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Medical Author:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medications

Medication does not treat the underlying neurologic problems associated with autism. Rather, medication is given to help manage behavioral manifestations of the disorder, such as hyperactivity, impulsivity, attention difficulties, and anxiety. In most cases, medication is given to lessen these problems so that the person can receive maximum benefit from behavioral and educational approaches.

Medications used in autism are psychoactive, meaning they affect the brain. Those used most often include the following:

• Antipsychotic drugs: This is the most widely studied group of drugs in autism. These drugs have been found to reduce hyperactivity, repetitive behaviors, withdrawal, and aggression in some people with autism. The newer, atypical antipsychotics, including risperidone (Risperdal), olanzapine (Zyprexa), aripiprazole (Abilify), and quetiapine (Seroquel), have replaced the older, traditional antipsychotics, which had more side effects. Risperidone (Risperdal) and aripiprazole (Abilify) are now approved by the U.S. Food and Drug Administration to treat irritability, aggression, and self-injurious behaviors in children and adolescents with autism.
  
  
• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) are one class of antidepressants that are commonly used to treat people with depression, obsessive compulsive disorder (OCD), and/or anxiety. In some people with autism, these drugs reduce repetitive behaviors, depression, irritability, tantrums, and aggression. Examples of SSRIs include fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). Other antidepressants, including clomipramine (Anafranil), mirtazapine (Remeron), amitriptyline (Elavil, Endep), bupropion (Wellbutrin), venlafaxine (Effexor), and duloxetine (Cymbalta) have less frequently been used.
  
  
• Stimulants: Drugs used to treat attention-deficit/hyperactivity disorder (ADHD) may help some people with autism. These drugs work by increasing the person's ability to concentrate and pay attention and by reducing impulsivity and hyperactivity. Examples include methylphenidate (Ritalin, Concerta), dexmethylphenidate (Focalin), as well as amphetamines (amphetamine and dextroamphetamine [Adderall], dextroamphetamine [Dexedrine], and lisdexamfetamine [Vyvanase]).
  
  
• Nonstimulant medications that treat ADHD may also help people with autism. These medications have been found to be equally effective as stimulants in their ability to increase the individual's ability to focus, manage their impulses and activity level. Examples of these medications are atomoxetine (Strattera) and guanfacine (Intuniv).
  
  
• Other drugs: Other drugs may also help some people with autism. Anticonvulsants are frequently used to manage seizures in people with autism. Anticonvulsants may also be used to stabilize mood and/or behavior. Alpha-2 adrenergic agonists (for example, clonidine [Catapres]) are also sometimes used to manage hyperactivity and behavioral problems in some individuals with autism. Buspirone (Buspar) and propanolol have also been prescribed.

Very few of these drugs have been tested in scientific studies in individuals with autism.

• Moreover, issues related to dosage (especially important in children), monitoring, and interactions with other drugs and foods are concerns, as are short- and long-term side effects.
  
  
• Many of these medications have side effects such as sleepiness (sedation) or trouble sleeping (insomnia), weight loss or weight gain.
  
  
• Infrequently, dependence may develop with some of these drugs.
  
  
• These medications should be prescribed only by a medical professional experienced in treating persons with autism.

Although many studies have been done to assess whether abnormal amounts of vitamins, minerals, or other nutrients can be found in people with autism, results have not clearly pointed to any abnormalities that are consistently linked with the disorder. Although few, if any, of these claims are backed up by scientific studies, parents and physicians alike have reported improvement in symptoms in people given certain supplements, including vitamin B, magnesium, cod liver oil, and vitamin C.

Some people with autism have food sensitivities and food allergies and dietary management is important to in these cases to maintain nutrition and health. Another focus of dietary therapy is on problems with intestinal digestion and absorption of nutrients in foods suspected to be present in some individuals with autism. Some parents and professionals have reported improvements in symptoms of autism when diets eliminating suspect proteins, such as gluten (found in wheat flour), are consistently followed. However, there are no scientific studies to confirm their effectiveness.

Do not start giving a child supplements or dramatically change his or her diet without discussing it with the treatment team. It is important to maintain adequate nutrition to ensure optimal growth and development. Furthermore, although vitamins, minerals, and many other substances available as supplements are necessary for body functions, some of them can be dangerous if taken in excess.