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Excerpts from Autism Speaks Canada website:
Medicines for treating autism are most effective when used in conjunction with behavioral therapies. Ideally, medicines are a complement to other treatment strategies…
Medicines for treating the three core symptoms of autism – communication difficulties, social challenges and repetitive behavior – have long represented a huge area of unmet need. Unfortunately, few drugs on the market today effectively relieve these symptoms and none of the options most often prescribed by practitioners work well for every individual.
In fact, while the Food and Drug Administration (FDA) has approved two drugs for treating irritability associated with the autism (risperidone and aripiprazole), it has yet to approve a medicine for treating autism’s three core characteristics. Nonetheless, medicines such as risperidone and aripiprazole can be beneficial… [note: there is no proven benefit to takers – SSRI Stories Ed]
The good news is that the range of medication options may soon change, thanks to recent advances in our understanding of the biology that produces autism’s core symptoms. This has made it possible for researchers to begin testing compounds that may help normalize crucial brain functions involved in autism. Early experiments suggest that several compounds with different mechanisms of action have great potential for clinical use, and many are now in clinical trials.
Although these developments are exciting and hold real promise for bettering the lives of people with autism, we will have to wait at least a few more years before we know if any of these drug studies produce enough information on safety and effectiveness to merit FDA approval for the treatment of core symptoms.
Today, most medicines prescribed to ease autism’s disabling symptoms are used “off label,” meaning that their FDA approval is for other, sometimes-related conditions such as attention deficit hyperactivity disorder (ADHD), sleep disturbances or depression. Such off-label use is common in virtually all areas of medicine and is usually done to relieve significant suffering in the absence of sufficiently large and targeted studies.
An example in autism would be the class of medicines known as selective serotonin re-uptake inhibitors (SSRIs), including fluoxetine. Several of these medicines are FDA-approved for the treatment of anxiety disorders and depression, in children as well as adults. Although large clinical trials have yet to demonstrate their effectiveness, parents and clinicians have found that they can ease social difficulties among some people with autism. However, it has proven to be difficult to predict which medicines in this class may produce the greatest benefit for a given patient with autism. Similarly, it can be challenging to determine the best dose.
Because using these medications in children and adolescents can be a difficult decision for parents, you may find it helpful to use our Medication Decision Tool Kit, a guide for actively working with a physician to find the approach that fits best with your values and goals. You can download it free here.
These are exciting times in the development of new medicines for relieving autism’s most disabling symptoms, and Autism Speaks is increasing its funding and focus in this promising area, while placing great emphasis on ensuring the safety of promising new medicines.
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Asperger syndrome has been associated with autism spectrum disorder, a complex neuro-biological disorder that affects the ability to verbalize thoughts, manage anxiety, cope with changes to routine and participate in unstructured social situations. Symptoms also include repetitive behaviours and fixations.
But violent behaviour is not typically associated with the disorder, said Margaret Spoelstra executive director of Autism Ontario.
“Autism and mental health (problems) are not synonymous. Autism is a neuro-biological disorder. But it is not about violence,” she said Tuesday. “Autism is not the reason someone gets behind the wheel of a van and plows through a crowd of people.”
Alek Minassian, 25, of Richmond Hill, is alleged to have been behind the wheel of a white rental van that struck pedestrians at Yonge St. and Finch Ave. He is facing charges in the deaths of 10 people, and attempted murder charges for 13 others who were injured.
In 2009, the Richmond Hill Liberal quoted Minassian’s mother Sona in a story about the loss of Helpmate, a local social service organization that helped her son, who she said has Asperger syndrome. The story did not name the son.
A 25-year-old who plowed a van into a crowded Toronto sidewalk was ordered held Tuesday on 10 counts of murder 13 of attempted murder. (The Associated Press)
However, Minassian’s classmates at Sixteenth Ave. Public School, Thornlea Secondary School and Seneca College, described him as socially awkward, someone who kept to himself and who would frequently fidget or twitch. He was also a computer whiz.
Asperger syndrome was dropped from the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) in 2013. Any previous subcategories of autism, such as Asperger’s, are now defined as autism spectrum disorder or ASD.
“Obviously, this is such a tragedy at every level. I cannot even begin to imagine these families going through such an awful time realizing their loved ones are gone,” Spoelstra said in an interview.
“Then, of course, I think of this young man and his family and what sounds like . . . a very complex-needs young man who was, indeed, participating in society,” she added, referring to Minassian’s years as a student at Seneca College
Spoestra said she does not know Minassian or any of the challenges he may have been facing.
“But what we can say is that diagnostic criteria for autism does not include violent behaviour,” she said.
“Clearly something was happening for this young man that was disturbing him in a serious way,” she said. “What that was, is not known or understood at this point. We feel the same sense of shock and would never make an assumption that someone with autism would do this. So the reasons for this are something else.”
Mark Mendelson, a former lead detective with the Toronto Police homicide squad, said it is too early to speculate about motive. But a key part of the investigation in the coming days will be a forensic analysis of online activity, examining the websites he visited and posts he made online.
Minassian’s mental health will be an important factor going forward, he said, predicting that the accused killer may attempt to claim to be not criminally responsible in the deaths — a legal defence known as NCR.
“If you look at it for what it is, it would not surprise me if an NCR defence is on the minds of any lawyer he is going to get,” Mendelson said.
The Canadian Mental Health Association has also urged people against connecting mental illness with violence, noting that those who suffer from mental health challenges are far more likely to self-harm or be a victim of violence than to be violent themselves.
With files from Wendy Gillis
Man who used van to kill pedestrians in Toronto found guilty on all counts — (The Glone and Mail)
MOLLY HAYES CRIME AND JUSTICE
PUBLISHED MARCH 3, 2021
Survivors along with family and friends of survivors and victims share a moment outside the courthouse in Toronto on March 3, 2021.
NATHAN DENETTE/THE CANADIAN PRESS
Nearly three years after he deliberately ran down pedestrians on Toronto’s busy Yonge Street, killing 10 people and injuring many others, a 28-year-old man has been convicted of carrying out the deadliest mass killing in the city’s history.
After a seven-week trial held virtually last fall as a result of the COVID-19 pandemic, a judge on Wednesday found Alek Minassian guilty on 10 charges of first-degree murder and 16 of attempted murder.
As she delivered her ruling, Superior Court Justice Anne Molloy said that she would avoid using the killer’s name, referring to him instead as “John Doe.”
Notoriety, she stressed, “is exactly what this man sought.”
Toronto van attack decision opens door for future verdict of not criminally responsible due to autism
She took a moment to read the names of each victim, carefully noting the lives lost and the catastrophic injuries suffered on April 23, 2018, in the attack, which he admitted planning and carrying out.
His defence, as argued by lawyer Boris Bytensky, was that his autism spectrum disorder (ASD) made him unable to understand on a rational level that what he was doing was wrong. As a result, he said, his client should be found not criminally responsible (NCR).
The not criminally responsible defence has traditionally applied to people with psychosis.
In her ruling, Justice Molloy concluded that the choice to carry out the attack was conscious and deliberate.
“He knew death was irreversible. He knew their families would grieve. At various times, during his assessments by various experts, he described his actions as being ‘devastating,’ ‘despicable,’ ‘shocking,’ ‘morally terrible,’ ‘a horrible thing’ and ‘irredeemable,’” she said of the killer. “He knew it was morally wrong by society’s standards, and contrary to everything he’d been taught about right and wrong. He then made a choice. He chose to commit the crimes anyway, because it was what he really wanted to do.”
Thousands of people tuned in to watch the verdict online – a reminder of how deeply the attack affected the city. The mayor and police chief issued statements afterward, expressing solidarity with the victims and their families.
The case was also high-profile because of the attempt to use autism as a defence, which drew ire from the autism community.
Mr. Bytensky stressed throughout the trial that the defence did not represent a generalized claim about people with ASD, who are more likely to be victims of violence than perpetrators. Justice Molloy, too, emphasized during the proceedings that autism itself was not on trial.
The defence relied heavily on the testimony of Alexander Westphal, a Yale University professor with expertise in ASD. In her ruling, Justice Molloy rejected much of his findings, calling them selective. She said that he at times “appeared to be more of an advocate than an objective expert witness.”
She said she was convinced ASD could qualify as a “mental disorder” eligible for a defence of not criminally responsible under the Criminal Code, but added that this does not “say anything at all about any connection between ASD and criminality,” and stressed that every case is different. This case, she found, did not meet the requirements for an NCR defence.
The van attack case also highlighted the dangers of misogyny and online radicalization after it was revealed that the assailant had been reading and fantasizing about mass murders since high school. The court heard the killer took particular interest in the incel (short for involuntarily celibate) subculture, an internet-based network of misogynistic men who blame women for their inability to have sexual relationships.
Minutes before the attack, he posted a message to Facebook that made specific reference to a U.S. mass killer who brought “incels” into the public eye by killing six people and then himself in Santa Barbara, Calif., in May, 2014.
And though Mr. Minassian gave differing explanations of his motive after the attack, he told psychiatrists he felt “happy” with how it went, and that he wished there were more female victims.
The court was told that on the morning of April 23, 2018, the killer asked his father for a ride to Woodbridge, where he said he planned to meet a friend for coffee at a bookstore. After his dad pulled away, he walked four kilometres to a Ryder rental car outlet to pick up a cargo van he’d booked three weeks earlier.
According to an agreed statement of fact, he drove southeast toward Toronto, reaching Yonge Street at Finch Avenue West just before 1:30 p.m. As he watched clusters of pedestrians crossing the road there, he decided this was where his “mission” would begin.
He accelerated into the crowd. For 2.57 kilometres, he weaved on and off the sidewalk, plowing into and over people, and stopping only after a drink held by his final victim splashed on his windshield, obstructing his view.
On a side street, Poyntz Avenue, Toronto Police Constable Ken Lam yelled at him to get down. He used his wallet to intimate having a gun, saying later that he had hoped the officer would shoot him. When that didn’t happen, he surrendered and was arrested.
In a matter of minutes, he’d killed 10 people: Ji Hun Kim, 22; So He Chung, 22; Geraldine Brady, 83; Chul Min (Eddie) Kang, 45; Betty Forsyth, 94; Munir Abdo Habib Najjar, 85; Anne Marie D’Amico, 30; Beutis Renuka Amarasingha, 45; Dorothy Sewell, 80; and Andrea Bradden, 33. Sixteen others were seriously injured.
In her ruling on Wednesday, Justice Molloy said she also wished to “acknowledge the true heroes of that day.”
Among the many first responders and the people who comforted those who lay injured and dying, she also thanked “those individuals who chased after the van in an attempt to stop it, shouted out warnings to others who might otherwise have become victims and particularly those who, without regard to their own safety, attempted to reach through the open window of the moving van and wrest control away from Mr. Doe.”
The case will return to court on March 18 to schedule sentencing proceedings.
Mr. Bytensky said he had not yet discussed any plans to appeal with his client. Both he and prosecutor Joseph Callaghan expressed gratitude to Justice Malloy for her careful and respectful analysis.
“Based on all the evidence in this case, this was the fair and just result,” Mr. Callaghan said at the courthouse, where some victims and family members had gathered to watch the verdict.
Cathy Riddell, one of the survivors, said she felt “relieved and grateful” her attacker was found guilty.
She was in hospital for months after the attack, and had no memory of what happened. She learned details after the agreed statement of facts was entered into evidence at the beginning of the trial.
“Since that day, it has been very hard to absorb. It’s like I’m going through trauma now that I didn’t go through before,” she said. But with the trial over and a guilty verdict entered, she said she “probably will sleep tonight, for the first time in a while.”
“It’s not closure,” she said. “And it’s not like I’m happy – I don’t feel like dancing. But I feel like justice has been done.”