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TABLE 1

Selected Potential Medication Options for Common Target Symptoms or Coexisting Diagnoses in Children With ASDs

Target Symptom ClusterPotential Coexisting DiagnosesSelected Medication ConsiderationsSelected References
Repetitive behavior, behavioral rigidity, obsessive-compulsive symptoms Obsessive-compulsive disorder, stereotypic movement disorder SSRIs (fluoxetine,a fluvoxamine,a citalopram, escitalopram, paroxetine, sertraline) McDougle et al,158 ,b Buchsbaum et al,180 ,b Sugie et al,159 ,b Hollander et al,157 ,b Moore et al,160 ,c Namerow et al,181 ,d Owley et al182 ,d 
  Atypical antipsychotic agents (risperidone,a aripiprazole, olanzapine, quetiapine, ziprasidone) McDougle et al164 ,b 
  Valproic acida Hollander et al183 ,b 
Hyperactivity, impulsivity, inattention Attention-deficit/hyperactivity disorder Stimulants (methylphenidate,a dextroamphetamine, mixed amphetamine salts) Quintana et al,168 ,b Handen et al,169 ,b RUPP Autism Network170 ,b 
  α2-agonists (clonidine,a guanfacine) Fankhauser et al,172 ,b Jaselskis et al,173 ,b Posey et al,175 ,d Scahill et al (RUPP Autism Network)174 ,d 
  Atomoxetinea Arnold et al,178 ,b Jou et al,176 ,d Posey et al177 ,d 
  Atypical antipsychotic agents (risperidone,a aripiprazole, olanzapine,a quetiapine, ziprasidone) McCracken et al,162 ,b Arnold et al,163 ,b Shea et al,165 ,b RUPP Autism Network,166 ,b Troost et al167 ,d 
Aggression, explosive outbursts, self-injury Intermittent explosive disorder Atypical antipsychotic agents (risperidone,a aripiprazole, olanzapine, quetiapine, ziprasidone) McCracken et al,162 ,b Arnold et al,163 ,b Shea et al,165 ,b RUPP Autism Network,166 ,b Troost et al167 ,d 
  α2-agonists (clonidine,a guanfacine) Fankhauser et al,172 ,b Jaselskis et al,173 ,b Posey et al175 ,d 
  Anticonvulsant mood stabilizers (levetiracetam, topiramate, valproic acid) Hollander et al184 ,d, Rugino and Samsock185 ,d, Hardan et al186 ,d, Myers148 ,c, Myers and Challman149 ,c 
  SSRIs (fluoxetine,a fluvoxamine,a citalopram, escitalopram, paroxetine, sertraline) McDougle et al,158 ,b Moore et al,160 ,c Namerow et al,181 ,d Owley et al182 ,d 
  β-blockers (propranolol, nadolol, metoprolol, pindolol) Connor et al,187 ,d Ratey et al,188 ,d Myers and Challman149 ,c 
Sleep dysfunction Circadian rhythm sleep disorder, dyssomnia–not otherwise specified Melatonin Giannotti et al,136 ,d Jan and Freeman,131 ,c Phillips and Appleton,133 ,c Turk,134 ,c Owens et al128 ,c 
  Ramelteon Stigler et al137 ,e 
  Antihistamines (diphenhydramine, hydroxyzine) Reed and Findling,189 ,c Owens et al128 ,c 
  α2-agonists (clonidine, guanfacine) Mehta et al,190 ,d Ingrassia and Turk,191 ,d Posey et al,175 ,d Owens et al128 ,c 
  Mirtazapine Posey et al192 ,d 
Anxiety Generalized anxiety disorder, anxiety disorder–not otherwise specified SSRIs (fluoxetine,a fluvoxamine,a citalopram, escitalopram, paroxetine, sertraline) McDougle et al,158 ,b Buchsbaum et al,180 ,b Sugie et al,159 ,b Hollander et al,157 ,b Moore et al,160 ,c Namerow et al,181 ,d Owley et al182 ,d 
  Buspirone Buitelaar et al193 ,d 
  Mirtazapine Posey et al192 ,d 
Depressive phenotype (marked change from baseline including symptoms such as social withdrawal, irritability, sadness or crying spells, decreased energy, anorexia, weight loss, sleep dysfunction) Major depressive disorder, depressive disorder–not otherwise specified SSRIs (fluoxetine,a fluvoxamine,a citalopram, escitalopram, paroxetine, sertraline) McDougle et al,158 ,b Moore et al,160 ,c Namerow et al,181 ,d Owley et al182 ,d 
  Mirtazapine Posey et al192 ,d 
Bipolar phenotype (behavioral cycling with rages and euphoria, decreased need for sleep, manic-like hyperactivity, irritability, aggression, self-injury, sexual behaviors) Bipolar I disorder, bipolar disorder–not otherwise specified Anticonvulsant mood stabilizers (carbamazepine, gabapentin, lamotrigine, oxcarbazepine, topiramate, valproic acid) Kowatch and DelBello,194 ,c Myers and Challman149 ,c 
  Atypical antipsychotic agents (risperidone, aripiprazole, olanzapine, quetiapine, ziprasidone) Cheng-Shannon et al,195 ,c Kowatch and DelBello,194 ,c Myers,148 ,c Myers and Challman149 ,c 
  Lithium DeLong,196 ,e Kerbeshian et al,197 ,e Steingard and Biederman,198 ,e Myers,148 ,c Myers and Challman149 ,c 
Target Symptom ClusterPotential Coexisting DiagnosesSelected Medication ConsiderationsSelected References
Repetitive behavior, behavioral rigidity, obsessive-compulsive symptoms Obsessive-compulsive disorder, stereotypic movement disorder SSRIs (fluoxetine,a fluvoxamine,a citalopram, escitalopram, paroxetine, sertraline) McDougle et al,158 ,b Buchsbaum et al,180 ,b Sugie et al,159 ,b Hollander et al,157 ,b Moore et al,160 ,c Namerow et al,181 ,d Owley et al182 ,d 
  Atypical antipsychotic agents (risperidone,a aripiprazole, olanzapine, quetiapine, ziprasidone) McDougle et al164 ,b 
  Valproic acida Hollander et al183 ,b 
Hyperactivity, impulsivity, inattention Attention-deficit/hyperactivity disorder Stimulants (methylphenidate,a dextroamphetamine, mixed amphetamine salts) Quintana et al,168 ,b Handen et al,169 ,b RUPP Autism Network170 ,b 
  α2-agonists (clonidine,a guanfacine) Fankhauser et al,172 ,b Jaselskis et al,173 ,b Posey et al,175 ,d Scahill et al (RUPP Autism Network)174 ,d 
  Atomoxetinea Arnold et al,178 ,b Jou et al,176 ,d Posey et al177 ,d 
  Atypical antipsychotic agents (risperidone,a aripiprazole, olanzapine,a quetiapine, ziprasidone) McCracken et al,162 ,b Arnold et al,163 ,b Shea et al,165 ,b RUPP Autism Network,166 ,b Troost et al167 ,d 
Aggression, explosive outbursts, self-injury Intermittent explosive disorder Atypical antipsychotic agents (risperidone,a aripiprazole, olanzapine, quetiapine, ziprasidone) McCracken et al,162 ,b Arnold et al,163 ,b Shea et al,165 ,b RUPP Autism Network,166 ,b Troost et al167 ,d 
  α2-agonists (clonidine,a guanfacine) Fankhauser et al,172 ,b Jaselskis et al,173 ,b Posey et al175 ,d 
  Anticonvulsant mood stabilizers (levetiracetam, topiramate, valproic acid) Hollander et al184 ,d, Rugino and Samsock185 ,d, Hardan et al186 ,d, Myers148 ,c, Myers and Challman149 ,c 
  SSRIs (fluoxetine,a fluvoxamine,a citalopram, escitalopram, paroxetine, sertraline) McDougle et al,158 ,b Moore et al,160 ,c Namerow et al,181 ,d Owley et al182 ,d 
  β-blockers (propranolol, nadolol, metoprolol, pindolol) Connor et al,187 ,d Ratey et al,188 ,d Myers and Challman149 ,c 
Sleep dysfunction Circadian rhythm sleep disorder, dyssomnia–not otherwise specified Melatonin Giannotti et al,136 ,d Jan and Freeman,131 ,c Phillips and Appleton,133 ,c Turk,134 ,c Owens et al128 ,c 
  Ramelteon Stigler et al137 ,e 
  Antihistamines (diphenhydramine, hydroxyzine) Reed and Findling,189 ,c Owens et al128 ,c 
  α2-agonists (clonidine, guanfacine) Mehta et al,190 ,d Ingrassia and Turk,191 ,d Posey et al,175 ,d Owens et al128 ,c 
  Mirtazapine Posey et al192 ,d 
Anxiety Generalized anxiety disorder, anxiety disorder–not otherwise specified SSRIs (fluoxetine,a fluvoxamine,a citalopram, escitalopram, paroxetine, sertraline) McDougle et al,158 ,b Buchsbaum et al,180 ,b Sugie et al,159 ,b Hollander et al,157 ,b Moore et al,160 ,c Namerow et al,181 ,d Owley et al182 ,d 
  Buspirone Buitelaar et al193 ,d 
  Mirtazapine Posey et al192 ,d 
Depressive phenotype (marked change from baseline including symptoms such as social withdrawal, irritability, sadness or crying spells, decreased energy, anorexia, weight loss, sleep dysfunction) Major depressive disorder, depressive disorder–not otherwise specified SSRIs (fluoxetine,a fluvoxamine,a citalopram, escitalopram, paroxetine, sertraline) McDougle et al,158 ,b Moore et al,160 ,c Namerow et al,181 ,d Owley et al182 ,d 
  Mirtazapine Posey et al192 ,d 
Bipolar phenotype (behavioral cycling with rages and euphoria, decreased need for sleep, manic-like hyperactivity, irritability, aggression, self-injury, sexual behaviors) Bipolar I disorder, bipolar disorder–not otherwise specified Anticonvulsant mood stabilizers (carbamazepine, gabapentin, lamotrigine, oxcarbazepine, topiramate, valproic acid) Kowatch and DelBello,194 ,c Myers and Challman149 ,c 
  Atypical antipsychotic agents (risperidone, aripiprazole, olanzapine, quetiapine, ziprasidone) Cheng-Shannon et al,195 ,c Kowatch and DelBello,194 ,c Myers,148 ,c Myers and Challman149 ,c 
  Lithium DeLong,196 ,e Kerbeshian et al,197 ,e Steingard and Biederman,198 ,e Myers,148 ,c Myers and Challman149 ,c 

RUPP indicates Research Units on Pediatric Psychopharmacology.

a

At least 1 published double-blind, placebo-controlled trial supports use in patients with an ASD.

b

Double-blind, placebo-controlled trial.

c

Review article.

d

Open-label trial or retrospective chart study.

e

Case report.

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