Symptom domains include repetitive and stereotyped behaviors, irritability and aggression, hyperactivity and inattention, and social impairment.
Medications covered include serotonin reuptake inhibitors (SRIs), mirtazapine, antipsychotics, psychostimulants, atomoxetine, -2 agonists,D-cycloserine, and memantine. Overall, SRIs are less efficacious and more poorly tolerated in children with ASDs than in adults. Antipsychotics are the most efficacious drugs for the treatment of irritability in ASDs, and may be useful in the treatment of other symptoms. Psychostimulants demonstrate some benefit for the treatment of hyperactivity and inattention in individuals with ASDs, but are less efficacious and associated with more adverse effects compared with individuals with ADHD. D-cycloserine and memantine appear helpful in the treatment of social impairment, although further research is needed.
Pros: Helpful for treating repetitive behaviors and stereotypies. May also be helpful for aggression and hyperactivity. Seems to be better for adults.
Cons: The adverse effects seemed to out weight the benefits for kids.
Dosing: Ranged from 75-250mg/day, sometimes divided
Adverse Effects: Sleep disturbances, dry mouth, constipation, fatigue, dystonia, depression, and behavioral problems.
Pros: Helpful for adults with the management of repetitive behaviors, maladaptive behaviors and aggression in adults.
Cons: Not very effective and not well tolerated with kids and teens.
Dosing: For adults, 50-300mg/day
Adverse Effects: Generally well tolerated by adults.
Pros: Most effective for adults and teens with autism. Teens seem to have more frequent adverse effects
Cons: Not found helpful for repetitive behaviors in kids.
Adverse Effects: Increased anxiety, agitation, hypomania. Again, better tolerated by adults.
Pros: "Moderately effective" and well-tolerated in managing aggression and repetitive with ASDs in adults
Cons: Minimal data for children.
Dosing: 25-200mg/day for adults
Adverse Effects: Minimal, most common were weight gain and anxiety/agitation.
Pros: May be helpful for disturbed mood and anxiety.
Cons: Seems to be of limited use in repetitive behaviors with children and teens, with some studies show no difference from the placebo.
Adverse Effects: Increased energy, impulsiveness, decreased concentration, hyperactivity, stereotypy, diarrhea, insomnia, and dry skin.
Pros: Possibly some benefit to children and teens.
Cons: No published adult studies. Some children/teens had irritability and or/hyperactivity.
Adverse Effects: Irritability and hyperactivity.
Pros: Found "somewhat effective" in kids, teens and adults with ASDs.
Cons: None listed
Adverse Effects: Behavioral activation, inattention, polyuria and nausea
Pros: Some efficacy in treatment-resistant cse study
Cons: Minimal evidence
Dosing: Most effective at 150mg/day in divided doses
Adverse Effects: Priapsim
Pros: "Somewhat effective" with behavior management. Positive response rate of folks showing inappropriate sexual behaviors in one study was 80%.
Cons: Adverse effects
Adverse Effects: Commonly weight gain and increased appetite. Agitation at higher doses.
Pros: Proven to be good for kids and teens ASD behaviors for short and long term. In adults, its proven to be better than Anafranil for irritability. Better than Prolixin at reducing withdrawal, aggression and stereotypies in kids with ASD.
Adverse Effects: Oversedation, akathisia and acute dystonia.
Pros: Reported specifically helpful in management of sleep and excretion disorders in children with autism.
Cons: No results with adult have been published. Frequency if dystonic reactions.
Adverse Effects: Dystonic reactions, sleepiness
Pros: Studies suggest good tolerability and effective management of severe aggression and irritability but trials are lacking. Case studies with adults have shown reduced irritability and aggression, and a reduction in medications needed overall.
Cons: Possible reductions in WBC
Adverse Effects: Metabolic syndrome, tachycardia, constipation
Pros: Proven to be better than Haldol in short and long term treatment of behavioral issues, impulsivity, impaired language skills and social relations. Adults had improvements in explosive aggression, SIB, and sleep hygiene.
Cons: Adverse effects, including weight gain averaging 5.4kg in adults in one study.
Dosing: (adults) 1-10mg/day
Adverse Effects: Increased appetite, weight gain, transient sedation and increased prolactin levels
Pros: Has shown some efficacy in adults with ASDs, moderately more efficacy in children. Was shown to help irritability, hyperactivity, excessive/inappropriate speech, aggression and depression in several studies.
Cons: Adverse effects, including weight gain, increased appetite and sedation were common in the literature. In the only double-blind placebo-controlled study, only 50% of children were considered responders. Repetitive behaviors did not seem to respond as well to the medication.
Adverse Effects: Most common weight gain, increased appetite and loss of strength.
Pros: Response rates vary study to study from 30% to 60% of subjects.
Cons: Was shown to be minimally effective in individuals with ASDs with significant adverse effects. There are no published controlled trials.
Adverse Effects: Sedation, weight gain, behavioral activation, akathisia, and a possible seizure.
Pros: Reported as 'moderately effective' in individual with ASDs. In a chart review, 60% of adults had a positive response with improved behavior.
Cons: There are no published controlled trials. Several patients with co-morbid BPAD had notably negative responses.
Adverse Effects: Weight loss and transient sedation.
Pros: Proven effective for irritability in children. Limited data is available on adults.
Cons: A chart review showed poorer responses in the management of aggression, hyperactivity, impulsivity and SIB.
Adverse Effects: Sedation, hypersalivation, hyperactivity, akathisia, dyskinesia, and tremor.
Pros: Appears effective in children, teens and adults in limited studies, notably for irritability.
Cons: Adverse effects.
Adverse Effects: Some experienced weight loss, others increased appetite and weight gain, mild-to-moderate EPS, and increased prolactin levels.
Pros: Overall, the response rate of hyperactivity in children appears to average around 50%. Children with Asperger's DO were more likely to respond than those with autism or PDD. Adult study had reduction in hyperactivity and aggression with improved attention.
Cons: Studies in adults limited to one case study.
Dosing: 40mg/day in three doses (for adult case study)
Adverse Effects: Irritability
Pros: Appears "moderately efficacious" in managing hyperactivity and possibly inattention in children and teens. One study showed improvements in children with irritability, social withdrawal, stereotypy and repetitive movements.
Cons: Again, adult study is limited to a single case report. High discontinuation rate related to adverse effects.
Adverse Effects: GI symptoms, decreased appetite, irritability, ear ringing, mood swings, sleep problems, and sedation.
Clonidine (Catapres)Pros: Showns to be "moderately efficacious" in treating hyperactivity and inattention in children with ASDs. Helpful for sleep initiation. Adult case study showed reduced aggression and increased alertness.
Cons: Yet again, only a single case report studying adult response.
Adverse Effects: Sedation, drowsiness, and decreased activity.
Pros: 24-57% of children in studies were responsive to the medication in treating hyperactivity, inattention, insomnia and tics. Noted to be well-tolerated overall.
Cons: No adult studies are mentioned in the article.
Dosing: 0.25-9mg/day in divided doses
Adverse Effects: Irritability, sedation, sleep disturbance, constipation, headache, and nocturnal enuresis.
Pros: Statistically significant improvements observed in CGI scale and on a scale of social withdrawal Cons: Research limited to a single study.
Dosing: 30/50/85mg/day for 2 weeks each
Adverse Effects: Transient motor tic and increased echolalia
Pros: Shown to be effective (one study 61% response rate) in treating social impairment and inattention with ASDs in preliminary studies. Some improvement in language function and stereotypic behaviors was noted.
Cons: Limited to preliminary studies.
Adverse Effects: Irritability, rash, emesis, sedation, and increased seizure frequency