If after careful and detailed observation of the subject, in different contexts, it emerges that problematic behaviors can limit adaptation and quality of life, integration with a PSYCHOPHARMACOLOGICAL INTERVENTION should be considered. Pharmacological therapy is symptom-based, as the underlying neurobiological mechanisms are not known. We have no data on the influence of drug treatment on the natural history of the disease: certainly, however, when it works, it can be useful for patient management. The considerable clinical heterogeneity within the spectrum disorders does not allow clear orientations.
The goals of pharmacotherapy in Autism Spectrum Disorders are:
Integration between educational, rehabilitative, psychosocial and pharmacological interventions
Some symptoms associated or present in coomorbidity in DSA can reduce the effectiveness and invalidate the rehabilitation measures
By mitigating the intensity of these symptoms, we can encourage rehabilitation and integration interventions
DISORDERS OF THE AUTISTIC SPECTRUM
pharmacological treatments
The specific objectives of psychopharmacological therapy are:
typical symptoms of the syndrome
associated symptoms (comorbidities)
Treatment must be preceded by a careful functional analysis that highlights the “target symptoms”.
Possible target symptoms are:
Hyperactivity, inattention
Repetitive behaviors
Aggression, self-harm, destructiveness
Psychomotor agitation
Impairment of social interaction
Behavioral disorders:
Unrecognized physical discomfort, constipation, epileptic phenomena not highlighted
Inability to understand the surrounding reality and behavior of others
Communication difficulties with respect to needs, desires
Learning difficulties
Difficulty adapting with peers
Psychiatric factors / comorbidities: psychosis, mood changes, depression, anxiety, ideational phenomena etc …
There are no drugs capable of substantially modifying the essential symptoms (“core”) of the disorder, and even if some drugs have shown efficacy on various problem behaviors, it is not possible to define specific therapeutic relationships. A drug is used after excluding any type of possible non-pharmacological intervention and after considering:
National and / or international guidelines
Literature
Cost / benefit ratio
Pharmacotherapy in Autism Spectrum Disorders
Epidemiological data show that 30 to 50% of children and adolescents with DPS take a psychotropic drug for at least one year (Aman et al 2010); about 56% of patients with ASD take psychopharmacological treatments (Mandell et al., Pediatrics, 2008); there is a frequency of prescriptions between 32% and 89% (Debel et al, 2015).
Summary
The effectiveness of psychopharmacological therapy in autism is proven, but at the same time limited. Pharmacological intervention must always be included within a personalized multidisciplinary therapeutic project. The assessment of any organic and psychiatric co-morbidities represents an essential starting point. Both symptomatic improvement and any side effects must be monitored over time.
Always be ready to reconsider your drug prescription based on the individual patient’s response.