• There is no pharmacological cure for autism
• Medications are most beneficial when used in conjunction with developmental, educational, behavioral and habilitative therapies
• There is no single medication that consistently benefits all patients with autism spectrum disorder (ASD)

Indications

• If presenting with comorbid psychiatric or neurodevelopmental conditions
• For short to medium term intervention for specific severe symptoms
• For aggressive or self-injurious behavior
• For anxiety, depression, tics, obsessive-compulsive behaviors, hyperactivity, sleep disorders

Goals

• Minimize disruptive/disturbing symptoms
• Facilitate access to intervention
• Maximize benefits of nonmedical intervention
• Improves the patient’s and the family’s quality of life

Atypical Antipsychotics

Aripiprazole

• Approved for the short-term treatment of irritability in autistic children 6-17 years of age
• Studies showed improvement in challenging behavior and repetitive behavior

Risperidone

• Approved for the short-term treatment of irritability, hyperactivity and stereotypic behavior in autistic children 5-16 years of age
• Has less extrapyramidal effects than typical antipsychotics
• Children may gain weight within the first few months of treatment
• Prolactin levels may rise but with no clinical effects seen
• Improvement in repetitive behavior, social withdrawal and hyperactivity were observed in several studies

Conventional Antipsychotics

• Eg Haloperidol, Chlorpromazine
• Haloperidol is being considered in the management of temper tantrums, aggression, hyperactivity, withdrawal and stereotypical behavior
• Limitation of use is due to sedation, irritability and extrapyramidal dyskinesia

Selective Serotonin Reuptake Inhibitors (SSRI)

• Eg Fluoxetine, Fluvoxamine
• Studies have shown that Fluoxetine improved the mood of adolescent and adult patients and reduced ritualistic or repetitive behavior
• Fluvoxamine has been shown to be effective in the treatment of obsessive-compulsive disorder (OCD), refractory depression and social phobia
• Fluvoxamine has been considered for repetitive thought and maladaptive behavior but it can cause occasional worsening of hyperactivity in patients

Investigative Agents

• Various clinical studies are being conducted to prove the therapeutic effects of Oxytocin on patients with autism spectrum disorder
  • Oxytocin therapy may have the potential to improve social responsiveness based on several studies
• Methylphenidate is another agent undergoing clinical trials, showing potential in controlling joint attention and self-regulation behaviors, but further studies are needed to conclude its use for the treatment of autism

Early Developmental Intervention

• Intervention programs for autistic toddlers commonly involve the following:
  • A predictable program with routine that should stress the ability to pay attention to other people, imitate others, use of preverbal and verbal communication, play and social interaction
  • Systematic individual teaching of skills to support the child’s specific needs
  • Functional approach to dealing with the child’s problematic behavior
  • Family involvement
• There is evidence that if intensive early intervention is done on children diagnosed before 5 years, a better outcome is expected

Educational Systems

• Help autistic children from the age of 3-21 years
• Individualize the intervention and consider the patient’s developmental status, (eg specific strengths and deficits)
• Usually includes speech therapy with use of visual cues
  • Shows improvement in the expressive language at 4 years of age if speech therapy is given between 2-3 years of age
• For the minimally speaking child, alternative-augmentative communication systems may be recommended because these may stimulate speech acquisition in non-verbal children and enhance expression in verbal children
• Other communication interventions includes: Responsive Education and Prelinguistic Milieu Teaching (RPMT), Reciprocal Imitation Training (RIT), Picture Exchange Communication System (PECS)
• Occupational therapy gives assessment and intervention to maximize daily living activities
  • Sensory Integration Therapy (SIT)
  • Perceptual Motor Training
• Social skills should be taught
  • Use strategies to minimize maladaptive behavior and encourage compliance
  • Social skill taught explicitly through modeling and feedback
• Positive reinforcement should be applied
• Involvement of the parents is critical
• Parents and caregivers should be encouraged to share information about special educational needs with school personnel for better planning of intervention and support

Behavioral Management

• Notable treatment approach to autistic disorder is Applied Behavior Analysis (ABA)
• Most effective when started early and applied consistently
• Reinforce proper desirable behavior using behavioral psychologic theory
  • Implement behavioral training and management protocols at home and school
• Should be initiated after complete assessment of the child’s behavioral characteristics and environment
• Positive reinforcement strategy should be used
• Parents, caregivers and teachers should be trained to consistently implement the behavioral strategy in all of the child’s environments
• Social competence should be developed as part of behavioral rehabilitation plan

Early intensive behavioral and developmental approach

• UCLA/Lovaas
• Early start Denver model
• Parent training approaches
• Discrete Trial Training (DTT)
• Pivotal Response Training (PRT)

Social skills approach

• Social skills training

Play/Interaction-based approach

• Joint attention intervention
• Symbolic play and play-based interventions

Behavioral intervention for commonly associated symptoms

• Cognitive behavioral therapy for anxiety or anger management
• Sleep workshop for sleep disturbances