Medications to Treat Co-Occurring Psychiatric Conditions in Autism Spectrum Disorder

Abstract

Although there are as yet no drugs specifically indicated for core symptoms of autism spectrum disorder (ASD), medications are frequently used as a component of comprehensive treatment for co-occurring psychiatric conditions in individuals with ASD across the lifespan. As is true for psychopharmacological treatment in general, the selection of particular therapeutic agents is not yet driven by an understanding of the contributions of specific genetic or other abnormalities to the development or expression of psychiatric symptoms. Treatment is thus largely empirical, and the most common therapeutic targets in ASD include hyperactivity and impulsivity, irritability, mood and anxiety symptoms, and insomnia. The literature suggests that individuals with ASD as a group respond less well to common pharmacologic interventions, and they are generally more likely to experience side effects. There is good evidence to support many of the commonly used medication strategies in ASD, particularly the use of stimulants and other drugs typically prescribed for attention deficit hyperactivity disorder, as well as atypical antipsychotics for a cluster of symptoms captured under the umbrella term of irritability. There is growing interest in exploring the role of drugs that act on glutamatergic and GABAergic systems. Overall, the evidence base to inform the practice of psychopharmacology is relatively limited even for situations where a Food and Drug Administration-approved indication exists, and considerable work needs to be done to better inform clinical practice.