When Medication Has a Role
Medication has a limited but meaningful role in the lives of some autistic individuals – not to alter who they are, but to address specific symptoms that interfere with their capacity to engage with the world, form connections, and live according to their own values and goals. As a child neurologist who has spent over a decade building clinical and research programs at the intersection of child neurology, neurogenetics, and autism, I have come to understand that the question of whether to use medication is rarely about the autism itself. It is about sleep that never comes, or anxiety so consuming it prevents a child from crossing the threshold of a classroom, or seizures that interrupt the fragile thread of attention during a conversation. It is also, and this is too often overlooked, about physical health across the lifespan: the gastrointestinal symptoms that go untreated for years, the pain that cannot be communicated but shapes behavior, the cardiovascular and metabolic conditions that emerge in adulthood with insufficient medical attention. This chapter offers a clinician&s;s perspective on the current pharmacological landscape in autism, grounded in the neurodiversity-affirming principle that our goal is never to suppress or change the autistic individual, but to remove specific barriers that stand between them and the social connection, independence, and well-being that this book is dedicated to building. It argues further that this goal must explicitly include individuals with profound autism – those with significant intellectual disability and complex support needs – whose voices have been underrepresented in research while their pharmacological burden has frequently been among the highest. Drawing on a recent comprehensive review of novel therapeutics in autism spectrum disorder published in Neurotherapeutics (Kevelson et al., 2026 ), this chapter situates medication within the larger framework of care described throughout this volume.