Explaining Autism to Children: ASD and Me
Association for Science in Autism Treatment
Are medications useful in treating the behavioral problems of autistic children?
No medication can cure autism. Some autistic children may require medication for a short time and others require life-long treatment to help with their behavior or other symptoms. Most autistic children require no medication at all. Many distressing symptoms and unusual behaviors can be improved without the medication. Reducing these distressing symptoms enhances the individual’s ability to participate in educational and community programs, as well as reducing the stress experienced by the parents or caregivers.
Behavioral problems in autistic children can range from hyperactivity, motor and vocal tics, difficulty with transitioning from task to task, uncooperativeness, or defiance to aggression, uncontrollable tantrums, and self-abusive behavior, such as biting of the hands and arms. Although most behavioral problems are amenable to behavior modification techniques such as ABA, refractory, severe, or dangerous behaviors may require medication to treat them effectively.
When a child develops new behaviors-especially when the onset is abrupt or the behavior is violent, parents and caregivers should be vigilant for identifiable causes of the behavior, such as conflicts at school with teachers, therapists, or classmates; allergies; physical ailments or injuries; or more serious illnesses. Even behavioral changes that occur slowly, that are sometimes dismissed as “typical autistic behavior,” can be caused by a reparable problem in the environment. Because communication is a problem with autistic children and adults, they may find it difficult to tell their caregivers that they are feeling sick or are in pain. This frustration may manifest itself as aggression or self-injury, especially if the person is pressured to continue with daily routine or work activities.
When a child exhibits a deterioration of behavior, although it may eventually be attributed to their underlying autism, parents should consider the following causes first:
Social conflict: Consult with teachers and therapists to see if there have been issues in your child’s school environment.
Infections: Physical ailments such as earaches, tooth abscesses, and influenza may be causing problems.
Unrecognized injury: Hyperactive children are prone to minor injuries and sometimes more serious injuries. An inability to communicate or explain the injury can result in unrecognized injuries going unnoticed by parents.
Dr. Quinn’s comment: Our child suffered a serious fracture of his upper arm that went unrecognized for 2 days, and whose only symptom was emotional withdrawal and decreased interest in his favorite meals.
Medication side effects: Many common medications, such as cold or allergy medication, can cause behavioral changes in autistic children. Paradoxically, medications used to improve behavior can sometimes worsen it.
Worsening of a chronic medical condition: Behavior changes may indicate a worsening of a chronic medical condition such migraine headache, stomach ulcers, hemorrhoids, rheumatoid arthritis, or Crohn’s disease.
Discussing new behaviors, as well as any other symptoms (such as fever, diarrhea, lethargy, or change in gait), with the child’s pediatrician is important. Every effort must be made in these cases to treat the underlying condition medically before treating the behaviors unnecessarily with sedatives, antidepressants, or tranquilizers.
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.
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.
Term:
Neuroleptic – A class of drug that includes Haldol and Risperdal. Also called antipsychotic medication.
No medication can cure autism.
