Psychotropic Medications in Children with Autism Spectrum Disorders: A Systematic Review and Synthesis for Evidence-Based Practice

Siegel, Matthew; Beaulieu, Amy

doi:10.1007/s10803-011-1399-2

Cited by 129 publications

(95 citation statements)

References 41 publications

(36 reference statements)

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“…However, given the exponential growth in the volume of ASD intervention research, we have narrowed the scope of the current review. We refer readers to McPheeters et al (2011, and Siegel and Beaulieu (2012) for systematic reviews of empirical reports on psychopharmacological treatments.…”

Section: Interventionmentioning

confidence: 99%

Evidence Base Update for Autism Spectrum Disorder

Smith

Iadarola

2015

Journal of Clinical Child & Adolescent Psychology

281

170

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This evidence base update examines the level of empirical support for interventions for children with autism spectrum disorder (ASD) younger than 5 years old. It focuses on research published since a previous review in this journal (Rogers & Vismara, 2008). We identified psychological or behavioral interventions that had been manualized and evaluated in either (a) experimental or quasi-experimental group studies or (b) systematic reviews of single-subject studies. We extracted data from all studies that met these criteria and were published after the previous review. Interventions were categorized across two dimensions. First, primary theoretical principles included applied behavior analysis (ABA), developmental social-pragmatic (DSP), or both. Second, practice elements included scope (comprehensive or focused), modality (individual intervention with the child, parent training, or classrooms), and intervention targets (e.g., spoken language or alternative and augmentative communication). We classified two interventions as well-established (individual, comprehensive ABA and teacher-implemented, focused ABA þ DSP), 3 as probably efficacious (individual, focused ABA for augmentative and alternative communication; individual, focused ABA þ DSP; and focused DSP parent training), and 5 as possibly efficacious (individual, comprehensive ABA þ DSP; comprehensive ABA classrooms; focused ABA for spoken communication; focused ABA parent training; and teacher-implemented, focused DSP). The evidence base for ASD interventions has grown substantially since 2008. An increasing number of interventions have some empirical support; others are emerging as potentially efficacious. Priorities for future research include improving outcome measures, developing interventions for understudied ASD symptoms (e.g., repetitive behaviors), pinpointing mechanisms of action in interventions, and adapting interventions for implementation with fidelity by community providers.Autism spectrum disorder (ASD) is defined by difficulties with reciprocal social communication and stereotyped interests or behaviors (American Psychiatric Association [APA], 2013) that usually emerge in early childhood. About one third of children with ASD have delays in cognitive development and daily living skills (Autism and Developmental Disabilities Monitoring Network, 2014). Co-occurring behavior problems (tantrums, aggression, self-injury, impulsivity, anxiety, extreme food selectivity, insomnia) and medical conditions (e.g., seizure disorder, gastrointestinal disturbance) are also common. Although ASD almost always persists across the lifespan, early intervention can alleviate symptoms (Rogers & Vismara, 2008).ASD has a prenatal origin related to genetic risk and environmental events; however, the precise etiology has not been determined (Volkmar, Paul, Rogers, & Pelphrey, 2014). Although once considered rare, ASD is now estimated to occur in approximately 1 in 68 individuals (Autism and Developmental Disabilities Monitoring Network, 2014). It remains unknown whethe...

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Section: Interventionmentioning

confidence: 99%

Evidence Base Update for Autism Spectrum Disorder

Smith

Iadarola

2015

Journal of Clinical Child & Adolescent Psychology

281

170

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“…Most studies of these agents have been open-label (Tables 4 and 5). 37 RCTs of these medications have included very small sample sizes. 38 …”

Section: Pathway 2: Medication Choicementioning

confidence: 99%

Clinical Practice Pathways for Evaluation and Medication Choice for Attention-Deficit/Hyperactivity Disorder Symptoms in Autism Spectrum Disorders

et al. 2012

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BACKGROUND AND OBJECTIVE: Hyperactivity, impulsivity, and inattention (referred to as "ADHD [attention-deficit/hyperactivity disorder] symptoms") occur in 41% to 78% of children with autism spectrum disorders (ASDs). These symptoms often affect quality of life, interfering with learning or interventions that target primary ASD symptoms. This practice pathway describes the guidelines for evaluation and treatment of children and adolescents with ASD and comorbid ADHD symptoms.METHODS: Current research in this area is limited, and, therefore, these recommendations are based on a systematic literature review and expert consensus in the Autism Speaks Autism Treatment Network Psychopharmacology Committee. RESULTS:The recommended practice pathway includes the Symptom Evaluation Pathway for systematic assessment of ADHD symptoms across settings; examination for comorbid sleep, medical, or psychiatric comorbidities that may contribute to symptoms; and evaluation of behavioral interventions that may ameliorate these symptoms. For children for whom medication is being considered to target the ADHD symptoms, the medication choice pathway provides guidance on the selection of the appropriate agent based on a review of available research, assessment of specific advantages and disadvantages of each agent, and dosing considerations.CONCLUSIONS: These recommendations provide a framework for primary care providers treating children who have ASD and ADHD symptoms. Our systematic review of the current evidence indicates the need for more randomized controlled trials of the medications for ADHD symptoms in ASD. There will also be a need for studies of the effectiveness of these practice pathways in the future. Pediatrics 2012;130: S125-S138

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“…Although there is strong evidence for the use of psychotropic medications in ASD-DD, 116,117,125 there are no controlled trials of these medications for acute agitation or sedation. Currently, there are no known contraindications to using common sedating medications for children with ASD-DD, although some experts believe that atypical medication responses may be more common (eg, idiosyncratic, disinhibition, or paradoxical reactions).…”

Section: Psychopharmacology and Asd-ddmentioning

confidence: 99%