Pharmacology effects and side effects

Currently there are no well-established, biologic therapies to effect clinically significant improvement in the core features (language and social impairments) of autism spectrum disorders (ASD). However, clinicians who specialize in the medical management of these individuals are often called upon to treat impairing behaviors associated with the disorder, which in many instances are highly similar to the symptoms of conventional child psychiatric syndromes. This chapter primarily focuses on instruments for assessing response to psychotropic medication for impairing behaviors in both research and everyday clinical settings. It addresses measures of repetitive behaviors and motor movements because they are responsive to certain medications. In all cases, drug therapies are palliatives; they do not alter underlying pathophysiology in such a way as to "cure" the behavioral disturbance. Therefore, drug discontinuation is often (but not always) associated with some degree of behavioral deterioration in the absence of alternative compensatory intervention. This chapter first addresses several variables and general concepts relevant to either the development or selection of assessment instruments for use in research and everyday clinical settings. Following this, the types of behavior and emotional problems experienced by individuals with ASD and the prevalence of use of psychotropic medicines are described. Finally descriptions of a number of measures that could be used to assess drug response as well as side effects are presented. The spotlight is mainly on clinician- and caregiver-completed rating scales, owing to the fact that little has been done with self-report measures or direct observations. Instruments were selected based on their track record, unique features, or potential with this population.