Little evidence supports medical treatment options for adolescents with autism, researchers say

Despite studies that show that many adolescents and young adults with autism spectrum disorders are being prescribed medications, there is almost no evidence to show whether these medications are helpful in this population, the researchers said.

These findings are featured in the Sept. 24 issue of Pediatrics.

"We need more research to be able to understand how to treat core symptoms of autism in this population, as well as common associated symptoms such as anxiety, compulsive behaviors and agitation," said Jeremy Veenstra-VanderWeele, M.D., assistant professor of Psychiatry, Pediatrics and Pharmacology and Vanderbilt Kennedy Center investigator. "Individuals, families and clinicians currently have to make decisions together, often in a state of desperation, without clear guidance on what might make things better and what might make things worse, and too often, people with autism spectrum disorders end up on one or more medications without a clear sense of whether the medicine is helping."

This research is part of a larger report on interventions for adolescents and young adults with autism that found there is little evidence to support findings, good or bad, for all therapies currently used.

The researchers systematically screened more than 4,500 studies and reviewed the 32 studies published from January 1980 to December 2011 on therapies for people ages 13 to 30 with autism spectrum disorders. They focused on the outcomes, including harms and adverse effects, of interventions, including medical, behavioral, educational and vocational.

Key findings:

• Some evidence revealed that treatments could improve social skills and educational outcomes such as vocabulary or reading, but the studies were generally small and had limited follow-up.

• Limited evidence supports the use of medical interventions in adolescents and young adults with autism. The most consistent findings were identified for the effects of antipsychotic medications on reducing problem behaviors that tend to occur with autism, such as irritability and aggression. Harms associated with medications included sedation and weight gain.

• Only five articles tested vocational interventions, all of which suggested that certain vocational interventions may be effective for certain individuals, but each study had significant flaws that limited the researchers' confidence in their conclusions. The findings on vocational interventions were featured in the Aug. 27 issue of Pediatrics.

Although the prevalence of autism is on the rise, much remains to be discovered when it comes to interventions for this population, the researchers concluded.

As recently as the 1970s, autism was believed to affect just one in 2,000 children, but newly released data from the Centers for Disease Control and Prevention (CDC) estimates that one in 88 children has an autism spectrum disorder. Boys with autism outnumber girls 5-to-1, which estimates that one in 54 boys in the United States has autism.

Additional investigators on this report include Melissa McPheeters, Ph.D., MPH, director of Vanderbilt's Evidence-Based Practice Center and senior author; Zachary Warren, Ph.D., director of the Vanderbilt Kennedy Center's Treatment and Research Institute for Autism Spectrum Disorders; Julie Lounds Taylor, Ph.D., assistant professor of Pediatrics and Special Education and lead author; Dwayne Dove, M.D., Ph.D., fellow in Developmental-Behavioral Pediatrics; Nila Sathe, M.S., M.L.I.S., program manager, Institute for Medicine and Public Health; and Rebecca Jerome, M.L.I.S., MPH, assistant director, Eskind Biomedical Library.

Their research, Interventions for Adolescents and Young Adults with Autism Spectrum Disorders, was funded by the Agency for Healthcare Research and Quality's Effective Health Care Program and conducted through Vanderbilt's Evidence-Based Practice Center.