Medications and Autism Spectrum Disorders

Autism spectrum disorders are characterized by three core deficits: problems with social relatedness; difficulties with communication and language; and restricted, repetitive patterns of behavior, activities, or interests. In addition, ASD often involves a host of associated issues, from inattention to sleep disturbance, from gastrointestinal problems to out-of-control tantrums. There is no medication that has been proven to address the core deficits of ASD. When a medication is added as part of a child's treatment program, it is usually to address one of these associated issues. To address them is crucial because they often interfere with a child's ability to fully benefit from other therapies or programs.

Most of the medications being prescribed for children with ASD are psychotropic, which means “affecting mental activity, behavior, or perception.” These include stimulants (like Ritalin), antidepressants (like Prozac), neuroleptics (like Risperdal), and anticonvulsants (like Depakote). Almost all are being used “off label.” In other words, they have not been approved by the U.S. Food and Drug Administration (FDA) to treat autism spectrum disorder in adults or children, although there is often some basis in the research literature for prescribing them. To actually test a drug and obtain FDA approval is a lengthy and expensive process. So far, only Risperdal (risperidone) is FDA approved for treatment of the irritability associated with autistic disorder in children and adolescents aged 5 through 16 years. (“Irritability,” in this instance, is defined as aggression, self-injury, tantrums, and quickly changing moods.)

Making decisions about whether to try a psychotropic medication, and which type, can be particularly hard for parents. Each child is different, which often means that finding a medication that works to address a child's major difficulty takes some trial and error -- never an enjoyable process. As physicians and parents evaluate a medication, there are two major considerations: effectiveness and side-effects. In brief, are any negative effects outweighed by the good a medication does?

When should children be treated with such medications? As Jacqueline M. Amato, M.D., writes in her article “Red Flags: When to Take Your Child with Autism to a Psychiatrist,” safety is a major consideration. Is a child harming him- or herself or others? Beyond this, medications are considered when a behavior or condition has become severe enough to interfere with a child's life and relationships, ability to learn, or ability to benefit from other therapies.

In the section that follows, we share the experiences of families participating in IAN with regard to medications.


IAN Families: Data on Use of Medications

Families participating in IAN Research have reported on more than 300 different autism treatments. When these are grouped into categories, medications -- which have been used 3,140 times by IAN families -- rank first in terms of frequency of use. Any specific medication is used far less than, for example, a school-based intervention such as speech and language therapy. Taken all together, however, medications represent a major treatment type.

Medications and Who Prescribes Them

What types of medications are children with ASD taking? Based on the IAN data, the vast majority of the medications are psychotropic. Parents have submitted information on about 2,900 stimulants, neuroleptics, anticonvulsants, antidepressants, and anxiolytics, while they have submitted information on only about 200 nonpsychiatric drugs. These nonpsychiatric medications range from antifungals (like Diflucan) to antibiotics, antihistamines, and laxatives.

Figure 1.