Exploring Medications for Autism: Key Considerations and Research
Overview: This article discusses medication use in the autistic community, the decision to take medications, medication assessment, and the research surrounding certain medication classifications commonly prescribed to autistic people. Be sure to use the “Medication Toolkit” to explore and track your own medication usage. Download the toolkit at the end of this article.
Deciding whether to take medications is often one of the most vexing choices that individuals and families face. This decision is especially difficult for autistic individuals and their families because there is no single medication to alleviate every symptom of autism. It is thus essential that medication decisions be approached with as much information, planning, and curiosity as possible.
Medications and Autism
There is no medication “cure” for autism, but there are many psychotropic interventions for specific autism symptoms such as attention, irritability, anxiety, and social engagement. Mandell et al. (2008) found that 56% of autistic children are on at least one such mental health drug, with many of them on three or more different medications at a time. While this type of medication intervention can be very effective in symptom management it can easily be overutilized resulting in side effects that are as or more debilitating than the original symptom. The risk of medication side effects if greater for autistic people who tend to be more sensitive to pharmacological interventions than their non-asd peers (Aishworiya et al., 2023).
Mental health challenges are often treated with medication coupled with another form of treatment like therapy, behavioral intervention, etc. An autistic individual seeking help in managing a mental health symptom associated with their autism – for example rigid thinking – would likely benefit from the same approach of combining medications with another form of treatment to achieve the best possible results. This does not mean that medications can’t be helpful on their own, but that long term symptom management is more likely to occur from changes in brain chemistry via medication use along with effortful changes via other modes of treatment.
Seeking Medications
Given the potential negative side effects as well as the general deleterious impact of long-term medication usage, pharmacological intervention should only be considered when other approaches to symptom management have failed. If therapy, behavioral intervention, social support, and any other attempts at symptom control have failed then a medical intervention may be indicated. The goal of the medicine in this situation is often as an aid to the efficacy of the other intervention approach. Once a pharmacological intervention is deemed appropriate, it is essential to approach the process with diligence and full information. Obtaining a prescription is just one step of the overall process. Consider the following issues, and utilize the accompanying personal development tool, to make your best medication decision.
Overall Treatment Goals
Cost
Side Effects
Logistics of Administration
Necessary Blood or Other Tests
Classification of Medication
Medication Timeline
Medication Alternatives
Overdose Possibility
How to Stop the Medication
Potential Interactions with other medications
Taking and Assessing Medications
Medication use is a very personal process and experience. No two people have the exact same experience with any pharmacological intervention. Prescribing doctors are often quite busy and may not be able to tailor medication regimens unless they are provided with specific feedback regarding your experiences with a particular medication. The patient is thus an essential player in curating pharmaceutical plans, and personal assessment of medication is an essential part of the process.
One important step in monitoring the efficacy of a medication is to establish a baseline of a person’s physiological and psychological function prior to introduction of the medication. It is generally recommended that a person track functioning for at least two weeks prior to starting a new medication. Once the medication regimen begins, it is important to know the target date for the medication to take full effect, and what the goal dosages may be. Once the medication is being taken at a therapeutic dose and enough time has passed for it to take effect it is important to continue assessing physiological and psychological functioning. This process should allow for the best possible assessment of the medication and inform any necessary changes. The medication personal development tool will help to track these changes.
Medications
There are numerous classifications of medications that are prescribed to autistic people – each one dependent on their presenting symptoms, medical history, and overall treatment goals. There are also countless vitamins and minerals that have been identified as having a potential positive impact on autism symptoms – for more on that refer to the article “Autism, Diet, and Supplements.” Below is an overview of medications that are often prescribed for autistic individuals. This is not meant to be an exhaustive list of medications, symptoms treated or side effects, rather it is a compilation of research on pharmacological interventions for autism. For the purposes of this review “Core autism symptoms” refer to social/communication issues as well as restricted interests and repetitive behaviors.
Medication Toolkit
References
Aishworiya, R., Valica, T., Hagerman, R., & Restrepo, B. (2023). An update on psychopharmacological treatment of autism spectrum disorder. Neurotherapeutics, 19(1), 248-262.
Chandana, S. R., Behen, M. E., Juhász, C., Muzik, O., Rothermel, R. D., Mangner, T. J., ... & Chugani, D. C. (2005). Significance of abnormalities in developmental trajectory and asymmetry of cortical serotonin synthesis in autism. International Journal of Developmental Neuroscience, 23(2-3), 171-182.
Coleman, D. M., Adams, J. B., Anderson, A. L., & Frye, R. E. (2019). Rating of the effectiveness of 26 psychiatric and seizure medications for autism spectrum disorder: results of a national survey. Journal of Child and Adolescent Psychopharmacology, 29(2), 107-123.
Gringras, P., Nir, T., Breddy, J., Frydman-Marom, A., & Findling, R. L. (2017). Efficacy and safety of pediatric prolonged-release melatonin for insomnia in children with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 56(11), 948-957.
Hellings, J. (2023). Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials. World Journal of Psychiatry, 13(6), 262.
Lemonnier, E., Villeneuve, N., Sonie, S., Serret, S., Rosier, A., Roue, M., ... & Ben-Ari, Y. (2017). Effects of bumetanide on neurobehavioral function in children and adolescents with autism spectrum disorders. Translational psychiatry, 7(3), e1056-e1056.
Mandell, D. S., Morales, K. H., Marcus, S. C., Stahmer, A. C., Doshi, J., & Polsky, D. E. (2008). Psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders. Pediatrics, 121(3), e441-e448.
Posey, D. J., Puntney, J. I., Sasher, T. M., Kem, D. L., & McDougle, C. J. (2004). Guanfacine treatment of hyperactivity and inattention in pervasive developmental disorders: a retrospective analysis of 80 cases. Journal of Child and Adolescent Psychopharmacology, 14(2), 233-241.
Sprengers, J. J., Van Andel, D. M., Zuithoff, N. P., Keijzer-Veen, M. G., Schulp, A. J., Scheepers, F. E., ... & Bruining, H. (2021). Bumetanide for core symptoms of autism spectrum disorder (BAMBI): a single center, double-blinded, participant-randomized, placebo-controlled, phase-2 superiority trial. Journal of the American Academy of Child & Adolescent Psychiatry, 60(7), 865-876.
Sturman, N., Deckx, L., & van Driel, M. L. (2017). Methylphenidate for children and adolescents with autism spectrum disorder. Cochrane Database of Systematic Reviews, (11).
Wang, T., Shan, L., Miao, C., Xu, Z., & Jia, F. (2021). Treatment effect of bumetanide in children with autism spectrum disorder: a systematic review and meta-analysis. Frontiers in Psychiatry, 12, 751575.
Williams, K., Brignell, A., Randall, M., Silove, N., & Hazell, P. (2013). Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews, (8).
Yamasue, H., & Domes, G. (2018). Oxytocin and autism spectrum disorders. Behavioral Pharmacology of Neuropeptides: Oxytocin, 449-465.
Yamasue, H., Okada, T., Munesue, T., Kuroda, M., Fujioka, T., Uno, Y., ... & Kosaka, H. (2020). Effect of intranasal oxytocin on the core social symptoms of autism spectrum disorder: a randomized clinical trial. Molecular psychiatry, 25(8), 1849-1858.
