Description: Use of psychotropic medication to change behavior.
Examples: risperidone (Risperdal), methylphenidate (Ritalin), fluoxetine (Prozac), aripiprazole (Abilify)
Research Summary: For individuals with autism spectrum disorder (ASD) who have persistent, severe tantrums, aggression, or self-injury, there is strong evidence from large, well-designed randomized clinical trials supporting the use of low doses of atypical antipsychotic medications such as risperidone (Risperdal) and aripiprazole (Abilify). These medications often produce major reductions in disruptive behavior (McCracken et al., 2002; Hirsh & Pringsheim, 2016) and may improve overall functioning (McDougle et al., 2005). However, the medications also may cause significant weight gain. Combining rispiridone with parent training on behavioral interventions appears to improve outcomes (Aman et al., 2009). Parent training may be an effective alternative to medication for disruptive behavior in younger children with ASD.
For individuals with autism spectrum disorders who have severe hyperactivity and inattention, there is evidence from a large, well-designed randomized clinical trial that stimulant medications such as methylphenidate (Ritalin) sometimes produce major reductions in hyperactivity (Research Units in Pediatric Psychopharmacology Autism Network, 2005). However, up to 20% of children with ASD experience intolerable side-effects when taking these medications. Other medications that can be effective in reducing hyperactivity in some children with ASD include a selective norepinephrine reuptake inhibitor, atomoxetine (Handen et al., 2015; Harfterkamp et al., 2015), and a selective alpha-2A receptor agonist, guanfacine (Scahill et al., 2015).
Selective serotonin inhibitors (SSRI’s) are sometimes prescribed for individuals with autism spectrum disorders who have severe repetitive behaviors or routines. Examples of SSRI’s are fluoxetine (Prozac), paroxetine (Paxil), and cital (Celexa). However, a large, well-designed study indicated that the SSRI cital had no effect on such behaviors (King et al., 2009). Preliminary studies indicate that medications may be effective in alleviating mood swings (Lewis & Lavoritz, 2005). Additional research is underway to test whether findings from preliminary research can be replicated in large, well-designed studies.
Recommendations: Medications are an effective intervention for some individuals with ASD who exhibit severe aggression, hyperactivity, or other disruptive behavior. Medications also can be useful for reducing hyperactivity in some children with ASD. When medications are used, they should be prescribed and monitored by a qualified physician. Because of the evidence for the effectiveness of medications for some individuals with ASD, professionals and families may wish to obtain additional information about this approach; resources are listed in the references below.
Systematic reviews of scientific studies:
Hirsch, L. E., & Pringsheim, T. (2016). Aripiprazole for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews, 6. doi: 10.1002/14651858.CD009043.pub3
Loy, J. H., Merry, S. N., Hetrick, S. E., & Stasiak, K. (2017). Atypical antipsychotics for disruptive behaviour disorders in children and youths. Cochrane Database of Systematic Reviews, 8, Cd008559.
Redman, T., Scheermeyer, E., Ogawa, M., Sparks, E. C., Taylor, J. C., Tran, Vi T., … van Driel, M. L. (2014). Methylphenidate for core and ADHD-like symptoms in children aged 6 to 18 years with autism spectrum disorders (ASDs). Cochrane Database of Systematic Reviews, 8. doi: 10.1002/14651858.CD011144
Williamson, E., Sathe, N. A., Andrews, J. C., Krishnaswami, S., McPheeters, M. L., Fonnesbeck, C., … Warren Z. Medical Therapies for Children With Autism Spectrum Disorder—An Update. Comparative Effectiveness Review No. 189. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2015-00003-I.) AHRQ Publication No. 17-EHC009-EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2017. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
Selected scientific studies:
Aman, M. G., McDougle, C. J., Scahill, L., Handen, B., Arnold, L. E., Johnson, C., … Wagner, A. (2009). Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry. 48, 1143-1154.
Handen, B. L., Aman, M. G., Arnold, L. E., Hyman, S. L., Tumuluru, R. V., Lecavalier, L., . . . Smith, T. (2015). Atomoxetine, Parent Training, and Their Combination in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 54(11), 905-915.
Harfterkamp, M., van de Loo-Neus, G., Minderaa, R. B., van der Gaag, R. J., Escobar, R., Schacht, A., … Hoekstra, P. J. (2012). A randomized double-blind study of atomoxetine versus placebo for attention-deficit/hyperactivity disorder symptoms in children with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51(7), 733-741.
King, B. H., Hollander, E., Sikich, L., McCracken, J. T., Scahill, L., Bregma, J.D., … Ritz, L. (2009). Lack of efficacy of cital in children with autism spectrum disorders and high levels of repetitive behavior: Cital ineffective in children with autism. Archives of General Psychiatry, 66, 583-90.
McDougle, C. J., Scahill, L., Aman, M. G., McCracken, J. T., Tierney, E., Davies, M., … Vitiello, B. (2005). Risperidone for the core symptom domains of autism: Results from the study by the Autism Network of the Research Units on Pediatric Psychopharmacology. American Journal of Psychiatry, 162, 1142-1148.
Research Units on Pediatric Psychopharmacology Autism Network. (2005). Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Archives of General Psychiatry, 62, 1266-1274.
McCracken, J. T., McGough, J., Shah, B., Cronin, P., Hong, D., Aman, M. G., … McMahon, D. (2002). Risperidone in children with autism and serious behavior problems. The New England Journal of Medicine, 347, 314-321.
Scahill, L., McCracken, J. T., King, B. H., Rockhill, C., Shah, B., Politte, L., … McDougle, C. J. (2015). Extended-Release Guanfacine for Hyperactivity in Children With Autism Spectrum Disorder. American Journal of Psychiatry, 172(12), 1197-1206.
Edmond, B. M., & Cicero, F. R. (2016). Research synopsis: Efficacy of low-dose buspirone for restricted and repetitive behavior in young children with autism spectrum disorder: A randomized trial. Science in Autism Treatment, 16(11).
For additional information:
Volkmar, F. R., & Wiesner, L. (2009). A practical guide to autism: What every parent, family member, and teacher needs to know. New York, NY: Wiley.