Q. My 10-year-old son has autism. I just started a behavioral treatment program with him and I'm trying to decide with the behavioral team which of the following drugs would be appropriate for him:

Could you let me know the history of the above drugs with children having the same issues?

A. Autism is one of the "Pervasive Developmental Disorders", the precise cause of which is still unknown. Though a good deal of research has been done, we still have not pinned down a specific gene or chemical abnormality that explains all the manifestations of autism, such as impaired language use or social withdrawal. Therefore, the medications used to treat autism cannot be considered specific treatments for the underlying disorder; rather, they are aimed at ameliorating specific symptoms, such as aggressive behaviors, agitation, and obsessive-compulsive rituals.

A review of this subject may be found in the article by Hunsinger et al in the journal, Life Sciences, August 2000 (ppl 1667-82). All of the medications, or related agents, that you name—buspirone [BuSpar], fluvoxamine [Luvox], guanfacine [Tenex], and risperidone [Risperdal]—have been used with varying degrees of success in small numbers of autistic patients.

For example, in a single case study of buspirone, the medication was found to be safe and effective for decreasing hyperactivity and increasing completion of assigned tasks (LH McCormick, Arch Fam Med 1997 Jul-Aug;6(4):368-70). Another study found buspirone useful for aggression and hyperactivity (Realmuto et al, J Clin Psychopharmacol 1989 Apr;9(2):122-5).

Fluvoxamine and other SSRI type medications have been found useful in reducing some aggressive and self-injurious behaviors in autistic patients (Yokoyama et al, 2002). Other data suggest that fluvoxamine may reduce repetitive behaviors and actually improve some social behaviors (Kauffmann et al, Psychiatry 2001 Fall;64(3):268-77). Although I did not find studies using Tenex, a closely-related medication, clonidine, has been found to be modestly effective in the short-term treatment of irritability and hyperactivity in some autistic children (Jaselskis et al, J Clin Psychopharmacol 1992 Oct;12(5):322-7).

Finally, atypical antipsychotic medications, such as risperidone, appear to be useful in autism. One 8-week, placebo-controlled study of risperidone (McCracken et al, N Engl J Med 2002 Aug 1;347(5):314-21) found the drug to be superior to placebo (sugar pill) for irritability, with a 56.9 percent reduction in the irritability score, as compared with a 14.1 percent decrease in the placebo group.

Other studies suggest that risperidone may be effective in reducing hyperactivity, aggression and repetitive behaviors, often without inducing severe adverse reactions. I can't say which, if any, of these medications would be most appropriate for your son, but the treatment team certainly seems to be on the right track with the overall group of agents under discussion. It would be important to discuss both the risks and benefits of each option with the team psychiatrist before making a decision.

November 2002

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