PSYCHOPHARMACOLOGY
To date there are no specific medications studied and approved to treat the core symptoms of autism spectrum disorders. These core symptoms include qualitative impairments in social interaction skills, social communication skills, and restricted, repetitive and stereotyped behaviors. However, medications are used to treat problem behaviors that may be seen in children who have autism spectrum disorders. The only medication approved thus far by the Food and Drug Administration for the treatment of problem behaviors is risperidone for the treatment of irritability and aggression. Risperidone can be very helpful for irritability and aggression, but because it has common side effects that can be troubling—such as weight gain---it needs to used carefully and, in most cases, only after well-planned behavioral interventions have been tried. Some children and adolescents with ASD can also develop other problems related to activity level, sleep, mood or anxiety difficulties that may benefit from medications which have been shown to improve symptoms in typically developing children. It is important that your child’s prescribing clinician have prior experience in using these medications in children and is aware of how the side effects of these medications may present in children with ASD. With all medications used to treat associated problems in ASD, it is important for the doctor and parent to “start low and go slow” with dosage and to communicate frequently in order to monitor your child’s progress. Successful treatment of problem behaviors or other difficulties can make a significant improvement on the overall quality of life for a child.
Any child with ASD whose parents are considering medication treatment of associated problems should have a comprehensive psychiatric evaluation, including medical assessment before starting a medication trial. In addition, other interventions should be explored as an alternative to medication, or as an adjunctive treatment. For example, a child with autism who presents with disturbing temper outbursts should have both a psychiatric/medical evaluation, as well as a behavioral assessment (functional behavior assessment) to best understand the role of possible environmental factors. Children with ASD are also frequently on other medications, such as medications to control seizures or other alternative supplements and prior to starting a new medication possible drug-drug or drug-supplement interactions should be considered. Parents know their children best and are in the optimal position to describe target symptoms, as well as positive and negative responses to a medication trial. Because children with ASD are vulnerable, it has historically been difficult to conduct research studies to help guide best practice. This has been changing recently as the National Institute of Mental Health has supported multi-site medical centers to work with each other to study the effectiveness and side-effects of specific medications.
Courtesy of: Maureen McSwiggan-Hardin, NP-PAgency: Columbia University Medical CenterWebsite: www.newyorkautism.columbia.eduEmail: hardinm@childpsych.columbia.eduPhone: 212-342-1600
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