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Autism and Medications
By Alan Harchik, Ph.D., BCBA

Can medications be helpful to children with autism? The answer is "maybe." Although there are no medications specifically designed to treat autism, and none can cure autism, some medications may be useful as part of a comprehensive treatment program to address behavioral problems such as aggression, self-injury, tantrums, and ritualistic compulsions.

These behaviors can be caused by psychiatric disorders, but are sometimes used by children to get attention, avoid unpleasant tasks, or obtain pleasurable feelings and stimulation.

Therefore, before medications are considered, a comprehensive program should be in place that includes:
o a clear definition of the problem behavior
o an assessment of the causes of the behavior
o a specific response to the behavior, such as ignoring or interrupting
o a way to count each time the behavior occurs
o teaching alternatives, such as language and play
o opportunities to participate in a wide variety of activities
o rewards for good behavior, and
o a plan to regularly review and modify the program.

Once a program has been implemented for at least a few weeks, physicians and parents may consider medications. There are six general classes of medications to consider:

1. Anti-psychotics (neuroleptics): These work at the neurotransmitter level in the brain and are used to address severe aggression and self-injury. (Their use does not mean that the child has a psychotic disorder.) The most typically prescribed antipsychotic is Risperdal®, Zyprexa®, Seroquel®, and Geodon® are other anti-psychotics.

2. Mood stabilizers (anti-convulsants): Depakote®, Tegretol®, Lamictal®, Neurontin®, and Topamax® are typically used to treat seizure disorders, but are also used to stabilize moods.

3. Anti-depressants: A special group of medications are designed to reduce depressive symptoms. These are called selective serotonin reuptake inhibitors (SSRIs), and include Prozac®, Zoloft®, Luvox®, and Anafranil®.

4. Anti-anxiety: Benzodiazepines, such as Ativan® and Klonopin® are used to address nervous anxiety symptoms. Medications designed for treating high blood pressure (beta-blockers, such as Inderal® and Catapres®) are also used for this purpose. And frequently, SSRIs are used to address repetitive, ritualistic, and compulsive behaviors.

5. Stimulants: Sometimes medications prescribed for attention deficit hyperactivity disorders, such as Ritalin®, are used. In my experience, these medications are not typically effective for children with autism.

6. Vitamins and supplements: Children sometimes receive vitamins and other dietary supplements to address behavior problems. There is little research to support these treatments.

In fact, most of the above named medications were tested with adults, not with autistic children. The decision to use medication is difficult. I would advise parents to obtain as much information as possible - from local physicians, books, and the Internet - about medications for children with autism. Many children at the May Institute receive medications. In some cases it is clearly helping, in others, we are still evaluating the effects.

Before embarking on a program that includes medication, parents and physicians need to take many factors into consideration including the age of the child, side effects, dosage, other medications the child may be taking, and duration and maintenance of the medication program.

Care must be taken when considering changes to successful medication use. For example, in more than one case, after the child achieved stability, medications were reduced too quickly and the beneficial effects were lost and could not be repeated, even when the medication was re-administered.

Finally, taking the time to evaluate the effectiveness of the medication is crucial. A daily count of each problem behavior should be kept prior to and after the use of medication. Also, sometimes the expectation of a positive effect can result in behavior change (also known as a placebo effect). Multiple therapy changes should not occur at the same time (for example, a new medication and a new reward system) because it is then impossible to determine what might be responsible for behavior change.

May Institute operates schools for children and adolescents with autism, Asperger's Syndrome, and other developmental disabilities in Chatham, Randolph, and West Springfield, Mass., and in Freeport, Maine. For more information, contact May Institute at 800-778-7601, or at www.mayinstitute.org.

The information presented on this site is intended solely as a general educational aid, and is neither medical nor healthcare advice for any individual problem, nor a substitute for medical or other professional advice and services from a qualified healthcare provider familiar with your unique circumstances. Always seek the advice of your physician or other qualified healthcare professional regarding any medical condition and before starting any new treatment.

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