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Pharmacologic Treatment of Behavioral Symptoms Associated With Autism and Other Pervasive Developmental Disorders

  • Pediatric Neurology
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Pervasive developmental disorders (PDDs), including autistic disorder (autism), Asperger’s disorder, and pervasive developmental disorder not otherwise specified (PDD NOS), are neurodevelopmental disorders of childhood onset. These disorders persist throughout the lifespan of affected individuals and are characterized by impaired social behavior and communication, along with repetitive, stereotypic behaviors. Early diagnosis and subsequent behavioral therapy have been shown to improve outcomes for these individuals. Risperidone and aripiprazole have been approved by the United States Food and Drug Administration (FDA) for treatment of irritability associated with autism in children and adolescents. Despite their efficacy, use of these medications is limited by their side effects. In individuals with severe irritability, the first-line treatment is often risperidone. Because of its relatively lower risk of weight gain and metabolic side effects, aripiprazole may be used initially if there is a personal or family history of obesity or diabetes. Monitoring of body mass index and metabolic profiles is indicated with both medications. Stereotypic behaviors associated with autism, though clearly driven by neurobiologic processes, can also be understood as coping mechanisms used to decrease anxiety. From this perspective, therapies targeting reduction of these symptoms may be contraindicated. However, when these symptoms are severe and interfering, pharmacotherapy may be necessary. Serotonin reuptake inhibitors are of limited efficacy in children and adolescents, but risperidone and aripiprazole have been shown to reduce these symptoms. There remains a need for further safety and efficacy research in this area. Hyperactivity and inattention are currently treated with a variety of medications, including guanfacine, which has a relatively benign side effect profile. Stimulant medications are generally avoided as first-line treatment for hyperactivity because of concerns about increased irritability. Currently, social impairment is best addressed through behavioral therapy and social skills training. Novel pharmacotherapies to improve social impairment are in the early stages of research.

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Acknowledgments

Dr. Erickson’s work is supported in part by The Division of Disability & Rehabilitative Services, Indiana Family and Social Services Administration; and National Institutes of Health grant K12 UL1 RR025761 Indiana University Clinical and Translational Sciences Institute Career Development Award. Dr. McDougle’s work is supported in part by The Division of Disability & Rehabilitative Services, Indiana Family and Social Services Administration; and NIMH grants R01 MH072964 and R01 MH077600.

Disclosure

Dr. Erickson receives consulting fees from Novartis, F. Hoffman-LaRoche, and McNeil Pediatrics, and research grant support from F. Hoffmann-LaRoche and Seaside Therapeutics. Dr. McDougle is a consultant to Bristol-Myers Squibb, receives grant support from that company, and serves on its Speakers Bureau. No other potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Department of Psychiatry, Indiana University School of Medicine, Psychiatry Building—A305, 1111 West 10th Street, Indianapolis, IN, 46202-4800, USA

    Logan K. Wink MD, Craig A. Erickson MD & Christopher J. McDougle MD

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  1. Logan K. Wink MD
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  2. Craig A. Erickson MD
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  3. Christopher J. McDougle MD
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Correspondence to Christopher J. McDougle MD.

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Wink, L.K., Erickson, C.A. & McDougle, C.J. Pharmacologic Treatment of Behavioral Symptoms Associated With Autism and Other Pervasive Developmental Disorders. Curr Treat Options Neurol 12, 529–538 (2010). https://doi.org/10.1007/s11940-010-0091-8

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  • DOI: https://doi.org/10.1007/s11940-010-0091-8

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