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Many children with autism on medication without behavioral therapy

Study by Autism Speaks ATN raises red flag because, in most cases, first-line treatment should involve non-drug behavioral approaches

Editor’s note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.

A new study out of the Autism Speaks Autism Treatment Network (ATN) found that around a third of children who were taking anti-psychotic medication for autism-related behavior problems were not receiving any form of non-drug behavioral therapy when they came to one of one the network’s specialty centers for care.

“It’s worrisome to find so many children taking psychiatric medicines for problem behaviors in the absence of behavioral intervention,” says pediatric neurologist Evdokia Anagnostou, the study’s senior author and co-director of the Autism Speaks ATN at Holland Bloorview Kids Rehabilitation Hospital, in Toronto. “In general, behavioral intervention should be our first line treatment, with medications added if those approaches are insufficient,” she says.

The study appears online ahead of print in the Journal of Autism and Developmental Disorders. Like much of the research conducted by the ATN, it was federally funded through the ATN’s role as the nation’s Autism Intervention Research Network on Physical Health.

Behavioral interventions and medications

Behavioral interventions such as Applied Behavior Analysis help children with autism regulate their emotions and reduce harmful behaviors while improving social interaction and communication.

Only two medicines – the anti-psychotics aripiprazole and risperidone – have FDA approval for treating behavioral problems related to “irritability” in children who have autism. Unfortunately, both medications have high rates of side effects, including significant weight gain and metabolic abnormalities that can lead to diabetes and heart disease.

Dr. Anagnostou and her colleagues reviewed the medical records of 5,150 children and teenagers whose families have enrolled in the ATN Research Registry. They found that the percentage of children with autism who were taking an anti-psychotic increased with age, from 5 percent among 2- to 11-year-olds to nearly 18 percent among those ages 11 to 17. One-third of these children were not receiving any form of behavioral therapy when they came to an ATN center for care.

The researchers linked use of these medicines to increased rates of gastrointestinal and sleep problems, both of which are unusually common and problematic among people who have autism. In addition, most of those taking an anti-psychotic were also taking one or more additional psychiatric medicines, for instance for depression and/or attention deficit hyperactivity disorder. Taking multiple medications increases the risk of both side effects and unwanted and potentially dangerous drug interactions.

The importance of medical and behavioral assessment

“It’s important for healthcare providers to understand the need to begin with medical and behavioral assessments to identify what might be motivating the challenging behavior,” says Autism Speaks Chief Science Officer Thomas Frazier. (Dr. Frazier was not directly involved in the study.) This is particularly true if the person affected by autism has difficulty recognizing and/or communicating his or her physical pain or emotional distress. Once medical issues are addressed or ruled out, the next step is an individually tailored behavioral intervention plan.

In some cases, Dr. Frazier adds, it may be appropriate to use an FDA-approved autism medication to curb dangerous self-injury or aggression while the assessment and behavioral therapy is underway.

Prior to coming to Autism Speaks, Dr. Frazier, conducted research on this issue – finding that behavioral intervention can reduce aggressive outbursts in children and teens with autism who are already taking psychiatric medicines for behavioral problems. Conversely, he found that risperidone and related anti-psychotics can increase the effectiveness of behavioral intervention for some children.

For more on autism and behavioral medicines, also see:

* Irritability and problem behavior in autism spectrum disorder: A practice pathway for pediatric primary care  (ATN/AIR-P practice guidelines for pediatricians)

* Autism: Should My Child Take Medicine for Challenging Behavior? An ATN/AIR-P tool kit

* Autism and Medication: Safe and Careful Use: An ATN/AIR-P tool kit

* An Introduction to Behavioral Health Treatments: An ATN/AIR-P guide for parents

* Applied Behavior Analysis: An ATN/AIR-P guide for parents

* Learn more about the Autism Speaks Autism Treatment Network here.
* Find the ATN center nearest you 
* Explore our archive of ATN expert-advice blogs and news stories 

The Autism Speaks blog features opinions from people throughout the autism community. Each blog represents the point of view of the author and does not necessarily reflect Autism Speaks' beliefs or point of view.