugs used on young Autists is Risperdal. The author of the study proported that it was the best course of action, even tho there was little evidence of global improvement in doing so and there remains an escalating risk (as an individual’s usage extends) of permanent neurological damage from using a-typical antipsychotics. In fact, the FDA rejected the application to have Risperdal licensed for use in Autists, citing the safety data was too detrimental to balance the low-level benefit (can’t believe the FDA got this one right). Of couirse, all that means is that Jansenn can’t market Risperdal for autism in print form; they are free to have their legion of salesmen tell drs. verbally about this application and drs. of course are free to prescribe as they choose (remind me why we bother to license drugs at all if drs. can prescribe “off-label” at will…)

I have to side with geodob on this one. A proper SIT program by a competant OT can bring very good improvements in Autists. Also, both chelation and the Diet should be explored to correct the underlying sources of SID before we turn to the medicine chest to mask the symptoms of it.

Thanks for that information Dad! I agree with you Geodob that desensitization would be preferable to meds. I personally hate to have a child dependent on them.

My son’s neurologist believes these kids need serotonin. I did read about the connection between serotonin and the sensory system. That a lack of it can affect the senses and also language (kind of suprising). I’m not sure how complete the research is regarding this, but it’s fascinating. My son’s neurologist gave us a prescription for Lexapro and told me that it should help even at a very minimal dosage. I do still want to look further at chelation. I’ve found a doctor who does this but he’s very difficult to get an appointment with him. Can any pediatric doctor do these tests and administer it if necessary?

With my son’s sound sensitivity I’m not sure if it’s actually SID or OCD. It’s a recent problem that seems to be getting worse (he can’t stand the sound of chewing so he has to eat his meals seperately, or be in another room when others are eating).

I’d go for SI therapy vs anti-depressants as well. Personal experience and all that. Drugs have their own effects which can also be troubling. I am not anti-drug, but think that if you are treating sensory issues then you are just likely to add to some sensory problems with drugs. For instance, you can get excessive thirst or dry mouth which will effect taste and even tactile sensations.

—des

Does the doctor think this OCD? SSRIs are often prescribed for this. I’ve been there, done that with my ds and if I had to do it over again and knew what I know now, medication would have been the very last thing I would have tried owing to the side effects, which I found caused almost as many problems as the problems they were supposed to treat.

What helped: cognitive behavior therapy. Very unpleasant actually for both ds and mother (the ones who have to do it ultimately), but it does work and, as in the case of my ds, who was loads worse than what you’ve described, can bring permanent results. If you go this route, you will be told that what you are doing now is contrary to the principles of CBT because you are shielding him from the stimulus that elicits his response by having him eat in another room or letting him leave the room while others are eating. The idea behind CBT is for him to be exposed to the stimulus and reward him for suppressing his response to, for example, leave the room. This is done bit by bit. I hope this hasn’t reached the point where the family caters to him by leaving the room if he’s there when they want to eat.

I’m sorry if this isn’t tactful—it’s quite late—but as I said, I’ve been there. My ds had a list of about 50 to 100 very common words he couldn’t bear to hear. The whole family used substitute words and phrases for a year and a half to the point where we were actually speaking a parallel language. I think the psychologist we finally used for CBT wrote us up (no names) in one of his articles as an example of one of the most extreme examples of family accommodation (misguided of course) he had encountered.

One other thing worth looking into because you have said this is recent (not the sort of longstanding or very early childhood occurrence that is usually associated with SID). There is mounting scientific evidence that sudden onset OCD or tics can be caused by after effects of strep infections. This was the case of my ds, who was diagnosed at the NIH. The symptoms will go away after a few months, but often if the child is infected again they come back with greater intensity and for longer duration andultimately can become chronic. The strep doesn’t have to be bad—my ds was symptom-less in all his strep infections and was tested only because his sister had been diagnosed. (His infections occurred before we knew about the strep/OCD-tic connection.) You may want to get him tested for strep or do some research on the disorder, which is called pediatric autoimmune disorder associated with strep or PANDAS.

Well you have to tease out Sensory from OCD. If he can’t stand the sound of chewing, it is sounding more like OCD. But it gets hard to tell sometimes. Say you have a child who will only wear certain kinds of clothes, or goes into fits at certain types. Is it, the actual types of cloths or is the feel of the cloths? It’s an important differentiation.

I am pretty familar with this in autism. And it can be both. I hate, still do to some extent certain types of noises. And I think this is sensory. But I also remember going thru a stage when I did not like the sound of certain words and I would have a fit if my mom said certain words like “jam” (always sounded like toe jam) or “pot roast” (potty)— I don’t think this was at all sensory.

I outgrew the latter but not the former— btw, I’m not recommending “growing out of” as a treatment approach. Just my comments as to the differences. It didn’t bother my family (I don’t think) not to say 3-4 words vs hundreds.

—des

Thanks for all the great advice! I’m actually looking into the whole autoimmune possiblity as a root for many of my son’s difficulties. In fact, I’ve been doing quite a bit of reading about symptoms, connections, etc… and I woke up at 4 a.m. unable to sleep because so much points to the immune (and possible thymiserol poisoning) theory. It’s like connecting dots, but very disturbing ones.

I’m going to take the advice here and try cognitive behavioral therapy. I like the idea. I’m also suspecting that because this particular sensitivty is recent, there’s a possibiltiy it may have developed from our Adderall trial a fews months ago. From what I’ve read, in rare instances stimulants can set off OCD symptoms (as well as tics). Nothing is perfect.

For my son it’s the texture of the clothing. He has to wear smooth clothes. Cotton feels rough to him, while synthetics like polyester, some poly blends and nylon don’t scratch.

Actually, now that I think about it, maybe it’s a combination of OCD and SID! I remember awhile back I asked my son about why he does not particularly like music with words and singing, but prefers classical music. He told me that classical is “smoother.” The sound of crunching would be rough. Fortunately he will listen to music with words. Maybe I need to have him rub his skin with scratchy textures (similar to brushing) and have him continue listening to music that’s not smooth….

I think I have told you before that our son has the chewing sensitivity problem, too. He never eats with the family anymore when he is here. But getting him to do cognitive behavior therapy at age 22 just isn’t going to happen. He definitely has an anxiety disorder and various symptoms that could fall into the categories of ADHD, OCD, etc. Unfortunately, 10 years ago when most of it started, I just didn’t know very much about all those things.

Janis

Janis,
In regard to chewing and oral hypersensitivity, I have read of a number of people who have been able to overcome this, by simply using an Electric Toothbrush. Where it appears that the Vibrations seem to desensitize the nerve endings in the mouth.
The only potential side-effects, are perhaps better teeth?
Geoff. :D

Your idea on the electric toothbrush is good for oral sensitivity (of course for some the electric toothbrush can be problematic), however, I believe they are talking about children who dislike *hearing chewing* (not their own apparently). I’m inclined to think it is OCD, but I am sure that OCD tendencies and SID problems can definitely go together. In fact, in something like Tourettes or Aspergers they will go together.

—des

Janis,

Don’t feel too bad. I think these sensory issues are extremely difficult to change. I’ve been trying to improve my son’s tactile defensiveness since he was a baby. I imagine the auditory sensitivities will probably be no easier. This whole thing is quite overwhelming.

Des,

I did some reading on OCD and this type of auditory sensitivity (at least with my son) seems more like SID. With OCD there’s a lot more anxiety, worry and the feeling that something terrible might occur if a particular action isn’t followed (like washing hands to avoid germs, or constantly checking the stove to make sure the house doesn’t burn down).

I spoke with an Occupational Therapist and was told Cognitive Therapy is useful for OCD, but is generally not successful, or recommended, for SID. One would use a combination of Occupational Therapy and sometimes (particularly if autism is involved) antidepressants. The reason for this is because serotonin levels effect the sensory system.

Personally, anidepressants for us would be a last resort. But at some point this may be necessary. (The other day my son spent three hours locked in a bathroom opening and closing an inside door because he was upset over his sister making chewing noises in the car. I’m not sure how long I can deal with situations like that!).

Here’s an interesting link:
http://www.angelfire.com/tn3/task/meds.html

Laura and all,

I will tell you that a friend of mine has a child on the mild end of the autism spectrum and they took him to one of the foremost autism experts at Duke University and he believes that autism is on the mood disorder spectrum and prescribes low doses of SSRI’s to these children with great success. When my friend’s child has little, he has melt-downs that looked very much like anxiety attacks. Once he was on the meds, he continued his speech therapy and occuoational therapy for the SID until he was at acceptable levels, but many of the symptoms he had were immediately alleviated. This child went on to a regular private school and has now completed 4th grade with no problems at all. He still is not overly social, but you would not know his diagnosis from looking at him. Our family doctor also takes his child to Dr. DeLong at Duke. So please don’t consider anti-depressants as a last resort. It just may be the key that allows a chidl to live a somewhat normal life. (My child is not on the spectrum, but I think he’d not be here if not for SSRI’s. I just wish we could have started him earlier.).

Janis

I can’t speak specifically about your son and I am not a doctor, but I do know that OCD is more than the more familar types of anxieties that are generally listed. I would also say that there may well be some kinds of overlaps here.

RE: autism as a mood disorder. Oh gee, this doesn’t sound like it would explain a lot of autism, even on the higher functioning levels. Just because a certain class of drug might work does not necessarily mean that— oh gee this is a drug for depression and it might work for OCD, autism, etc. that means they are mood disorders. These drugs usually have pretty wide actions so that the possible therapeutic effects as well.

For example, shingles is treated with anti-depressants and even anti-seizure drugs, does this imply that this pain is really depression or seizure related? Prob. not. Heart attack might be treated with aspirin, does that mean it is really a pain disorder?

Also note that none of these conditions is treated quite as well as depression is. I know that anorexia is treated with SSRIs but it isn’t quite as good a treatment as it is for depression, same is true for autism or OCD.

—des

I think the more intriguing theory is autism as possibly an autoimmune response. In addition, one could even consider some mood disorders being somehow connected to an immune condition (with some type of genetic kink linked in). I’m just guessing here, but I think these are all interesting possibilities to explore.

hi Laura,
Here’s a link to an article on the helpwithautism.com website. Which discusses recent research which has identified chronic inflammation, which is an autoimmune response. In people with autism.

http://www.helpwithautism.com/forums/index.php?showtopic=13

Geoff.

Thanks for sharing that!!!!!

I’ve read research about fish oil being used to treat seizures. And interestingly, I’ve been told that seizures (not necessarily grand mal, but temporal lobe staring spells and auras) are very common in kids with autism. The only difficulty with this is replicating the high levels of fish oil needed for effectiveness.

Yet, I certainly wouldn’t rule out trying EFAs! (I have a bottle in my cupboard and try to regularly give it to my son), but there are other anti-inflammatories as well like Bromelain (from pineapple — also used as a natural digestive enzyme).

By the way, here’s an interesting article. I don’t know how reliable the information is, but it theorizes that depression may orginate in the immune system (not merely a product of difficulties associated with immune diseases!).

http://virtualhometown.com/dfwcfids/research/inflamm2.htm

Here’s some other articles on herbs that have anti-inflammatory characteristics.

http://www.uspharmacist.com/index.asp?show=article&page=8_1234.htm
http://www.mskcc.org/mskcc/html/11571.cfm?recordid=641
http://www.findarticles.com/p/articles/mi_m0FDN/is_6_7/ai_96416604

Whether they can help with inflammation in the brain is another question altogether. My daughter had truly remarkable success with isatis root (and intestinal inflammation) so I’m including a link about it just in case anyone is curious. Unfortunately all of this is like grasping for straws.

Yet, I wonder, if autism is possibly set off or caused by inflammation, what role is serotonin playing? Does it have anti-inflammatory properties? I’m sure this is all much more complex. And, unfortunately I’m quite ignorant here.

One small caution about fish oils…

Be careful about how much you give at any given time as fish oil contains vitamin A, which is highly liver toxic when given in large doses.

One solution is to balance fish oil with evening primrose extract, another good source of EFA’s.

Thanks for the advice Dad!

I’ve been hesitant to use fish oil since most of the fish has mercury now and have considered switching to flax oil. What have you heard might be the best protocol for EFAs?

Laura,

Consumer Reports did an article a couple of years ago and found many major brands of fish oil safe. I feel safer with the supplements than I do the fish! The two least expensive adult products were Member’s Mark from Sam’s and Kirkland from Cotsco. Flaxseed oil is not as effective because it is not a direct source of EPA and DHA. Read this:

http://www.nordicnaturals.com/direct/whatareefas.asp

Janis

Hi Laura,
Simply buying Omega3 capsules would be the easiest solution.
Given that it avoids the mercury problem. Also avoids the potential long term overdosing of vitamin A. As well, their is no associated fish taste, which is a problem for some people.
Omega3 only contains DHA and EPA as well. Rather than ALA, which requires the body to use enzymes to convert it to DHA and EPA. Which is why it is less effective.
As with any nutritional supplement, it must be taken with a meal to be absorbed. Not between meals.
Geoff.

:D