Description: Use of psychotropic medication to change behavior.
Examples: risperidone (Risperdal), methylphenidate (Ritalin), fluoxetine (Prozac)
Research Summary: For individuals with autism spectrum disorders who have persistent, severe tantrums, aggression, or self-injury, there is strong evidence from large, well-designed randomized clinical trials supporting the use of medications such as risperidone (Risperdal). These medications often produce major reductions in problem behaviors (McCracken et al., 2002) and may improve overall functioning (McDougle et al., 2005). However, the medications also may cause significant weight gain. Combining rispiridone with parent training on behavioral interventions appears to improve outcomes (Aman et al., 2009).
For individuals with autism spectrum disorders who have severe hyperactivity and inattention, there is strong evidence from a large, well-designed randomized clinical trial that medications such as methylphenidate (Ritalin) sometimes produce major reductions in hyperactivity (Research Units in Pediatric Psychopharmacology Autism Network, 2005).
Selective serotonin inhibitors (SSRI's) are sometimes prescribed for individuals with autism spectrum disorders who have severe repetitive behaviors or routines. may be effective. Examples of SSRI's are fluoxetine (Prozac), fluvoxetine (Paxil), and citalopram (Celexa). However, a large, well-designed study indicated that the SSRI citalopram had no effect on such behaviors (King et al., 2009). Preliminary studies indicate that medications may be effective in alleviating mood swings (Lewis & Lavoritz, 2005). Additional research is underway to test whether findings from preliminary research can be replicated in large, well-designed studies.
Recommendations: Medications are an effective intervention for some individuals with autism spectrum disorders who exhibit severe aggression, hyperactivity, or other problem behavior. When they are used, they should be prescribed and monitored by a qualified physician. Because of the evidence for the effectiveness of medications for some individuals with autism spectrum disorders, professionals and families may wish to obtain additional information about this approach; resources are listed in the references below.
Selected scientific studies:
Aman MG, McDougle CJ, Scahill L, Handen B, Arnold LE, Johnson C, et al. (2009). Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry. 2009, 48, 1143-1154.
King, B. H., Hollander, E., Sikich, L., McCracken, J. T., Scahill, L, et al. (2009). Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Archives of General Psychiatry, 66, 583-90.
McCracken, J. T., McGough, J., Shah, B., Cronin, P., Hong, D., Aman, M. G., et al. (2002). Risperidone in children with autism and serious behavior problems. The New England Journal of Medicine, 347, 314-321.
McDougle, C. J., Scahill, L., Aman, M. G., McCracken, J. T., Tierney, E., Davies, M., et al. (2005). Risperidone for the core symptom domains of autism: Results from the study by the Autism Network of the Research Units on Pediatric Psychopharmacology. American Journal of Psychiatry, 162, 1142-1148.
Research Units on Pediatric Psychopharmacology Autism Network (2005). Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Archives of General Psychiatry, 62, 1266-1274.
For additional information:
Volkmar, F. R., & Wiesner, L. (2009). A practical guide to autism: What every parent, family member, and teacher needs to know. New York: Wiley.