Psychiatric Annals

Feature Articles 

Pharmacotherapy of Autism and Related Disorders

Craig A. Erickson, MD; David J. Posey, MD; Christopher J. McDougle, MD; Kimberly A. Stigler, MD

Abstract

In recent years increasingly rigorous pharmacotherapy study has addressed interfering symptoms associated with autism and related pervasive developmental disorders (PDDs). This review will focus primarily on controlled drug trials in PDDs with emphasis on future directions of treatment. The rapid increase in systematic PDD pharmacotherapy trials has been grounded in treatment success, combined with increased awareness of both the prevalence and morbidity of PDDs. This review will discuss pharmacotherapy options in PDDs based upon the following target symptom clusters: inattention/hyperactivity, interfering repetitive and stereotypic behavior, aggression and self-injurious behavior (SIB), and the core social impairment of autism and related PDDs. An emphasis will be placed on randomized, placebo-controlled trials when available and drug adverse effects seen in the PDD population.

ABOUT THE AUTHORS

Craig A. Erickson, MD; David J. Posey, MD; Kimberly A. Stigler, MD; and Christopher J. McDougle, MD, are with the Department of Psychiatry, Department of Psychiatry, Indiana University School of Medicine, and the Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana.

Address correspondence to: David J. Posey, M.D., Department of Psychiatry, Indiana University School of Medicine, Riley Hospital Child and Adolescent Psychiatry Clinic, 702 Barnhill Drive, Room 4300, Indianapolis, IN 46202-4800; fax 317-278-4241; or e-mail: dposey@iupui.edu.

Dr. Stigler disclosed the following relevant financial relationships: Bristol-Myers Squibb: Investigator-initiated Grant Support. Dr. Posey disclosed the following relevant financial relationships: Forest Pharmaceuticals: Consultant; and Shire: Stockholder. Dr. Stigler disclosed the following relevant financial relationships: Bristol-Myers Squibb, Eli Lilly, and Janssen Pharmaceutica: Research Support Recipient. Dr. McDougle disclosed the following relevant financial relationships: Bristol-Myers Squibb, Eli Lilly, Janssen Pharmaceutica, and Forest Research Institute: Consultant; Bristol-Myers Squibb and Janssen Pharmaceutica: Research Grant Recipient; and Bristol-Myers Squibb and Janssen Pharmaceutica: Speakers’ Bureau.

Acknowledgments: This work was supported in part by a grant from the National Institute of Mental Health (K23 MH68627, Dr. Posey), a Daniel X. Freedman Psychiatric Research Fellowship (Dr. Stigler), and the Department of Housing and Urban Development (B-01-SP-IN-0200, Dr. McDougle).

EDUCATIONAL OBJECTIVES

  1. Assess which medication classes are commonly employed targeting specific symptom domains associated with pervasive developmental disorders (PDD).
  2. Describe medication side-effects noted specifically in the PDD population.
  3. Discuss the future directions of research as they relate to the treatment of interfering symptoms associated with PDDs.

Abstract

In recent years increasingly rigorous pharmacotherapy study has addressed interfering symptoms associated with autism and related pervasive developmental disorders (PDDs). This review will focus primarily on controlled drug trials in PDDs with emphasis on future directions of treatment. The rapid increase in systematic PDD pharmacotherapy trials has been grounded in treatment success, combined with increased awareness of both the prevalence and morbidity of PDDs. This review will discuss pharmacotherapy options in PDDs based upon the following target symptom clusters: inattention/hyperactivity, interfering repetitive and stereotypic behavior, aggression and self-injurious behavior (SIB), and the core social impairment of autism and related PDDs. An emphasis will be placed on randomized, placebo-controlled trials when available and drug adverse effects seen in the PDD population.

ABOUT THE AUTHORS

Craig A. Erickson, MD; David J. Posey, MD; Kimberly A. Stigler, MD; and Christopher J. McDougle, MD, are with the Department of Psychiatry, Department of Psychiatry, Indiana University School of Medicine, and the Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana.

Address correspondence to: David J. Posey, M.D., Department of Psychiatry, Indiana University School of Medicine, Riley Hospital Child and Adolescent Psychiatry Clinic, 702 Barnhill Drive, Room 4300, Indianapolis, IN 46202-4800; fax 317-278-4241; or e-mail: dposey@iupui.edu.

Dr. Stigler disclosed the following relevant financial relationships: Bristol-Myers Squibb: Investigator-initiated Grant Support. Dr. Posey disclosed the following relevant financial relationships: Forest Pharmaceuticals: Consultant; and Shire: Stockholder. Dr. Stigler disclosed the following relevant financial relationships: Bristol-Myers Squibb, Eli Lilly, and Janssen Pharmaceutica: Research Support Recipient. Dr. McDougle disclosed the following relevant financial relationships: Bristol-Myers Squibb, Eli Lilly, Janssen Pharmaceutica, and Forest Research Institute: Consultant; Bristol-Myers Squibb and Janssen Pharmaceutica: Research Grant Recipient; and Bristol-Myers Squibb and Janssen Pharmaceutica: Speakers’ Bureau.

Acknowledgments: This work was supported in part by a grant from the National Institute of Mental Health (K23 MH68627, Dr. Posey), a Daniel X. Freedman Psychiatric Research Fellowship (Dr. Stigler), and the Department of Housing and Urban Development (B-01-SP-IN-0200, Dr. McDougle).

EDUCATIONAL OBJECTIVES

  1. Assess which medication classes are commonly employed targeting specific symptom domains associated with pervasive developmental disorders (PDD).
  2. Describe medication side-effects noted specifically in the PDD population.
  3. Discuss the future directions of research as they relate to the treatment of interfering symptoms associated with PDDs.

In recent years increasingly rigorous pharmacotherapy study has addressed interfering symptoms associated with autism and related pervasive developmental disorders (PDDs). This review will focus primarily on controlled drug trials in PDDs with emphasis on future directions of treatment. The rapid increase in systematic PDD pharmacotherapy trials has been grounded in treatment success, combined with increased awareness of both the prevalence and morbidity of PDDs. This review will discuss pharmacotherapy options in PDDs based upon the following target symptom clusters: inattention/hyperactivity, interfering repetitive and stereotypic behavior, aggression and self-injurious behavior (SIB), and the core social impairment of autism and related PDDs. An emphasis will be placed on randomized, placebo-controlled trials when available and drug adverse effects seen in the PDD population.

ABOUT THE AUTHORS

Craig A. Erickson, MD; David J. Posey, MD; Kimberly A. Stigler, MD; and Christopher J. McDougle, MD, are with the Department of Psychiatry, Department of Psychiatry, Indiana University School of Medicine, and the Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana.

Address correspondence to: David J. Posey, M.D., Department of Psychiatry, Indiana University School of Medicine, Riley Hospital Child and Adolescent Psychiatry Clinic, 702 Barnhill Drive, Room 4300, Indianapolis, IN 46202-4800; fax 317-278-4241; or e-mail: dposey@iupui.edu.

Dr. Stigler disclosed the following relevant financial relationships: Bristol-Myers Squibb: Investigator-initiated Grant Support. Dr. Posey disclosed the following relevant financial relationships: Forest Pharmaceuticals: Consultant; and Shire: Stockholder. Dr. Stigler disclosed the following relevant financial relationships: Bristol-Myers Squibb, Eli Lilly, and Janssen Pharmaceutica: Research Support Recipient. Dr. McDougle disclosed the following relevant financial relationships: Bristol-Myers Squibb, Eli Lilly, Janssen Pharmaceutica, and Forest Research Institute: Consultant; Bristol-Myers Squibb and Janssen Pharmaceutica: Research Grant Recipient; and Bristol-Myers Squibb and Janssen Pharmaceutica: Speakers’ Bureau.

Acknowledgments: This work was supported in part by a grant from the National Institute of Mental Health (K23 MH68627, Dr. Posey), a Daniel X. Freedman Psychiatric Research Fellowship (Dr. Stigler), and the Department of Housing and Urban Development (B-01-SP-IN-0200, Dr. McDougle).

EDUCATIONAL OBJECTIVES

  1. Assess which medication classes are commonly employed targeting specific symptom domains associated with pervasive developmental disorders (PDD).
  2. Describe medication side-effects noted specifically in the PDD population.
  3. Discuss the future directions of research as they relate to the treatment of interfering symptoms associated with PDDs.

10.3928/00485713-20070701-03

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