Pharmacological treatments in autism spectrum disorder: a narrative review

Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects about 1% of the population. It is characterized by deficits in social interaction and communication, as well as repetitive behaviors and/or interests. Individuals with ASD have a higher prevalence of psychiatric disorders compared to neurotypical samples. Although psychiatric medications are widely used in this population, evidence on effective pharmacological interventions for ASD-associated psychiatric problems is limited. Therefore, this narrative review aims to summarize the current evidence for efficacy of pharmacological treatments of ASD-related comorbidities, including emotional dysregulation, irritability and aggression, ADHD, tics and Tourette syndrome, anxiety, affective disorders such as unipolar and bipolar depression, sleep disorders, obsessive-compulsive disorder, and schizophrenia spectrum disorders. A comprehensive search of PubMed for all types of articles, except case reports, was conducted. The review synthesizes and presents all data in a narrative form. Aripiprazole and risperidone have shown effectiveness in treating irritability and aggression in ASD, while methylphenidate may be helpful in reducing hyperactivity and inattention in children with ADHD, although this group may be more susceptible to adverse effects. Melatonin is commonly used to address sleep problems in ASD and appears to be effective. Fluoxetine and fluvoxamine have shown some effectiveness in reducing symptoms of OCD. However, due to the lack of validated measures for assessing OCD in ASD and the challenges in distinguishing between the two disorders, clinicians must exercise caution when interpreting these results. In general, there is a lack of robust evidence for treating other co-occurring psychiatric problems, and caution should be exercised when using SSRIs in ASD. To address these gaps in knowledge, larger prospective trials are necessary.