What is the research about?

The core symptoms of Autism Spectrum Disorder (ASD) are social communication deficits and restricted interests and repetitive behaviours, which are often accompanied by irritability, inattention, anxiety, and hyperactivity. Currently, no medications are approved for treatment of the core symptoms and only 2 drugs are approved by the United States FDA for treatment of irritability associated with ASD. This review of several studies serves as a summary and update regarding medication management for behavioural disorders in ASD.


What did the researchers do?

The researchers reviewed several studies looking at the use and efficacy for a variety of medications for treatment of different symptoms in ASD, including: antipsychotic agents to treat irritability, antidepressant agents to treat agitation/irritability, adrenergic agents to help regulate the body's reaction to stress and reduce hyperactivity and irritability/aggression, and novel agents to treat the disruptive behaviours or core symptoms.


What did the researchers find?

Antipsychotic agents It is suggested that these medications should be considered only when behavioural interventions have been tried and have failed. Guidelines for their use are not clear. Frequent monitoring is important.

Antidepressant agents. Use of these drugs is not recommended to treat repetitive behaviours. There have not been any studies examining their use for treating anxiety and depression in children with ASD. Use should be made on a case by case basis, consulting with a specialist.

ADHD Medications The use of ADHD medications in children with ASD is on the rise, so guidelines for their have been put forward by the Autism Treatment Network. Regular monitoring of overall health is recommended.

Anticonvulsants There is little evidence to date to support the use of anticonvulsants as treatment for behavioural disorders in ASD.

Adrenergic agents Limited evidence supporting the use of these medications in ASD exists; however, given the fact that they are generally well tolerated and have limited side effects, their use may be considered for ADHD symptoms.

Novel agents Many novel agents are under investigation as possible treatments for the core symptoms and associated behaviours of ASD. An example is the dozen studies currently examining the use of oxytocin in ASD, with early work gaining significant interest.


Take home message

The past 3 years have not produced any further medications approved for the treatment of the symptoms associated with ASD. Large trials for new medications (e.g. Oxytocin) are under way, with the promising results expected in the near future. Changes to the DSM 5 allow children to receive a diagnosis for ADHD along with ASD, permitting easier treatment of certain symptoms of ASD. Thanks to data being published, clinicians are now able to make more informed choice regarding medication treatment, however much more research in this field is needed.


Notes

The original Research Review was written by D.A. Baribeau and E. Anagnostou and was published in Current Psychiatry Reports in 2014.