Behavioral therapy vs. pharmacological treatment: effectiveness in managing core symptoms of autism

Should clinicians prioritize behavioral approaches or medication when treating core autism symptoms? This question shapes treatment planning for thousands of families each year, yet head-to-head comparisons remain surprisingly rare. This research compared the effectiveness of behavioral therapy and pharmacological treatment in managing core symptoms of autism spectrum disorder (ASD) in children aged 3 to 8 years in New Zealand. Eighty-eight children with confirmed ASD diagnoses were randomly assigned to either a behavioral therapy group (n = 47) receiving applied behavior analysis combined with social skills training, or a pharmacological group (n = 41) receiving dose-adjusted risperidone or aripiprazole. Both treatments lasted 12 months. Outcomes were assessed at baseline, 3, 6, and 12 months using the Social Responsiveness Scale (SRS-2), the Vineland Adaptive Behavior Scales (VABS-3), the Aberrant Behavior Checklist (ABC), and the Clinical Global Impression-Severity scale (CGI-S).The behavioral therapy group showed greater improvement in social communication (mean change: 18.3 vs. 11.2, p = 0.003), adaptive behavior (19.8 vs. 8.7, p < 0.001), and daily living skills (15.1 vs. 7.3, p < 0.001). The pharmacological group showed a modest advantage in reducing repetitive behaviors (16.8 vs. 14.7, p = 0.14), though this difference did not reach statistical significance. Treatment duration was positively correlated with symptom reduction in the behavioral group (r = 0.72, p < 0.001) but showed a weaker association in the pharmacological group (r = 0.41, p = 0.008). Adverse events were more frequent and medically significant in the pharmacological group, with 29.3% experiencing weight gain exceeding 5% of baseline and 24.4% reporting sedation. These findings suggest that behavioral therapy produces broader and more durable improvements in core ASD symptoms, while pharmacological treatment may offer targeted benefits for specific symptom clusters at the cost of greater side effect burden.