Copyright Harvard Health Publications
Although medication prescriptions are common, there is little evidence they do any good.
Surveys indicate that nearly half of children with autism spectrum disorders take some type of psychiatric medication, most often antidepressants, antipsychotics, or stimulants. Unfortunately there is as yet no good evidence that any of these drugs effectively treat symptoms of autism spectrum disorders.
According to the U.S. Centers for Disease Control and Prevention (CDC), one in 68 U.S. children has autism spectrum disorder. The key deficits in autism spectrum disorder (ASD), as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are problems with communication and social interaction as well as behaviors, interests and activities that are restricted and repetitive. Examples are ritualistic behaviors like constantly tapping of fingers or humming.
Early intervention behavioral therapy, typically delivered at home or in school, forms the foundation of treatment for autism spectrum disorders. These therapies are labor- and time-intensive, producing modest improvements at best. Parents and clinicians, often desperate for additional options, have increasingly turned to unproven drug treatments to alleviate symptoms such as aggression, irritability, and repetitive behaviors, or to prevent children from injuring themselves.
The hormone secretin is one example of a medication that did not live up to expectations or hopes. In 1998, case reports of three children with autism spectrum disorders who were given secretin during medical procedures suggested that secretin improved thinking ability and communication skills. However, several randomized controlled studies did not show secretin to be helpful for children with autism spectrum disorders. (An earlier review by the international independent research network known as the Cochrane Collaboration concluded the same thing.) Therefore secretin should not be prescribed for ASD, although some Web sites still promote it.
In fact, research has not shown that any medication is effective for improving social skills or communication ability in children with autism spectrum disorders. Some drugs may modestly improve behavior.
A number of studies have shown that antipsychotic medications provide modest improvement on some behavior measures. Risperidone (Risperdal) and aripiprazole (Abilify) have been helpful for reducing repetitive behavior and hyperactivity. Both medications can cause significant side effects so should probably be used only when children with autism spectrum disorders are severely impaired or at risk of injuring themselves.
There is scant evidence that antidepressants help improve behavior in children with autism spectrum disorders.
Stimulants do not fare much better. Methylphenidate (Ritalin) may reduce hyperactivity in some youths with ASD. This benefit, however, may be offset by side effects such as lethargy, social withdrawal, irritability, sleep problems, headaches, and diarrhea.
Behavioral interventions are still best. Most early intervention therapies used in treating children with autism spectrum disorders are based on basic principles of behavioral therapy, which uses positive reinforcement and other techniques to encourage behavior change.
Although the evidence is limited, studies suggest that high-intensity interventions (at least 30 hours a week for one to three years) improve children’s language skills, behavior, and thinking ability when compared with other (broadly defined) community treatments. As difficult as they are to implement, behavioral interventions remain the best choice for treating children with autism spectrum disorders.