Autism Medication Strategies

Physicians generally follow published guidelines for managing medication and treatment of children with Autism. Many medical societies publish guidelines. For example, in the U.S.A, the American Academy of Pediatrics (AAP), the American Academy of Neurology (AAN), and the American Academy of Child and Adolescent Psychiatry (AACAP) have all created and published ASD-specific guidelines for practitioners in their fields.

Categories of Medication for Autism
Categories of Medication for Autism

Nonetheless, none of these organizations provide specific guidance on which medications should be used in children with a particular Autism type. As a result, other practice parameters developed for psychiatric conditions in children without Autism are drawn upon for guidance.

While the guidelines are published as a strategy model for the best care of children on Autism Spectrum, they may differ slightly in their approaches. Teachers and family members of children who have been referred to different specialists by their primary care physician (PCP) may encounter different approaches to medication management as well.

Some clinicians may order medical tests (such as a blood test) or an electrocardiogram (EKG) before prescribing certain medications. Others may not order any tests at all or may order tests only when prescribing specific medications. Some autism medications require ongoing monitoring with blood tests every four to six months to rule out unwanted side effects on the body’s metabolism (e.g., changes in liver function, cholesterol levels).

2 Key Strategies for Autism Medication

There are two approaches to prescribing medication for children with Autism. They are:

Diagnosis-First Approach

In this approach, clinicians want to identify the comorbid condition prior to initiating medication for Autism. For example, the clinician will ask parents and teachers to complete standardized forms to identify the possibility of Attention Deficit Hyperactivity Disorder (ADHD or ADD) as an additional diagnosis. Then, at a return visit, after reviewing the information, the clinician prescribes Autism medication after making the diagnosis of ADHD in addition to ASD diagnosis.

Advantage: Medications are generally approved for diagnostic conditions, not symptoms. By treating a diagnosis (or a group of symptoms that fall into one category), this is considered a more evidence-based approach.

Disadvantage: The process can take time, especially if data from other environments is needed; may delay treatment if the diagnosis is not conclusive.[/fusion_content_box]

Symptom-Based Approach

In this approach, clinicians may want to treat symptoms that interfere with functioning, regardless of whether the child has a comorbid condition or not. For example, the clinician would start medication after determining that the behavior is interfering with a child’s school performance, and afterward (if required) would diagnose the ADHD based on either form sent back or response of symptoms to medication.

Advantage: Generally there is no delay in initiation of medication, which is especially important if symptoms are dangerous or seriously interfering with functioning.

Disadvantage: There may be concerns about insurance approval for medication without valid comorbid diagnosis.

7 Question to Ask before Considering Medication for Autism

As parents, it is your right (and duty) to ask your primary care physician or the referred specialist these questions before considering any options around medication for Autism treatment.

decision

  1. Why is medication needed for my child?
  2. Which type of medication are you considering?
  3. How long will it take me to see effects?
  4. What type of side effects should I expect?
  5. What should I do if I see these side effects?
  6. When will we know it is time to increase the medication dose?
  7. When will we know it is time to change the medication?

Psychotropic Medication for Children with Autism

Autism Spectrum Disorder, the set of neuro-developmental disorders and symptoms, originate in the brain. Certain imbalances in the neurochemicals are generally held responsible for certain behavioral symptoms; which, medications can target and manage effectively as far as behavioral patterns are concerned. Estimates go for as many as 60% of Autism affected children receive at least one psychotropic medication, but there also remains certain challenges and complications with administering psychiatric medications for children with Autism, of which, a difficulty in measuring the effects of medication is perhaps the highest.

Estimates go for as many as 60% of Autism affected children receive at least one psychotropic medication, but there also remains certain challenges and complications with administering psychiatric medications for children with Autism, of which, a difficulty in measuring the effects of medication is perhaps the highest.

This is due to children’s limited scope for self-reporting due to impairment in language skills (which is quite common in Autism). Identifying different symptoms which may overlap other functions (e.g. lack of attention due to ADHD; anxiety disorders, learning disorders, etc) makes it all the more difficult. A difficulty also to account for every ASD-affected child’s individuality (due to different chemical pathways in their brain than the typically developing children) makes things all the more complicated.

Such differences in brain structures and pathways often result in paradoxical or opposite effects (e.g. hyperactivity) in children with ASD, who are more susceptible to stimuli than other typically-developing children to whom, the same stimuli might not cause any effect.

Current Approved Forms of Medication for Autism

Currently, the two approved psychiatric medications for Autism affected children are Risperidone and Aripiprazole. These are meant to treat irritability, aggression, and self-injury. Anything else is considered off-label i.e. a drug that treats a condition despite not being specifically approved by the by the U.S. Food and Drug Administration (FDA) to treat that particular condition.

Clinicians, based on the limited data available from controlled pediatric trials, sometimes take decisions on biomedical treatment procedures according to their own clinical experiences. Such cases require the clinician to ensure the selected medication to be warranted, after considering other FDA-approved potential medications with elaborate data proving that they are safer and more efficient their actions; and the benefits outweigh/balance the risks.

Numerous studies have been conducted so far on the positive and the negative side effects of many such Autism medications that have been used on children with or without ASD, and, in some cases, on adults too. Out of these, researches on medications especially meant for children with ASD are scarce, making it all the more difficult to predict their response. However, there are studies currently being conducted upon the use of other medications (for children with ASD). This is an encouraging sign!

General Autism Medication Prescription Guidelines

When prescribing medication to children with Autism, most physicians should follow these generic set of guidelines. It is important for parents to note that these are tried and tested methods and in case you see a significant deviation to the approach taken by your child’s physician please have a conversation with the healthcare provider to understand why.

In general, the physician should:

  • Use a multidisciplinary approach where various team members (nurse, educator, psychologist, physician) contribute to decision making
  • Have a specific reason to use Autism medication with a rationale for how change in behavior will occur
  • Have a plan in place to track outcomes and side effects
  • Start medication for Autism at the lowest possible dose and increase the dose gradually only after checking that an increase is actually necessary
  • Avoid using medications in place of therapy and educational and/or behavior services
  • Stay updated on research and safety information about medications and keep the family informed
  • Develop an alliance with the family to monitor effects and side effects of the medication
  • Avoid frequent changes in medications, and change the medication only if its found not to be effective or if the side effects of the medication are not worth the risk of using it
  • Review the child’s functioning from time to time
  • Engage in coordination of care to ensure that the patient obtains and takes the medication as prescribed

Frequently Used Medication for Autism

Commonly Used Autism Medications
Commonly Used Autism Medications for Children

Listed above is just a snapshot of some of the commonly used medications for Autism. For the full list and details of common Autism medications, please see our Autism Resources section on Frequently Used Autism Medications

Autism Medication Side Effects

Again, the above resource contains a list of some of the known side effects of each of these medications. Essentially, all medications carry risk of side effects. This is especially true for psychotropic medications, even in children without Autism.

In general, there are common side effects and rare side effects. The latter may be quite severe and should be kept in mind while starting a medication, even though they may not occur in a particular child. Side effects are generally common to a particular type of medication.

Some medications may carry warnings from the FDA. The most serious, “black box” warning requires pharmaceutical companies to list potential serious side effects on the prescription label.

Examples of Black Box Warning on Medication for Autism:

  • SSRIs: increased risk of suicidal tendencies in children, adolescents, and young adults with depression
  • Stimulants: risk of abuse and dependency on the medication, potential heart side effects, and sudden cardiac death with abuse of the medication
  • Atomoxetine: increased risk of suicidal tendencies in children and adolescents

Other Considerations for Autism Medication

Informed Consent

It’s the duty of visiting clinicians to provide all the information they can on medications they are about to prescribe to your child. That includes the reasons behind using a particular medication, its side effects and observation reports; they must also answer the caregivers’ questions in details and in a way that allays their concerns.

It’s mandatory to obtain informed consent from the parents/legal guardians of a child prior to prescribing medications; it is also important that the parent(s)/legal guardian(s) fully understand the information provided prior to the onset of the first dosage.

Note: it’s also the child’s willingness that must be considered. Helping the child to achieve an awareness that’s developmentally appropriate with the use and purpose of the medication is important too. So is assessing the child’s willingness to a medication regimen.

Written information makes adolescent children and their parents understand medication the best, provided it pertains to an appropriate level complying with their respective educational backgrounds. The language must also be the best that’s understood by the caregivers and also to the developmental level of the child.

Pill Swallowing

Please refer to our free eBook on Parent’s Guide for Pill Swallowing of Autism Medication.

Medications for Autism - Pill Swallowing Parents Guide
Click for Free Download

Resource: There are some very helpful videos on Pill Swallowing that could be found here.

Complementary and Alternative Medicine (CAM)

About 70% of ASD-affected children have been seen to be given at least one complementary and/or alternative medicine (CAM). CAM is defined as – a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine”. Some common examples are coral-derived calcium, tinctures, skin creams, bentonite (clay) baths and removal of parasitic worms.

Often perceived as natural, CAM is chosen by families since they exhibit much less and sometimes, no safety issues and unwanted side effects that prescribed medications often bring. A few such families shared relevant information about CAM with the treatment providers for their children solely due to reasons like:

  • The clinician lacks knowledge about CAM therapies.
  • The clinician failed to see reporting CAM use unnecessary.
  • Concerns about the physician disapproving CAM use.
Examples of some Common Alternative Medications for Autism
Examples of some Common Alternative Medication for Autism (CAM)

It’s for the core symptoms of ASD that CAM therapies are often pursued; also to increase attention, to enhance relaxation, to decrease gastrointestinal symptoms, to regulate sleep and thereby, to promote general well-being. Conventional medicines, for these purposes, do not give results as good.

There is limited data available regarding side effects (allergic reactions, presence of contaminants, interactions with prescribed medications etc.) of CAM practices. Both clinicians and families that are pursuing CAM must be candid about the practice and monitor if any side effects occur. This shall help in minimizing those unwanted side effects.

Also read: Homeopathy for Autism

Role of School & Educators in Managing Autism Medication

Teacher's role in Autism medicationsTeachers, paraprofessionals, and therapists play key roles in medication management prescribed by a healthcare provider. These personnel have opportunities to observe a child with ASD in a naturalistic social environment for periods of time, unlike a healthcare provider who sees the child intermittently for only brief periods of time. They are also the key to providing information about triggers in the environment such as social and academic stressors in a classroom, playgroup, or daycare setting that can make certain behaviors more obvious. Again, such opportunities are not available in the clinic setting.

Finally, educational and therapeutic personnel can provide data in the form of anecdotal information about behaviors and side effects of medications, often in the form of responses to checklists. Further, schools have expertise in behavior analysis and can conduct a Functional Behavioral Assessment (FBA) to determine antecedents of behaviors, and also develop and implement the behavior plan as necessary.

How Can Educators, Parents, and Health Professionals Collaborate?

Open communication and mutual respect between clinicians, teachers and family members are vital in this respect. It helps to provide important and unique information that comes as a big help towards guiding decision-making. Most importantly, it is must to consider the regulatory laws surrounding their field of work while working with individuals from different professional backgrounds.

For example, FERPA or the Federal Educational Right to Privacy Act is meant for educational professionals and they must abide to it. Similarly, medical professionals must stick to the guidelines meant to protect a patient’s privacy. This is HIPAA, the Health Insurance Portability and Accountability Act.

Healthcare professionals working with children with disabilities are free to use as many such tools that apply, in the same manner as an educational professional might use for educational assessments. Therefore, with the most updated and relevant tools (most recent psychological test results, IQ assessments, behavioral questionnaires etc.) healthcare professionals shall be greatly benefitted. Such materials, if sent by the school personnel in advance, it will reduce the burden on teachers and family members to create duplicate measures.

In case a child has been evaluated by a medical professional, communicating the results (it can be a copy of the report or a signed release of information) shall prove helpful to the teachers and education professionals who will be working with the child. Staying informed on a child’s medical care is going to ease up treatment procedures up to a great deal.

How Can Parents Collaborate with Medical Professionals?

  • Through prioritizing the problem behaviors to let the treatment procedure advance smoothly. Starting multiple medications at once to serve different purposes is difficult at best; more so, when it comes to stopping them or to attribute side effect(s) to any one, none or all of them.
  • By keeping a log either in a handwritten or in an electronic format. This could even be a form with preset questions given by the attending clinician.
  • By informing the clinician events that are causing interference to the treatment procedures or anything that you might consider important; This may include new stressors, altered life situations, illnesses etc. which bring changes in behavior.
  • By creating a medication list and an action plan. This becomes particularly helpful; when you need to deal with doctors who are unfamiliar with a child’s condition.
  • By informing the prescribing clinician about the visible and noticeable effect(s) or untoward symptom(s).
  • By notifying the physician of any currently administered medications. This may include herbal medicines, over-the-counter medication, and CAM.
  • By educating yourself about medications and their use; also on their side effects. You may gather them from fact sheets, drug information available from the physician, or from medical websites that are well-reputed.

To Conclude

Medication for Autism help to manage behaviors in some children and also treat the co-occurring symptoms such as behavior difficulties, anxiety, and mood disorders. But treatment with medication depends on the decision of the family and it’s also true that prescription medication is not always right for every individual with ASD. The core deficits of ASD cannot be reversed by medications and there is no medication that has been identified so far to cure ASD.

Working with children showing ASD symptoms requires keeping communications open with a primary care physician (PCP) who is prescribing the medications; it applies both to the parents and educational professionals. Know that you are the one who can provide the most valuable resources for information related to baseline levels of functioning, medicinal side effects and any improvement on or worsening of existing behaviors.

Open communications between a medical and an educational professional is a KEY towards providing children with ASD an optimal care and the right treatment as far as Autism Medication therapy is concerned.


Mary Alexa
Mary Alexa

Hello everyone my name is Mary. I studied at University of Michigan under Dr. Richard Solomon, founder of the P.L.A.Y. Project for Children on the Autism Spectrum. I live in the Dominican Republic working at an International School with children on the autism spectrum. Empowering parents with knowledge and techniques to support their children’s needs as well as the needs of the entire family and community has been my main focus for the past seven years. Read More

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