Pharmacologic treatment of behavioral symptoms associated with autism and other pervasive developmental disorders.

OPINION STATEMENT: Pervasive developmental disorders (PDDs), including autistic disorder (autism), Asperger's disorder, and pervasive developmental disorder not otherwise specified (PDD NOS), are neurodevelopmental disorders of childhood onset. These disorders persist throughout the lifespan of affected individuals and are characterized by impaired social behavior and communication, along with repetitive, stereotypic behaviors. Early diagnosis and subsequent behavioral therapy have been shown to improve outcomes for these individuals. Risperidone and aripiprazole have been approved by the United States Food and Drug Administration (FDA) for treatment of irritability associated with autism in children and adolescents. Despite their efficacy, use of these medications is limited by their side effects. In individuals with severe irritability, the first-line treatment is often risperidone. Because of its relatively lower risk of weight gain and metabolic side effects, aripiprazole may be used initially if there is a personal or family history of obesity or diabetes. Monitoring of body mass index and metabolic profiles is indicated with both medications. Stereotypic behaviors associated with autism, though clearly driven by neurobiologic processes, can also be understood as coping mechanisms used to decrease anxiety. From this perspective, therapies targeting reduction of these symptoms may be contraindicated. However, when these symptoms are severe and interfering, pharmacotherapy may be necessary. Serotonin reuptake inhibitors are of limited efficacy in children and adolescents, but risperidone and aripiprazole have been shown to reduce these symptoms. There remains a need for further safety and efficacy research in this area. Hyperactivity and inattention are currently treated with a variety of medications, including guanfacine, which has a relatively benign side effect profile. Stimulant medications are generally avoided as first-line treatment for hyperactivity because of concerns about increased irritability. Currently, social impairment is best addressed through behavioral therapy and social skills training. Novel pharmacotherapies to improve social impairment are in the early stages of research.