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About 40% of children with ASD have Attention deficit and hyperactivity disorder (ADHD). If the ADHD has been diagnosed, using appropriate tools, and is causing significant functional problems for the child\u2019s learning, socialising and day-to-day life, then consider methylphenidate (Davis & Kollins, 2012).<\/span><\/p>\n <\/p>\n Lower doses (range 2.5\u201310mg or 0.14\u20130.58 mg\/kg for both the morning and noon doses) may be effective and avoid side effects associated with higher doses.<\/span><\/p>\n <\/p>\n A larger multicenter trial conducted by RUPP Autism Network reported\u00a0<\/span>that treatment of 101 ASD children and adolescents (5\u201317 years old) with risperidone (mean dose 1.8 mg\/kg) for 8 weeks resulted in 57% reduction in irritability vs. 14% reduction in the placebo group.<\/span><\/p>\n <\/p>\n Risperidone treatment also significantly improved aggression, social\u00a0<\/span>withdrawal, repetitive behaviours, and hyperactivity (McCracken et al.,\u00a0<\/span>2002).<\/span><\/p>\n <\/p>\n <\/p>\n Risperidone treatment was associated with significant weight gain as well as fatigue, drowsiness and dizziness.<\/u><\/span><\/p>\n <\/p>\n Low doses of risperidone (0.5\u20131.5 mg\/d) are effective in reducing irritability and agitation in very young ASD children (aged 2\u20139 years) (Luby et al., 2006; Posey, Walsh, Wilson, & McDougle, 1999).<\/span><\/p>\n <\/p>\n Two double-blind RCTs evaluated the efficacy and safety of\u00a0aripiprazole in ASD children. The first study included 218 autistic children\u00a0and adolescents (aged 6\u201317 years) who were randomized to receive\u00a0either one of three different doses of aripiprazole (5, 10 or 15\u00a0Mg\/d) or placebo for 8 weeks. All three doses significantly reduced irritability<\/span><\/p>\n compared with placebo at week 8. The three most common side\u00a0<\/u>effects were sedation, drooling and tremor<\/u>,\u00a0 and this contributed to a\u00a0higher mean of discontinuation rate of aripiprazole-treated patients\u00a0(10.3%) vs. placebo (7.7%) (Marcus et al., 2009).<\/span><\/p>\n <\/p>\n These trials led to FDA approval of aripiprazole as the second atypical\u00a0antipsychotic drug to treat irritability in children and adolescents with\u00a0autistic disorder aged 6\u201317 years (Blankenship, Erickson, Stigler,\u00a0Posey, & McDougle, 2010).<\/span><\/p>\n <\/p>\n Dose (2.5 mg a day for children age 6 years and older, 5 mg in age 17 years and older).<\/span><\/p>\n <\/p>\n An 8-week double-blind RCT reported that olanzapine improved response rates in 11 young ASD patients (Hollander et al., 2006). Open-label treatment of 8 children, adolescents, and adults (age range, 5\u2013 42 years)with olanzapine (mean dose 7.8 mg\/d) significantly improved many symptoms including irritability, anger, anxiety, hyperactivity, social withdrawal, and language usage (Potenza, Holmes, Kanes, & McDougle, 1999).<\/span><\/p>\n <\/p>\n In spite of the superior efficacy of olanzapine in managing symptoms of ASD,\u00a0<\/span>its clinical use has been limited due to its well-known metabolic side effects<\/u><\/span><\/p>\n including increased appetite, excessive weight gain and impaired\u00a0<\/u><\/span>insulin sensitivity (<\/u>Tschoner et al., 2007<\/u>).<\/u><\/span><\/p>\n <\/p>\n Few trials have evaluated the efficacy and tolerability of sertraline in ASD patients. A small open-label clinical trial found that 2\u20138 weeks of treatment with sertraline (25\u201350 mg) significantly improved anxiety and irritability in 8 out of 9 pediatric ASD patients (Steingard, Zimnitzky, DeMaso, Bauman,& Bucci, 1997). A larger open-label trial reported that 12-week treatment with higher doses of sertraline (50\u2013200 mg) reduced aggressive and repetitive behaviours in adult ASD patients (McDougle et al., 1998). The medication was well tolerated with minimal adverse events.<\/span><\/p>\n <\/p>\n The use of alpha-2 adrenergic receptor agonists is associated with the treatment of aggressive behaviour, sleep disturbances and anxiety, which are prominent symptoms in ASD patients. These medications inhibit norepinephrine neurotransmission in the brainstem, leading to a decrease in sympathetic outflow and peripheral resistance thereby diminishing states of hyper-arousal, anxiety, and\/or motor spasms (Newcorn et al., 1998).<\/span><\/p>\n A third open-labelled retrospective clinical trial found that clonidine was \u00a0effective in reducing sleep initiation latency and night awakening, and to a<\/span><\/p>\nAtypical antipsychotic drugs<\/strong><\/h2>\n
Risperidone<\/strong><\/h2>\n
Aripiprazole<\/strong><\/h2>\n
Olanzapine<\/strong><\/h2>\n
Antidepressant drugs<\/strong><\/h2>\n
Sertraline<\/strong><\/h2>\n
Alpha-2 adrenergic receptor agonists <\/strong><\/h2>\n
Clonidine<\/strong><\/h2>\n