Autism treatment: are drugs always the best option?

                       
Psychiatric drugs are often prescribed to people living with autism spectrum disorder (ASD). But are they the best form of treatment?

In the UK, autism is more prevalent than most think. Today, there are over 700,000 people on the autism spectrum — more than 1 in every 100 people. When we include families, autism is a daily part of life for around 2.8 million people.

For people on the autism spectrum, it’s not uncommon to take four medications simultaneously (known as polypharmacy). A 2012 study released by the National Institute of Mental Health revealed that 56% of children and teens on the spectrum are taking one or more meds.

Though cocktails of psychiatric medication can improve life in the short term — particularly for struggling parents — they can also have unwanted effects.

Critics such as Ari Ne’eman, president and co-founder of the Autistic Self Advocacy Network, argue that “a sizable percentage of the medications being prescribed are serving as a means of chemical restraint, rather than having a legitimate therapeutic purpose.”

No wonder drug for autism

No existing medication treats autism specifically. Most treatment plans prescribed to people with autism are not for the condition itself, but for a range of secondary conditions that are often related to mental health.

Some of the key symptoms of autism include difficulty with social interaction, heightened sensory experience, repetitive behaviour and a lack of communication skills. Depression, anxiety and insomnia are also common.

According to a 2010 study in the US, more than 80% of children with autism also have ADHD, 61% had at least two anxiety disorders, and 56% had major depression.

Because there is no autism-specific medication to help with these experiences, doctors can often prescribe medication that treats some of the challenging peripheral features of autism — including anxiety, depression and ADHD.

This can lead to imperfect outcomes. A person with ASD doesn’t have the same needs as a non-ASD person suffering from anxiety, for example. The drug can often come with additional or different side effects, which can lead to new drugs being prescribed. This, in turn, can lead to continuing attachment to multiple psychiatric medications, all fighting the negative impacts of each other.

What are alternative autism treatments?

For self-advocates, medical professionals and parents, pharmaceuticals aren’t always the answer. Ari Ne’eman suggests that “improving communication supports and educational interventions are far more meaningful and appropriate mechanisms to address behavioural challenges.”

Education and behavioural therapies are undoubtedly often some of the most effective strategies for people with autism. However, they don’t always work, especially for people who are at the far reaches of the spectrum.

Technology is also having an increasing influence on autism treatment. From biometric technology, which forms the basis of Autism Together’s Future 50 campaign, to Leka, a multisensory robot companion for children which helps to improve communication skills, these technologies have the potential to make a big impact for people with autism.

Why are so many drugs prescribed?

Why are so many psychiatric drugs administered to people with autism in the UK? One of the reasons could be limited access to specialists.

With fewer specialists in medical institutions and increasing cost pressures, pharmaceuticals are often the first point of call. For parents struggling to cope with the challenges of raising an ASD child, as well as doctors with limited expertise and time, psychiatric drugs can be a quick and simple solution.

Of course, non-pharmaceutical interventions, such as occupational therapy, aren’t always enough to help people with autism properly integrate into society.

At its most extreme, ASD can lead to uncontrollable violence and extreme isolation. In such a situation, what is a parent meant to do?

Finding the right balance between therapeutic and pharmaceutical solutions is not a path that has a clear direction. After all, no two people with autism spectrum disorder have the same experience of the world. For parents, in particular, finding the right balance can often be a long, and often painful, journey.

The main issue is that this journey is not a well-trodden path. People who experience ASD are confronted with different challenges. And whilst we all like to think of the pharmaceutical industry as being driven by science and data, prescribing drugs for people with ASD can often be an art. An absolute solution, or even clear guidelines, are still a long way off.

What drugs are currently being developed for autism?

There will never be a complete cure for autism (many self-advocates would argue that it’s not something we should be aiming for), but there are drugs in development which could potentially help alleviate some of the most common symptoms.

In January 2018, the Swiss multinational pharmaceutical company Roche was granted Breakthrough Therapy Designation by the US Food and Drug Administration (FDA) for its oral medicine, Balovaptan.

A vasopressin receptor antagonist (VRA), Balovaptan works by preventing a molecule that’s thought to influence social behaviour from binding to brain receptors.

The drug is still in the development phase, but initial findings are said to be promising. An accessible drug for autism may be close, but it won’t be a cure-all. There’s also the potential that Balovaptan could add to the confusion — joining the growing list of pharmaceuticals administered to those with ASD.

Balovaptan is just the starting point for autism treatment. As a condition, it’s not given an adequate amount of funding, especially as it costs the UK economy £32 billion each year. According to a recent LSE report, autism research is annually allocated just £4 million of funding.

Without adequate funding, we’re not likely to see much progress in caring for autism, whether that be through digital, therapeutic or pharmacological solutions.

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