Finding the Right Autism Treatment
Early, intense therapy works, but hundreds of other treatments being used are untested.
Drug Treatments for Autism
Unfortunately, many children with autism aren't able to enter any kind of
behavioral or educational treatment. Some of these kids respond with violence
or tantrums to any attempt to interrupt their obsessive "stimming"
behavior. For some, this self-stimulation takes the form of self-injury. Other
children with autism are hyperactive.
Might psychiatric drugs calm these symptoms enough to allow such children to
enter behavioral and educational programs? Yes, says Yale's Lawrence David
Scahill, MSN, PhD, a leader in pediatric psychopharmacology research.
Scahill was part of an NIH-funded group that showed that the anti-psychotic
drug Risperdal could calm extreme behavior in autism spectrum disorder
"Some 20% to 30% of school age kids with ASD, down to age 5 years, have
problems with aggression, tantrums, or self-injury -- we thought that would be
a good target for Risperdal," Scahill says. "We enrolled children with
autism and at least moderate levels of tantrums -- not the kid who flops a
little bit, but kids with outbursts you can measure on the Richter scale. They
are not going to learn to toilet themselves or to play with toys. We thought if
we could give these kids a medication, maybe they would be more malleable to
The result was surprising -- kids who got the drug had a 58% improvement in
this behavior, compared with 12% getting placebo.
"It was a big difference, the kind of difference we don't see in child
psychiatry very often," Scahill says. "We credit it first to the drug,
but also to the fact we only enrolled children with moderate or higher levels
of this behavior. "
As a result of this study, the FDA approved Risperdal for treatment of
irritability in kids with autistic disorder with symptoms of aggressive
behavior, deliberate self-injury, or temper tantrums. Now Scahill
and colleagues are trying to find out how soon kids can be tapered off the
medication -- and whether parent training improves outcomes for kids receiving
Getting off Risperdal will be important, Scahill says, because a major side
effect of the treatment is unhealthy weight gain.
A subsequent study looked at whether hyperactive kids with autism respond to
Ritalin as well as ADHD kids without autism. The important finding: While 75%
to 80% of ADHD kids without autism do better on Ritalin, this happens in only
about 50% of hyperactive kids with autism. And the improvement in kids with
autism wasn't as large as the improvement in kids without autism.
A more recent study is looking at whether the antidepressant Celexa, which
helps control symptoms of obsessive-compulsive disorder, can reduce repetitive
behaviors in children with ASD. Results of that study are expected soon.
Scahill notes that all of these studies have looked for ASD symptoms that
match symptoms for which psychiatric treatments exist. Now, however,
researchers are cautiously exploring a larger goal -- treating autism