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A Review of Pharmacotherapy for Autism Treatment

A Review of Pharmacotherapy for Autism Treatment

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A Review of Pharmacotherapy for Autism Treatment

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  1. A Review of Pharmacotherapy for Autism Treatment by: Bridget Spanarkel

  2. Sources • Books • Hollander, E. (2003). Autism Spectrum Disorders. New York, NY: Marcel Dekker, Inc. • Jacobson, J.W., Foxx, R.M., & Mulick, J.A. (2005). Controversial therapies for developmental disabilities: Fad, fashion, and science in professional practice. New York, NY: Routledge. • Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc. • Websites • United States Food and Drug Administration • Google

  3. Sources • PsycINFO • Search: • Subject field: “autis*” • Any field: “pharmacotherapy”, “medication”, “psychotropic”, “antipsychotic”, “antidepressant” psychopharmacological”, and/or “drugs” • Search: • Subject field: “autis*” • Any field: “pharmacotherapy”, “medication” and/or “applied behavior analysis”, “behavior therapy” • 22 results • 5 articles using applied behavior analysis alone • 3 articles using pharmacotherapy alone • 4 reviews of autism in general • 3 articles recommending multidimensional treatment plans • 3 articles including both ABA and pharmacotherapy • 4 other

  4. What is Pharmacotherapy? • Definition: the use of medications or drug therapy for the purpose of preventing and/or treating a disease, disorder, or illness • Also known as: Pharmacologic Treatment, Psychopharmacology, Psychopharmacological Management, Medical Intervention, and Drug Therapy Antonacci, D.J., Manuel, C., & Davis, E. (2008). Diagnosis and treatment of aggression in individuals with developmental disabilities. Psychiatric Quarterly, 79, 225-247.

  5. Statistics • Approximately 56% of children with ASD are prescribed at least one psychoactive medication per year, and 20% of those children use three or more concurrent psychoactive medications (national Medicaid data in 2001) • Approximately 70% of children diagnosed with ASD between the ages of 8-21 years receive at least one psychoactive medication annually (national insurance company data in 2002) Antonacci, D.J., Manuel, C., & Davis, E. (2008). Diagnosis and treatment of aggression in individuals with developmental disabilities. Psychiatric Quarterly, 79, 225-247. Self, T.L., Hale, L.S., & Crumrine, D. (2010). Pharmacotherapy and children with autism spectrum disorder: A tutorial for speech-language pathologists. Language, Speech, and Hearing Services in Schools, 41, 367-375.

  6. History of Pharmacotherapy • 1954: first psychotropic medication was introduced • Thorazine (antipsychotic) • 1960 - 1970s: several studies published using antipsychotic medications for autism Matson, J.L. & Dempsey, T. (2008). Autism spectrum disorders: Pharmacotherapy for challenging behaviors. Journal of Developmental and Physical Disabilities, 20, 175-191. Posey, D.J., Stigler, K.A., Erickson, C.A., & McDougle, C.J. (2008). Antipsychotics in the treatment of autism. The Journal of Clinical Investigation, 118, 6-14. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  7. History of Pharmacotherapy • Food and Drug Administration (FDA): “Off-label” • Central nervous system stimulants, antipsychotics, anticonvulsant mood stabilizers, selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, and more • 2006: first drug FDA approved specifically for autism • Risperidone (Risperdal) – antipsychotic medication to treat irritability associated with autistic disorder, including symptoms of aggression, self-injury, tempter tantrums, and quick changes in mood in adolescents aged 5 to 16 years old. United States Food and Drug Administration (n.d.) FDA approves risperdal for treatment of irritability associated with autistic disorder. Retrieved from http://www.fda.gov/Drugs/ScienceResearch/ResearchAreas/Pharmacogenetics/ucm237637.html. Self, T.L., Hale, L.S., & Crumrine, D. (2010). Pharmacotherapy and children with autism spectrum disorder: A tutorial for speech-language pathologists. Language, Speech, and Hearing Services in Schools, 41, 367-375. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  8. Comorbidity • Comorbidity: being diagnosed with more than one disorder at a time • Differences in opinion worldwide about comorbidity and autism • For example, should a child with autism also be diagnosed with an anxiety disorder, or is anxiety simply an associated symptom/behavior of the autism diagnosis? • Specific medications have been developed to target symptoms of major depression, ADHD, bipolar disorder, and anxiety conditions, all of which may occur in persons with autism. • Great area for future research! Matson, J.L. & Dempsey, T. (2008). Autism spectrum disorders: Pharmacotherapy for challenging behaviors. Journal of Developmental and Physical Disabilities, 20, 175-191. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  9. Core Deficits and Associated Behaviors of Autism West, L., Waldrop, J., & Brunssen, S. (2009). Pharmacologic treatment for the core deficits and associated symptoms of autism in children. Journal of Pediatric Health Care, 23, 75-89.

  10. Discussion Questions • Do you feel psychotropic medications such as antipsychotics should be prescribed “off-label” to children and adults with autism? Is this ethical? • What are your thoughts on comorbidity in individuals with autism? Should symptoms such as impulsiveness, anxiety, irritability, and mood changes be considered separate disorders or be considered associated behaviors of the autism diagnosis?

  11. Types of Medication • Antipsychotics (Typical and Atypical) • Stimulants • Antidepressants & Selective Serotonin Reuptake Inhibitors (SSRIs) • Mood Stabilizers & Anticonvulsants • Anti-anxiety and Benzodiazepines • Sleep Medications

  12. Antipsychotics • Also known as: major tranquilizers • Some of the first psychiatric medications developed • Typical (first-generation or conventional) and Atypical (second-generation) • Block the effects of dopamine neurotransmitters in the brain Findling, R.L. (2005). Pharmacologic treatment of behavioral symptoms in autism and pervasive developmental disorders. Journal of Clinical Psychiatry, 66, 26-31. Hollander, E. (2003). Autism Spectrum Disorders. New York, NY: Marcel Dekker, Inc. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  13. Typical Antipsychotics • Claim to: • Decrease irritability, aggression, hyperactivity, and tantrums • Decrease self-injurious behavior, motor tics, inattention, and mania • Due to serious side effects, clinicians and researchers have shifted their focus to atypical antipsychotic medications. Findling, R.L. (2005). Pharmacologic treatment of behavioral symptoms in autism and pervasive developmental disorders. Journal of Clinical Psychiatry, 66, 26-31. Handen, B.L. & Lubetsky, M. (2005). Pharmacotherapy in autism and related disorders. School Psychology Quarterly, 20, 155-171. Erickson, C.A., Posey, D.J., Stigler, K.A., & McDougle, C.J. (2007). Pharmacotherapy of autism and related disorders, Psychiatric Analysis, 37, 490- 500.

  14. Generic Name Haloperidol Thiothixene Chlopromazine Brand Name Haldol Navane Thorazine Typical Antipsychotics Findling, R.L. (2005). Pharmacologic treatment of behavioral symptoms in autism and pervasive developmental disorders. Journal of Clinical Psychiatry, 66, 26-31. Handen, B.L. & Lubetsky, M. (2005). Pharmacotherapy in autism and related disorders. School Psychology Quarterly, 20, 155-171. Erickson, C.A., Posey, D.J., Stigler, K.A., & McDougle, C.J. (2007). Pharmacotherapy of autism and related disorders, Psychiatric Analysis, 37, 490- 500.

  15. Atypical Antipsychotics • Claim to: • Decrease self-injurious behavior, aggression, and stereotyped behavior • Decrease agitation, impulsivity, high activity levels, and temper tantrums • Increase motivation and decrease social withdrawal • Greatly reduced risk of side effects • Tardive dyskinesia: motor/movement disorder Findling, R.L. (2005). Pharmacologic treatment of behavioral symptoms in autism and pervasive developmental disorders. Journal of Clinical Psychiatry, 66, 26-31. Handen, B.L. & Lubetsky, M. (2005). Pharmacotherapy in autism and related disorders. School Psychology Quarterly, 20, 155-171. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  16. Atypical Antipsychotics • Brand Name • Risperdal • Clozapine • Seroquel • Zyprexa • Geodon • Abilify • Generic Name • Risperidone • Clozapine • Quetiapine • Olanzapine • Ziprasidone • Aripiprazole Chez, M.G., Memon, S., & Hung, P.C. (2004). Neurologic treatment strategies in autism: An overview of medical intervention strategies. Seminars in Pediatric Nursing,11, 229-235. Hollander, E. (2003). Autism Spectrum Disorders. New York, NY: Marcel Dekker, Inc. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  17. Stimulants • Medications widely used for treating problems with attention and hyperactivity • Attention Deficit Hyperactivity Disorder (ADHD) • Increase levels of dopamine in the brain • Different types • Longer lasting effects • Different side effects Handen, B.L. & Lubetsky, M. (2005). Pharmacotherapy in autism and related disorders. School Psychology Quarterly, 20, 155-171. Findling, R.L. (2005). Pharmacologic treatment of behavioral symptoms in autism and pervasive developmental disorders. Journal of Clinical Psychiatry, 66, 26-31. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  18. Stimulants • Claim to: • Increase focus and attention • Decrease restlessness, hyperactivity, and impulsivity Erickson, C.A., Posey, D.J., Stigler, K.A., & McDougle, C.J. (2007). Pharmacotherapy of autism and related disorders, Psychiatric Analysis, 37, 490- 500. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  19. Stimulants • Generic Name • Methyphenidate • Dextroamphetamine • Amphetamine • Atomoxetine • Brand Name • Ritalin • Dexedrine • Adderall • Strattera Erickson, C.A., Posey, D.J., Stigler, K.A., & McDougle, C.J. (2007). Pharmacotherapy of autism and related disorders, Psychiatric Analysis, 37, 490- 500. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  20. Antidepressants and SSRIs • Originally developed for the treatment of depression or obsessive-compulsive disorder (OCD) • Four types of antidepressants • Monoamine oxidase (MAO) inhibitors • Tricyclic antidepressants (TCAs) • Selective serotonin reuptake inhibitors (SSRIs) • “Other agents” • SSRIs are most commonly used with autism • Different brain chemicals involved in each • SSRIs: prevent (inhibit) the reabsorption (reuptake) of serotonin after it is produced in the brain, thereby increasing levels of serotonin in the brain Handen, B.L. & Lubetsky, M. (2005). Pharmacotherapy in autism and related disorders. School Psychology Quarterly, 20, 155-171. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  21. Antidepressants and SSRIs • Claim to: • Treat behavioral rigidity, ritualistic behaviors, and rituals • May help decrease self-injurious behaviors and compulsive behaviors Handen, B.L. & Lubetsky, M. (2005). Pharmacotherapy in autism and related disorders. School Psychology Quarterly, 20, 155-171. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  22. Antidepressants and SSRIs • Generic Name • Clomipramine • Fluoxetine • Citalopram • Sertraline • Venlafaxine • Bupropion • Mirtazaphine • Brand Name • Anafranil • Prozac • Celexa • Zoloft • Effexor • Wellbutrin • Remeron Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  23. Mood Stabilizers & Anticonvulsants • Originally developed to treat mood disorders such as bipolar disorder or mania • Anticonvulsants are commonly used to treat seizure disorders • Some researchers believe that mood disorders may be increased in children with PDDs, as indicated by irritability, over-activity, and aggressive behaviors. • These types of medications are usually only used for autism if the child has an additional diagnosis of a mood disorder, or display cyclical patterns of insomnia and over activity. Handen, B.L. & Lubetsky, M. (2005). Pharmacotherapy in autism and related disorders. School Psychology Quarterly, 20, 155-171. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  24. Mood Stabilizers & Anticonvulsants • Claim to: • Decrease mood swings, irritability, over activity, impulsivity and aggressive behaviors • Decrease self-injury, depression (lithium only), and disruptive behaviors Handen, B.L. & Lubetsky, M. (2005). Pharmacotherapy in autism and related disorders. School Psychology Quarterly, 20, 155-171. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  25. Mood Stabilizers & Anticonvulsants • Generic Name • Divalproex • Valproic acid • Carbamazepine • Oxcarbamazepine • Lithium compounds • Brand Name • Depakote • Depakene • Tegretol • Trilepta • Eskalith, Lithone, Lithobid Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  26. Anti-anxiety Medications • Limited research for these types of medication specifically for autism • Three types sometimes used as treatment for autism • Benzodiazepines • Beta blockers • Opiate blockers Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  27. Anti-anxiety Medications • Claim to: • Decrease anxiety and stress • Decrease irritability and agitation Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  28. Anti-anxiety Medications • Brand Name • Ativan • Klonopin • Inderal • Corgard • Generic Name • Lorazepam (benz.) • Clonazepam (benz.) • Propranolol (beta bl.) • Nadolol (beta bl.) Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  29. Video: “Medicating my Son with Autism: Why and When its OK” http://www.youtube.com/watch?v=Zmh7BhM49OA

  30. Side Effects of Pharmacotherapy • All medications have the potential for adverse effects. • Side effect reactions can be neurological, behavioral, cognitive, or physiological. • Severity of side effects • Duration of side effects • Rate of side effect development • Many of the neurological, cognitive, and behavioral side effects mimic symptoms of autism itself. Self, T.L., Hale, L.S., & Crumrine, D. (2010). Pharmacotherapy and children with autism spectrum disorder: A tutorial for speech-language pathologists. Language, Speech, and Hearing Services in Schools, 41, 367-375. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  31. Side Effects of Antipsychotics • Second-Generation antipsychotics have significantly less side effects than first-generation antipsychotics • Tardive dyskinesia • Movement problems • Sedation • Weight gain (Risperidone, Olanzapine) • Possible diabetes • Reducing white blood count (Clozapine) • Fatigue/Drowsiness • Drooling • Restlessness or akathisia • Allergic reactions (breathing problems, hives, etc.) • Dry mouth • Constipation • Seizures • Malignant hyperthermia Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  32. Side Effects of Stimulants • Irritability • Occasional worsening of hyperactivity • Sleep problems • Decreased appetites • Dizziness • Moodiness/agitation • Tics • Habit problems like skin picking • Hallucinations Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  33. Side Effects of Antidepressants • Agitation • Hyperactivity • Insomnia • Elated affect • Decreased appetite • Impulsivity/restlessness • Withdrawal effects such as vomiting, nausea, headaches, abdominal pain • Highly sensitive to drug interaction Handen, B.L. & Lubetsky, M. (2005). Pharmacotherapy in autism and related disorders. School Psychology Quarterly, 20, 155-171. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  34. Side Effects of Mood Stabilizers • Sedation • Changes in blood count • Liver toxicity • Hyperactivity/Insomnia • Weight gain • Abdominal pain/upset stomach • Hyperthyroidism and kidney problems (Lithium) • Tremors • Polydipsia-- extreme thirst (Lithium) • Polyuria-- excessive urination (Lithium) • Severe acne (Lithium) • Muscle weakness • Hemorrhagic pancreatitis (Valproic acid) Handen, B.L. & Lubetsky, M. (2005). Pharmacotherapy in autism and related disorders. School Psychology Quarterly, 20, 155-171. Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  35. Side Effects of Anti-anxiety Medications • Paradoxical agitation • Low blood pressure • Heart rate problems • Sedation • Dizziness • Nausea • Vomiting Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  36. Video: “Drugging Our Children” http://www.youtube.com/watch?v=MR4EWSbXLWA

  37. Discussion Question • After hearing both the claims and side effects, what are your opinions on the use of pharmacotherapy as a treatment for autism?

  38. Interview with Dr. Gina Del Giudice • Mother and Medical Doctor • Andrew, 19, is diagnosed with autism • Has been prescribed various medications, such as mood stabilizers, anti-anxiety medications, and sleeping medications • Also has attended a private school for autism based on applied behavior analysis since he was 3 years old Dr. Del Giudice has given permission for Andrew’s name and photo to be used in this presentation.

  39. As a doctor, what are your feelings on the use of medications/pharmacotherapy as a treatment for autism? What are the pros and cons? • “Medications should be used primarily as a means of targeting and controlling certain behavioral symptoms so that learning can occur in an individual more easily. This is usually done most effectively when the individual displays symptoms of an additional diagnosis, such as bipolar or an anxiety disorder, because medications have been approved by the FDA specifically for these symptoms. The pros of using medications would be that, when prescribed and monitored correctly, medications can decrease the maladaptive symptoms of autism so that the individual can be more capable of learning and assimilating into society. Some of the cons would be that medications need to be monitored on a consistent basis, which can require frequent visits to the doctor and/or blood tests. Also, many people are not aware of the long term side effects of many psychotropic medications, such as thyroid or heart problems, weight gain, diabetes, or high cholesterol.”

  40. Does thinking about the use of pharmacotherapy from a mother’s perspective change your opinion at all? If so, how? • “It’s funny, because when I was going through medical school, I had no problem reading about all of the side effects that go along with medications on the market today. It was just factual information to be aware of for my future patients. Years later when Andrew was diagnosed with autism, I revisited this same information. Everything became much scarier and much more real. The first time I read about some of the medications that were options for Andrew, I had to put the books away. But now, after seeing the relief that some of these medications has brought him, I know that they do have a role in the treatment of autism, so long as they are prescribed and monitored appropriately.”

  41. Do you think ABA is an effective treatment for autism? • “In my opinion, ABA is the only treatment that works for autism. In some cases, treatments like speech therapy, OT/PT, and medications can be helpful as add-on’s, but the bottom line for me has been simple: the only way Andrew has been able to learn has been through ABA techniques.”

  42. What do you think society’s opinion is on the use of medications as a treatment for children with autism? How does this differ from your opinion as a medical professional? How does this differ from your opinion as a mother? • “I think that, generally speaking, people in society have negative feelings towards the use of medications as a treatment for autism, mainly because it can be very confusing and difficult to understand how and why these medications work. In addition, the side effects that can accompany these medications can be frightening and may seem too cruel to be worth the risk. However, there are also a handful of people in society, especially those who are affected by autism firsthand, who might find themselves feeling desperate to help their children in any way they can, even if that means trying pharmacotherapy as a treatment. As a medical professional, I believe that medications can be a very safe and often times effective treatment for specific symptoms of autism, so long as they are prescribed and monitored correctly. As a mother, there isn’t a day that goes by that I do not worry about Andrew’s health, especially when I think about the side effects of the medications he is on. I am disappointed and sad that he needs to be on medications, and worry about the negative connotations attached to these medications. However, I know that Andrew is in good hands, from both a medical and family perspective, and have seen a tremendous difference in his ability to learn and interact with others, once his anxiety was lessened by these medications. These medications have reduced some of his more problematic symptoms enough that the foundation of his learning, ABA, can work, and at the end of the day, knowing that Andrew is learning is one of the most important things to me.”

  43. What does the evidence say?

  44. Evidence • Overall, there is partial scientifically validated evidence supporting the effectiveness of pharmacotherapy as a treatment for autism. • Medication – Placebo studies • Flawed Methodologies • Core deficits versus associated behavioral symptoms? • Very few studies comparing pharmacotherapy and applied behavior analysis Jacobson, J.W., Foxx, R.M., & Mulick, J.A. (2005). Controversial therapies for developmental disabilities: Fad, fashion, and science in professional practice. New York, NY: Routledge. Canitano, R. & Scandurra, V. (2011). Psychopharmacology in autism: An update. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 35, 18-28.

  45. Evidence: Antipsychotics • Overall, typical and atypical antipsychotic medications have shown some efficacy in the treatment of autism. • Typical agents, e.g. Haloperidol – effective in treating aggression, but adverse effects are unacceptable • Atypical agents, e.g. Risperidone – demonstrated more favorable results in treating irritability, aggression, and self-injury than other similar antipsychotic medications West, L., Waldrop, J., & Brunssen, S. (2009). Pharmacologic treatment for the core deficits and associated symptoms of autism in children. Journal of Pediatric Health Care, 23, 75-89.

  46. Evidence: Antidepressants • Very few placebo-controlled, double-blind studies supporting the use of antidepressants or SSRIs for autism treatments. • Overall, there is moderate support for antidepressants and SSRIs (fluvoxamine, fluoxetine, escitalopram) effectively treating symptoms of autism, but adverse effects are intolerable. West, L., Waldrop, J., & Brunssen, S. (2009). Pharmacologic treatment for the core deficits and associated symptoms of autism in children. Journal of Pediatric Health Care, 23, 75-89.

  47. Evidence: Stimulants • Very few studies of stimulant medications in children with autism. • Methylphenidate (Ritalin) – more effective than placebo control groups, but only about 50% of subjects showed improvement. • This positive response rate is much lower than the positive response rate of subjects who had ADHD (and not autism) diagnoses • Overall, research tends to show that stimulant medications are less effective in treating symptoms of autism when compared to similar symptoms in typically developing peers Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  48. Evidence: Mood Stabilizers • Overall, research has shown that children with autism do not show a positive response to mood stabilizers. • However, these medications may be helpful if the child has symptoms suggesting comorbidity, such as an additional diagnosis of bipolar disorder or another mood disorder • A few reports of case studies in which mood stabilizers and anticonvulsants were effective in decreasing impulsivity and aggression, but these were not of high experimental quality. • Need more research! Volkmar, F.R. & Wiesner, L.A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.

  49. Evidence: Anti-anxiety Medications • Very little research • Benzodiazepines: very little research conducted with children as subjects, and even less with children with autism specifically • Beta blockers and opium blockers: a few open-label studies and case studies, but good double-blind controlled studies are not yet available • Need more research!

  50. Evidence • Matson, J.L. & Dempsey, T. (2008). Autism spectrum disorders: Pharmacotherapy for challenging behaviors. Journal of Developmental and Physical Disabilities, 20, 175-191. • Provided a data based review of existing trends in the treatment of pharmacotherapy for persons with autism • Quantified the level of research support available for various pharmacological medications on the market today