These medications effectively treat a number of symptoms and behaviors frequently present in individuals with autism. These include hyperactivity, impulsivity, attentional difficulties, anxiety, obsessive-compulsive symptomatology, repetitive motor behaviors (for example, tics and stereotypies), depression, mood swings, agitation, aggression, self-injurious behavior and insomnia.
Most of these clinical characteristics are considered "associated behaviors" in autism. Impairments in certain aspects of attention (for example, joint attention) and repetitive, ritualized behaviors are examples of core autistic symptomatology, which can be positively affected by medication.
The ultimate goal of medication in an individual who has autism is to prepare the brain's physiology to take optimal advantage of other aspects of treatment. These efforts include behavioral, educational and other experiential learning that can directly address core autistic cognitive impairments such as receptive, expressive, and pragmatic language abilities, social deficits and self-directed, repetitive behavior. In other words, pharmacologic intervention should typically be viewed as only one part of a multi-modal treatment plan for an individual with autism.
Overview of Medications
In this two-part series, we will focus on four major groups of medications: neuroleptics, anti-depressant/anti-anxiety agents, stimulants and anticonvulsants. It will become readily apparent that many of these medications affect more than one symptom or behavior. That is, they are relatively nonspecific in terms of their benefits. For each of these commonly prescribed groups of medications, general indications and side effects will be discussed.
As the medical community gains a better understanding of the genetics and biochemistry of autism, it will be possible to develop pharmacologic therapies which directly address underlying abnormalities; ie, more specific treatments.
However, the potential benefits of these nonspecific medications should not be underestimated. In some individuals they can result in a significant increase in the rate of learning or reduce aggressive behavior for an individual with autism so that institutionalization can be avoided.
It must be recognized that different people may respond to the same medication quite differently and an individual's response at different stages of brain development may vary depending upon age, associated medical conditions and other factors. For example, a medication which produces a behavioral side effect preventing its use for a child at age seven may not produce this side effect and be quite useful at age ten.
The brain is continually developing, especially during the first 21 years of life, and this needs to be taken into account. Because of individual differences in brain chemistry as well as differences in the rate of metabolism (breakdown) of medications, markedly different doses may be required for different individuals.
Even though the situation is quite complex, the prescription of medication for autism is not purely a "shot in the dark." Patients are not guinea pigs, and a physician should not simply prescribe whatever first comes to mind as an experiment.
There have been multiple scientifically sound, double-blind, controlled studies of all these medications. Most have been done on adults with other conditions; however, there is a sound base of information on psychopharmacologic agents from studies in children and a growing body of scientific data on medications in children and adolescents with autism. The prescribing physician needs to be aware of these studies and experienced in the pharmacologic treatment of patients with severe neurodevelopmental disorders, including autism.
Optimizing the benefits of the available medications requires the physician to bring to bear both art and science. …