Are medications effective in Autism? Current Opi Psy.March.2015

04.02.2015

Autistic spectrum Disorders (ASD) affect 1% of population.Along with the core difficulties (defective reciprocal communication & repetitive behaviour), they also suffer from anxiety, aggression, self injury , mood symptoms etc. Generally, these individuals do not respond favourably to antipsychotics. They tend to experience more side effects than others. Despite these , a good proportion are treated with antipsychotics.

Na Young Jia,and Robert L. Findling review the recent evidence for medications in ASD.

Risperidone  and aripiprazole are approved by FDA for problematic irritability in ASD.They could reduce stereotypy and hyperactivity.Use is recommended to be reserved for severe problems only. Antipsychotics do not have any effect on communication defects. Olanzapine can also improve behavours but risk of metabolic effects are more than the other two medications.

Stimulants: Atomexetine  may offer benefits when ADHD symptoms dominate ASD.It may take longer time for benefits of atomexetine to be seen. Methyl phenidate has also been tried in trials- response rates are generally lower than in ADHD.

Antidepressants: There is no evidence to support SSRI use in ASD. In fact evidence of harm is present.

Antiepiletics: no evidence to suppport use in ASD.

Others: Medications acting on GABA, glutamate, cholenrgic systems- so far no good news. Oxytocin has attracted lot of interest and several trials on ongoing. However two recent trails in children reported no improvement in emotional  cognition or social behaviours .

Conclusion: No medication is shown to be effective in treating the core symptoms of ASD. Nonpharmacologic options such as modifications in the setting and behavioral interventions may improve target symptoms. Severe problematic irritability can be treated with either risperidone or aripiprazole.

summary of the article

An update on pharmacotherapy for autism spectrum disorder in children and adolescents.

Young N Ji, Findling RL.Curr Opin Psychiatry. 2015 Mar;28(2):91-101.

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