Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder.

Broadstock M, Doughty C, Eggleston M.

Autism. 2007; 11(4): 335-348.

Question: What medications are effective in the treatment of the autistic symptoms and behavioural problems of people with autism spectrum disorder (ASD)?

Background: One of the hallmark symptoms of ASD is repetitive behaviours. Some people with ASD may spin, flap their hands, or rock their bodies. The behaviours may help alleviate their feelings of anxiety but they can also interfere with the person’s ability to function at home, school, or in their community. Many people with ASD also self injure by biting or hitting themselves. Some may become aggressive towards others, including their family members. While many of these symptoms and behaviours can be treated with behavior management techniques, others might be better treated with medications, usually in combination with the behavior therapy.

Design: A systematic review of studies of medication therapies for ASD symptoms.

Participants: Children, adolescents, and adults with ASD who displayed problem behaviours.

Intervention: Medication use alone, or in combination with behavior therapy.

Main Outcome Measures: Incidents of self-injurious behavior, aggression, property damage, stereotyped behaviours, depression, irritability, or nervousness.

Main Results: Five randomized controlled trials were included in the review. The other studies either did not involve people of the right age groups or were not conducted in the proper manner. Two studies on Risperidone (Risperdal) were carried out with 51 people, 50% of whom responded to treatment with a reduction of problem behaviours. No serious side effects were reported during the 12-week trial. One study looked at naltrexone hydrochloride use by 33 adults. The drug had side effects of nausea, sleepiness, and in one case, an increase in self-injurious behaviours. No one benefited from use of the drug. Another study looked at Fluvoxamine, an SSRI. The 15 patients who received the drug showed significant benefit from the drug with only minor side effects. They showed decreases in repetitive thoughts and behaviours, aggression, and also showed improvements in language use and autistic symptoms. Haloperidol and clomipramine were compared to each other and to placebo in another study with 37 patients between the ages of 10 and 36. Patients improved only while taking Haloperidol. There were only minor side effects.

Conclusions: Most of the studies of medication use were not conducted in the appropriate manner; that is, they were not randomized and did not use control groups. The five RCTs reported that showed Risperidone, Fluvoxamine, or Haloperidol were the only drugs that showed benefits in people with ASD. The studies were small and firm conclusions cannot be drawn from them. It appears that these three medications may be effective in treating behavioural and mood problems seen in people with ASD.