For cognitively able individuals, college is often possible, but social and academic support is frequently required to help with navigating the challenges of a more self-directed academic program and dorm life.14 An increasing number of universities now offer ASD-specific programs. However, these can be costly, and there is little indication of their effectiveness. For many families, it may be necessary to select a college and work with administrators to develop a custom plan to support the student in the college transition.
Persons with ASD often have significant difficulty with obtaining and maintaining employment because of their social vulnerabilities. Psychotherapy and job coaching may be necessary to build interview, interpersonal, and on-the-job vocational skills and to identify employment settings where an individual can be most successful.
Finally, many individuals with ASD desire romantic relationships, and issues of sex and sexuality are common. Guiding exploration and navigation of sexuality and relationship issues can be an important role for mental health clinicians.
There are no medications that effectively target the core social symptoms of ASD. However, many individuals with ASD benefit from drug treatment to address a subset of their presenting symptoms or associated psychiatric problems. Risperidone and aripiprazole are atypical antipsychotics that have demonstrated efficacy and are FDA approved for reducing irritability, challenging behaviors, and repetitive behaviors in children with ASD.15 There is, however, strong evidence for adverse effects, such as weight gain, sedation, and extrapyramidal effects.
All other medications are used off-label for ASD, although several are FDA approved for children with other conditions. Stimulants can be effective for children with ASD and comorbid ADHD or attention problems. One randomized controlled study showed improvement in hyperactivity among children with ASD.16 SSRIs are often used to address comorbid mood and anxiety symptoms. Studies have examined whether they are also effective in reducing ASD-specific repetitive behaviors, but support for their effectiveness in this capacity is insufficient.
Newer drugs are in development. The GABA agonist arbaclofen targets challenging behavioral and social withdrawal,17 and intranasal oxytocin targets social communication deficits.18
However, while several potential pharmacological agents have shown promise in pre-clinical animal models, clinical trials have demonstrated more tempered results. More research remains to determine both the efficacy and the safety of these drugs. Overall, it is important to consider whether particular medications are helpful in alleviating symptoms and to remain vigilant to avoid polypharmacy, while chasing elusive symptoms whose biological origin and responsiveness to medication are not yet understood.
Dr Foss-Feig is Postdoctoral Associate at the Child Study Center of Yale University School of Medicine in New Haven, CT. Dr McPartland is Associate Professor in the Child Study Center and department of psychology at Yale University and Director of the Developmental Disabilities Clinic at the Yale Child Study Center in New Haven, CT.
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