DokuWiki Prosemirror Plugin

1. Stimulants
2. Non-stimulants
3. Atypical antipsychotics
4. Other options (e.g., amitriptyline, memantine, loxapine)

• Mechanism: Improve ADHD symptoms like inattention and hyperactivity.
• Efficacy:
  • Methylphenidate improves concentration in 56.1% of children with ASD but worsens behavioral symptoms in 45.6%.
  • Lisdexamfetamine is an alternative when methylphenidate is poorly tolerated.
• Considerations:
  • Start with very low doses (e.g., 0.3–0.5 mg/kg/day) and titrate slowly.
  • Watch for side effects such as appetite loss, insomnia, and behavioral changes.

• atomoxetine (Strattera):
  • Mechanism: Norepinephrine reuptake inhibition improves emotional regulation and ADHD symptoms.
  • Efficacy: May have a slightly poorer effect on ADHD symptoms in ASD but is generally well-tolerated.
• guanfacine ER (Intuniv):
  • Mechanism: Alpha-2 agonist that reduces hyperactivity and improves emotional regulation.
  • Efficacy: Equally effective for hyperactivity in ASD but less tolerated due to sedation and fatigue.

• Risperidone:
  • Efficacy: FDA-approved for irritability in ASD; helps with hyperactivity and impulsivity.
  • Considerations: Requires cautious dosing due to potential metabolic side effects.
• Aripiprazole:
  • Efficacy: Effective for irritability and emotional dysregulation; off-label for ADHD symptoms.
  • Dosing: Start at 2.5 mg/day and titrate to a maximum of 10 mg/day.

• Amitriptyline:
  • Uses: Addresses ADHD symptoms, anxiety, sleep issues, and repetitive behaviors.
  • Dosing: Start at 1 mg/kg/day with gradual increases.
• Memantine:
  • Mechanism: NMDA receptor antagonist that may benefit both ADHD and ASD traits.
  • Efficacy: Fewer side effects compared to antipsychotics; improves cognitive flexibility and attention.
• Loxapine:
  • Dosing: 5–10 mg/day; provides atypical antipsychotic effects without significant weight gain.

• Start with the lowest possible doses and titrate cautiously.
• Monitor closely for adverse effects, including behavioral changes and sedation.
• SSRIs like citalopram are not recommended for repetitive behaviors due to poor efficacy and tolerance.
• Oxytocin and other experimental treatments lack sufficient evidence of effectiveness.
• Behavioral and educational interventions should accompany pharmacological treatments for comprehensive care.

ASD frequently coexists with ADHD, presenting unique challenges in treatment. Individuals with ASD often exhibit heightened sensitivity to medications, necessitating cautious dosing and careful monitoring. Medications that are effective for ADHD in typically developing children may have diminished efficacy or a higher likelihood of side effects in individuals with ASD. Addressing both ASD traits and ADHD symptoms typically requires a tailored approach, with low starting doses and specific attention to side effects such as appetite loss, insomnia, and behavioral changes.

1. Low-dose stimulants (methylphenidate preferred)
2. Non-stimulants (atomoxetine, guanfacine)
3. Atypical antipsychotics (e.g., aripiprazole, risperidone)
4. Other options (amitriptyline, memantine, loxapine)

1. Low-Dose Stimulants (e.g., Methylphenidate, Vyvanse):
   • Mechanism: Improves ADHD symptoms such as inattention and hyperactivity.
   • Efficacy:
     • Methylphenidate improved concentration in 56% of children but worsened behavioral symptoms in 45.6%.
     • Vyvanse can be used as an alternative when methylphenidate is ineffective or poorly tolerated.
   • Considerations:
     • Use extremely low initial doses (e.g., 0.3–0.5 mg/kg/day) with careful titration.
     • Common side effects include appetite loss, insomnia, and restlessness.
2. Non-Stimulants (e.g., Atomoxetine, Guanfacine):
   • Atomoxetine:
     • Efficacy: May be less effective for ADHD symptoms in ASD compared to ADHD alone, but better tolerated.
     • Considerations: Suitable for those who cannot tolerate stimulants.
   • Guanfacine:
     • Efficacy: Equally effective for hyperactivity in ASD as in typically developing individuals, but with poorer tolerance.
3. Atypical Antipsychotics (e.g., Aripiprazole, Risperidone):
   • Aripiprazole:
     • Dosing: Start at 2.5 mg/day, titrate up to 7.5–10 mg/day.
     • Efficacy: Off-label use to reduce hyperactivity, impulsivity, and irritability.
   • Risperidone:
     • Efficacy: FDA-approved for irritability in ASD; may improve hyperactivity/impulsivity but requires cautious dosing due to potential side effects.
4. Other Options:
   • Amitriptyline:
     • Dosing: 1 mg/kg/day; addresses ADHD symptoms, anxiety, sleep disturbances, and repetitive behaviors.
   • Memantine:
     • Efficacy: Demonstrates potential benefits for both ADHD and ASD traits, with fewer side effects compared to antipsychotics.
   • Loxapine:
     • Dosing: 5–10 mg/day; similar to atypical antipsychotics but may avoid weight-related side effects.

• Monitor closely for adverse reactions due to heightened sensitivity.
• Avoid SSRIs like citalopram for repetitive behaviors due to poor efficacy and tolerance.
• Oxytocin and other experimental treatments currently lack evidence of effectiveness.

Medication for autism spectrum disorder and comorbid ADHD:

• There are frequent reports of increased sensitivity to medication in general, including ADHD medication, or a reduced dose requirement. In some cases, the doses required are extremely low^{<span aria-expanded=“false” data-tippy-content=“}Stutzman DL, Dopheide JA (2024): Practice Pearls for Stimulant Treatment of Attention-Deficit/Hyperactivity Disorder in Youth. J Pediatr Pharmacol Ther. 2024 Jun;29(3):215-231. doi: 10.5863/1551-6776-29.3.215. PMID: 38863854; PMCID: PMC11163912.^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>39}
• Stimulants
  • Children with ASD and comorbid ADHD reported (% of patients):^{<span aria-expanded=“false” data-tippy-content=“}Silva FAE, P Morais J, Mira Coelho A (2024): Evaluation of the Behavioral Effect of Psychostimulants in Children with Autism Spectrum Disorder: A Cross-Sectional Study. Neuropediatrics. 2024 Aug 6. doi: 10.1055/s-0044-1788891. PMID: 39106875. n = 86^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>86}
    • Restlessness:
      • 47.4 % improved (especially in children diagnosed later)
      • 28.1 % worsened (especially due to sustained release MPH)
    • Concentration
      • 56.1 % improved
      • 15.8 deteriorated
    • Sleep
      • 8.8 % improved
      • 17.5 % deteriorated
    • Language
      • 86 % unchanged
      • 12.25 % deteriorated
      • 1.75 % improved
    • Other behavioral changes
      • 50.9 % unchanged
      • 45.6 % negative changes
      • 3.5 % positive changes
• MPH:
  • Poorer effect on hyperactivity with intellectual impairment^{<span aria-expanded=“false” data-tippy-content=“}Joshi, Wilens (2022): Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder in Individuals with Autism Spectrum Disorder. Child Adolesc Psychiatr Clin N Am. 2022 Jul;31(3):449-468. doi: 10.1016/j.chc.2022.03.012. PMID: 35697395. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>87}
  • Poorer effect and worse level of side effects than with ADHD without ASA^{<span aria-expanded=“false” data-tippy-content=“}Hellings J (2023): Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials. World J Psychiatry. 2023 Jun 19;13(6):262-277. doi: 10.5498/wjp.v13.i6.262. PMID: 37383284; PMCID: PMC10294139. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>88}
  • Dose MPH low (e.g. 0.3 mg/kg/day) with low target doses (e.g. 0.5 mg/kg/day) under careful monitoring^{<span aria-expanded=“false” data-tippy-content=“}Hyman SL, Levy SE, Myers SM; COUNCIL ON CHILDREN WITH DISABILITIES, SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS (2020): Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics. 2020 Jan;145(1):e20193447. doi: 10.1542/peds.2019-3447. PMID: 31843864. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>89}
  • More sensitive side effect reactions to stimulants possible, especially loss of appetite and insomnia^{<span aria-expanded=“false” data-tippy-content=“}Hyman SL, Levy SE, Myers SM; COUNCIL ON CHILDREN WITH DISABILITIES, SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS (2020): Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics. 2020 Jan;145(1):e20193447. doi: 10.1542/peds.2019-3447. PMID: 31843864. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>89}
• Vyvanse
  • Choice of medication if MPH does not work or shows inappropriate side effects. Here too, use a low dose and expect a lower target dose^{<span aria-expanded=“false” data-tippy-content=“}Hyman SL, Levy SE, Myers SM; COUNCIL ON CHILDREN WITH DISABILITIES, SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS (2020): Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics. 2020 Jan;145(1):e20193447. doi: 10.1542/peds.2019-3447. PMID: 31843864. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>89}
• Atomoxetine:
  • Poorer effect on ADHD symptoms with the same level of tolerability^{<span aria-expanded=“false” data-tippy-content=“}Joshi, Wilens (2022): Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder in Individuals with Autism Spectrum Disorder. Child Adolesc Psychiatr Clin N Am. 2022 Jul;31(3):449-468. doi: 10.1016/j.chc.2022.03.012. PMID: 35697395. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>87<span aria-expanded=“false” data-tippy-content=“}Hellings J (2023): Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials. World J Psychiatry. 2023 Jun 19;13(6):262-277. doi: 10.5498/wjp.v13.i6.262. PMID: 37383284; PMCID: PMC10294139. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>88}
• Guanfacin:
  • Same effect on hyperactivity with intellectual impairment, with poorer tolerance^{<span aria-expanded=“false” data-tippy-content=“}Joshi, Wilens (2022): Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder in Individuals with Autism Spectrum Disorder. Child Adolesc Psychiatr Clin N Am. 2022 Jul;31(3):449-468. doi: 10.1016/j.chc.2022.03.012. PMID: 35697395. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>87}
  • Same effect on hyperactivity in ASD as in TD^{<span aria-expanded=“false” data-tippy-content=“}Hellings J (2023): Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials. World J Psychiatry. 2023 Jun 19;13(6):262-277. doi: 10.5498/wjp.v13.i6.262. PMID: 37383284; PMCID: PMC10294139. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>88}
• Amitriptyline:
  • At a dosage of about 1 mg/kg/day with cautious use is effective for^{<span aria-expanded=“false” data-tippy-content=“}Hellings J (2023): Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials. World J Psychiatry. 2023 Jun 19;13(6):262-277. doi: 10.5498/wjp.v13.i6.262. PMID: 37383284; PMCID: PMC10294139. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>88}
    • Sleep, anxiety, impulsivity and ADHD, repetitive behavior and enuresis
• Aripiprazole (off label) 2.5 mg (starting dose) to 10 mg^{<span aria-expanded=“false” data-tippy-content=“}Endrass (2019): Leitfaden zur Diagnostik und Therapie der ADHS im Erwachsenenalter in der neuropsychiatrischen Praxis, 3. Auflage^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>67}

For autistic traits (subclinical ASD)

• Fluoxetine 10 to 20 mg^{<span aria-expanded=“false” data-tippy-content=“}Endrass (2019): Leitfaden zur Diagnostik und Therapie der ADHS im Erwachsenenalter in der neuropsychiatrischen Praxis, 3. Auflage^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>67}
• Fluoxetine 5 to 20 mg^{<span aria-expanded=“false” data-tippy-content=“}Krause, Krause (2014): ADHS im Erwachsenenalter: Symptome – Differenzialdiagnose – Therapie, Seite 289^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>50}
• Aripiprazole 2.5 to 7.5 mg^{<span aria-expanded=“false” data-tippy-content=“}Krause, Krause (2014): ADHS im Erwachsenenalter: Symptome – Differenzialdiagnose – Therapie, Seite 289^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>50}

Pure ASA medication:
In the USA, only risperidone and aripiprazole are approved by the FDA for ASA treatment^{<span aria-expanded=“false” data-tippy-content=“}

Hellings J (2023): Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials. World J Psychiatry. 2023 Jun 19;13(6):262-277. doi: 10.5498/wjp.v13.i6.262. PMID: 37383284; PMCID: PMC10294139.REVIEW

” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>88

• Risperidone
  • Hyperactivity/impulsivity in autism or mental retardation can be improved by stimulants such as risperidone. Risperidone is not generally approved for the treatment of ADHD, but could be considered for comorbidautism. Due to the potential for increased side effects, cautious dosing is required for these symptom combinations.^{<span aria-expanded=“false” data-tippy-content=“}Banaschewski T, Coghill D, Santosh P, Zuddas A, Asherson P, Buitelaar J, Danckaerts M, Döpfner M, Faraone SV, Rothenberger A, Sergeant J, Steinhausen HC, Sonuga-Barke EJ, Taylor E (2006): Long-acting medications for the hyperkinetic disorders. A systematic review and European treatment guideline. Eur Child Adolesc Psychiatry. 2006 Dec;15(8):476-95. doi: 10.1007/s00787-006-0549-0. PMID: 16680409. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>18}
• Citalopram and fluoxetine (SSRI):
  • Poor tolerance and lack of effectiveness for repetitive behaviors^{<span aria-expanded=“false” data-tippy-content=“}Hellings J (2023): Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials. World J Psychiatry. 2023 Jun 19;13(6):262-277. doi: 10.5498/wjp.v13.i6.262. PMID: 37383284; PMCID: PMC10294139. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>88}
• Oxytocin:
  • Showed no effectiveness^{<span aria-expanded=“false” data-tippy-content=“}Hellings J (2023): Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials. World J Psychiatry. 2023 Jun 19;13(6):262-277. doi: 10.5498/wjp.v13.i6.262. PMID: 37383284; PMCID: PMC10294139. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>88}
• Amitriptyline and loxapine:
  • Promising^{<span aria-expanded=“false” data-tippy-content=“}Hellings J (2023): Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials. World J Psychiatry. 2023 Jun 19;13(6):262-277. doi: 10.5498/wjp.v13.i6.262. PMID: 37383284; PMCID: PMC10294139. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>88}
• Loxapine:
  • In a dosage of 5 to 10 mg daily in PET similar to atypical antipsychotic, possibly without weight side effects^{<span aria-expanded=“false” data-tippy-content=“}Hellings J (2023): Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials. World J Psychiatry. 2023 Jun 19;13(6):262-277. doi: 10.5498/wjp.v13.i6.262. PMID: 37383284; PMCID: PMC10294139. REVIEW^{” style=“–tw-border-spacing-x: 0; –tw-border-spacing-y: 0; –tw-translate-x: 0; –tw-translate-y: 0; –tw-rotate: 0; –tw-skew-x: 0; –tw-skew-y: 0; –tw-scale-x: 1; –tw-scale-y: 1; –tw-scroll-snap-strictness: proximity; –tw-ring-offset-width: 0px; –tw-ring-offset-color: #fff; –tw-ring-color: rgb(59 130 246 / .5); –tw-ring-offset-shadow: 0 0 #0000; –tw-ring-shadow: 0 0 #0000; –tw-shadow: 0 0 #0000; –tw-shadow-colored: 0 0 #0000; box-sizing: border-box; cursor: pointer; border: 0px solid rgba(var(–gray-200),1);”>88}

Memantine has been shown to be helpful for both ASD and ADHD. More on this under Memantine for ADHD.