Read the Full Guide for Autism and ADHD
Parents of children and teens with co-occurring ASD and ADHD report high rates of use of medications. However, research on psychopharmacological treatments is limited in both number and type.
Risperidone and aripiprazole are called Risperdal and Abilify are the only drugs that have been approved by the FDA to be used by children with autism to help in the reduction of irritability and aggressive behavior. Other drugs can be helpful.
Antipsychotics
Research on co-occurring ADHD symptoms and ASD remains limited, despite the growing interest. A variety of psychosocial treatments are available for each disorder but few studies have characterized treatment effectiveness in the context of co-occurring symptoms. It is crucial to gain a better understanding of the interaction between co-occurring disorders as well as how they develop over time. This will aid in the development of both pharmacological and psychosocial treatments.
Many people suffering from ASD have ADHD and other mental conditions such as anxiety or depression. There are a variety of psychosocial treatments available 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 core ASD symptoms, such as poor social communication skills and rigid thinking, non-drug interventions are typically preferred. These include behavioral training as well as peer support groups. The use of medication can help with ASD symptoms that are comorbid with ADHD, such as irritability and aggression, or disruptive mood dysregulation. However the use of atypical antipsychotics has not been proven to help improve the fundamental ASD symptoms and the evidence supporting these medications is sporadic at best.
The current theories suggest that symptoms of autism spectrum disorders (ASD) and ADHD are caused by alterations in neurotransmitter pathways, particularly ones that involve glutamate, dopamine and serotonin.2 These changes affect the mesocorticolimbic and prefrontal cortex which is involved in the regulation of emotions and behavior control.
Some of these abnormalities are believed to be the result of decreased activity in specific brain regions, like the striatum. Thus, a range of drugs that are believed to modulate dopamine and glutamate are being studied for use in the treatment of ADHD and ASD co-morbidities.
Different dopamine antagonists are being investigated for the treatment of co-occurring ADHD and ASD symptoms such as risperidone (Risperdal, Janssen Pharmaceutical Inc.; Titusville, NJ) as well as aripiprazole (Abilify, Otsuka America Pharmaceutical Inc.; Rockville, MD) and domperidone (Motilium, Johnson & Johnson; New Brunswick, NJ). The emergence of a consensus nomenclature for dopamine antagonists is still in the works.
Antipsychotics are no different than any other medication. The most reliable data available on risperidone and aripiprazole in adults with ASD and ADHD come from controlled, randomized trials. These trials employed crossover, parallel and withdrawal strategies. In general, these medications are more effective than placebo in decreasing aggression, irritability and improving function. The drugs are generally well-tolerated. However, one-third of those who take these medicines will find that they work well for all or a majority of their symptoms. However, the remaining two-thirds will experience only partial improvement.
Stimulants
While non-medical treatment is generally recommended for autism, medication can be beneficial for certain adults and children. Antipsychotics, for instance, help to ease anxiety and reduce self-injurious behavior and stimulants such as methylphenidate, which helps with ADHD symptoms, can help improve the ability to focus. However, these medications do not tackle the underlying autism issues like restricted and repetitive activities or difficulty communicating. Many adults and children with autism also have co-occurring mental health disorders such as depression, mood disorders, or anxiety that hinder daily functioning.
Irritability is a different issue for people with autism. It can cause outbursts and self-injury as well as difficulties with routines and transitions. Atypical antipsychotics such as risperidone (Risperdal) and aripiprazole (Abilify) are the only approved medications for treating autism-related anger. They are believed to affect the brain's dopamine system which is involved in emotions as well as decision-making.
The most commonly prescribed ADHD medication is methylphenidate like Ritalin. It also includes mixed amphetamines salts which increase dopamine levels in the frontal regions of the brain. Some studies suggest that these drugs are equally effective in treating patients with autism and ADHD than they are for those with pure ADHD. However some studies suggest they may not be as effective. It's important that parents discuss with their doctor if the benefits of these medications outweigh any potential negative side effects.
Some researchers believe that second-line ADHD medications such as Guanfacine and atomoxetine may be more helpful in the reduction of ADHD symptoms for people with autism. These medications are thought to function by interfering with the dopamine-norepinephrine system that is linked to motivation and mood.
Connor's psychiatrist, and behavioral therapist, are working hard to help him improve his social skills and deal with his anxiety. However, even with these interventions however, his hyperactivity and lack of attention can hinder the pace of his improvement. His family decided to give him an ADHD medication to help him focus.
After three months, he's become more focused at school and in his daily activities. His parents can see that he is more attentive and attentive to what others are saying and is more involved in group activities. His mother says that the medication has been a lifesaver.
Benzodiazepines
The benzodiazepines are a category of drugs that slows the central nervous system and causes sleepiness. They are utilized to treat a wide variety of ailments that include anxiety disorders, seizures and insomnia. They target specific receptors for the neurotransmitter GABA (gamma-aminobutyric acid), which inhibits brain waves and impedes communication between neurons. By keeping GABA receptors open longer and opening them more the benzodiazepines improve inhibition and prevent excitatory neuron overactivity. The theory suggests that the defining traits of autism are due to an imbalance in excitatory and inhibitory neurotransmissions in the brain. Animal models support this idea, showing that clonazepam reverses some autistic behaviors in mice suffering from Dravet syndrome, a form of epilepsy.
Anxiety is often a co-occurring disorder for people suffering from autism spectrum disorders. In some cases, anxiety is the motivation behind an individual's aggressive or self-injurious behavior. In other cases, it's a response to sensory issues that make life difficult and trigger anxious feelings.
Antidepressants are one of the treatments available. They increase the amount of norepinephrine, a chemical in the brain that is believed to improve self-esteem and cope. They also reduce the reuptake of neurotransmitters norepinephrine and serotonin, which reduces irritability and anxiety. Atypical antipsychotics, such as risperidone and aripiprazole can help people with autism with anger, irritability, or Tourette syndrome.
Melatonin may improve the quality and duration of sleep for adults with ASD. There are no controlled studies for this group. Methylphenidate can be effective in treating ADHD in children with ASD. However it's not nearly as effective in typical-developing kids.
Treatments for autism and ADHD can be dangerous if they're not used properly. It is important to consult with your doctor to find the appropriate dosage and medication for your child or teenager. Always follow the instructions on the medication label. Do not abruptly stop or commence taking your medication. This could be dangerous. You should seek immediate help if you suspect that you or someone else has taken too much medication. Additionally, keep track of your child's height and weight regularly, as well as their menstrual cycle to ensure that the medications aren't having any unintended side effects.
Medication Options
Both conditions are common in children with autism. Treatment is often a part of the treatment program for both. The most commonly used to treat ADHD -such as methylphenidate (Ritalin) amphetamines (Adderall, Vyvanse), atomoxetine (Strattera) and guanfacine (Intuniv, Tenex) -can be very effective in treating the impulsivity and hyperactivity that is associated with autism.
Certain children with autism have severe irritability or aggression. These behaviors can be difficult for parents to manage with only behavior-based strategies. The use of medications like Abilify and Risperdal can reduce aggression, irritability and self-injury by affecting a neurotransmitter called dopamine. These drugs aren't approved by the FDA to be used with children with autism, however they can be prescribed "off-label" to treat specific symptoms.
It is essential that parents consult their pediatricians to determine if medication is appropriate for their child. A number of studies show that children who are taking ADHD medication for autism that coexists may enjoy a better quality of life at home as well as at school, and may make significant academic and social, as well as behavioral, progress.
Psychiatrists are trained to help children with the symptoms of ADHD and autism. They can provide behavior-oriented parental training that involves manuals and group-based courses that teach parents how to minimize disruptive behaviors. They also offer psychosocial treatment that focuses on improving communication and relationships between family members.
However, some families opt to use medication to control their child's behavior. Some parents have found that antipsychotics have a calming effect on their child which can reduce irritability and aggression.
In the same way, many children with autism also suffer from a mental illness that affects their ability to learn and function, such as depression or anxiety. These disorders are often co-occurring and can affect the effectiveness of therapy. For these children using a combination of cognitive behavioral therapy and medication can be helpful. This approach is especially helpful for children who have an extreme form of autism, or those who do not respond to other interventions.