Medication Treatment in Autism: What Really Works
What types of medications are used to treat autistic children?
The types of medications used to treat an autistic child depend on the symptoms as well as any other condition that may contribute to unacceptable behavior. Medications commonly prescribed to treat the behaviors of autistic children include antidepressants, anticonvulsants, neuroleptic medications (also known as antipsychotic medications), sedatives, and stimulants. These medications all can have serious side effects and are not prescribed lightly by concerned physicians.
Although most medications can be used safely for long periods of time without harm, the use of any medication is associated with health risks. Parents should be aware of the risks to the child as well as the likely benefit to the child. Treating a child with medication should only be undertaken after the parents (and the child, when appropriate) have balanced the risks and benefits of the medication. Parents need to be made aware of all the possible side effects of any new medication as they will be observing the child most closely and can aid the treating physician in decisions about adjusting the dose of medication or eliminating it.
Term:
Neuroleptic–A class of drug that includes Haldol and Risperdal. Also called antipsychotic medication.
Is there anything I should do before giving my child a medication?
Behavioral problems, such as aggression, self-injurious behavior, and severe tantrums, can keep the person with autism from functioning effectively at home or in school. Physicians can use medications to treat these behavioral problems. When your child is treated with medication, you should observe the following rules:
1. Consult experienced physicians. A child with autism may not respond in the same way to medications as typically developing children. Given the complexity of medications, drug interactions, and the unpredictability of how each patient may react to a particular drug, parents should seek out and work with a physician who has experience in treating autistic children with these medications. This physician should be able to tell the parents what the appropriate dosage for their child is and how it should be administered (e.g., pills, liquid, or injection).
2. Observe closely. Like any person taking a new medication, an autistic child should be monitored closely by the parents and medical professionals. You should ask the physician how your child will be monitored and by whom. Ask your physician about what signs or symptoms you should look for that may signal a problem or what laboratory tests are required before starting the drug and during treatment.
3. Begin with low doses. Because the amount and severity of medication side effects tend to heighten with an increase in the dose of the medication, doctors should prescribe the lowest dose possible that is effective. The doctor may begin with a low dose and then observe its effects on your child’s behavior for weeks or months. The doctor may have to make several adjustments to get the right dose that optimizes behavior and minimizes side effects.
4. Be aware of the side effects of the medications prescribed. When medication is being discussed or prescribed, ask about the safety of its use in children with autism. Ask the doctor about any side effects the medication may have and if there are any long-term consequences to the use of the medication. It is helpful to keep a record of how your child responds to the medication at what dose. The product insert that comes with your child’s medication lists the drug’s indications, side effects, and monitoring requirements; parents should read this and discuss any concerns they have with the doctor. Some people keep the product inserts in a small notebook to be used as a reference. This is especially useful when your child is prescribed several medications.
5. Be aware of drug or food interactions. The physician should be made aware of any other medications your child is taking, including over-the-counter cold medications, home remedies, or nutritional supplements. Ask the physician if there are there possible interactions with other drugs, vitamins, or foods.
Are antipsychotic medications helpful in the treatment of autism?
Antipsychotic medications have been used to treat severe behavioral problems in autistic children. These medications work by reducing the activity in the brain of the neurotransmitter dopamine. The use of antipsychotic medication in autism is not intended to imply that autism and psychosis are in any way related. However, these medications, used to treat psychotic behaviors in psychiatric patients, also have been shown to be effective with autism. Antipsychotic medications are divided into two classes: typical and atypical.
Term:
Typical antipsychotic medications – Some examples of the typical antipsychotics include haloperidol (Haldol), thioridazine, fluphenazine, and chlorpromazine. The most commonly used medication in this group is haloperidol.
Haloperidol was found in more than one study to be more effective than a placebo in treating serious behavioral problems in autistic patients. Unlike some prescription drugs that must be taken several times during the day, some antipsychotic medications can be taken just once a day. In order to reduce daytime side effects such as sleepiness, some medications can be taken at bedtime. Some antipsychotic medications are available in “depot” forms that can be injected once or twice a month. A “depot form” of an injectable drug is formulated by the manufacturers to be released slowly from the injection site into the bloodstream. This prolongs the effect of a single injection, allowing a larger dose to be administered less frequently.
Most side effects of antipsychotic medications are mild; many common ones lessen or disappear after the first few weeks of treatment. These include drowsiness, rapid heartbeat, and dizziness when changing position. Infrequent side effects can include muscle stiffness and abnormal muscle tics and facial movements called tardive dyskinesia. Tardive dyskinesia is a condition associated with the use of antipsychoticmedication. It is characterized by involuntary, rhythmic movements of the face, jaw, mouth, and tongue, such as lip pursing, chewing movements, or protrusion of the tongue. These facial movements are sometimes accompanied by involuntary jerky or writhing motions of the trunk, arms, and legs.
Atypical antipsychotic medication. The early typical antipsychotic medications often had unpleasant side effects, such as muscle stiffness, tremor, and abnormal movements. Looking for a way to avoid these side effects, researchers continued their search for better drugs. This research resulted in the development of the atypical antipsychotic medications. The atypical antipsychotic medications are generally more effective in treating behavioral symptoms, but are not without their own side effects, which include dizziness, rapid heartbeat, and fainting. Atypicals are also known for their propensity to induce weight gain. Some examples of aytpical antipsychotics include Risperdal (risperidone), Seroquel (quetiapine), Zyprexa (olanzapine), Zeldox (ziprasidone), Clozaril (clozapine), and Abilify (aripiprazole).
The medication most frequently studied in children is risperidone. Risperidone has a wealth of data supporting its efficacy in the improvement of behavioral disturbances in autistic children. It helps to lessen aggression, agitation, and explosive behaviors. In the systematic review on the use of atypical antipsychotics in autism, researchers concluded that risperidone might be effective in reducing hyperactivity, aggression, and repetitive behaviors, often without inducing severe adverse reactions. The mostcommon side effects were increased appetite, weight gain, and sedation.
Olanzapine (Zyprexa) and ziprasidone (Geodon) have been studied in autistic children with encouraging results. The most important adverse events reported with olanzapine were weight gain, loss of strength (asthenia), and increased appetite. Ziprasidone has not been associated with significant weight gain.
Terms:
Haloperidol – A medication that has been found to decrease symptoms of agitation, hyperactivity, aggression, stereotyped behavior, and affective liability.
Atypical antipsychotic medications – A group of drugs that are different chemically from the older drugs used to treat serious mental illnesses. They are called atypical because they have different side effects than the conventional antipsychotic agents. The atypical drugs are less likely to cause drug induced involuntary movements than are the older drugs. They may also be effective for some conditions that are resistant to older drugs. The drugs in this group are clozapine (Clozaril), loxapine (Loxitane), olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal).
Risperdal – Generic name: risperidone; Risperdal, like other new antipsychotic drugs currently under development, is designed to block the effects of serotonin and dopamine, two neurotransmitter chemicals, in the brain. Conventional antipsychotics seem to affect only dopamine.
Antipsychotic medications have been used to treat severe behavioral problems in autistic children.
