ABSTRACT
Lack of understanding of the origins of abnormal behaviors in autism has impeded the development of rational drug therapies. Treatment is further complicated by a tremendous range of syndrome expression, perhaps due to the involvement of many neurotransmitters (1). There is no specific drug to cure autism or to treat its core symptoms of poor social relatedness and communication skills deficit. Therefore, the goal of drug treatment of autism is, at present, to decrease the frequency of maladaptive behaviors, such as hyperactivity, aggression, self-abusive behavior, temper tantrams, lability of mood, irritability, social withdrawal, anxiety, repetitive compulsive behaviors, and stereotypies. Atypical behaviors should be examined for their antecedents and contexts in which they occur and treatment should be considered only if the behaviors are maladaptive, interfere with programming, or impair the quality of life. For example, if a child flaps his hands when he is overaroused, but is still responsive to programming, his behavior may not require treatment. On the 5 contrary, if a child turns an electric switch off and on repeatedly, and throws a tantrum when removed from the switch, his behavior is maladaptive and requires treatment. If a behavior occurs to avoid a socially threatening situation or a distressing sensory stimulus, behavioral interventions should be tried before drug treatment is initiated. An embarrassing behavior that occurs in public may be considered for treatment earlier than if it occurs in private. In other words, a proper behavioral diagnosis should be made before initiating treatment. Even if a decision is made to treat a behavior, drug treatment or pharmacotherapy should not be the sole treatment, but should be part of an overall management plan that includes other therapeutic and educational interventions. Some guidelines for drug treatment of target behaviors are given in Table 1. Although, in this chapter, medications have been grouped under the predominant symptom for which they are used, they often have effects on other symptoms as well. In other words, there are no specific drugs for target symptoms in autism and hit and trial is the rule.
