Recent Advances in Pharmacological Management of Autism: A Narrative Review.

Abstract

Autism Spectrum Disorders (ASD) are a highly heterogeneous neurodevelopmental conditions defined by impairments in social communication, reciprocal interaction, and the presence of restricted or repetitive behaviors. While its "spectrum" nature highlights variability in symptom severity and presentation, ASD often coexists with conditions like attention deficit hyperactivity disorder (ADHD), anxiety, depression, epilepsy, digestive, metabolic, and immune disorders. No pharmacological treatments currently address the core deficits of ASD; instead, behavioral and educational interventions remain central. Medications, including US Food and Drug Administration (FDA)‑approved antipsychotics such as risperidone and aripiprazole, are used to manage comorbid irritability and aggression, stimulants and non‑stimulants (e.g., methylphenidate, atomoxetine, clonidine, guanfacine) to treat ADHD-like symptoms, and melatonin for sleep disturbances. Other off‑label agents like selective serotonin reuptake inhibitor (SSRIs) for anxiety/obsessive compulsive disorder (OCD), anticonvulsants or mood stabilizers for mood dysregulation. Emerging compounds such as intranasal oxytocin and N‑acetylcysteine are under investigation but have not yet been formally approved. The future of ASD care hinges on the development of objective, biologically based diagnostic tools ranging from EEG and neuroimaging biomarkers to proteomic and metabolomic panels that could enable early, precise identification and guide personalized treatment strategies.