“I’m at my wit’s end.”
Many parents of children with autism have uttered these words when faced with challenging symptoms.
Some children are prone to self-injury — or even aggression toward others. Some children are likely to wander off, so parents have to watch them 24-7. Still others suffer from attention deficits that keep them from developing socially and academically.
Behavioral intervention is our first line of treatment. But when it’s not enough, we talk to parents about medication.
Anxious parents have concerns about medications. That’s understandable. To ease that worry, start by learning what they can and can’t do for your children.
When is medication an option?
As a parent, how do you know when it’s time to consider medication for your child? Often, uncontrolled aggression is the tipping point.
“We always start with safety,” says Veena Ahuja, MD, a pediatric psychiatrist who works with our Cleveland Clinic Center for Autismpatients. “That includes concern for a child’s safety, or a sibling’s safety, or peers at school. Safety is a big trigger for us to start considering medications.”
It’s not the only trigger, though. For example, a teacher may tell parents a child is not progressing at school because of outbursts or elopement (wandering off). Issues such as mood disorders, a lack of attention or high anxiety get in the way of development.
The decision to use medication comes down to function. Is your child’s ability to function impaired? Have other efforts failed to control symptoms? If so, we may make a referral to a psychiatrist.
After a referral, collaboration is the key. Psychologists such as I want to know how treatment is going, and psychiatrists such as Dr. Ahuja want to know if medication is helping improve therapy. To be effective, the two must work together.
“I stress to parents that medication is not the solution to a problem,” Dr. Ahuja says. “It’s a way to help make therapy more effective. Sometimes a child can’t progress any further without medications to calm them down or make them safer.”
Symptoms — and the medications that treat them
Psychiatrists have a few options at their disposal, depending on symptoms.
Aggression and self-injury: These symptoms are major concerns. Fortunately, there are two drugs that treat them — the only two drugs approved by the FDA for treating autism symptoms, risperidone and aripiprazole, known as atypical antipsychotics. “Out of all the medications used in treating symptoms associated with autism, these have the most evidence behind them,” Dr. Ahuja notes.
Hyperactivity and impulsivity: Grabbing, touching, fidgeting — these symptoms can get in the way of everyday learning and interaction. Doctors often use clonidine and guanfacine, known as alpha-2 adrenergic agonists, to treat these symptoms. In some cases, they improve sleep and ease aggression, as well.
Depression, anxiety and OCD-like behavior: Many children with autism also have these other mental concerns. Certain antidepressants, called SSRIs — including fluoxetine, citalopram, and sertraline — often help treat symptoms, including repetitive or inflexible behavior. Doctors may use anti-anxiety medications, too, but the SSRIs tend to have fewer side effects. “We see kids improve with the right medication,” Dr. Ahuja says. “It can help take away that overwhelming desire to control everything around them.”
Attention deficit hyperactivity disorder (ADHD): There is a lot of crossover between autism and ADHD. Because of this, treatment with typical ADHD medications — methylphenidate and amphetamine — is common.
Both getting the right medication at the correct dose is critical and monitoring for side effects are critical. As a parent, ask questions, and be sure you are comfortable with any prescription.
“We never force medications on parents or their children,” Dr. Ahuja says. “We just want them to know they have options. We want them to know, when they’re at their wit’s end, that a combined approach to treatment might help their child improve.”
–Thomas Frazier II, PhD, health.clevelandclinic.org