Psychotropic medication prescribing in people with autism spectrum disorders with and without psychiatric comorbidity

Abstract

SUMMARY Autism spectrum disorders (ASDs) are a group of lifelong neurodevelopmental disorders characterised by difficulties in social interactions and social communication, and restricted and repetitive behaviours. Relative to the general population, individuals with ASDs are likely to be overrepresented in secure psychiatric care and custodial settings. Outcomes vary and can be problematic in the context of co-occurring intellectual disability, psychiatric disorder and challenging behaviours. To date, there is little in the way of specialised clinical guidance on the prescription of psychotropic medicines for individuals with ASDs, particularly information on any differences in efficacy and/or tolerability of specific medications. This review summarises the key research to date on the prescription of psychotropic medication in ASD with and without comorbid psychiatric or neurodevelopmental disorders, within the context of the existing clinical guidance. Some critical analysis is provided to aid clinicians in following a safe, effective and individualised approach to prescribing for people with ASDs.

Current Status of Psychopharmacological, Neuromodulation, and Oxytocin Treatments for Autism: Implications for Clinical Practice

“…Vorstman et al (2017) and Chawner et al (2021) argued that incapacity to address autism impairment arises from the fact that current medications were not developed concurrently with an explicitly stated a priori autism-related molecular target. Because behavioural intervention and psychosocial therapy modalities continue to form the foundation for systematically addressing core features of ASD (Carthy et al, 2023), the principal role for psychotropic medications is to act as an adjunctive treatment option aimed at managing "high frequency-high intensity" behavioural challenges and comorbid conditions (Feroe et al, 2021;Siafis et al, 2022).…”

Rhyme or reason in therapeutics

“…The increasing number of in-patients having ‘autism spectrum disorder’ as part of their diagnosis makes the review of treatment by Carthy et al (2023) very timely. Written from the perspective of a high-security hospital, it discusses current classifications and highlights the wider range of indications for risperidone and aripiprazole by the US Food and Drug Administration (FDA) under the label of pervasive developmental disorders.…”

Exploratory focused pharmacogenetic testing reveals novel markers associated with risperidone pharmacokinetics in Saudi children with autism

“…According to recent updates, the medications commonly used to address the comorbidities associated with ASD are atypical antipsychotics, which are frequently employed on a chronic basis according to standard dosing guidelines, which might not fit all etiological subtypes ( Aishworiya et al, 2022 ; Ooi et al, 2023 ). Additionally, off-label antipsychotic use is still an ongoing clinical practice, despite the lack of evidence for its safety and tolerability ( Højlund et al, 2021 ; Wang et al, 2021 ; Carthy et al, 2023 ). This practice was thought to be justified given the shortage of approved clinical cures and was even found to be motivated by advancements in diagnostic and clinician recognition of disparity in ASD and cooccurring mental health issues ( Gupta and Gupta, 2023 ).…”