The pharmacotherapy of target symptoms associated with autistic disorder and other pervasive developmental disorders

Research into the pharmacotherapy of autistic disorder has steadily increas ed over the past two decades. Several psychoactive medications have shown e fficacy for selected symptoms of autistic disorder and can be used to augme nt critical educational and behavioral interventions that are the mainstays of treatment. A comprehensive review of medication trials conducted In ind ividuals with autistic disorder and other pervasive developmental disorders is presented. The typical antipsychotic haloperidol is the best-studied me dication in autistic disorder but is associated with a high rate of dyskine sias. investigations to date suggest that the atypical antipsychotics such as risperidone have efficacy for certain symptoms of autistic disorder and may be better tolerated than typical antipsychotics. Preliminary results fr om trials with serotonin-reuptake inhibitors are favorable, although effica cy has not been demonstrated in younger age groups. Recent controlled studi es of naltrexone suggest that the drug has minimal efficacy. In two small c ontrolled Investigations, clonidine was more effective than placebo for a v ariety of symptoms, including hyperactivity and irritability; in one of the se studies, however, the majority of patients relapsed within several month s. Psychostimulants reduced hyperactivity and irritability in one small dou ble-blind crossover study in children with autistic disorder, although thes e agents are frequently reported to exacerbate irritability, insomnia, and aggression in clinical populations. Recent controlled trials of secretin ha ve not shown efficacy compared to placebo. Several other medications, inclu ding buspirone, mood stabilizers, and beta-blockers, have produced symptom reduction in some open-label studies and may warrant controlled investigati on.