October 1, 2025

expert reaction to randomised clinical trial of memantine for social impairment in young people with autism spectrum disorder

Results from a randomised clinical trial (RCT) look at the use of Memantine to treat social impairment in young people with autism.

Professor Ian Maidment, Professor in Clinical Pharmacy, Aston University, said:

“This small study showed that memantine may treat social impairment in youths with Autism Spectrum Disorder. The numbers were very small – only 16 patients received memantine. Much larger studies are required to inform day-to-day clinical practice and identify possible side-effects in the population. The people included were mainly white ethnicity and male; thus further research is also required in more diverse populations.”

Dr Catherine Fava, Consultant Clinical Psychologist and Clinical Lead, Neurodevelopmental Assessment Team and Specialist Neuro divergent Support Team, Oxford Health NHS Foundation Trust, said:

Have the authors accounted for confounders?  Are there important limitations to be aware of?

“The research is based solely on informant and clinician rated measures. The degree to which social impairments in the context of autism are seen as a difficulty or a barrier must be viewed through the eyes of the young person themselves, and not their carers.

“The authors do not define what is meant by social impairment, which is a socially constructed idea, depending on the context and circumstances of the young person at that time. Neither does the research state what particular social impairments are improved by the medication.

“Memantine is licenced in the UK for dementia and memory loss and can also help with confusion and anxiety. One hypothesis may be that the young person’s anxiety and executive functioning improved, which enabled a greater capacity to manage in overwhelming social contexts. Other, more cognitive and behavioural interventions can have this same impact, that come with no risk of side effects. The research did not compare memantine to these psychological, behavioural and contextual interventions.

What are the implications in the real world?  Is there any overspeculation?

“The implications of this research promote an idea that the young person with autism needs to change. The shift in thinking now is that our efforts need to be more contextual; in supporting others to better understand autism and create a safe and neuro affirming environment.

“The research also makes no attempt to understand the young person’s perspective, and whether they feel the medication has helped. With extensive research on masking and camouflaging in autism, the informant perspective cannot be seen as reliable.  

‘Memantine to Treat Social Impairment in Youths With Autism Spectrum Disorder A Randomized Clinical Trial’ by Gagan Joshi et al. was published in JAMA Network Open at 16:00 UK time on Wednesday 1 October. 

DOI: 10.1001/jamanetworkopen.2025.34927

Declared interests

Professor Ian Maidment: Over 12 years ago, before moving into academia, I was part of a study funded by the manufacturer of memantine to study it for use in dementia.

Dr Catherine Fava: I do not have any declared interests.