Recent Advances in the Pharmacological Management of Behavioral Disturbances Associated with Autism Spectrum Disorder in
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REVIEW ARTICLE
Recent Advances in the Pharmacological Management of Behavioral Disturbances Associated with Autism Spectrum Disorder in Children and Adolescents Martine Lamy1 · Ernest V. Pedapati1 · Kelli L. Dominick1 · Logan K. Wink1 · Craig A. Erickson1
© Springer Nature Switzerland AG 2020
Abstract Autism spectrum disorder (ASD) is a heterogeneous neuropsychiatric condition affecting an estimated one in 36 children. Youth with ASD may have severe behavioral disturbances including irritability, aggression, and hyperactivity. Currently, there are only two medications (risperidone and aripiprazole) approved by the US Food and Drug Administration (FDA) for the treatment of irritability associated with ASD. Pharmacologic treatments are commonly used to target ASD-associated symptoms including irritability, mood lability, anxiety, and hyperactivity. However, evidence for the efficacy of many commonly used treatments is limited by the lack of large placebo-controlled trials of these medications in this population. Research into the pathophysiology of ASD has led to new targets for pharmacologic therapy including the neuroimmune system, the endocannabinoid system, and the glutamatergic neurotransmitter system. The goal of this review is to provide an overview of the current evidence base for commonly used treatments, as well as emerging treatment options for common behavioral disturbances seen in youth with ASD.
Key Points
1 Introduction
Youth with autism spectrum disorder (ASD) may exhibit severe behavioral disturbances including irritability, aggression, and hyperactivity, as well as anxiety, repetitive behaviors, and sleep disturbances.
The prevalence of autism spectrum disorder (ASD) in the United States is currently estimated to be 2.24%, and the disorder is associated with significant disability [1]. Behavioral therapy remains the mainstay of treatment for the core symptoms of ASD: communication deficits, social-interaction deficits, and repetitive behavior. Despite the degree of psychopathology requiring pharmacologic management, there are no US Food and Drug Administration (FDA)-approved medications that target core symptoms. A recent systematic review estimated that approximately 50% of children with ASD in North America and Europe are treated with medications to target non-core symptoms such as irritability, aggression, hyperactivity, anxiety, and oppositional behaviors [2]. Comorbid psychiatric disorders affect up to 70% of children with ASD; social anxiety disorder, attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) are among the most common comorbid diagnoses [3]. Currently, there are only two medications, risperidone and aripiprazole, that are FDA-approved in the United States for treating any ASD-associated comorbid behavioral disturbances, specifically irritability marked by aggression, self-injurious behavior (SIB), and severe
This review highlights commonly used psychopharmacologic treatments for the behavioral disturbances associated with ASD in childre
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