Pharmacotherapy of challenging behaviours in children and adolescents with autism spectrum disorder

Purpose
The article attempts to answer the question whether a drug-therapy of challenging behaviours in paediatric patients with autism is warranted. If so, how should it be implemented, including mainly the choice of agent, dosage, length of therapy and drug’s expected efficacy and safety.

Views
Challenging behaviours (CB) are common problems in discussed population that additionally aggravate the level of individual functioning. When a drug-therapy of CB is concerned, there is an alarming tendency of increasing antipsychotic use and polypharmacy which exceeds the body of evidence. Out of many agents studied, only risperidone and aripiprazole exhibit established evidence for effectiveness and safety during a short-term use. Research shows comparable efficacy of these drugs and several particularities in secondary outcomes profile. It is established that in pedopsychiatric patients with autism and challenging behaviours both agents equally increase body weight in a statistically significant way; however, risperidone is associated with bigger risk of metabolic changes and extrapyramidal symptoms than aripiprazole. In addition, risperidone significantly augments the risk of hyperprolactinaemia while aripiprazole exhibits no such an action. Aripiprazole, on the other hand, is linked with higher frequency of sedation.

Conclusions
Drug-therapy of CB in autism should be considered only as an addition to comprehensive interventions when behavioural and psychosocial measures lack effectiveness. The safety/efficacy profile in long-term use remains undetermined and needs further studies.