Understanding Medications for Autism Spectrum Disorders
Many children with an autism spectrum disorder (ASD) can benefit from medications, but unfortunately there is a very poor understanding of overall medication use for these kids, says Paul T. Shattuck PhD, an assistant professor with the Brown School at Washington University.
As of now, there are not any drugs that will help with the core symptoms of autism, including social withdrawal. Medications are often used to treat behavioral problems, such as aggression, self-injuring behaviors, and severe tantrums that keep them from functioning more effectively at school or home.
Most often, the medications have been officially approved by the US FDA for another disorder, but are prescribed for children with autism “off-label.” Children with co-morbid conditions, such as anxiety or depression, epilepsy, or ADHD are prescribed additional medications to treat those symptoms.
The first medication approved for behaviors in children and adolescents with autism was Risperdal (risperidone) in October of 2006. This drug treats irritability, aggression, sudden mood changes, and self-injurious behaviors. The drug is also approved for use in schizophrenia and bipolar disorder. Risperidone is an antipsychotic which works by changing the activity of certain natural brain chemicals. Side effects of the drug include drowsiness, dizziness, nausea, constipation, increased appetite and weight gain, difficulty falling or staying asleep, or (unfortunately) agitation.
What Risperdal cannot do, however, is improve conversational ability or social skills in autistic children, nor does it appear to reduce other behavioral traits common in autism such as obsessive behavior. Drugs such as Prozac (fluoxetine) or Zoloft (sertraline) may be prescribed for obsessive-compulsive disorders.
Other antipsychotics, such as Zyprexa (olanzapine) may also be prescribed for the treatment of aggression; however these are not specifically approved for children with autism.
Anxiety and Depression
Selective serotonin reuptake inhibitors (SSRIs) are most often prescribed for symptoms of anxiety and depression. In children, the approved drugs include Prozac (fluoxetine), Luvox (fluvoxamine), and Zoloft (sertraline). Parents should note that there is an increased risk of suicidal thoughts or behavior (suicidality) in children and adolescents treated with SSRI antidepressants. But recently, studies have shown that more often than not, the benefits of these drugs outweigh the risks to children with major depression and anxiety disorders.
For example, one study found that 60% of patients with autism became less distraught and aggressive when on Prozac (fluoxetine). They were also calmer and better able to handle changes in their routine or environment.
For more information, an excellent resource is the National Institute of Mental Health’s “Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers.”
Epileptic seizures are common among children with autism, occurring in one in four. Seizures are treated with anticonvulsant medications such as Tegretol (carbamazepine), Lamictal (lamotrigine), Topamax (topiramate), and Depakote (valproic acid). Keep in mind, though, that anticonvulsant medications usually reduce the number of seizures that occur, but cannot always eliminate them.
Inattention and Hyperactivity
Stimulant medications such as Ritalin (methylphenidate) are also sometimes prescribed for children with autism who have impulsivity or hyperactivity. One study from the University of Arizona College of Medicine found that 50% of children on Ritalin responded positively. These are most effective when given to higher-functioning autistic children who do not have seizures or other neurological problems.
Side effects include nervousness and restlessness, difficulty falling or staying asleep, loss of appetite and gastrointestinal problems such as nausea or diarrhea.
Parents should keep in mind that a child with autism may not respond in the same way to medications as typically developing children. It is important to work with a doctor who has experience with children with an ASD and they should be monitored closely.
Professionally, Dr. Shattuck says that there needs to be a clearer guide for treating children with autism spectrum disorders due to the complexity of this pharmacologic regimen. Most often, there is a “trial and error” type of approach. “Additional studies examining the treatment of core and associated ASD symptoms are needed to guide the treatment of these kids,” he says.
National Institute of Mental Health
National Library of Medicine, National Institute of Health
“Prevalence and Correlates of Psychotropic Medication Use in Adolescents with an Autism Spectrum Disorder with and without Caregiver-Reported Attention-Deficit/Hyperactivity Disorder,” is published in the current issue of the Journal of Child and Adolescent Psychopharmacology.