The Full Picture on Autism Medication

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Every child with autism is different, and there is no common approach to autism management. For the sake of their child, parents also need to consider the risks involved with every treatment available.

 

There’s an abundance of evidence-based treatments for children with Autism Spectrum Disorder (ASD). As children with ASD have different needs, abilities, and levels of severity, there is no single best treatment.

In general, the recommendation is that early intervention is important, and most kids with autism respond well to highly-structured and specialized therapies like applied behavior analysis, speech and occupational therapies. The goal with any therapy is to match a child’s specific needs and abilities with strategies that will help them reach their greatest potential.

Alongside the structured therapies, the role of medications definitely cannot be ignored completely in the treatment of autism’s symptoms. It’s worth noting that medication is not a ‘cure’ for ASD. In spite of the extensive research conducted, we have not yet identified a singular cause or cure for autism. Medicines for treating the three core symptoms of autism – communication difficulties, social challenges, and repetitive behavior – have long represented a huge area of unmet need. For some children with ASD, medication can reduce challenging behavior that might be interfering with their ability to learn. Medications can also be considered if a characteristic or condition is very severe or hasn’t responded to other approaches. Research shows that medications are most effective when used in combination with behavioral therapies.

Most common challenging behavior in children where medications can help include:

  • Hyperactive behavior or overactivity: finding it hard to sit still and concentrate
  • Anxiety: worrying too much or being afraid of things
  • Obsessive or repetitive behavior: doing something over and over again
  • Tics: having uncontrollable jerky movements of face like blinking or twitching of the arm or shoulder
  • Aggressive behavior: behaving aggressively towards other people, breaking things, hurting themselves by hitting or head-banging
  • Sleep problems: having difficulty falling asleep or waking up often during the night
  • Seizures: Suddenly becoming stiff with jerking followed by unconsciousness

The U.S. Food and Drug Administration (FDA) has approved the use of some antipsychotic drugs, such as Risperidone and Aripiprazole, for treating irritability associated with ASD in children of certain ages. Decreasing irritability improves sociability and reduces tantrums, aggressive outbursts, and self-injurious behaviors.

Many other drugs, that are not approved by FDA for use in ASD in particular, can still improve symptoms of autism. They fall under the category of “off-label” drugs, which are used for different conditions from the ones that have received FDA approval. Conditions approved by FDA for which these drugs can be used are attention deficit hyperactivity disorder (ADHD), sleep disturbances and depression.

Both FDA approved and off-label drugs used in ASD have common side effects such as:

  • Diarrhea and vomiting
  • Rashes, hives, and itching
  • Dry mouth
  • Fatigue
  • Weight gain

Some of the drugs used to treat ASD are listed below with common trade names, approved uses and more serious side effects.

DRUG TRADE NAME TREATS SIDE EFFECTS
Risperidone Risperdal Psychosis, mania Weight gain, hormone imbalance
Aripiprazole Abilify Psychosis, mania, depression, aggression Nervousness, weight gain, drooling, tremors
Fluoxetine Prozac Depression, obsessive compulsive disorder,  panic disorder Allergies, anxiety, seizures, suicidal tendencies.
Sertraline Zoloft Depression, obsessive compulsive disorder,  panic disorder Drowsiness, nausea
Methylphenidate Ritalin ADHD Delirium, irregular heartbeat, psychosis
Amphetamine salts Adderall ADHD Delirium, irregular heartbeat, psychosis
Clonazepam Klonopin Seizures, panic, anxiety Paranoia,  judgment and memory impairment
Naltrexone Revia Alcohol dependency (anti-repetitive) Allergies, constipation
Alprazolam Xanax Anxiety, panic disorder Paranoia, impairment in memory, judgment, and coordination

 

Most families try unproven Complementary and Alternative Medicine (CAM) because they hear about it in the media, perceive it as “natural,” and are eager to leave no stones unturned in their efforts to manage their kids’ autism symptoms. The FDA has warned and taken action against a number of companies that have made improper claims about their products being effective in treatment or cure for autism or autism-related symptoms.  These include:

  • Hyperbaric Oxygen Therapy – This involves breathing oxygen in a pressurized chamber and it has been cleared by the FDA only for certain medical uses, such as treating decompression sickness suffered by divers.
  • Supplements – Studies done have found that supplements and special diets for children with autism commonly result in excessive amounts of some nutrients and deficiencies in others.
  • Chelation therapies – This therapy is based on the notion that heavy metal poisoning causes autism. But there is no evidence or research done to mark their safety or effectiveness. In fact, in 2005, a child died when a chelating agent removed calcium, leading to cardiac arrest.

Ari Ne’eman, president and co-founder of the Autistic Self Advocacy Network, argues that “A sizable percentage of the medications being prescribed are serving as a means of chemical restraint, rather than having a legitimate therapeutic purpose. Improving communication support and educational interventions are far more meaningful and appropriate mechanisms to address behavioral challenges.”

All medications carry risks, some of them serious. Families should work closely with their children’s healthcare providers to ensure the safe use of any medication. Not every medication helps every person with symptoms of autism. One person with autism might respond to medications differently than another person with autism or than people who don’t have autism. Decisions about if and when to try medications can be hard. Parents need to weigh up the benefits for their child against the possible risks.


References:

  1. Autism Treatment: Children; Psych Central. Retrieved from https://psychcentral.com/autism/autism-treatment-children/
  2. Medicines for treating autism’s core symptoms; Autism Speaks. Retrieved from https://www.autismspeaks.org/medicines-treating-autisms-core-symptoms
  3. Suitable for 2-18 years old; Medications and autistic spectrum disorder; raising children.net.au. Retrieved from https://raisingchildren.net.au/autism/therapies-services/therapies-interventions/medications-asd
  4. Medication treatment for autism; Eunice Kennedy Shriver national institute of child health and human development; US department of health and human services. Retrieved from https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/medication-treatment.
  5. What drugs are used for treating autism?; Applied Behavior AnalysisEdu.org. Retrieved from https://www.appliedbehavioranalysisedu.org/what-drugs-are-used-for-treating-autism/
  6. Alison Singer, MBA, and Ramita Ravi – Complementary and Alternative Treatments for Autism Part 2: Identifying and Avoiding Non-Evidence-Based Treatments – AMA Journal of Ethics. April 2015, Volume 17, Number 4: 375-380
  7. Kane K. Death of 5-year-old boy linked to controversial chelation therapy. Pittsburgh Post-Gazette. January 6, 2006. http://old.post-gazette.com/pg/ 06006/633541.stm
  8. Be Aware of Potentially Dangerous Products and Therapies that Claim to Treat Autism. US Food and Drug Administration. Retrieved from https://www.fda.gov/consumers/consumer-updates/be-aware-potentially-dangerous-products-and-therapies-claim-treat-autism
  9. For kids with autism, supplements often results in nutritional imbalances; Autism speaks. Retrieved from https://www.autismspeaks.org/science-news/kids-autism-supplements-often-result-nutrient-imbalances
  10. Autism and medication; Why are so many kids on the spectrum taking it? Is it being misused? Child mind institute. Retrieved from https://childmind.org/article/autism-and-medication/
  11. The guide to off label prescription drugs. Kevin Loughlin and Joyce Generali. 2006 edition.

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