Around 1% of the population have autism. There are a number of treatments available for the condition, including learning and development techniques, as well as medical interventions. However, there is little consensus about which drug treatments are most effective.
A team of researchers from Nashville have recently published two systematic reviews in the Pediatrics journal, which investigate the effectiveness of various drug treatments for children aged 12 years and younger with autism spectrum disorders. The treatments studied include antipsychotics, antidepressants and the hormone therapy secretin.
Both reviews involved systematic literature searching of a range of databases over the last 10 years and independent assessment of which studies to include. Two reviewers independently extracted data from the included studies.
One review found evidence of benefit of risperidone and aripiprazole for challenging and repetitive behaviors, but it also found significant side effects of these drugs.
There was not enough evidence to come to any conclusions about the benefits or harms of serotonin-reuptake inhibitors and stimulant medications.
The authors concluded:
Although many children with autism spectrum disorders are currently treated with medical interventions, strikingly little evidence exists to support benefit for most treatments. Risperidone and aripiprazole have shown benefit for challenging and repetitive behaviors, but associated adverse effects limit their use to patients with severe impairment or risk of injury.
The other review found 7 randomised controlled trials that showed a lack of effectiveness of secretin for the treatment of autism symptoms including language and communication impairment, symptom severity, and cognitive and social skill deficits. They found no studies that showed secretin was any better than placebo in the treatment of autism.
The authors concluded:
Secretin has been studied extensively in multiple randomized controlled trials, and there is clear evidence that it lacks benefit. The studies of secretin included in this review uniformly point to a lack of significant impact of secretin in the treatment of autism spectrum disorder symptoms. Given the high strength of evidence for a lack of effectiveness, secretin as a treatment approach for autism spectrum disorders warrants no further study.
McPheeters ML, Warren Z, Sathe N, Bruzek JL, Krishnaswami S, Jerome RN, Veenstra-Vanderweele J. A systematic review of medical treatments for children with autism spectrum disorders. Pediatrics. 2011 May;127(5):e1312-21. Epub 2011 Apr 4. [PubMed abstract]
Krishnaswami S, McPheeters ML, Veenstra-Vanderweele J. A systematic review of secretin for children with autism spectrum disorders. Pediatrics. 2011 May;127(5):e1322-5. Epub 2011 Apr 4. [PubMed abstract]
As a Nursery Nurse you form a bound with a child and parent and are 4 ever looking 4 ways 2 improve your practice and 2 give them the right advise,
but after reading the above it makes you wounder the choice the parent has 2 make has become harder because if the meds don’t work what damage has it cause the child and what other choices do I have now.
Readers interested in more detailed evidence about the use of SSRIs (antidepressants) for the treatment of autism in children, should read the Cochrane systematic review from last year:
Williams K, Wheeler DM, Silove N, Hazell P. Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2010 Aug 4;(8):CD004677.
The review concludes:
Autism spectrum disorders (ASD) are characterised by problems with social interaction and communication, as well as repetitive behaviours and limited activities and interests. Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants which are sometimes given to help anxiety or obsessive compulsive behaviours. We found seven trials which evaluated four SSRIs: fluoxetine, fluvoxamine, fenfluramine and citalopram. Five studies included only children and two studies included only adults. One trial enrolled 149 children, but all other trials were small. We found no trials which evaluated sertraline, paroxetine or escitalopram.
There is no evidence to support the use of SSRIs to treat autism in children. There is limited evidence, which is not yet sufficiently robust, to suggest effectiveness of SSRIs in adults with autism. Treatment with an SSRI may cause side effects. Decisions about the use of SSRIs for established clinical indications that may co-occur with autism, such as obsessive compulsive disorder and depression in adults or children, and anxiety in adults, should be made on a case by case basis.