Medication for Autism and ADHD
Parents of children with ASD/ADHD that co-occur have reported high rates of medication use. However, research on psychopharmacological treatments is limited in both number and type.
Risperidone (Risperdal) and aripiprazole (Abilify) are the only two medications approved by the FDA to be used in children with autism to help reduce anger and irritability. But other drugs may also be beneficial.
Antipsychotics
While the interest in co-occurring ADHD and ASD symptoms has risen but research remains insufficient. There are a variety of psychosocial treatment options that exist for each disorder, however, very few studies have assessed treatment effectiveness in the context of co-occurring symptoms. Enhanced understanding of how co-occurring disorders develop and interplay over time will be important for determining both pharmacological as well as psychosocial approaches.
Many people with ASD suffer from ADHD as well as other mental illnesses such as depression or anxiety. Several psychosocial treatments exist for these disorders, such as cognitive behavioral therapy (CBT) and interpersonal therapy, and family therapy. These psychosocial therapies may be more effective than pharmacological treatment for certain people suffering from co-occurring ADHD and ASD.
The use of non-drug therapies is usually recommended for core ASD symptoms, such as rigid thinking and ineffective social communication skills. These include peer support groups and behavioral training. Medicines can be beneficial for ASD symptoms that are comorbid with ADHD such as irritability, aggression, or disruptive mood dysregulation. However the use of atypical antipsychotics has not been proven to help improve the core ASD symptoms and the evidence for these medications is sporadic at best.
Current hypotheses suggest that symptoms of autism spectrum disorders and ADHD are caused by dysfunctions in neurotransmitter signalling pathways especially those that involve glutamate, dopamine and serotonin.2 These changes affect mesocorticolimbic and prefrontal cortex which are involved in emotional regulation and behaviour control.3
A few of these issues are believed to be the result of decreased activity in specific brain regions, including the striatum. In order to treat ADHD and ASD there are a variety of medications that alter dopamine or glutamate levels are being studied.
Dopamine antagonists of various types are being investigated in the treatment of comorbid ADHD and ASD symptoms such as risperidone (Risperdal, Janssen Pharmaceutical Inc.; Titusville, NJ) and aripiprazole (Abilify, Otsuka America Pharmaceutical Inc.; Rockville, MD) and domperidone (Motilium, Johnson & Johnson; New Brunswick, NJ). The emergence of a consensus label for dopamine antagonists is still in the works.
Antipsychotics are just like any other medication. The most reliable data available on aripiprazole and risperidone in adults suffering from ASD and ADHD come from randomized controlled trials. These trials utilized crossover, parallel, and withdrawal designs. In general, these medications are more effective than placebo in reducing irritability, aggression and improving function. The drugs are generally well-tolerated. However, one-third of those who use these medications will find that they work well for all or most of their symptoms. However, the other two-thirds will see only a slight improvement.
Stimulants
Although non-medical care is not typically recommended for autism, medication may be beneficial for certain children and adults. Antipsychotic medications help to ease anxiety and reduce self-injurious behavior and stimulants such as methylphenidate that help with ADHD symptoms, can enhance the ability to concentrate. Medication does not address core autism behaviors like repetitive or limited interest or difficulties in communicating. best adhd medication for adults with anxiety and children who have autism also suffer from mental health conditions such as anxiety, depression or mood disorders. These conditions can cause problems with daily functioning.
Irritability is another challenge for children and adults with autism. It can result in anger outbursts, self-injury or difficulty with transitions or following routines. Risperdal (Risperdal), and aripiprazole, (Abilify) are the only two medications that have been approved for treating autism-related irritation. They are believed to work by altering dopamine, a brain system that is involved in decisions and emotions.
The most frequently prescribed ADHD medication is methylphenidate, such as Ritalin. It also contains mixed amphetamines salts that increase dopamine levels in the frontal brain lobes. Certain studies suggest that these medications are equally effective in treating people with autism and ADHD as they are for those with pure ADHD. However, other studies indicate they may not be as efficient. Parents should discuss with their doctor if the benefits of these medications outweigh any potential side effects.
Some researchers believe that second-line ADHD medications such as Guanfacine and atomoxetine may be more effective in decreasing ADHD symptoms in people with autism. These medications are believed to function by interfering with the dopamine-norepinephrine system, which is associated with motivation and mood.
Connor's psychiatrist, and behavioral therapist, are working hard to help him improve his social skills and cope with his anxiety. However, even with these treatments however, his hyperactivity and lack of attention can get in the way of his progress. So his family decided to take an ADHD medication to help him focus.
After three months, he's become more focused at school and in his daily activities. Parents can tell that he's more focused, listens to what others are saying and is more involved in group activities. His mother says the medication is an absolute lifesaver.
Benzodiazepines
The benzodiazepines comprise a category of drugs that slow down the central nervous system, resulting in sleepiness and a calm mood. They are used to treat a wide range of conditions that include anxiety disorders, seizures, and insomnia. They target specific GABA receptors (gamma aminobutyric acid) which is a neurotransmitter, which inhibits brainwaves and communication between neurons. By opening GABA receptors and keeping them open longer benzodiazepines increase inhibition and prevent excitatory neurons from becoming hyperactive. The theory is that characteristic autism-related behaviors are triggered by an imbalance in inhibitory and excitatory neurotransmission in the brain. Animal models support this theory, showing that clonazepam reverses some autistic behaviors in mice with Dravet syndrome, which is a type of epilepsy.
Anxiety is often a comorbid disorder for people suffering from autism spectrum disorders. In some instances anxiety can be the reason behind an individual's aggressive or self-injurious behavior. In other instances, anxiety is a reaction to sensory issues which create difficulties.
Antidepressants are among the treatment options. They boost the levels of norepinephrine, which is a chemical found in the brain believed to improve self-esteem and cope. They also decrease reuptakes of neurotransmitters like norepinephrine, serotonin and dopamine. This reduces irritability and anxiety. Atypical antipsychotics such as risperidone and aripiprazole are able to aid people suffering from autism, aggression, irritability and Tourette syndrome.
Melatonin could increase the duration and quality of sleep for adults with ASD. There aren't any controlled studies for this group. Methylphenidate has proven effective in treating ADHD symptoms in children who have ASD however, it's not as efficient as it is for typical children.
The medications for autism and ADHD can be dangerous when not used correctly. The most important thing to do is collaborate with your doctor to determine the most appropriate dosage and medication for your child or teen. Always follow the instructions on the medication label. Do not stop or change the dosage of your medication suddenly, as this could be extremely risky. If you suspect that you or someone you know has taken too much, seek medical attention immediately. Note your child's weight and height on a regular basis as well as their menstrual cycle to make sure the medication isn't causing any undesirable adverse side effects.
Medication Options
Both of these conditions are common among children with autism. Both are usually treated with medication. The medications that are most commonly used to treat ADHD -the methylphenidate (Ritalin), amphetamines (Adderall, Vyvanse), Atomoxetine (Strattera) and guanfacine (Intuniv, Tenex) -- can be effective in treating the hyperactivity and impulsivity that is associated with autism.
In addition, certain children with autism are susceptible to severe aggression and irritability and these signs can be difficult to manage using behavior strategies on their own. Abilify and Risperdal are medications that can decrease aggression as well as self-injury. They affect the neurotransmitter dopamine. These medications have not been approved by the FDA to be used in conjunction with children with autism. However they are often prescribed 'off-label' to treat specific symptoms.
It's important parents discuss with their pediatricians if medication is suitable for their child. Several studies show that kids who are taking ADHD medications for coexisting autism may enjoy a better quality of life at home and at school, and may make significant academic and social, as well as behavioral, progress.
Psychiatrists are trained to help children cope with symptoms of autism and ADHD. They can suggest behavior-based parent training that involves manuals and classes that teach parents how to reduce disruptive behavior. They also offer psychosocial therapy that focuses on improving communication and relationships among family members.
Some families, however, prefer to use medication to manage their child's behavior. Some parents have discovered that the calming effects of antipsychotics can aid in reducing their child's anger, aggression and self-injury, and they might be willing to consider this option if other treatments aren't working.
In the same way, a lot of children with autism also suffer from a mental illness that hinders their ability to function and learn like anxiety or depression. These conditions are often co-occurring and can interfere with the effectiveness of therapy. Combining cognitive-behavioral therapy with medication may be beneficial for children. This approach is especially helpful for children who have an extreme form of autism or those who don't respond to other interventions.