Therapies for Children With Autism Spectrum Disorders

eported hyperactivity and noncompliance measure also showed significant improvement.
Although it was not the primary target behavior addressed in these studies, repetitive behavior
also showed improvement with both risperidone and aripiprazole. Both medications also cause
significant side effects, including marked weight gain, sedation, and risk of extrapyramidal
symptoms. When considered in aggregate, risperidone and aripiprazole are efficacious but are
associated with significant side effects that limit their use to patients with severe impairment or
risk of injury (Table 33).
Table 33. Summary of results of medical studies
Intervention Study design/Quality Study results and overall strength of evidence
Risperidone vs. placebo
Aripiprazole vs.placebo
Cyproheptadine added to
haloperidol vs. haloperidol
and placebo
Fluoxetine vs. placebo
Antipsychotics
4 RCT / 1 good, 201,202,204-209 3
fair 203,210-212
2 prospective case series 213,214
2 RCT / 2 good 215,216
1 RCT / 1 fair 217
1 RCT / 1 fair 220
1 Retrospective case series 221
Citalopram vs. placebo 1 RCT / 1 good 222
Various SRIs (including
sertraline,citalopram,
paroxetine, fluvoxamine)
1 Prospective case series 223
1 Retrospective case series 224
108
• Improvements in challenging behavior and
repetitive behavior.
• Adverse effects, including weight gain, sedation
and extrapyramidal effects.
• Strength of evidence for reducing challenging
behavior and repetitive behavior is moderate.
• Strength of evidence for adverse events is high
based on RCTs and case series; common side
effects include weight gain, sedation, and extrapyramidal
effects.
• Improvements in challenging behavior and
repetitive behavior.
• Adverse effects, including weight gain, sedation
and extrapyramidal side effects.
• Strength of evidence for reducing challenging
behavior and repetitive behavior is high.
• Strength of evidence for adverse events is high;
common side effects include weight gain, sedation,
and extra-pyramidal effects.
• Behavioral improvement reported but without
indicating specific domains in one study.
• Strength of evidence for reducing challenging
behavior and repetitive behavior is insufficient.
• Greater change in repetitive behavior with
fluoxetine compared with placebo.
• Strength of evidence for SRIs to decrease
repetitive behavior is insufficient.
• Strength of evidence for adverse events is
insufficient with only one RCT of fair quality.
• No significant difference between the groups on
repetitive behavior in one study.
• Significant but clinically small reduction in
challenging behavior in the treatment group
compared with placebo.
• Genotype effect on improvement in challenging
behavior.
• Strength of evidence for effect of SRIs to reduce
repetitive behavior is insufficient.
• Strength of evidence for adverse events is
insufficient.
• 40/89 subjects ranked as “much improved.”
• Strength of evidence for effect of SRIs to reduce
repetitive behavior is insufficient.
• Strength of evidence for adverse events is low
when SRIs are considered as a class.