Efficacy of Risperidone and Methylphenidate for Problem Behaviors and Core Symptoms in Autism Spectrum Disorder: A Randomized Trial

Background: Risperidone and methylphenidate are commonly used drugs to manage problem behaviors in individuals with autism spectrum disorder (ASD). Studies report that these 2 drugs may be helpful in improving core symptoms of ASD as well. Aim: To assess and compare the efficacy and safety profile of risperidone and methylphenidate for problem behaviors and core symptoms in children and adolescents with ASD. Setting and Design: An 8-week, prospective, interventional, randomized, and open-label trial carried out in a tertiary care hospital of northern India. Materials and Methods: Forty subjects with a diagnosis of ASD according to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition were randomized to risperidone and methylphenidate groups. Childhood Autism Rating Scale, Second Edition, Indian Scale for Assessment of Autism, and Nisonger Child Behavior Rating Form were used for assessments. Adverse effects, physical, and laboratory parameters were monitored regularly. Statistical Analysis: Tests applied include chi-square test, repeated measures Analysis of Variance, and Student t test, and nonparametric tests for skewed data. Data was analyzed using SPSS Version 22.0. Level of significance was set at 0.05. Results: Both drugs improved inattention, hyperactivity, and stereotypies. Methylphenidate reduced self-isolation, and risperidone improved emotional dysregulation, aggression, and self-injury. Adverse effects were seen in 55% of methylphenidate group (commonly decreased appetite and irritability) and 40% of risperidone group (commonly sedation and increased appetite). Improvement in stereotypy with both drugs and self-isolated behavior with methylphenidate indicates a possible role in improving core symptoms of ASD. Conclusion: Both drugs were beneficial in the management of behaviors associated with ASD. Further research to establish their role in reducing core symptoms and long-term safety is warranted.