Is Abilify (aripiprazole) effective for treating autism spectrum disorder?

Aripiprazole for Autism Spectrum Disorder

Aripiprazole is FDA-approved and effective for treating irritability associated with autism spectrum disorder in children and adolescents aged 6-17 years, but it does not treat the core social communication deficits of ASD. 1

Efficacy for Specific Symptoms

Irritability and Aggression

• Aripiprazole has demonstrated significant improvement on the Aberrant Behavior Checklist-Irritability subscale compared to placebo, with large effect sizes 1, 2
• Recommended dosage range is 5-15 mg/day for treating irritability and aggression in ASD 1
• Aripiprazole is one of only two FDA-approved medications (along with risperidone) for treating irritability in autism 3
• Multiple studies have consistently shown clear benefit of aripiprazole compared to placebo for reducing irritability, aggression, and self-injurious behaviors 2, 4

Other Behavioral Symptoms

• Treatment with aripiprazole is associated with global improvements in behavior and quality of life from both patient and caregiver perspectives 4
• In adult patients with ASD and challenging behaviors, 4 out of 5 patients in a case series were classified as "much improved" or "very much improved" according to Clinical Global Impression scales 5
• Regular assessment of treatment response using standardized rating scales is recommended when using aripiprazole 1

Safety and Side Effect Profile

• Aripiprazole is generally well-tolerated, with most adverse events considered mild to moderate 4
• Common side effects include:
  • Sedation (more common than with placebo) 2
  • Extrapyramidal symptoms (though less than some other antipsychotics) 2
  • Weight gain (occurs in approximately 30% of patients) 4
• Compared to other atypical antipsychotics like risperidone, aripiprazole appears to have fewer metabolic effects and lower risk of weight gain 4, 6
• Akathisia can occur, particularly at higher doses (30 mg) 5
• Careful monitoring is essential as the long-term effects of antipsychotic therapy in pediatric populations are not well established 4

Clinical Approach to Treatment

• Medication should be used to target specific symptoms (irritability, aggression) rather than core features of autism 1
• Combining aripiprazole with parent training is moderately more efficacious than medication alone for decreasing serious behavioral disturbance 1
• Periodic reassessment is necessary to determine if ongoing treatment is needed 3
• Medication should facilitate the child's adjustment and engagement with educational interventions 1

Important Considerations

• The unique partial agonist dopaminergic mechanism of aripiprazole may contribute to its favorable side effect profile compared to other antipsychotics 6
• Careful metabolic monitoring is required despite potentially lower metabolic risks compared to other antipsychotics 3
• Treatment should be initiated at lower doses and titrated based on response and tolerability 4

Aripiprazole represents an important pharmacological option for managing the challenging behaviors associated with autism spectrum disorder, particularly when irritability and aggression interfere with daily functioning and quality of life.