Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects 1 in 68 children in the United States. Even though it is a common disorder, only two medications (risperidone and aripiprazole) are approved by the U.S. Food and Drug Administration (FDA) to treat symptoms associated with ASD. However, these medications are approved to treat irritability, which is not a core symptom of ASD. A number of novel medications, which have not been approved by the FDA to treat ASD have been used off-label in some studies to treat ASD symptoms, including medications approved for Alzheimer’s disease. Interestingly, some of these studies are high-quality, double-blind, placebo-controlled (DBPC) studies. This article systematically reviews studies published through April, 2014, which examined the use of Alzheimer’s medications in ASD, including donepezil (seven studies, two were DBPC, five out of seven reported improvements), galantamine (four studies, two were DBPC, all reported improvements), rivastigmine (one study reporting improvements), tacrine (one study reporting improvements), and memantine (nine studies, one was DBPC, eight reported improvements). An evidence-based scale was used to rank each medication. Collectively, these studies reported improvements in expressive language and communication, receptive language, social interaction, irritability, hyperactivity, attention, eye contact, emotional lability, repetitive or self-stimulatory behaviors, motor planning, disruptive behaviors, obsessive–compulsive symptoms, lethargy, overall ASD behaviors, and increased REM sleep. Reported side effects are reviewed and include irritability, gastrointestinal problems, verbal or behavioral regression, headaches, irritability, rash, tremor, sedation, vomiting, and speech problems. Both galantamine and memantine had sufficient evidence ranking for improving both core and associated symptoms of ASD. Given the lack of medications approved to treat ASD, further studies on novel medications, including Alzheimer’s disease medications, are needed.
Highlights
Autism spectrum disorder (ASD) is a heterogenous neurodevelopmental disorder that is defined by behavioral observations and characterized by developmental delays in communication and social interaction and by repetitive behaviors and/or restricted interests
Well-designed, and blinded studies are needed to further evaluate the efficacy of memantine in children with ASD as well as define the subgroups that might optimally respond to this medication. This manuscript reviews the evidence for the use of medications which are Food and Drug Administration (FDA) approved for Alzheimer’s disease in individuals with ASD
These medications target two neurotransmitter systems, acetylcholine and glutamate, which are both neurotransmitter systems with abnormalities associated with ASD
Summary
Autism spectrum disorder (ASD) is a heterogenous neurodevelopmental disorder that is defined by behavioral observations and characterized by developmental delays in communication and social interaction and by repetitive behaviors and/or restricted interests. Since irritability is not a core feature of ASD, there are currently no U.S FDA approved medications for treating the core symptoms of ASD. A number of novel medications have been used to treat the symptoms of ASD [4, 5]. Some of these medications are approved for the treatment of Alzheimer’s disease. A connection between Alzheimer’s disease and autism has been proposed by some investigators [6] and will be reviewed below. Because of the evidence of this connection, several medications approved for Alzheimer’s disease have been investigated for use in ASD
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