Which medications are commonly prescribed for autistic people and why?

Autism is a neurodevelopmental condition. Someone may have social and communication differences, sensory issues and/or restricted, repetitive patterns of behaviour or interests.

There has been increased awareness and an expanded definition of autism over the past couple of decades. Now around one in 40 people are thought to be autistic.

Autistic people often have strengths such as focus, honesty and dedication. But due to a combination of genetic and autism-related factors, they also have higher rates of other health conditions.

Common mental health conditions include anxiety, depression, attention-deficit and hyperactivity disorder or ADHD, obsessive-compulsive disorder, eating disorders and intellectual developmental disorder.

Common physical health conditions include epilepsy, rheumatoid arthritis and heart disease.

The core features of autism can’t and don’t need to be altered. But a range of talking therapies and medications can help manage these other health conditions.

Commonly prescribed medications

The increased awareness of autism and availability of new medications has seen increased rates of prescribing for autistic people and those with other chronic conditions over the past few decades. This is a trend we have seen internationally.

The most common medications for mental health conditions among autistic people are:

1. selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), for anxiety and depression

2. low-dose antipsychotic medications, such as risperidone and aripiprazole, for reducing stress-related irritability and aggression

3. stimulants such as methylphenidate (Ritalin) for ADHD

4. melatonin and other sleep medications.

The most common medications for physical health conditions among autistic people are:

1. painkillers, such as paracetamol and ibuprofen, for pain and fever, especially in younger children. These are also the most commonly prescribed medication for non-autistic children

2. antibiotics, such as amoxycillin, for suspected or confirmed infections (autistic children tend to have more infections)

3. asthma and allergy medications, including salbutamol inhalers, loratadine and oral steroids (autistic people have similar rates of allergies to non-autistic people)

4. laxatives, such as lactulose, for constipation. Autistic people are at increased risk of constipation due to limited food preferences, rigid toilet habits, and difficulty recognising when they need to use the toilet.

Multiple medications, or not enough

Prescribing multiple medications at the same time is known as polypharmacy. This has become more of an issue for autistic people in Aotearoa New Zealand and Australia.

One study found autistic children and young people from Aotearoa New Zealand received a mean (average) four medications in one year (versus 2.9 medications for non-autistic people). Some 57% were prescribed three or more medications at a time.

Medications may work as well for people with and without autism. However, autistic people are more likely to have side effects. This might be due to heightened sensory sensitivities and the way medications affect the nervous system.

Polypharmacy increases the risk of medication interactions. It is also likely to contribute to autistic people’s higher chance of dying early. A 2024 study confirms this occurs at double the rate of non-autistic people.

Possible reasons for polypharmacy include:

• lack of agreement between doctors and clear guidelines for prescribing medication

• insufficient access to non-medication options to manage health conditions

• greater likelihood of being treated during crises. For instance, behaviour that escalates to the point of personal or property damage and family burnout may require medication to allow a child to stay at home.

However, at times, autistic people may not receive appropriate medications. This may be because doctors do not have clear prescribing guidelines or vary in how they prescribe. It can also be because someone or their family are concerned about side effects.

The right dose for the right time

We should aim to use the appropriate medication for the appropriate period of time for the growing number of people diagnosed with autism.

It’s essential prescribers have clearer prescribing guidance, aim for the lowest possible dose of medication, actively address polypharmacy and regularly monitor autistic people with a view to weaning medications as soon as possible.

Earlier identification and support for autistic children and their families would reduce the chance of crises and stress-related health conditions.

We need health services that can better meet the needs of autistic people. Flexible, tailored care should be provided in an environment that matches someone’s sensory needs. For instance, an environment should not be too bright or loud, or overstimulating. Ideally, this will have been designed with autistic people.

We also need an adequately resourced health system to provide autistic people with timely, appropriate, safe and equitable care.

Hiran Thabrew is a child and adolescent psychiatrist, paediatrician, autism researcher and New Zealand Chair for the Royal Australian and New Zealand College of Psychiatrists. He has never received any pharmaceutical company sponsorship for his clinical or research activities.