a review of pharmacotherapy for autism treatment by: bridget spanarkel
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A Review of Pharmacotherapy
for Autism Treatment
by: Bridget Spanarkel
SourcesBooks
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
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
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.
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.
History of Pharmacotherapy 1954: first psychotropic medication
was introducedThorazine (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.
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.
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.
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.
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?
Types of Medication
Antipsychotics (Typical and Atypical) Stimulants Antidepressants & Selective
Serotonin Reuptake Inhibitors (SSRIs) Mood Stabilizers & Anticonvulsants Anti-anxiety and Benzodiazepines Sleep Medications
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.
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.
Typical Antipsychotics Generic Name
Haloperidol Thiothixene Chlopromazine
Brand Name Haldol Navane Thorazine
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.
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.
Atypical Antipsychotics Generic Name
Risperidone Clozapine Quetiapine Olanzapine Ziprasidone Aripiprazole
Brand Name Risperdal Clozapine Seroquel Zyprexa Geodon Abilify
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.
Stimulants Medications widely used for treating
problems with attention and hyperactivityAttention Deficit Hyperactivity Disorder
(ADHD) Increase levels of dopamine in the brain Different types
Longer lasting effectsDifferent 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.
Stimulants
Claim to: Increase focus and attentionDecrease 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.
Stimulants Brand Name
Ritalin Dexedrine Adderall Strattera
Generic Name Methyphenidate Dextroamphetamin
e Amphetamine Atomoxetine
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.
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.
Antidepressants and SSRIs
Claim to:Treat behavioral rigidity, ritualistic
behaviors, and ritualsMay 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.
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.
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.
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.
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.
Anti-anxiety Medications
Limited research for these types of medication specifically for autism
Three types sometimes used as treatment for autismBenzodiazepinesBeta blockersOpiate 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.
Anti-anxiety Medications
Claim to:Decrease anxiety and stressDecrease 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.
Anti-anxiety Medications Generic Name
Lorazepam (benz.) Clonazepam (benz.) Propranolol (beta
bl.) Nadolol (beta bl.)
Brand Name Ativan Klonopin Inderal Corgard
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.
Video: “Medicating my Son with
Autism: Why and When its OK”
http://www.youtube.com/watch?v=Zmh7BhM49OA
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.
Side Effects of Antipsychotics
Second-Generation antipsychotics have significantly less side effects than first-generation antipsychotics
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.
•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
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.
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.
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.
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.
Video: “Drugging Our Children”
http://www.youtube.com/watch?v=MR4EWSbXLWA
Discussion Question
After hearing both the claims and side effects, what are your opinions on the use of pharmacotherapy as a treatment for autism?
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.
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.”
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.”
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.”
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.”
What does the evidence say?
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.
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.
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.
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.
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, andTeacher Needs to Know. Hoboken, NJ: John Wiley & Sons, Inc.
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!
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
Trends in the Data
Matson, J.L. & Dempsey, T. (2008). Autism spectrum disorders: Pharmacotherapy for challenging behaviors. Journal of Developmental and Physical Disabilities, 20, 175-191.
Methodology Concerns because the methods used in the experimental
designs are not adequate enough to make reliable or valid conclusions about the drugs being tested
“Double-blind, placebo-controlled studies” versus “Open-label studies”
Such publications can give the false impression that the medication has been partially validated, when in fact the data are suspect. Very few subjects No control groups Poor reliability and validity measures Rating Scales and Diagnostic Instruments may not be
accurate/reliable Reporting biases
Matson, J.L. & Dempsey, T. (2008). Autism spectrum disorders: Pharmacotherapy for challenging behaviors. Journal of Developmental and Physical Disabilities, 20, 175-191.
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.
Evidence Identified 14 different
drugs with published studies to treat challenging behaviors and core symptoms of autism
Matson, J.L. & Dempsey, T. (2008). Autism spectrum disorders: Pharmacotherapy for challenging behaviors. Journal of Developmental and Physical Disabilities, 20, 175-191.
Matson, J.L. & Dempsey, T. (2008). Autism spectrum disorders: Pharmacotherapy for challenging behaviors. Journal of Developmental and Physical Disabilities, 20, 175-191.
Additional Concerns with the Evidence
Short length of studies Difficult to use animal models for
experimentation Lack of research about the effectiveness of
combined treatments – pharmacotherapy AND behavioral intervention
Intolerable costs of adverse side effects
Matson, J.L. & Dempsey, T. (2008). Autism spectrum disorders: Pharmacotherapy for challenging behaviors. Journal of Developmental and Physical Disabilities, 20, 175-191.
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.
Why is Pharmacotherapy Used?
Only partial support for the effectiveness of pharmacotherapy for autism!
Inconsistent findings in research Often times, symptoms subside relatively
quickly Requires less intensive staffing/training than
behavioral interventions Pharmacotherapy can be easily administered
outside of facilities with trained staffAntonacci, 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.
Discussion Questions
Do you think pharmacotherapy could be considered an “effective” treatment for autism if it does not directly affect any of the disorder’s core symptoms?
In other words, medications have been shown to target the behavioral symptoms associated with autism, but research has not been able to consistently show improvements in the core deficits of communication, social interaction, and stereotyped behaviors/interests.
Can this still be considered an effective treatment for autism?
Conclusion
Most researchers agree that behavioral treatments remain the primary treatment method for ASD
Pharmacotherapy should only be used to treat the most severe or challenging symptoms of autism that prevent the individual from successfully completing behavioral therapies
Hollander, E., Phillips, A.T., & Yeh, C. (2003). Targeted treatments for symptom domains in child and adolescent autism. The Lancet, 362, 732-734.
Matson, J.L. & Hess, J.A. (2010). Psychotropic drug efficacy and side effects for persons with autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 230-236.
Matson, J.L. & Dempsey, T. (2008). Autism spectrum disorders: Pharmacotherapy for challenging behaviors. Journal of Developmental and Physical Disabilities, 20, 175-191.
Conclusion Pharmacotherapy, then, should be used as an
adjunctive treatment when behavioral interventions are not fully effective Consider:
Definition of “ineffective” Age of participant Safety of patient, family, and others Patient’s psychological distress Symptoms that jeopardize sustained educational progress
In these extreme cases, it may not be a matter of selecting medication or behavior therapy. Rather, it may be more useful to combine the two interventions.
Matson, J.L. & Hess, J.A. (2010). Psychotropic drug efficacy and side effects for persons with autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 230-236.
Scahill, L. (2008). How do I decide whether or not to use medication for my child with autism? Should I try behavior therapy first?. Journal of Autism and Developmental Disorders, 38, 1197-1198.
Additional Research Needed
Controlled, experimentally sound research on the effectiveness of pharmacotherapy
Additional studies to determine whether behavioral interventions or pharmacotherapy is more effective overall
Studies to determine the effectiveness of medications when used in combination with behavioral intervention
References
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Matson, J.L. & Dempsey, T. (2008). Autism spectrum disorders: Pharmacotherapy for challenging behaviors. Journal of Developmental and Physical Disabilities, 20, 175-191.Matson, J.L. & Hess, J.A. (2010). Psychotropic drug efficacy and side effects for persons with autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 230-236.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. Scahill, L. (2008). How do I decide whether or not to use medication for my child with autism? Should I try behavior therapy first?. Journal of Autism and Developmental Disorders, 38, 1197-1198.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. 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.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.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.
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