Current Autism Treatments Have Shortcomings, Reviews Find

April 6, 2011

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A Systematic Review of Medical Treatments for Children With Autism Spectrum Disorders

Melissa L. McPheeters, PhD, MPHa,b, Zachary Warren, PhDc,d, Nila Sathe, MA, MLISa, Jennifer L. Bruzek, PhDa, Shanthi Krishnaswami, MBBS, MPHa, Rebecca N. Jerome, MLIS, MPHe, Jeremy Veenstra-VanderWeele, MDd,f,g

aVanderbilt Evidence-Based Practice Center, Institute for Medicine and Public Health; and
bDepartment of Obstetrics and Gynecology, Vanderbilt University Medical Center;
cDepartments of Psychiatry and Pediatrics;
dVanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders;
fDepartments of Psychiatry, Pediatrics, and Pharmacology,
gCenter for Molecular Neuroscience; and
eEskind Biomedical Library and Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee

Context As many as 1 in every 110 children in the United States has an autism spectrum disorder (ASD). Many medical treatments for ASDs have been proposed and studied, but there is currently no consensus regarding which interventions are most effective.

Objective To systematically review evidence regarding medical treatments for children aged 12 years and younger with ASDs.

Methods We searched the Medline, PsycInfo, and ERIC (Education Resources Information Center) databases from 2000 to May 2010, regulatory data for approved medications, and reference lists of included articles. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Studies of secretin were not included in this review. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength-of-evidence ratings on the basis of predetermined criteria.

Results Evidence supports the benefit of risperidone and aripiprazole for challenging and repetitive behaviors in children with ASDs. Evidence also supports significant adverse effects of these medications. Insufficient strength of evidence is present to evaluate the benefits or adverse effects for any other medical treatments for ASDs, including serotonin-reuptake inhibitors and stimulant medications.

Conclusions Although many children with ASDs are currently treated with medical interventions, strikingly little evidence exists to support benefit for most treatments. Risperidone and aripiprazole have shown benefit for challenging and repetitive behaviors, but associated adverse effects limit their use to patients with severe impairment or risk of injury.

Key Words: autism spectrum disorders • antipsychotics • risperidone • aripiprazole • serotonin-reuptake inhibitors • citalopram • fluoxetine • psychostimulants

Abbreviations: ASD = autism spectrum disorder • SRI = serotonin-reuptake inhibitor • RCT = randomized controlled trial • RUPP = Research Units on Pediatric Psychopharmacology • ABC-C = Aberrant Behavior Checklist Community Version • ABC-C-I = ABC-C irritability/agitation/crying subscale • ABC-C-H = ABC-C hyperactivity/noncompliance subscale • ABC-C-S = ABC-C stereotypy subscale • CY-BOCS = Children's Yale-Brown Obsessive Compulsive Scale