Pervasive Developmental Disorder Medication
- Author: Sufen Chiu, MD, PhD; Chief Editor: Caroly Pataki, MD more...
Many types of medications are used to address different behavioral issues and comorbid disorders associated with pervasive developmental disorder (PDD/ASD). For example, the US Food and Drug Administration (FDA) has approved risperidone and aripiprazole for use in children to treat irritability associated with autistic disorder.[39, 40, 41]
Data from several large, randomized, placebo-controlled trials suggested that antipsychotic medications may be helpful, particularly for aggression. In addition, treatment with antipsychotics may improve restricted, repetitive, and stereotyped patterns of behavior and interests. However, no medications substantially change deficits in social interaction and communication.
The use of antipsychotic medications requires careful monitoring of weight, fasting lipid profile, and fasting plasma glucose as recommended by the consensus statement published in Diabetes Care.
Treatment of comorbid conditions such as ADHD and OCD may be indicated, although few research studies support the efficacy of the medications currently approved for use in children who are developing normally. Because FDA guidance is absent, child and adolescent psychiatrists target disruptive behaviors with the class of medications indicated by the symptom clusters.
Innovative treatments currently in the development phase include N-methyl-D-aspartate (NMDA) receptor (a type of glutamate receptor) blockers. A preliminary trial using a similar agent, amantadine, proved promising in a placebo-controlled trial. Inhibition of group 1 metabotropic glutamate receptor is being considered specifically in the use of individuals with Fragile X syndrome, because studies demonstrate that FMRP affects dendrite maturation via this neurotransmitter system.
Herbal and alternative treatments require more research. The most promising is melatonin, the hormone that regulates sleep. A pharmaceutical-grade, melatonin like compound, ramelteon, is available commercially. Children with ASD often have sleep disorder that may be ameliorated with melatonin. The most commonly prescribed sleep medications are melatonin followed by central alpha agonists.
Other herbal treatments should be carefully weighed like any traditional medication for their risks and benefits. Most importantly, parents should be cautioned that little oversight exists for these compounds and that some have been found to contain unacceptable levels of heavy metals. Intravenous chelation has been identified by the American Academy of Pediatrics as particularly risky without demonstrated benefit, resulting in 1 reported death.
Antipsychoticmedications may help with a patient’s aggressive behavior and may improve restricted, repetitive, and stereotyped patterns of behavior and interests.
Risperidone is an atypical antipsychotic agent. It binds to the dopamine D2-receptor with 20 times lower affinity than for 5-HT2-receptor affinity. It improves negative symptoms of psychoses and reduces the incidence of extrapyramidal adverse effects compared with conventional antipsychotics. Risperidone is indicated for irritability associated with autistic disorder in children and adolescents aged 6-16 years.
The mechanism of action of aripiprazole is unknown, but it is hypothesized to work differently from other antipsychotics. Aripiprazole is thought to be a partial dopamine (D2) and serotonin (5-HT1A) agonist and to antagonize serotonin (5-HT2A). Additionally, no QTc interval prolongation has been reported in clinical trials.
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