Medically reviewed by ADDitude’s ADHD Medical Review Panel
Q: “What medications are prescribed to treat autism spectrum disorder (ASD)?”
A: Risperidone and aripiprazole are the only medications approved by the FDA for patients with autism spectrum disorder. These medications typically target the autism symptoms of severe irritability, outbursts, or aggressiveness. Below, we explain how medications address those symptoms — plus attention, executive function, and sleep — for ASD patients.
Attention and Executive Function
Patients with autism often have attention deficit hyperactivity disorder (ADHD or ADD) or demonstrate common symptoms of ADHD, such as executive dysfunction. Research has found that stimulant medication is less effective for patients on the autism spectrum than it is for those with pure ADHD (about 50% effectiveness vs. 80% effectiveness).
Patients with autism report more adverse reactions to stimulant medications than do individuals with pure ADHD; reported side effects include insomnia, appetite loss, irritability, social withdrawal, tics, anxiety, behavioral problems, GI complaints/stomach aches, sedation, and headache. The rates of side effects vary by study, individual characteristics of patients, and other factors, but they seem to range between 18% and 66%.
Some studies suggest that non stimulant ADHD medication may be somewhat more helpful than stimulant medication in controlling attention and with fewer side effects for the patient with autism, though it’s worth noting that studies are few and results are mixed. Within my patient population of adults with autism, roughly 20% of those who have tried medication for attention report the perception of benefit, while the other 80% report lack of benefit and/or uncomfortable side effects. Some studies conclude that the use of medication for attention may be quite helpful for some ASD patients, but medication responses should be monitored closely to watch for both benefits and side effects.
Sleep
Sleep problems are common for individuals with autism. In my clinic, I notice that many of my patients specifically have issues falling asleep and many are night owls, sometimes with a reversed sleep cycle that keeps them up all night. As a result, sleep supplements like melatonin and/or prescribed medicines such as Clonidine or Trazodone may help when monitored by a physician.
Mood and anxiety
Anxiety and depression commonly occur within the autism spectrum. In my experience, anxiety seems to be a core component of autism, while depression is more reactive — it results from the life stressors and difficulty navigating daily activities associated with autism. Many patients with ASD benefit from a supportive layer of anxiety/depression medication such as an SSRI, although research also suggests that these medications show less benefit for individuals with autism than they do for patients with pure anxiety or depression.
Outbursts, Severe Irritability, and Aggression
Risperidone and aripiprazole are the only medications approved by the FDA for use in treating autism-related irritability and outbursts. Multiple other antipsychotics and mood stabilizers may be tried with a goal toward better emotional regulation for the patient.
One key takeaway regarding all of the medications used for autism is that, though medication may be a helpful layer of support, it alone will not likely remove the symptoms of concern. Other interventions are typically needed and may include skills training, environmental changes, behavioral techniques, and the use of sensory inputs.
The following information came from Theresa Regan, Ph.D and her webinar “Could I Be on the Autism Spectrum?” The Adults’ Guide to Pursuing an Accurate ASD Diagnosis. That webinar is available for replay here.
Sources
Cara M. Fosdick, etal. Pharmacologic treatment options for children and adolescents with autism spectrum disorder. Clinical Pharmacist (Oct. 2017)