Medication Rankings for Core Symptoms of Autism
Direct Answer: No Medications Effectively Treat Core Symptoms
No medications are currently proven to treat the core social communication deficits of autism spectrum disorder. The American Academy of Child and Adolescent Psychiatry explicitly states that pharmacotherapy for ASD should target specific symptoms or comorbid conditions rather than the core features of autism 1. The FDA has approved only risperidone and aripiprazole for irritability associated with ASD—not for core symptoms 1, 2.
Why Core Symptoms Cannot Be Ranked
The core symptoms of autism include:
- Social communication deficits
- Restricted, repetitive behaviors and interests
Currently, social impairment is best addressed through behavioral therapy and social skills training, not medication 3. Pharmacotherapy in autism targets emotional and behavioral symptoms, not the fundamental diagnostic features 4.
Important Clinical Context
What Medications Actually Target
The FDA-approved medications work on associated symptoms:
- Risperidone (0.5-3.5 mg/day): Treats irritability, aggression, temper tantrums, and quickly changing moods—not social communication 1, 2
- Aripiprazole (5-15 mg/day): Treats irritability associated with ASD—not social communication 1
Both medications showed efficacy on the Aberrant Behavior Checklist Irritability subscale, which measures emotional and behavioral symptoms including aggression, self-injury, and tantrums 2.
Emerging but Unproven Evidence
One small retrospective case study (n=10, mean age 2 years 10 months) suggested that risperidone or aripiprazole might improve core ASD symptoms when started very early 5. However, this is a single, low-quality study that contradicts established guidelines and requires validation through clinical trials 5.
Research on Alzheimer's medications (galantamine, memantine, donepezil) reported improvements in some core symptoms like social interaction and communication in small studies 6. However, these are not FDA-approved for ASD and lack sufficient high-quality evidence for routine use 6.
The Evidence Hierarchy
The American Academy of Child and Adolescent Psychiatry recommends that medication choice must proceed from diagnosis of a DSM-5 psychiatric disorder, not from targeting autism symptoms themselves 1. This means:
- Treat comorbid ADHD with methylphenidate (starting 0.3-0.6 mg/kg/dose, 2-3 times daily) 1
- Treat comorbid anxiety with SSRIs as first-line 1
- Treat sleep disturbances with melatonin 1
- Treat severe irritability/aggression with risperidone or aripiprazole 1
Critical Treatment Principle
Psychotropic medications should never substitute for appropriate behavioral and educational services 1, 7. Combining medication with parent training is moderately more efficacious than medication alone for serious behavioral disturbance 1, 7.