Mar 1, 2020
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List of questions to ask before considering medication

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Question 1. Is there a formal diagnosis of an Autism Spectrum Disorder?

Yes -> Go to next question

No -> Ask your doctor to refer for a full assessment

Question 2. Have you removed any potential environmental factors that could be impacting symptoms of the autism spectrum disorder, such as food allergies or intolerances, chemical sensitivities or other environmental toxins?

Yes -> Go to the next question

No -> Remove environmental causes and evaluate if symptoms improve

Question 3. Medication should be viewed as a footnote to treatment and is only one part of a comprehensive treatment approach, have you tried other treatments before medication?

Yes -> Go to the next question

No -> Consider using other treatments, therapies or interventions to improve symptoms of an autism spectrum disorder

Question 4. Are you looking to medicate core symptoms of autism spectrum disorder? Core symptoms include impairment in social interaction, impairment in communication and/or language, and restricted and repetitive behaviors or interests.

Yes -> There are no medications currently available for Core symptoms. Treatment options are non-medication based therapies and interventions

No -> Go to the next question

Question 5. Are you looking to medicate ‘target’ co-occurring symptoms of seizures, aggression, and self-injury, irritability, property destruction, hyperactivity, inattention, or repetitive behaviours?

Yes -> Target symptoms may be modified with medication. Talk to your doctor about which medication would be best to modify the symptoms

Copyright Autism Spectrum Directory, please request permission to use, All rights reserved.

TYPES OF MEDICATION FOR TARGET CO-OCCURRING SYMPTOMS

Symptom: Irritability, aggression, self-injury, property destruction

  • Traditional antipsychotics
    • Dopamine antagonists – block dopamine receptors in the brain
    • Effective in small randomized controlled trials
    • Risks of tardive dyskinesia, an irreversible side effect in a small number of cases
    • Atypical antipsychotics
      • Mixed mechanism of action
      • Promising in case series and open trials
      • Lower risk of dystonias
    • Risperidone
      • studies show a high rate of effectiveness for aberrant behavior in Autism
      • better results achieved if used with psychosocial interventions such as parent training, visual schedules, positive reinforcement, functional communication skills, behavior rehearsal, and feedback problematic behaviors
      • side effects are weight gain and potential future metabolic problems
    • Aripiprazole

Symptom: Hyperactivity, inattention

  • Stimulant medications
    • Commonly used for symptoms of ADHD, not as useful for symptoms in Autism
    • Adverse side effects of stimulant medications
      • Worsening of repetitive behaviors
      • Irritability
      • Social withdrawal
    • Types of methylphenidate and amphetamines (stimulants)
      • Ritalin
      • Dopamine antagonists – increase the levels of dopamine in the brain, this is a contradicting effect to what antipsychotic medication does

Symptom: Repetitive behaviors

  • Repetitive behaviors similar to OCD
  • Strong support for SSRI medication in OCD
  • Evidence of serotonin metabolism is abnormal in autism
    • Elevated serotonin in blood a consistent finding
    • SSRIs block the uptake of serotonin
    • Preliminary finding in adults with autism that SSRIs are helpful
      • Useful medication for depression and anxiety common for higher functioning people on the autism spectrum who have a heightened awareness of their social disability
    • Types of SSRIs
      • Prozac
      • Fluvoxamine(Luvox) – study showed substantial improvements in repetitive behaviors
      • Citalopram (Celexa, Cipramil)
        • No better results than placebo
        • Poorly tolerated with side effects of impulsivity, hyperactivity, insomnia, behavioral action

 

 

Question 1. Is there a formal diagnosis of an Autism Spectrum Disorder? Yes -> Go to next question No -> Ask your doctor to refer for a full assessment Question 2. Have you removed any potential environmental factors that could be impacting symptoms of the autism spectrum disorder, such as food allergies or intolerances, chemical sensitivities or other environmental toxins? Yes -> Go to the next question No -> Remove environmental causes and evaluate if symptoms improve Question 3. Medication should be viewed as a footnote to treatment and is only one part of a comprehensive treatment approach, have you tried other treatments before medication? Yes -> Go to the next question No -> Consider using other treatments, therapies or interventions to improve symptoms of an autism spectrum disorder Question 4. Are you looking to medicate core symptoms of autism spectrum disorder? Core symptoms include impairment in social interaction, impairment in communication and/or language, and restricted and repetitive behaviors or interests. Yes -> There are no medications currently available for Core symptoms. Treatment options are non-medication based therapies and interventions No -> Go to the next question Question 5. Are you looking to medicate ‘target’ co-occurring symptoms of seizures, aggression, and self-injury, irritability, property destruction, hyperactivity, inattention, or repetitive behaviours? Yes -> Target symptoms may be modified with medication. Talk to your doctor about which medication would be best to modify the symptoms Copyright Autism Spectrum Directory, please request permission to use, All rights reserved. TYPES OF MEDICATION FOR TARGET CO-OCCURRING SYMPTOMS Symptom: Irritability, aggression, self-injury, property destruction Traditional antipsychotics Dopamine antagonists – block dopamine receptors in the brain Effective in small randomized controlled trials Risks of tardive dyskinesia, an irreversible side effect in a small number of cases Atypical antipsychotics Mixed mechanism of action Promising in case series and open trials Lower risk of dystonias Risperidone studies show a high rate of effectiveness for aberrant behavior in Autism better results achieved if used with psychosocial interventions such as parent training, visual schedules, positive reinforcement, functional communication skills, behavior rehearsal, and feedback problematic behaviors side effects are weight gain and potential future metabolic problems Aripiprazole Symptom: Hyperactivity, inattention Stimulant medications Commonly used for symptoms of ADHD, not as useful for symptoms in Autism Adverse side effects of stimulant medications Worsening of repetitive behaviors Irritability Social withdrawal Types of methylphenidate and amphetamines (stimulants) Ritalin Dopamine antagonists – increase the levels of dopamine in the brain, this is a contradicting effect to what antipsychotic medication does Symptom: Repetitive behaviors Repetitive behaviors similar to OCD Strong support for SSRI medication in OCD Evidence of serotonin metabolism is abnormal in autism Elevated serotonin in blood a consistent finding SSRIs block the uptake of serotonin Preliminary finding in adults with autism that SSRIs are helpful Useful medication for depression and anxiety common for higher functioning people on the autism spectrum who have a heightened awareness of their social disability Types of SSRIs Prozac Fluvoxamine(Luvox) – study showed substantial improvements in repetitive behaviors Citalopram (Celexa, Cipramil)…

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