The pharmacological management of Autism Spectrum Disorder in children.

Abstract

Background Autism Spectrum Disorder (ASD) is a developmental disorder that affects individuals from early childhood. The pharmacological management of ASD in children remains a challenge due to limited effective management options and the absence of approved drugs to manage the core symptoms. This study aimed to review pharmacological treatment options used in the management of ASD in children at a public hospital in KwaZulu-Natal by identifying pharmacological agents prescribed and determining the role and impact on treatment outcomes. Additionally, the study aimed to review effective pharmacological management options employed in managing the core symptoms and comorbidities of ASD on an international scale by conducting a systematic review. Method A quantitative retrospective study was conducted by reviewing patient files of children diagnosed with ASD, meeting the inclusion criteria. A descriptive analysis was done to identify prescribing trends and therapeutic outcomes. A systematic review was also conducted to identify pharmacotherapeutic options for the management of ASD in children and adolescents. A systematic search for studies from January 2012 to January 2022 was performed using four databases, which included: PubMed, Scopus, Science Direct, and PsycInfo. A narrative synthesis was used for data analysis. Results A total of 181 children met the inclusion criteria for the study. Risperidone was the most frequently prescribed drug (88%) for the management of comorbidities and/or core symptoms of ASD. Attention deficit hyperactivity disorder (54%), irritability or aggression (25%), and

sleep dysregulation (22%) were frequent ASD comorbidities that warranted pharmacotherapy. Drugs prescribed to manage ASD comorbidities included methylphenidate, melatonin, sodium valproate, risperidone, oxybutynin, carbamazepine, and others. Risperidone and non-pharmacological therapies played a prominent role in targeting the core symptoms of ASD. In 41% of patients, there was a positive response to treatment and 20% of patients experienced improvements in the core symptoms of ASD. The systematic review provides a comprehensive list of effective management options for ASD comorbidities and core symptoms from 33 included studies. Risperidone, aripiprazole, methylphenidate, guanfacine, levetiracetam, and atomoxetine are examples of effective pharmacological drugs against ASD comorbidities. Effective drugs for the management of ASD core symptoms include but are not limited to, bumetanide, fluoxetine, intranasal oxytocin, intranasal vasopressin, and prednisolone. Conclusion Pharmacotherapy plays an important role in managing the comorbidities of ASD, however, the use of drugs in the management of ASD core symptoms is limited at the public hospital in KwaZulu-Natal. The systematic review successfully summarised the pharmacological advancements made in the past decade and includes promising therapeutic options that manage the core symptoms and comorbidities of ASD.