Rapid ReviewTargeted treatments for symptom domains in child and adolescent autism
Section snippets
Drug treatments for autism
Recent reviews2, 3, 4, 5 describe drug treatment strategies for various associated symptom domains commonly found in autism, and suggest that behavioural and drug treatments are complementary and can be integrated. It is important to understand the nature of the social deficit, to establish a therapeutic relationship with the patient to increase treatment compliance, to optimise home and school environments, and to involve parents. Interventions should be used in a priority based on risks,
Atypical antipyschotic agents for disruptive behaviour in autism
McCracken et al6 evaluated the efficacy and safety of risperidone in children with autism and serious behavioural disturbances, and found an improvement in aggressive symptoms, rather than core symptoms, of autism (table 2). This multisite study, in just over a 101 patients used an 8-week, was a double-blind placebo-controlled trial followed by open-label treatment for 4 months. Children had autism and serious behavioural disturbances with tantrums, aggression, and/or self-injury, which was
Mood stabilisers
Several mood stabilisers have been shown to improve symptoms related to affective instability and aggression in autism. In two open-label studies, the anticonvulsants valproate and levetiracetam were effective in reducing aggression, impulsivity, and mood lability, and also improved communication.9, 10 Lithium is effective in some autistic individuals, and those who have milder variants of autism and a family history of manic depression were found to have a good response.11
Serotonin-reuptake inhibitors for repetitive behaviours and mood disorders in autism
Selective serotonin-reuptake inhibitors are potentially useful drugs for the treatment of anxiety, repetitive behaviours, or core symptoms of autism. In a recent retrospective chart analysis of children and adolescents with autism and pervasive developmental disorder, not otherwise specified, L Namerov and colleagues12 treated patients with citalopram for 14–624 days (mean 219).12 Ten out of 15 patients showed significant improvement on the clinical global impressions scale (73% much improved
Recent behavioural trials
A recent behavioural trial19 in autistic adults suggests that residential programmes based on the TEACCH model (treatment and education of autistic and related communication handicapped children) led to a decrease in difficult behaviours over time and increased family satisfaction, but no difference in the acquisition of skills. Similar programmes could be implemented for children.
Conclusion
These studies focused on patients selected for severity of specific target symptoms, and found improvements in those symptoms, despite differences in diagnosis and level of intellectual functioning. The findings support the pharmacological and behavioural targeting of specific problem symptoms in autism. As the number of children treated with medication increases, it is important to examine the safety and efficacy of these medications, particularly in very young populations such as preschool
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