Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder

The variable expression of autism over the lifespan is likely to lead to different symptoms and support requirements, and to distinct responses to pharmacotherapy treatment, in older patients compared to children. This systematic review considers the effectiveness of pharmacological treatment in managing autism spectrum disorder in adolescents and adults. Following a comprehensive search of literature published in English from 1980, methodological criteria were applied to identify studies designed to reliably assess treatment effectiveness. Only five double-blind, randomized controlled trials were eligible for appraisal. All had small sample sizes (mean = 30) and brief treatment duration of no more than 12 weeks. The paucity of trials and their methodological limitations means that there is only preliminary evidence about the short-term effectiveness of a few drug treatments for this age group. There was also a lack of reliable data reported on drug safety profiles. Methodological challenges and directions for future research are discussed.

[1]  L. Burd,et al.  Pharmacotherapy of Autism: A Review and Clinical Approach , 2001 .

[2]  A. Young,et al.  A systematic review of the use of atypical antipsychotics in autism , 2002, Journal of psychopharmacology.

[3]  S. Folstein,et al.  Current directions in research on autism. , 2001, Mental retardation and developmental disabilities research reviews.

[4]  R. Tuchman,et al.  Antiepileptic drugs: affective use in autism spectrum disorders. , 2001, Pediatric neurology.

[5]  S. E. Mouridsen,et al.  The outcome in children with childhood autism and Asperger syndrome originally diagnosed as psychotic. A 30-year follow-up study of subjects hospitalized as children , 1997, European Child & Adolescent Psychiatry.

[6]  C. McDougle,et al.  Methodological issues in designing a multisite trial of risperidone in children and adolescents with autism. , 2001, Journal of child and adolescent psychopharmacology.

[7]  A. Brice,et al.  Combined vitamin B6-magnesium treatment in autism spectrum disorder. , 2002, The Cochrane database of systematic reviews.

[8]  M. Aman,et al.  Prevalence and patterns of use of psychoactive medicines in individuals with autism in the Autism Society of North Carolina. , 2002, Journal of child and adolescent psychopharmacology.

[9]  S R Schroeder,et al.  Effects of risperidone on aberrant behavior of persons with developmental disabilities: I. A double-blind crossover study using multiple measures. , 2001, American journal of mental retardation : AJMR.

[10]  M. Larkin.  Approaches to amelioration of autism in adulthood , 1997, The Lancet.

[11]  C. McDougle,et al.  A double-blind, placebo-controlled study of fluvoxamine in adults with autistic disorder. , 1996, Archives of general psychiatry.

[12]  C. Lord.  Commentary: Achievements and Future Directions for Intervention Research in Communication and Autism Spectrum Disorders , 2000, Journal of autism and developmental disorders.

[13]  A. Brice,et al.  Combined vitamin B6-magnesium treatment in autism spectrum disorder. , 2005, The Cochrane database of systematic reviews.

[14]  J. Kleijnen,et al.  Niacin and vitamin B6 in mental functioning: A review of controlled trials in humans , 1991, Biological Psychiatry.

[15]  Abraham Weizman,et al.  Use of atypical neuroleptics in child and adolescent psychiatry. , 1998, The Journal of clinical psychiatry.

[16]  C. McDougle,et al.  Pharmacotherapeutic management of autism , 2001, Expert opinion on pharmacotherapy.

[17]  S. Shott,et al.  Efficacy of vitamin B6 and magnesium in the treatment of autism: A methodology review and summary of outcomes , 1995, Journal of autism and developmental disorders.

[18]  G. Remington,et al.  Clomipramine Versus Haloperidol in the Treatment of Autistic Disorder: A Double-Blind, Placebo-Controlled, Crossover Study , 2001, Journal of clinical psychopharmacology.

[19]  S. Hill,et al.  Psychopharmacological Treatments for Patients with Intellectual Disability , 2000 .

[20]  Victoria Shea,et al.  Adolescents and Adults with Autism , 2005 .

[21]  M. Rutter,et al.  Cognitive deficits in the pathogenesis of autism. , 1983, Journal of child psychology and psychiatry, and allied disciplines.

[22]  C. McDougle,et al.  A double-blind, placebo-controlled study of risperidone in adults with autistic disorder and other pervasive developmental disorders. , 1998, Archives of general psychiatry.

[23]  J. Cunha.  General view on the criteria utilized for psychiatric diagnoses feighner research diagnostic criteria diagnostic and statistical manual of mental disorders dsm iii , 1986 .

[24]  J. Rumsey,et al.  Autistic children as adults: psychiatric, social, and behavioral outcomes. , 1985, Journal of the American Academy of Child Psychiatry.

[25]  H. Engeland,et al.  Failure of naltrexone hydrochloride to reduce self-injurious and autistic behavior in mentally retarded adults. Double-blind placebo-controlled studies. , 1995, Archives of general psychiatry.

[26]  J. E. Carr,et al.  Secretin as a Treatment for Autism: A Review of the Evidence , 2004, Journal of autism and developmental disorders.

[27]  K. Williams,et al.  Intravenous secretin for autism spectrum disorder. , 2005, The Cochrane database of systematic reviews.

[28]  C. McDougle,et al.  The Pharmacotherapy of Target Symptoms Associated with Autistic Disorder and Other Pervasive Developmental Disorders , 2000, Harvard review of psychiatry.

[29]  P. Sturmey.  Secretin is an ineffective treatment for pervasive developmental disabilities: a review of 15 double-blind randomized controlled trials. , 2005, Research in developmental disabilities.

[30]  G. Colditz,et al.  How to use the evidence: assessment and application of scientific evidence , 1999 .

[31]  F. Volkmar,et al.  Seizure disorders in autism. , 1990, Journal of the American Academy of Child and Adolescent Psychiatry.

[32]  M. Shepherd,et al.  Secretin Treatment for Autistic Disorder: A Critical Analysis , 2002, Pharmacotherapy.