New Zealand Autism Spectrum Disorder Guideline - Ministry of Health
New Zealand Autism Spectrum Disorder Guideline - Ministry of Health
New Zealand Autism Spectrum Disorder Guideline - Ministry of Health
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Part 4: Treatment and management <strong>of</strong> ASD<br />
4.4 Pharmacological interventions<br />
Summary <strong>of</strong> recommendations<br />
Recommendations:<br />
4.4.1 SSRIs (eg, fluoxetine) may be effective for some children with ASD and high<br />
anxiety and/or obsessive symptoms. However, in the absence <strong>of</strong> good evidence,<br />
these drugs should be used with caution and careful monitoring.<br />
Grade<br />
B<br />
4.4.2 There is insufficient evidence to make any recommendation in relation to the use<br />
<strong>of</strong> other types <strong>of</strong> antidepressants in children with ASD.<br />
I<br />
4.4.3 Risperidone is effective in reducing aggressive behaviour, irritability and<br />
self-injurious behaviour in children with ASD. It may be useful in improving<br />
restricted interests and patterns <strong>of</strong> behaviour. It should be used with caution<br />
because <strong>of</strong> the high risk <strong>of</strong> adverse effects and the uncertainly about longterm<br />
effects. Monitoring for side effects should be carried out on a regular<br />
basis. Risperidone is currently on the IMMP (Intensive Medicines Monitoring<br />
Programme) in <strong>New</strong> <strong>Zealand</strong> and all new clinical events should be reported.<br />
B<br />
4.4.4 There is insufficient evidence to make any specific recommendation regarding<br />
atypical antipsychotic agents other than risperidone. Clinicians prescribing these<br />
drugs need to keep up to date with current literature.<br />
I<br />
4.4.5 Typical antipsychotics are effective in reducing motor stereotypies, temper<br />
tantrums and improving social relatedness. These drugs have a high rate <strong>of</strong><br />
adverse effects and are therefore not recommended for first-line use. Haloperidol,<br />
in particular has been shown to cause little weight gain. Thioridazine should<br />
only be used in exceptional circumstances, as recent reports have implicated<br />
thioridazine in cases <strong>of</strong> sudden death.<br />
B<br />
4.4.6 Methylphenidate is effective for some children with ASD and co-morbid ADHD.<br />
It should be used with caution because <strong>of</strong> the high risk <strong>of</strong> adverse effects.<br />
C<br />
Part 4<br />
4.4.7 Melatonin may be useful for improving sleep in children with ASD who have<br />
impaired sleep.<br />
4.4.8 Co-morbid bipolar disorder should be managed in consultation with an<br />
appropriately experienced psychiatrist.<br />
B<br />
C<br />
4.4.9 Children with ASD who also have epilepsy should be managed in consultation<br />
with an appropriately experienced clinician.<br />
C<br />
144<br />
<strong>New</strong> <strong>Zealand</strong> <strong>Autism</strong> <strong>Spectrum</strong> <strong>Disorder</strong> <strong>Guideline</strong>
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