Williamson and Martin from Vanderbilt University and Yale University respectively, recently summarized some practical considerations on psychtropic medications targeted for parents. This review provides an up-to-date summary of research. The review identifies three clusters of symptoms common in autism: irritability, inattention and motor hyperactivity and repetitive behavior. Here is a synopsis of their recommendations:
Irritability
- Risperidone first FDA approved drug for irritability in autism
- New England Journal published study found 57% decrease in irritability in children with autism compared to only a 14% decrease in placebo group
- Aripiprazole is a newer atypical agent with some promise
- Primary side effects of these agents are metabolic-weight gain, increased cholesterol, increased prolactin hormone levels, increased risk is type 2 diabetes
- Adding psychoeducation and parental training augments effect of risperidone on irritability outcomes
- Older typical antipsychotics may be effective--these have less metabolic side effects but higher risk for inducing movement disorders (tardive dyskinesias)
- Mood stabilizers such as lithium and valproic acid have limited evidence of effectiveness for irritability
- One small study of 25 children with autism found 40% reduction in irritability with alpha-2 agonist guanfacine
- Symptoms similar to those found in children with ADHD common in autism
- Stimulants such as methylphenidate and dextroamphetamine very effective in ADHD without autism
- Stimulants have less effectiveness for inattention and hyperactivity in children with autism
- Response rates lower in this group--may require trials of several agents before effective response seen
- Children with autism appear more likely to experience side effects with stimulants
- Alpha-2 agonists (guanfacine) commonly used for ADHD but limited research in autism populations
- Medications studied have typically been drugs that have shown some effectiveness in treating repetitive behaviors in obsessive compulsive disorder, i.e. the selective serotoning re-uptake inhibitors
- However, randomized trial of the selective serotonin re-uptake inhibitor, citalopram found no benefit over placebo
- One small study of 13 patients found improvement in repetitive behaviors with the mood stabilizer valproic acid
The authors note that parents should consider medication options only in the context of comprehensive treatment programs with a physician who has expertise in pediatric psychopharmacology. Currently available medications are not a cure, but may substantially improve some target symptoms. Side effects can be serious and require careful consideration of the risk-benefit profile and careful medical monitoring.
Our understanding of autism has evolved from a disorder once incorrectly considered a result of disordered parenting to a genetic disorder of neurodevelopment. I agree with the authors closing statement: "Well-informed, engaged and proactive parents will continue to play a pivotal role in the treatment of their own children, and as the past two decades have shown, through their advocacy and involvement, help in the care of all children with autism spectrum disorders."
3 D Model of Risperidone Courtesy of Wikepedia Commons file authored by Ben Webber
Additional Recommended Resources for Parents with a Child with Autism
- American Academy of Pediatrics Autism Information
- American Academy of Child and Adolescent Psychiatry Autism Resource Center
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