Magazine article Clinical Psychiatry News

Meds for Children with Autism: No Magic Bullets Yet

Magazine article Clinical Psychiatry News

Meds for Children with Autism: No Magic Bullets Yet

Article excerpt

EXPERT ANALYSIS FROM THE PSYCHOPHARMACOLOGY UPDATE INSTITUTE

NEW YORK -- Neither approved nor investigational drugs seem to work on autism's core symptoms.

Medications that help psychiatric conditions in children with otherwise normal development don't work as well for children with autism spectrum disorders (ASDs), Dr. Jean A. Frazier said at a psychopharmacology update held by the American Academy of Child and Adolescent Psychiatry.

"The effects seem to be maximized at lower doses than in typically developing youth, and the medications are often much less well tolerated," said Dr. Frazier, professor of psychiatry at the University of Massachusetts, Worcester.

"If you do try them, the old axiom, 'Start low, go slow' certainly applies."

Because nothing reliably ameliorates the core symptoms, clinicians and parents focus on the behavioral symptoms of aggression, irritability, and self-injury; hyperactivity and anxiety; and sleep problems. A major cause of death among children with ASDs is "bolting" and falling into a swimming pool, or being hit by a car, Dr. Frazier said.

Risperidone and aripiprazole are approved by the Food and Drug Administration for aggression and irritability. But the other commonly used medications --selective serotonin reuptake inhibitors, atypical antipsychotics, and stimulants--are used off label and backed by limited evidence.

Risperidone is "effective for reducing tantrums and self-injury," with stable gains over time, Dr. Frazier said. But it's associated with weight gain. In its two pivotal trials, children on risperidone gained

an average of 5.6 kg over 6 months. Even so, relapse will occur if treatment stops. Aripiprazole was effective in its two pivotal studies, but those were of short duration, she said. Both of the drugs are backed by A-level evidence--the highest grade.

Methylphenidate is used off label and is supported by B-level evidence. In two randomized, placebo-controlled studies, it was superior to placebo, but the studies were short and had small numbers enrolled. One showed very high levels of "intolerable side effects"--agitation, mood changes, and movement disorders. Divalproex sodium, lamotrigine, and naltrexone have much less supporting evidence.

SSRIs are used off label for repetitive behaviors. …

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