Nelson Theodora, Liu Yi Hui, Bagot Kara S, Stein Martin T
*Division of General Academic Pediatrics and Child Development, University of California San Diego, Rady Children's Hospital, San Diego, CA; †Department of Psychiatry, University of California San Diego, Rady Children's Hospital, San Diego, CA.
J Dev Behav Pediatr. 2017 Jul/Aug;38(6):446-448. doi: 10.1097/DBP.0000000000000464.
Alex is a 13-year-old adolescent with high-functioning autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD)-combined type, anxiety, and depression. He has been resistant to engaging in therapy and treatment with various medications has been unsuccessful. Alex's parents are concerned about his anxiety, isolation, oppositional behaviors, academic underachievement, truancy, and substance use. A recent altercation with his stepfather led to a police intervention and a brief removal of Alex from the home. Alex previously used alcohol and other drugs; at present, he reports that his current drug use consists of frequently smoking pot. Alex states that he uses marijuana to relieve his anxiety and does not understand why this is problematic as marijuana is now legal in his state.Kevin is a 24-year-old adult man with diagnoses of autism spectrum disorder, mild intellectual disability, and schizoaffective disorder. He has a long history of challenging and problematic behaviors including aggression toward self and others, property destruction, inappropriate sexual behaviors, elopement, emotional outbursts, anxiety, and suicidal ideation. Past diagnoses include bipolar affective disorder, depression, and intermittent explosive disorder. Kevin is notably obese and somnolent. His current medications include 8 psychotropic medications, 3 antiallergy medications, levothyroxine, and a fish oil supplement. His father reports that medications have gradually been added and dosages increased over time. Two weeks ago, his new psychiatrist initiated a trial of medical marijuana. His father hopes that the marijuana will allow Kevin's other medications to be decreased or discontinued.Linda is an 11-year-old girl with high-functioning autism spectrum disorder, anxiety, and ADHD-inattentive subtype. Anxiety has been her most impairing condition, and Linda has been responding well to a treatment with cognitive behavioral therapy and a selective serotonin reuptake inhibitor. She is also working with her therapist on strategies to address her symptoms of ADHD. Linda has had no side effects from her medication and she and her family have been pleased with her progress. At a follow-up appointment, her mother brings an article from the lay press authored by a parent who claims that marijuana "saved" her autistic son. Linda's mother asks if marijuana should be considered for her daughter.
亚历克斯是一名13岁的青少年，患有高功能自闭症谱系障碍、注意力缺陷多动障碍（ADHD）混合型、焦虑症和抑郁症。他一直抗拒接受治疗，尝试过的各种药物治疗均未成功。亚历克斯的父母担心他的焦虑、孤僻、对立行为、学业成绩不佳、逃学和药物滥用问题。最近他与继父发生了争执，导致警方介入，亚历克斯被短暂带离家庭。亚历克斯以前使用过酒精和其他毒品；目前，他报告说自己目前的吸毒行为包括经常吸食大麻。亚历克斯表示，他使用大麻来缓解焦虑，不明白为什么这有问题，因为大麻在他所在的州现在是合法的。
凯文是一名24岁的成年男性，患有自闭症谱系障碍、轻度智力障碍和分裂情感障碍。他有长期的具有挑战性和问题性的行为史，包括对自己和他人的攻击行为、破坏财产、不当性行为、出走、情绪爆发、焦虑和自杀念头。过去的诊断包括双相情感障碍、抑郁症和间歇性爆发障碍。凯文明显肥胖且嗜睡。他目前的药物包括8种精神药物、3种抗过敏药物、左甲状腺素和一种鱼油补充剂。他的父亲报告说，随着时间的推移，药物逐渐增加，剂量也不断提高。两周前，他的新精神科医生开始试用医用大麻。他的父亲希望大麻能使凯文的其他药物减少或停用。
琳达是一名11岁的女孩，患有高功能自闭症谱系障碍和焦虑症，以及注意力不集中型ADHD。焦虑一直是她最严重的问题，琳达对认知行为疗法和选择性5-羟色胺再摄取抑制剂的治疗反应良好。她还在与治疗师合作，学习应对ADHD症状的策略。琳达服用药物没有出现副作用，她和家人对她的进展感到满意。在一次随访预约中，她的母亲带来了一篇外行媒体上一位家长撰写的文章，这位家长声称大麻“拯救”了她患自闭症的儿子。琳达的母亲询问是否应该考虑让女儿使用大麻。
