Medication for Autism and ADHD
Parents of children who have co-occurring ASD/ADHD report high rates of use of medications. However, research on psychopharmacological treatments is limited in both number and type.
types of adhd medication (Risperdal) and aripiprazole (Abilify) are the only two medications approved by the FDA for use in kids with autism. They can help decrease anger and irritability. But some other drugs can also be beneficial.
Antipsychotics
While the interest in co-occurring ADHD and ASD symptoms has grown but research remains insufficient. There are a variety of psychosocial treatment options that exist for each disorder, however, very few studies have assessed effectiveness of treatments in the context of co-occurring symptoms. An improved understanding of how co-occurring psychiatric disorders develop and interact over time will be important for determining both pharmacological as well as psychosocial approaches.
Many people who suffer from ASD also suffer from the comorbidity of ADHD and other mental health issues such as anxiety or depression. There are many psychosocial treatments for these disorders, including cognitive behavioral therapy (CBT) and interpersonal therapy and family therapy. These psychosocial treatments are more effective than pharmacological therapies for people with comorbid ADHD/ASD.
For the most fundamental ASD symptoms like low social skills and rigid thinking, non-pharmacological interventions are generally preferred. These include behavioral training as well as peer support groups. In the case of comorbid ADHD and ASD symptoms like irritability, aggression, and disordered mood dysregulation medication can be helpful. However Atypical antipsychotics haven't been proven to help improve core ASD symptoms and the evidence for these drugs is weak at best.
Current hypotheses suggest symptoms of autism spectrum disorders (ASD) and ADHD are mediated through abnormalities in neurotransmitter pathways, particularly those involving glutamate dopamine, and serotonin.2 These changes affect the mesocorticolimbic and prefrontal cortex which is involved in the regulation of emotions and control of behavior.
These abnormalities could result from a reduction in brain activity in specific regions, such the striatum. In order to treat ADHD and ASD, several medications that alter dopamine or glutamate levels are being studied.
A variety of types are being investigated for treatment of the comorbid ADHD symptoms and ASD, including risperidone, aripiprazole, and domperidone. The development of a consensus label for dopamine antagonists is still in the works.
Antipsychotics are the same as any other medication. Randomized controlled trials provide the most reliable information about the effects of aripiprazole or risperidone on adults with ASD or ADHD. These trials used parallel, crossover and withdrawal strategies. In general, the medications work better than placebo in reducing irritability and aggression and enhancing functioning. The medications are generally well-tolerated. One-third of those who take these medications will find that the medication is effective for the majority or all of their symptoms. The other two-thirds may only see partial improvement.
Stimulants
Despite the fact that non-medicated treatment is usually recommended for autism, medication can be beneficial to some adults and children. Medications such as antipsychotics can ease anxiety and decrease self-injurious behavior and stimulants such as methylphenidate that help with ADHD symptoms, can help improve the ability to concentrate. The medication does not address the core autism-related behaviors such as repetitive and limited interest or difficulties communicating. Many children and adults who have autism also suffer from mental health disorders like anxiety, depression, or mood disorders. These conditions can cause problems with daily functioning.
Autism can also cause irritability in children and adults. This can lead to outbursts, self-injury and difficulty with transitions or adhering to routines. Atypical antipsychotics such as risperidone (Risperdal) and Aripiprazole (Abilify) are the only drugs that have been approved for treating autism-related irritation. These drugs are thought to affect dopamine, which is a brain system that is involved in emotion and decision-making.
Most commonly prescribed ADHD medication is methylphenidate like Ritalin. It also contains mixed amphetamines, which increase dopamine levels in the frontal regions of the brain. Certain studies suggest that these medications are as effective for patients with autism and ADHD as they are in those with pure ADHD however other studies indicate that they are less helpful. It's important that parents discuss with their doctor if the benefits of these drugs outweigh any potential side effects.
Some researchers believe that second-line ADHD medications such as atomoxetine or Guanfacine, are more efficient in decreasing ADHD symptoms among people with autism. These medications are thought to work by interfering with the dopamine-norepinephrine axis, which is linked to motivation and mood.
Connor's psychiatrist and behavioral therapist are striving to teach him social skills and assist him in overcoming his fears. However, even with these interventions, the hyperactivity and inattention can hinder the pace of his improvement. His family decided to give him an ADHD medication to aid in his focus.
After three months, he's much more focused at school and in his daily activities. Parents can tell that he is more attentive, listens to what others speak and participates in group activities. His mother says that the medication has saved her life.
Benzodiazepines
The benzodiazepines are a class of drugs which slows the central nervous system and causes sleepiness. These medications are used to treat many conditions, including anxiety disorders, seizures, and insomnia. They target specific GABA receptors (gamma aminobutyric acid) which is a neurotransmitter, which blocks brainwaves and the communication between neurons. By opening GABA receptors and keeping them open longer benzodiazepines increase inhibition and stop excitatory neurons from becoming hyperactive. The theory is that hallmark behavioral features of autism are caused by an imbalance in the excitatory and inhibitory neurons in the brain. This hypothesis is supported by animal studies that show that clonazepam is able to reverse autistic behaviors in mice with Dravet Syndrome, a type of epilepsy.
Anxiety is often a co-occurring disorder in people with autism spectrum disorders. In some cases anxiety may be the primary reason behind a person's aggressive or self-injurious behavior. In other cases, anxiety is a reaction to sensory issues that can make life difficult.
Antidepressants are one of the treatment options. They boost the levels of norepinephrine, which is a chemical found in the brain that is believed to improve coping and self-esteem. They also decrease the reuptake rate of neurotransmitters serotonin and norepinephrine which reduces irritability and agitation. Atypical antipsychotics like risperidone (Risperdal) and Aripiprazole (Abilify) can assist with irritability, aggression, and Tourette syndrome in people who have autism.
There is evidence that melatonin can increase the duration and quality of sleep in adults with ASD. However, controlled studies are lacking in this population. Methylphenidate has proven effective in treating ADHD symptoms in children with ASD however, it's not as efficient as it is for typical children.
If they aren't used correctly, the medication for autism and ADHD could be harmful. It is important to consult with your doctor to determine the appropriate dosage and medication for you child or teen. Always adhere to the instructions on the label of the medication. Don't discontinue or start taking your medication suddenly, as this could be very dangerous. You should seek immediate assistance if you suspect that you or someone else has taken too much medication. Also, keep track of your child's weight and height regularly, as well as their menstrual cycle to ensure that the medications don't have any unwanted side effects.
Medication Options
Many kids with autism also suffer from ADHD and it's common for both conditions to coexist. Treatment is often a part of the treatment program for both. The most commonly used for ADHD -such as methylphenidate (Ritalin), amphetamines (Adderall, Vyvanse), Atomoxetine (Strattera) and Guanfacine (Intuniv, Tenex) -- can be effective in treating the hyperactivity and impulsivity that are associated with autism.
In addition, some children with autism are prone to severe irritability and aggression, and those symptoms can be difficult to manage using methods for managing behavior on their own. Medications like Abilify and Risperdal can reduce aggression and self-injury through affecting a neurotransmitter called dopamine. These medications aren't endorsed by the FDA for use with children with autism, but they are sometimes prescribed "off-label" to treat specific symptoms.
It's important parents discuss with their pediatricians whether medication is appropriate for their child. Numerous studies have shown that children who are taking ADHD medication for coexisting Autism can enjoy a higher living conditions both at home and in school, and make significant progress in academics and behavior.
Psychiatrists are trained to assist children cope with symptoms of autism and ADHD. They can suggest behaviorally-oriented parent training, which involves manual and group-based programs that teach parents skills to minimize disruptive behaviors. They also offer psychosocial services which focus on improving relationships and communication between family members.
However, some families prefer to rely on medication to control their child's behavior. Some parents have discovered that the calming effects of antipsychotics can help reduce the child's aggression, anger and self-injury, and they may be willing to consider this option when other therapies do not work.
In the same way, a lot of children with autism also suffer from a mental illness that interferes with their ability to function and learn, such as anxiety or depression. These disorders often co-occur and can affect the effectiveness of therapy. Combining cognitive behavioral therapy with medication can be beneficial for these children. This method is particularly beneficial for children with an extreme form of autism, or those who do not respond to other treatments.