Psychopharmacological intervention is very common in adults with ASD. Studies estimate up to 80% of adults with ASD are on at least one behavioral medication.3 This is despite no medication being FDA-approved specifically for adults with autism, and no medications available to target the condition’s core deficits.

Medication utilization patterns resemble those used to treat children and adolescents, with stimulants, selective serotonin reuptake inhibitors, and atypical antipsychotics leading the way. Mood stabilizers and alpha agonists are also fairly commonly used. No consensus exists regarding which specific medication within each class should be used, although lower starting dosages are generally recommended.


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Identifying the goal of treatment prior to initiation is critical as the target can vary from traditional symptoms to more atypical behaviors such as impulsiveness, aggression, self-injury, or increased self-stimulation and repetitive mannerisms.

Implementing behavioral strategies, psychopharmacological therapies, and mental health counseling is even more challenging for the medical provider when working with adults as compared to children with ASD. High-functioning adults with decision-making rights will often be lacking in self-motivation or will have other executive functioning deficits which can create significant treatment barriers. Also, as the role of the parent often shrinks, obtaining a reliable history of events such as effects of treatment can become even more challenging.

In summary, recognition and management of co-occuring mental health conditions in adults with ASD is of critical importance if these adults are to reach their maximal functional level. Adult mental health providers will need to demonstrate patience and a willingness to work with this population as more and more individuals transition into adulthood.

Gary Stobbe, MD, is a clinical assistant professor in the Departments of Neurology and Psychiatry at the University of Washington School of Medicine in Seattle. His research interests include autism and the transition to adulthood of individuals with neurological and neurodevelopmental disorders.

References

  1. Center for Disease Control and Prevention. Prevalence of autism spectrum disorder among children aged 8 years – autism and developmental disabilities monitoring network, 11 sites; United States, 2010. CDC Morbidity and Mortality Weekly Report. March 28, 2014.
  2. Wang P. 1 in 68: what do autism’s rising numbers mean for our families? Autism Speaks. March 28, 2014. Available at www.autismspeaks.org/blog/2014/03/28/1-68-what-do-autism%E2%80%99s-rising-numbers-mean-our-families
  3. Esbensen AJ, Greenberg JS, Seltzer MM, et al. A longitudinal investigation of psychoactive and physical medicaltion use among adolescents and adults with autism spectrum disorders. J Autism Dev Disord, 2009; 39:1339-49.