Not all children with Autism Spectrum Disorder (ASD) will require medication for intervention. For some children, non-medication based therapies such as speech, feeding therapies, occupational therapies or play therapies may be sufficient to help alleviate some of the more worrisome behaviors in children.
Patricia Evans, M.D., Ph.D., a Professor of Pediatrics, Neurology and Psychiatry; Director of the Neurodevelopmental Disabilities Residency Program at University of Texas at Southwestern School of Medicine (UTSW) and Neurodevelopmental Disability clinical programs at UTSW and clinical Co-Director for the Center for ASD and Developmental Disabilities (CADD) at Children’s Health℠, says physicians should try non-medication therapies first.
“However, if the family and the care provider feel that a trial of medication might have value, families should bring all questions to their provider and carefully sift through the myriad of medication choices and doses,” Dr. Evans says. “At CADD, we work carefully with each family and review and prioritize the most significant concerns the family has. We discuss with each family the goals we are trying to achieve. Most importantly, we discuss if the medicine will make a difference in the child’s ability to learn and thrive.”
Dr. Evans stresses there while there is no cure for ASD, there are medications which can make a child’s life significantly happier and more engaging with her environment. The decision to have a child start a medicine should be made carefully with input from both the parents and the medical team. “We’re a team – the parents and the clinicians – and we work together to determine the most appropriate treatment,” Dr. Evans says.
Each child has a different therapy plan tailored to their individual diagnosis and need. Some common medications used as part of a treatment plan are listed below. Children’s doses and medication instructions may vary.
As many as one-third of children of children with ASD have a seizure disorder. Children with both ASD and a seizure disorder may need to take anti-seizure medicines. These medicines prevent seizures and may help a child to better learn and control her moods.
Atypical neuroleptics are commonly used in individuals with aggression or mood disorders, particularly associated with ASD. Two in particular, risperidone and aripiprazole, are FDA-approved medicines for use in children ages 5 years and older who have aggression and extreme mood issues. These medicines may help prevent self-injury, tantrums and other aggressive behaviors.
Children may experience significant potential side effects with this class of drugs. However, when appropriate, these medications may be very effective in providing a child with significant relief of anxiety and life-disabling aggression and rage.
Selective serotonin re-uptake inhibitors (SSRIs)
Individuals with ASD often experience anxiety, which may look like frequent tapping, counting, rigid routines or exceptional tantrums if a small part of the routine is disrupted. SSRIs help these particular individuals who struggle with anxiety or Obsessive Compulsive Disorders (OCD) as part of their ASD.
Some children with ASD may see improvements in social behaviors when taking SSRIs. Physicians and parents work together with the child to determine the most appropriate medicine.
Medications for impulse control
Individuals with ASD often have difficulty with being too flighty or too rigidly fixed on an item or thought to learn the necessary skills they need to be effective in social or academic settings. Medications that reduce impulse control can sometimes make anxiety worse. However, in specific situations, controlled substances such as methylphenidate or dextroamphetamine or non-controlled substances like atomoxetine or clonidine can reduce problems with focus or attention.
With all children and all behavior medications, parents and physicians should always start with a small dose and increase it gradually only if symptoms are not made better. Additionally, physicians should never alter more than one medication at a time so they can see what has helped a child.
Finally, it is critical that you communicate closely with your child’s care team and school to ensure the best results with minimal medications.
The Center for Autism and Developmental Disabilities is an interdisciplinary program offering comprehensive patient care and translational medicine for individuals with autism and related neurodevelopmental disorders. Learn more about our program and services.
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