Although non-pharmacological therapies are centrally important to treating autism, medications have a place in the overall treatment plan. Autism can have associated problematic behaviors for which medications are necessary. Too often, by the time medications are brought in to help, the dilemmas that have arisen from disruptive behavior have escalated to uncomfortable or even unacceptable levels.
One example of a disruptive behavior is aggression, being aggressive against other children (or adolescents or adults) or against objects in the environment. Another such behavior is overly-energetic hyperactivity. Here are a few more examples: repeating the same movements over and over; being remarkably and unexpectantly irritable and cranky; daydreaming and not paying attention at a time when attention is needed; being markedly nervous and anxious; and depression, either depression that socially isolates or angry depression, far more than just a down mood. When one of these behaviors occurs in social situations it leaves the child feeling awful about themselves. It creates a social environment exactly the opposite of what a child with autism needs to feel secure and to do well.
Making the Medication Decisions
As with therapies and other non-pharmacologic care, medication decisions are made by the health care professional in charge of the treatment plan design, working with the rest of the treatment team for the best possible eventual clinical outcome for the child. See the page on non-pharmaceutical therapies for more on this topic: (https://www.neuroscirandd.com/asd-education-therapy/).
No Medications For Autism
No medications have been developed yet that treat the autism itself. That is, there is no medication to rapidly reverse or cure autism. One hope is that medical science will discover such a medication.
But Medications Can Help
Any medication used to treat problematic behaviors in the context of autism is meant just to lessen the behavior and its negative impact on the child’s environment. It’s often a dilemma to try to choose the best medication for any specific disruptive behavior. It needs to be a good fit for the child, the child’s environment, and the target behavior. A medication that is remarkably helpful to lessen anxiety in one child might be useless to treat anxiety in another child. There is no “one-size-fits-all”, not one-size-fits-all for the child nor one-size-fits-all for the medications.
Irritability in Autism
The FDA has approved 2 medications for irritability in autism, risperidone (Risperdal) for ages 5 to 16 and aripiprazole (Abilify) for ages 6 to 17. As FDA-approved medications they have gone through the rigorous testing the FDA requires to approve a medication for a specific medical indication.
Medications That Are Not FDA-Approved
A medication does not have to be government-agency-approved for a behavior in autism for it to be used and helpful. Most medications with good efficacy in treating behavioral symptoms in autism are used in line with “community standards”. That is, they are known to be safe and effective because they are prescribed frequently for those indications by experienced clinicians and usually work well with few side effects or adverse reactions.
Other Medication Choices Beyond risperidone and aripiprazole
One example of this “community standards” approach is the use of antidepressants. They were developed for treating major depression in adolescents and adults. It has been realized by clinicians over time that In autism these medications can reduce repetitive behaviors, anxiety, and irritability. This beneficial effect is not related to the autistic child being or not being depressed. In some situations these medications can make tantrums less intense and lower the aggression level in aggressive behavior. They can at times greatly improve eye contact and social interaction in an autistic child.
Medicines for Anxiety and “Nervousness”
Some medications used in adults to treat anxiety can help lower an autistic child’s anxiety and even treat panic-attack-like symptoms.
The Calming Effect of “Stimulants”
This effect might seem to work in a non-intuitive direction, but it is a real effect. Some children with autism can feel calmer and better with one of the medications that in adults would be called “stimulants”. (This counter-intuitive effect is more often associated with treating children with attention deficit hyperactivity disorder, that is, ADHD.)
A Medication for Seizures in an Autistic Child Who Does Not Have Seizures
Anti-seizure medications are used to treat seizures and seizure disorders like epilepsy. Some people with autism also have seizures, thus, it seems reasonable that these medications are used for seizures that occur in the context of autism. But they are also used for children with autism for situations that have no seizure component. One example is a child being upset in an “out-of-control” kind of way, that is, disruptive behavioral dyscontrol. Anti-seizure medications are also used in adults who do not have epilepsy or seizures. One example is a medical condition called Intermittent Explosive Disorder.
Department of Health and Human Services (United States), National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Library of Medicine (United States), PubMed Central
Centers for Disease Control and Prevention