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. 2020 May;29(2):110-120.
Epub 2020 May 1.

Clonidine as a Treatment of Behavioural Disturbances in Autism Spectrum Disorder: A Systematic Literature Review

Krystyna Banas  1 , Brett Sawchuk  1
Affiliations

Clonidine as a Treatment of Behavioural Disturbances in Autism Spectrum Disorder: A Systematic Literature Review

Krystyna Banas et al. J Can Acad Child Adolesc Psychiatry. 2020 May.

Abstract
in English, French

Background: Agitation and aggression are commonly cited reasons for psychiatry consultation for individuals diagnosed with autism spectrum disorder (ASD). While risperidone and aripiprazole do not carry Health Canada approval for management of ASD-associated irritability, both are used for this indication but are not universally effective and carry substantial risk of adverse effects. This necessitates use of off-label medications to assist in management of behavioral dysregulation. Clonidine, an alpha-2 receptor agonist, is approved in Canada for treatment of hypertension. The evidence base also supports its use for attention deficit/hyperactivity disorder (ADHD) and for tics in Tourette's disorder. This review focuses on examining the literature regarding clonidine as a treatment of challenging behaviours in the ASD population.

Method: Systematic search of MEDLINE, EMBASE, and PsycINFO databases resulted in 540 unique records. Ten publications were relevant to this review.

Results: Two cross-over studies, one open-label case series, and seven case reports were identified. One of two controlled studies suggested benefit from clonidine versus placebo. Caregivers typically noted improvement in behaviour with clonidine versus baseline. Clonidine was generally well-tolerated. Sedation was the most consistently reported adverse effect. Despite being an anti-hypertensive medication, few discontinued clonidine due to hypotension or bradycardia.

Conclusion: Clonidine has a limited evidence base for use in the management of behavioural problems in patients with ASD. Most evidence originates from case reports. Given the paucity of pharmacological options for addressing challenging behaviours in ASD patients, a clonidine trial may be an appropriate and cost-effective pharmaceutical option for this population.

Contexte: L’agitation et l’agressivité sont des raisons justifiant fréquemment une consultation psychiatrique pour les personnes ayant reçu un diagnostic de trouble du spectre de l’autisme (TSA). Bien que la rispéridone et l’aripiprazole ne soient pas approuvés par Santé Canada pour la prise en charge de l’irritabilité associée au TSA, les deux médicaments sont utilisés à cette indication mais ne sont pas universellement efficaces et comportent un risque substantiel d’effets indésirables. Il faut donc utiliser des médicaments hors indications pour aider à la prise en charge des perturbations du comportement. La clonidine, un agoniste des récepteurs de type alpha-2, est approuvée au Canada pour le traitement de l’hypertension. L’ensemble des données probantes en soutient l’utilisation pour le trouble de déficit de l’attention avec hyperactivité (TDAH) et pour les tics du syndrome de Tourette. La présente revue se penche sur l’examen de la littérature en ce qui concerne la clonidine comme traitement des comportements difficiles dans la population du TSA.

Méthode: Une recherche systématique des bases de données MEDLINE, EMBASE, et PsycINFO a produit 540 documents uniques. Dix publications correspondaient à cette revue. Résultats: Deux études croisées, une série de cas ouverts, et sept études de cas ont été identifiées. L’une de deux études contrôlées suggérait un bénéfice de la clonidine contre un placebo. Les soignants notaient généralement une amélioration du comportement avec la clonidine par rapport au départ. La clonidine était généralement bien tolérée. La sédation était l’effet indésirable le plus constamment déclaré. Malgré que ce soit un médicament anti-hypertensif, peu interrompaient la clonidine en raison d’hypotension ou de bradycardie. Conclusion: Des données probantes limitées appuient l’utilisation de la clonidine pour la prise en charge des problèmes de comportement chez les patients souffrant de TSA. La plupart des données probantes sont issues d’études de cas. Étant donné la rareté des options pharmacologiques pour aborder les comportements difficiles chez les patients souffrant de TSA, un essai de clonidine peut constituer une option pharmaceutique appropriée et rentable pour cette population.

Keywords: aggression; clonidine; irritability of autism; self-injurious behavior.

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Figures

Figure 1
Figure 1
The PRISMA flow chart summarizes the search, selection, and exclusion of articles related to clonidine use for behavioural disturbances in ASD.
See this image and copyright information in PMC

References

    1. American Academy of Pediatrics. Clonidine – Catapres (IR) 2019. Retrieved June 5, 2019, from https://www.aap.org/en-us/professional-resources/Psychopharmacology/Page....
    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
    1. Baio J, Wiggins L, Christensen DL, Maenner MJ, Daniels J, Warren Z, Dowling NF. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. Morbidity and Mortality Weekly Report Surveillance Summary. 2018;67(6):1–23. - PMC - PubMed
    1. Blew P, Luiselli JK, Thibadeau S. Beneficial effects of clonidine on severe self-injurious behavior in a 9-year-old girl with pervasive developmental disorder. Journal of Child and Adolescent Psychopharmacology. 1999;9(4):285–291. - PubMed
    1. Canadian ADHD Resource Alliance. Canadian ADHD Practice Guidelines. 4th ed. Toronto, ON: CADDRA; 2018.

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