Kathryn Park, age 12 and on the autism spectrum, is a sweet and loving child whose emotional behavior appears to turn on a dime, says her mother, Kristi Park. Much is due to her limited communication skills, however tantrums can stem from someone saying the wrong thing, making a request or not repeating the plan for the day back to Kathryn in the right order. Daily tantrums would last for more than an hour and sometimes resulted in physical harm to herself or others and almost always included destruction of property.
Families are often faced with the option of treating autism symptoms or comorbid disorders with prescribed medications. There is no one medication specifically designed to treat autism, according to the National Autism Center (NAC). The decision to treat symptoms of the disorder, such as behavior challenges, anxiety, sleep issues and hyperactivity is a profoundly personal one. Saying yes to medication is one that takes deep thought and careful review with a health care team.
The short answer: there is no one right answer.
“While medication certainly is not the right choice for everyone, dismissing the idea of medication from the outset can be a missed opportunity,” says Dr. Bennett Gertz, developmental behavioral pediatrician with Albertina Kerr’s Children’s Developmental Health Services.
A year ago, Park started her daughter on a daily dose of Citalopram, a liquid form of a selective serotonin reuptake inhibitor (SSRI). In addition, Kathryn receives speech and occupational therapies through her school. The combined approach of therapy and medication has lessened Kathryn’s meltdowns to about twice a month and minor things that caused tantrums are rare, her mother says.
“Life is much better!” Park says. “I am more able to take her to public places, especially by myself, without the stress of knowing there will be a meltdown.”
Medication can be a very effective tool to optimize all of the other educational and behavioral therapies being used, Gertz says.
“A stimulant medication used to improve attention and impulse control can make a huge difference in a child’s ability to make the most of these other approaches, or even be able to participate in them at all,” Gertz says.
Treating diseases or disorders, such as diabetes, that have a clear-cut treatment options can cause less confusion or consideration among parents than that of treating autism symptoms with medication. While there isn’t a special “autism pill” that can treat the core symptoms of ASD—difficulties with communication, social interaction and restricted, repetitive behaviors—some medications can be used to complement a comprehensive treatment program to address behavioral problems, such as self-injury, aggression and tantrums, according to the NAC.
“It is important for families to have clear goals for medication therapy such as anxiety, attention and irritability, reasonable expectations for benefits in the context of their child’s disability, and an understanding
of the risks,” Gertz says.
Pathways to Diagnosis and Services Study, sponsored by the National Institute for Mental Health (NIMH) in 2012, found that more than 50 percent of school-aged children with an autism or developmental delay diagnosis are taking a psychotropic drug. These include stimulants, anti-anxiety of mood stabilizers or antidepressants.
“Medication, when effective, opens a window of opportunity for developmental and behavioral interventions to be more effective,” says Sherri Alderman, developmental pediatrician at Albertina Kerr’s Children’s Developmental Health Services. “Before administering medication, there needs to be a discussion between the prescribing physician and the family in relation to what to expect as a response to the medication. This would include setting a goal of the desired response, as well as understanding any potential side effects. There needs to be ongoing monitoring by the family and the physician to see if the response to the medicine is meeting the initial goal and/or if the side effects or outweighing the benefits.”
Understanding the risks, benefits and long-term side effects can help pinpoint if it is the right decision for your family. Families are faced with weighing the risks of continued behavior versus the risk of introducing a medication for such symptoms of autism as attention problems, challenging behavior, anxiety and sleep issues.
Park says that she hasn’t noticed any side effects from Kathryn taking her medication. Because Kathryn’s communication is rote with no original or spontaneous speech, there have been no noticeable negative reactions to the Citalopram.
April Horning of Vancouver, Wash. tried three prescriptions for her 7-year-old son, Alex, before finding the right combination of Prozac and melatonin. Two years later, Alex’s anxiety and self-harming was preventing him from leaving the house, sleeping and being in a state of panic.
“His anxiety is not able to be managed with therapy alone and his hurting himself was getting worse,” Horning says. Daily life is much better now, she reports. Alex is able to slow down the process of becoming overwhelmed and the self-injuries are few and far between. “Looking at medication as a way to treat chemical imbalances in the body is not something to be afraid of,” Horning adds.
The NAC suggests reviewing several points with a health care professional or care team before deciding to introduce medication:
- A clear definition of the problem behavior
- An assessment of the causes of the behavior
- A specific response to the behavior, such as ignoring or interrupting
- A way to count each time the behavior occurs
- Teaching alternatives, such as language and play
- Opportunities to participate in a wide variety of activities
- Rewards for good behavior, and a plan to regularly review and modify the program
The NAC lists general classes of medications to consider or talk to your doctor about:
- Anti-psychotics (neuroleptics)
- Mood stabilizers (anti-convulsants)
- Vitamins and supplements
Dr. Alderman continues that young children are still experiencing rapid brain growth, presenting the opportunity for developmental approaches to behavior and attachment to influence how the brain develops.
“For young children, it is a reasonable approach to first try the developmental approaches to building social skills and monitor response before considering medication,” Alderman says. “Most children less than 5 years old will respond to some degree without medications when ample time, energy and intensive therapy and parent coaching are implemented over a significant period of time.”
Dr. Gertz, who generally treats children over the age of 5, says there are numerous reasons that families may have had a negative experience with trying medication. A possible misdiagnosis, overly aggressive dosing, a bad reaction with another medication or even an inadequate trial period can trigger fear in continuing to experiment until the right medication is found, Gertz says.
“Stories about bad outcomes can cause a lot of fear for parents considering medication, but it is important to realize that there are many success stories out there too,” he says.
Park echoes Gertz’s sentiment.
“Trying medication and not being ashamed of trying something that might help your child is the key,” Park explains. “And if the first medication is not the right fit, keep trying. Just because one didn’t work, doesn’t mean none will work. It really can change your life.”