Psychopharmacological interventions in autism spectrum disorder

ABSTRACT

Introduction: Individuals with autism spectrum disorder (ASD) commonly present for treatment of emotional and behavioral disturbances associated with ASD’s “core” symptoms. Psychotropic medications are widely utilized in alleviating associated emotional and behavioral symptoms.

Areas covered: Emotional and behavioral disturbances associated with ASD include irritability/severely disruptive behavior, which comprises the heaviest symptom burden; hyperactivity and other Attention-Deficit-Hyperactivity-Disorder (ADHD)-type symptoms; repetitive/stereotyped behaviors; and social withdrawal. Existing evidence for medications for each of these symptom clusters will be examined in this review.

Expert opinion: Psychopharmacological treatment of core and associated symptoms in ASD is challenging, in large part because of the heterogeneity in the presentation of ASD. Furthermore, children and adolescents with ASD are more vulnerable to the side effects of psychopharmacological intervention than their age-matched, typically developing counterparts. Currently, risperidone and aripiprazole are the only medications that have been (relatively) reliably shown to help treat certain symptom clusters associated with ASD, namely severely disruptive behavior and hyperactivity. Recent studies have begun to look at medications with mechanisms that are novel in the treatment of ASD and that may address underlying pathophysiology and/or core symptoms such as glutamate-modulating agents. Overall, randomized, placebo-controlled studies of medications for the treatment of ASD are scarce.

KEYWORDS:

• Antidepressants
• atypical antipsychotics
• autism
• autism spectrum disorder
• mood stabilizers
• oxytocin
• pervasive developmental disorders
• psychopharmacology
• stimulants

Article highlights

• Currently, risperidone and aripiprazole are the only medications that have been reliably shown to help treat certain symptom clusters associated with autism spectrum disorder (ASD), namely irritability/severely disruptive behavior and hyperactivity.

• For the treatment of repetitive/stereotyped behaviors, selective serotonin reuptake inhibitors demonstrate less efficacy and are less well tolerated in children with ASD than in adults with ASD.

• For the treatment of social withdrawal and core deficits in ASD, oxytocin and glutamate-modulating agents show some potential efficacy but more randomized controlled trials are needed.

• To improve treatment for ASD in the long term, it will be potentially important to focus studies on more homogeneous sub-populations in ASD in order to uncover the heterogeneous neurobiological entities that likely underlie ASD.

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Acknowledgments

The authors wish to acknowledge Isobel Green for her assistance with this paper.

Declaration of interest

C Henry has acted as a consultant for Beacon Health Strategies. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.