Atypical antipsychotics are efficacious for the treatment of irritability in children, adolescents, and adults with ASDs. For hyperactivity and inattention, psychostimulants

may be beneficial but are less efficacious and associated with more adverse effects compared to individuals with ADHD, α-2 Adrenergic #find more randurls[1|1|,|CHEM1|]# agonists and the non-stimulant atomoxetine may be effective where psychostimulants are not, although subjects should be monitored for adverse effects. Mirtazapine has shown benefit in the management of a wide range of symptoms in ASDs, including anxiety, irritability, SIB, repetitive behaviors, and inappropriate Inhibitors,research,lifescience,medical sexual behaviors, although further research is needed. D-cycloserine and memantine appear helpful in the treatment of social impairment, although again, further research is needed. In the Inhibitors,research,lifescience,medical past quarter century, significant progress has been made in the psychopharmacology of ASDs. Target symptom domains associated with ASDs have been identified that are amenable to pharmacotherapy. Drugs that are efficacious interventions for other neuropsychiatric disorders have been evaluated in subjects with ASDs for the treatment of symptoms that appear similar phenotypically (eg, Inhibitors,research,lifescience,medical the repetitive

behavior of OCD vs the repetitive behavior of ASDs; the motor hyperactivity of ADHD vs the motor hyperactivity of ASDs). Importantly, these drug treatments have largely been ineffective or less effective Inhibitors,research,lifescience,medical in subjects with ASDs than in those with the prototypical disorders. In addition, the tolerability of these drugs has been reduced in the subjects with ASDs. Inhibitors,research,lifescience,medical These results suggest that fundamental biological mechanisms may be quite different between disorders despite similarities in aspects of clinical

presentation. Differences in response to drugs have also been identified across development in subjects with ASDs; the same has been observed with regard to drug tolerability. As in most areas of research, first the more we have learned the more we have realized how much more we need to know. Clearly, additional randomized double-blind, placebo-controlled trials are needed, particularly in adults with ASDs. An ultimate goal is to develop a “rational pharmacology” that targets fundamental biological mechanisms underlying these complex disorders. Acknowledgments This work was supported by the State of Indiana Division of Mental Health and Addiction Services and Indiana University Health (Dr Doyle) and the Nancy Lurie Marks Family Foundation, Autism Speaks, and the National Institute of Mental Health (MH077600, MH083739) (Dr McDougle). Disclosure of conflicts of interest: Drs Doyle and McDougle have nothing to disclose.