аЯрЁБс>ўџ 02ўџџџ/џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС7 №ПЊbjbjUU ",7|7|ЊџџџџџџlЈЈЈЈЈЈЈМ>>>> JМ-ЖjjjjjjjjЌЎЎЎЎЎЎ$у JвЈjjjjjвjЈЈjjчjjjjЈjЈjЌjjЌjBjЌЈЈЌj^ `NВбюСМ‚>jЌЌ§0-ЌMjMЌjММЈЈЈЈйRichard Mills Director of Services NAS Church House Church Road Filton Bristol BS34 7BD David N Andrews APANA, etc Dear Mr Andrews, The Chief Executive has asked that I respond to your recent letter. On examination of my files I discovered that I did draft a response to a letter from Mrs Kehala in November 2000. I am afraid that I am at a loss as to what subsequently happened to that draft and can only apologise for the delay in response. I am happy to reproduce the content of that draft here and on reviewing it conclude that what I said then still pertains although we have recently been made aware of further concerns around the use of Melleril and Chlorpromazine that I am following up with a colleague. The main approach the NAS takes to the management of autism spectrum disorders is that of the SPELL framework, an ecological means of understanding and responding to autism which places the individual at the centre of all processes. It is essentially about assisting the individual by reducing the disabling effects of the condition. We would contend that autism per se may not be amenable to treatment with particular pharmacological agents but there may be other associated conditions, for example seizure disorders, depression or anxiety states that are. It is the major tranquillisers, particularly the phenothiazines that are most problematic in that they are the drugs most frequently misused to control those behaviours that may best addressed by environmental, cognitive or other behavioural approaches. Of course, many people with autism reside within settings with low levels of understanding of specialised practice in autism or there may be acute health or safety emergencies in which the only practical short-term alternative to serious restriction of liberty has been the use of the major tranquillisers. 1t is also the case that some people with autism themselves tell us that they can only cope with overwhelming obsessive/ compulsive behaviours, panic or anxiety attacks with that aid of antidepressant / tranquillising medication, particularly the more modern SSRI drugs. We do of course share the concern around the indiscriminate use of the major tranquillisers in autism where there is little clinical rationale for so doing and where the long-term effects point to serious detrimental physical effects, including irreversible neurological damage. The problem is particularly serious in the case of younger children. We understand that the newer atypical neuroleptic drugs developed since the mid 1990s may have fewer adverse side effects than earlier versions but even then we have a concern that many health professionals in the UK will not have appropriate awareness of the specific needs of people with autism spectrum disorders and may be prescribing inappropriate medication. The NAS raised this in its report ”Ignored or ineligible? The reality for adults with autism spectrum disorders”. This called for [inter alia]; ў A national strategy of training to be developed for all primary care practitioners, health visitors and mental health professionals in identifying autism spectrum conditions. ў Psychiatrists working with adults in particular to be targeted for training to expand their expertise in developmental disorders. This will avoid the treatment of people with autism and Asperger syndrome for acquired conditions such as mental health problems without reference to their underlying diagnosis. Similarly, we raised the key areas of concern of psychopharmacology, the absence of review of treatments and inexperience in recognition of side effects in people with autism with the Department of Health in our response to the consultation on a new Mental Health Act. The proposal of a natural health clinic with a rehabilitation centre could prove a welcome step forward for many families with individuals affected by autism. We wish you well in your efforts to secure funding for this. 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