Medications (Psychopharmacology) for an Autism Spectrum Disorder

Dr. Andrés Martin

Yale University

Psychotropic medications can be an important part of the treatment of children and adolescents with autism-spectrum disorders. Dr. Andrés Martin reviews target symptoms that can be successfully treated with medications.

Lecture Notes

1. General Considerations

Prevalence

–          Medication use is widespread

–          Many medications have been tried, some helpful, some not helpful

–          Psychotropics are costly

Best Practices

–          When used, medication should be viewed as a footnote to treatment and is only one part of a comprehensive treatment approach

–          ‘Core’ vs. ‘target’ symptoms

  • Do not have medications for ‘Core’ symptoms of impairment in social interaction, communication and language, and restricted and repetitive behaviors or interests
  • Do have medications used to ‘target’ co-occurring symptoms of seizures, aggression, and self-injury

–          Medical aspects should not be overseen

  • Pain, especially if language is limited
  • Puberty transitions, hormones and sexual development

Diagnostic Overshadowing

–          Not all problems are explained by autism

–          Easy to oversee common co-occurring psychiatric disorders

  • Intellectual disability
  • Depression and anxiety
  • ADHD
  • Psychosis

–          Psychiatric diseases over-represented

  • Seizures, ID (4-fold)
  • Psychosis

–          Having an autism spectrum disorder does not prevent someone from having other psychiatric disorders, in fact there is a higher expression of psychiatric disorders such as anxiety, depression, etc in people on the autism spectrum

–          DSM discourages making other diagnosis

  • ‘’Symptoms of over activity and inattention are frequent in Autistic Disorder, but a diagnosis of ADHD is not made is Autistic Disorder is present’’

2. Lessons Learned: Ineffective Interventions

–          Irlen lenses

–          Facilitated communication

–          Psychodynamic psychotherapy

–          Sacrocraneal therapy

–          Animal-assisted therapies

–          Le packing

–          Antimychotic therapy

–          Chelation therapy

–          Secretin (15 studies show without a shadow of a doubt that this intervention does not work)

Major advances over the past decade

–          Not many good studies before 2000

  • None with samples >100

–          Recruitments into studies is challenging

  • Multi site studies a necessity

–          Studies are time-consuming and costly

  • Federal funding key: NIMH, NICHD

–          The evidence base is growing

3. Ongoing Efforts: Problems Targeted with Medication Studies

–          Core symptoms cannot really be modified with medication

–          Target symptoms that can be modified with medication

Symptom: Irritability, aggression, self-injury, property destruction

  • Traditional antipsychotics
    • Dopamine antagonists – block dopamine receptors in the brain
    • Effective in small randomized controlled trials
    • Risks of tardive dyskinesia, an irreversible side effect in a small number of cases
    • Atypical antipsychotics
      • Mixed mechanism of action
      • Promising in case series and open trials
      • Lower risk of dystonias
    • Risperidone
      • studies show high rate of effectiveness for aberrant behaviour in Autism
      • better results achieved if used with psychosocial interventions such as parent training, visual schedules, positive reinforcement, functional communication skills, behavior rehearsal and feedbackfor problematic behaviours
      • side effects are weight gain and potential future metabolic problems
    • Aripiprazole

Symptom: Hyperactivity, inattention

  • Stimulant medications
    • Commonly used for symptoms of ADHD, not as useful for symptoms in Autism
    • Adverse side effects of stimulant medications
      • Worsening of repetitive behaviors
      • Irritability
      • Social withdrawal
    • Types of methylphenidate and amphetamines (stimulants)
      • Ritalin
      • Dopamine antagonists – increase the levels of dopamine in the brain, this is a contradicting effect to what antipsychotic medication does

Symptom: Repetitive behaviours

  • Repetitive behaviours similar to OCD
  • Strong support for SSRI medication in OCD
  • Evidence of serotonin metabolism is abnormal in autism
    • Elevated serotonin in blood a consistent finding
    • SSRIs block the uptake of serotonin
    • Preliminary finding in adults with autism that SSRIs are helpful
      • Useful medication for depression and anxiety common for higher functioning people on the autism spectrum who have a heightened awareness of their social disability
    • Types of SSRIs
      • Prozac
      • Fluvoxamine(Luvox) – study showed substantial improvements in repetitive behaviours
      • Citalopram (Celexa, Cipramil)
        • No better results than placebo
        • Poorly tolerated with side effects of impulsivity, hyperactivity, insomnia, behavioral action

4. Future Directions and Hopes

–          Medications for target symptoms, not core symptoms

Symptom: Irritability, aggression, self-injury, property destruction

  • Other atypical antipsychotics
  • Ziprasidone, Quetiapine, Paliperidone

Symptom: Hyperactivity, inattention

  • Guanfacine, Atomoxetine

Symptom: Repetitive behaviours

  • Riluzole

Genetics

mGlur5 antagonists

Other Resources

Article: List of Questions to Ask Before Considering Medication

Book: Taking the Mystery Out of Medications in Autism/Asperger’s Syndromes

Book: Autism, Brain And Environment

Book: How to Talk to Parents About Autism

Book: Mental Health Aspects Of Autism And Asperger Syndrome

Book: Is My Child OK?: When Behavior is a Problem, When It’s Not, and When to Seek Help

Book: The OASIS Guide to Asperger Syndrome: Advice, Support, Insight, and Inspiration

Book: Diagnosis Autism: Now What?

MP3: Bottles Of Pills – Medication Options For Autistic Patients

Related Articles:

Yale Seminar on Autism and Related Disorders List of Lectures

Complete List of All Articles on Autism Spectrum Directory


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Comments
2 Responses to “Medications (Psychopharmacology) for an Autism Spectrum Disorder”
  1. Thank you for the post, I really learned a lot from it. Extremly good content on this blog. Always looking forward to new entry.

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