Psychopharmacology of autism spectrum disorders: A selective review

Abstract

While there is no cure for autism spectrum disorder, psychopharmacologic agents are often used with behavioral and educational approaches to treat its comorbid symptoms of hyperactivity, irritability, and aggression. Studies suggest that at least 50% of persons with autism spectrum disorder receive psychotropic medications during their life span. This selective review examines recent studies about the use of psychotropic medications in persons with autism spectrum disorder. The aim was to focus on randomized controlled trials conducted from 1990 to 2010 on this topic. A comprehensive literature search was performed using PubMed and Cochrane databases. Out of 105 studies identified for the review, only 24 were randomized controlled trials. Thus, despite the common use of these medications in autism spectrum disorder, more controlled studies are needed to determine their long-term efficacy and safety.

Safety and Efficacy of Memantine in Children with Autism: Randomized, Placebo-Controlled Study and Open-Label Extension

“…In children with ASD, risperidone and aripiprazole can be used to treat the associated symptoms of irritability, aggression, self-injury, temper tantrums, and mood swings (McCracken et al 2002; Curran 2011). However, no medications are currently approved for treating the core domains of ASD (impaired social communication and interaction, and stereotyped behaviors and restricted interests), which represents a challenging unmet medical need (Mohiuddin and Ghaziuddin 2013; Rossi et al 2013; Yudell, et al 2013). …”

Psychotropic Medication Use and Polypharmacy in Children With Autism Spectrum Disorders

“…Although we did not correlate the use of a particular class of medication with the diagnosis for which it was given, it is likely that some of the commonly used medications such as ADD medications are prescribed for symptoms fitting a diagnosis of ADD. The appropriate reasons and indications for antipsychotic medications and antidepressants, however, are less clearly defined; these medications could have been given for a wide variety of symptoms among children with ASD, 13 without proven benefit or safety. 22 Although older age was significantly associated with both psychotropic use and polypharmacy, consistent with the literature, 7,11,12 polypharmacy was still significant among the younger age groups (33% of children aged 2-10 years and 10% of 0-to 1-year-olds) for whom safety concerns are increased and evidence of benefit even more sparse.…”

“…[6][7][8][9][10][11][12] General concerns about these medications include the lack of evidence documenting the safety or effectiveness of psychotropic treatment during childhood, when developing brains and bodies may be particularly vulnerable to environmental or biological influences. 7,8,13 For ASD treatment in particular, the only US Food and Drug Administration-approved medications are risperidone and aripiprazole (indicated for the treatment of irritability [including symptoms of aggression] in 2006 and 2009, respectively). However, physicians often prescribe nonindicated medications to children in an "off-label," trial-and-error fashion to help manage troublesome symptoms in patients, especially if other treatments are not available or accessable.…”

Annual Research Review: Threats to the validity of child psychiatry and psychology

“…A fourth example would be the lack of response of core symptoms of autism to medication (see McCracken, 2011;Mohiuddin & Ghaziuddin, 2013). Although the same may apply to eating disorders, it is unusual among multifactorial mental disorders.…”